75 results on '"Moss JG"'
Search Results
2. Effect of renal-artery stenting on progression of renovascular renal failure
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Harden, PN, MacLeod, MJ, Rodger, Rsc, Baxter, GM, Connell, Jmc, Dominiczak, AF, Junor, Bjr, Briggs, JD, and Moss, JG
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- 1997
3. The effects of uterine artery embolisation and surgical treatment on ovarian function in woman with uterine fibroids
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Khaund, A, primary, Murray, LS, additional, Moss, JG, additional, Cooper, K, additional, and Lumsden, MA, additional
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- 2010
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4. The effects of uterine artery embolisation and surgical treatment on ovarian function in women with uterine fibroids
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Rashid, S, primary, Khaund, A, additional, Murray, LS, additional, Moss, JG, additional, Cooper, K, additional, Lyons, D, additional, Murray, GD, additional, and Lumsden, MA, additional
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- 2010
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5. Accidental blood exposure: risk and prevention in interventional radiology
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Vijayananthan, A., primary, Tan, LH, additional, Owen, A., additional, Bhat, R, additional, Edwards, R, additional, Robertson, I, additional, Moss, JG, additional, and Nichols, R, additional
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- 2006
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6. Colour doppler ultrasound in renal transplant artery stenosis: Which doppler index?
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Baxter, GM, primary, Ireland, H, additional, and Moss, JG, additional
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- 1996
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7. Clinical review. ABC of arterial and venous disease: renal artery stenosis.
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McLaughlin K, Jardine AG, and Moss JG
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- 2000
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8. Percutaneous fibrin sleeve stripping of failing haemodialysis catheters.
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Johnstone, RD, Stewart, GA, Akoh, JA, Fleet, M, Akyol, M, and Moss, JG
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Background.One of the most frequent reasons for failure of haemodialysis lines is catheter blockage caused by fibrin sheath formation. We report our experience of percutaneous fibrin sheath stripping in treating this problem. [ABSTRACT FROM PUBLISHER]
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- 1999
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9. Covered stent placement for duodenocolic fistula: a novel use of the "body floss" technique.
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Kulkarni S, Hay C, Moss JG, Chandramohan S, Kulkarni, Shubhang, Hay, Chris, Moss, Jonathan G, and Chandramohan, Sivanathan
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- 2011
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10. Paediatric polypharmacy and deprescribing: the views of UK healthcare professionals.
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Moss JG, Young D, Rashed AN, Walker LE, and Hawcutt DB
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- Humans, Child, Health Personnel, Attitude of Health Personnel, United Kingdom, Polypharmacy, Deprescriptions
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Competing Interests: Competing interests: None declared.
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- 2023
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11. 5-ASA induced interstitial nephritis in patients with inflammatory bowel disease: a systematic review.
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Moss JG, Parry CM, Holt RCL, and McWilliam SJ
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- Adult, Anti-Inflammatory Agents, Non-Steroidal adverse effects, Child, Chronic Disease, Female, Humans, Male, Mesalamine adverse effects, Inflammatory Bowel Diseases chemically induced, Inflammatory Bowel Diseases complications, Inflammatory Bowel Diseases drug therapy, Nephritis, Interstitial chemically induced, Nephritis, Interstitial drug therapy, Nephritis, Interstitial pathology
- Abstract
Background: Acute interstitial nephritis (AIN) is an important cause of kidney injury accounting for up to 27% of unexplained renal impairment. In up to 70% of cases, drugs, including aminosalicylates, are reported as the underlying cause. Following two recent paediatric cases of suspected mesalazine induced AIN within our own department, we performed a systematic review of the literature to address the following question: In patients with inflammatory bowel disease (IBD), is interstitial nephritis associated with 5-aminosalicylate (5-ASA) treatment? Our primary objective was to identify the number of cases reported in the literature of biopsy-proven 5-ASA induced interstitial nephritis, in children and adults with IBD. We also aimed to identify which variables influence the onset, severity and recovery of 5-ASA interstitial nephritis., Methods: Embase and PubMed databases were searched from inception to 07/10/20. Search terms had three main themes: "inflammatory bowel disease", "interstitial nephritis" and "aminosalicylates". Studies were included if they reported an outcome of AIN, confirmed on biopsy, suspected to be secondary to a 5-ASA drug in those with IBD. A narrative synthesis was performed., Results: Forty-one case reports were identified. Mesalazine was the most frequently reported aminosalicylate associated with AIN (95%). The median duration of treatment before AIN was diagnosed was 2.3 years (Interquartile Range (IQR) 12-48 months). The median rise in creatinine was 3.3 times the baseline measurement (IQR 2.5-5.5). Aminosalicylate withdrawal and steroids were the most frequently used treatments. Despite treatment, 15% of patients developed end-stage renal failure., Conclusions: AIN is a serious adverse drug reaction associated with aminosalicylates, with mesalazine accounting for most reports. The current guidance of annual monitoring of renal function may not be sufficient to identify cases early. Given the severity of AIN and reports in the literature that early treatment with steroids may be beneficial, we would recommend at least 6 monthly monitoring of renal function. PROSPERO registration number CRD42020205387., (© 2022. The Author(s).)
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- 2022
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12. Central venous access devices for the delivery of systemic anticancer therapy (CAVA): a randomised controlled trial.
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Moss JG, Wu O, Bodenham AR, Agarwal R, Menne TF, Jones BL, Heggie R, Hill S, Dixon-Hughes J, Soulis E, Germeni E, Dillon S, and McCartney E
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- Adult, Aged, Aged, 80 and over, Antineoplastic Agents therapeutic use, Catheter-Related Infections etiology, Cost-Benefit Analysis, Female, Humans, Male, Middle Aged, Young Adult, Antineoplastic Agents administration & dosage, Catheterization, Peripheral adverse effects, Catheters, Indwelling adverse effects, Catheters, Indwelling economics, Central Venous Catheters adverse effects, Central Venous Catheters economics, Neoplasms drug therapy, Vascular Access Devices economics
- Abstract
Background: Hickman-type tunnelled catheters (Hickman), peripherally inserted central catheters (PICCs), and totally implanted ports (PORTs) are used to deliver systemic anticancer treatment (SACT) via a central vein. We aimed to compare complication rates and costs of the three devices to establish acceptability, clinical effectiveness, and cost-effectiveness of the devices for patients receiving SACT., Methods: We did an open-label, multicentre, randomised controlled trial (Cancer and Venous Access [CAVA]) of three central venous access devices: PICCs versus Hickman (non-inferiority; 10% margin); PORTs versus Hickman (superiority; 15% margin); and PORTs versus PICCs (superiority; 15% margin). Adults (aged ≥18 years) receiving SACT (≥12 weeks) for solid or haematological malignancy from 18 oncology units in the UK were included. Four randomisation options were available: Hickman versus PICCs versus PORTs (2:2:1), PICCs versus Hickman (1:1), PORTs versus Hickman (1:1), and PORTs versus PICCs (1:1). Randomisation was done using a minimisation algorithm stratifying by centre, body-mass index, type of cancer, device history, and treatment mode. The primary outcome was complication rate (composite of infection, venous thrombosis, pulmonary embolus, inability to aspirate blood, mechanical failure, and other) assessed until device removal, withdrawal from study, or 1-year follow-up. This study is registered with ISRCTN, ISRCTN44504648., Findings: Between Nov 8, 2013, and Feb 28, 2018, of 2714 individuals screened for eligibility, 1061 were enrolled and randomly assigned, contributing to the relevant comparison or comparisons (PICC vs Hickman n=424, 212 [50%] on PICC and 212 [50%] on Hickman; PORT vs Hickman n=556, 253 [46%] on PORT and 303 [54%] on Hickman; and PORT vs PICC n=346, 147 [42%] on PORT and 199 [58%] on PICC). Similar complication rates were observed for PICCs (110 [52%] of 212) and Hickman (103 [49%] of 212). Although the observed difference was less than 10%, non-inferiority of PICCs was not confirmed (odds ratio [OR] 1·15 [95% CI 0·78-1·71]) potentially due to inadequate power. PORTs were superior to Hickman with a complication rate of 29% (73 of 253) versus 43% (131 of 303; OR 0·54 [95% CI 0·37-0·77]). PORTs were superior to PICCs with a complication rate of 32% (47 of 147) versus 47% (93 of 199; OR 0·52 [0·33-0·83])., Interpretation: For most patients receiving SACT, PORTs are more effective and safer than both Hickman and PICCs. Our findings suggest that most patients receiving SACT for solid tumours should receive a PORT within the UK National Health Service., Funding: UK National Institute for Health Research Health Technology Assessment Programme., Competing Interests: Declaration of interests JGM is paid a personal fee to run PORT training courses for Smith Medical and received PORTs free of charge from four manufacturers. OW is deputy chair of NIHR HTA general funding board (2020 onwards) and was a committee member of NIHR HTA general funding board 2016–19. BLJ receives payment for lectures from Merck Sharp and Dohme and Pfizer; attendance at advisory board for Menarini; owns shares in Novartis and Gilead Sciences; and is a member of the Scottish Medicines Consortium. All other authors declare no competing interests, (Copyright © 2021 Elsevier Ltd. All rights reserved.)
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- 2021
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13. Randomised trial of two embolic agents for uterine artery embolisation for fibroids: Gelfoam versus Embospheres (RAGE trial).
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Yadavali R, Ananthakrishnan G, Sim M, Monaghan K, McNaught G, Hamoodi I, Bryden F, Lassman S, and Moss JG
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Background: Uterine artery embolisation (UAE) is an established treatment option for women with symptomatic uterine fibroids who wish to avoid surgery. However the most efficacious embolic agent remains uncertain., Methods: We conducted a pilot double blind randomized controlled trial comparing Gelfoam with Embospheres in women undergoing UAE. Outcomes recorded at baseline, 24-h, 1 and 6 months included complications, inflammatory, haematological markers and ovarian function. Contrast enhanced MRI (CEMRI) was acquired at baseline, 24-h and 6 months. Pain score (visual analogue) was measured at 24-h, quality of life (UFS-Qol) at baseline, 1 and 6 months. All patients were followed to 6 months., Results: Twenty patients were randomized 1:1 to receive either Gelfoam (G) or Embospheres (E). The UFS-Qol symptom score improved in both groups at 6 months mean of 64 ± 18 to 23 ± 16 and 54 ± 15 to 32 ± 26 in the E and G groups respectively. UFS-Qol HRQL also improved in both groups at 6 months, mean 41 ± 28 to 79 ± 20 and 53 ± 19 to 78 ± 21 in the E and G groups respectively.Uterine volume at 6 months reduced from 1018 ± 666mls to 622 ± 436 ( p = 0.001) and from 1026 ± 756 to 908 ± 720 ( p = 0.15) in the E and G groups respectively. There was a significant difference between groups for this parameter p = 0.01. All uterine arteries were patent at 24-h and 6 months. Complete (100%) fibroid infarction rates were 5(50%) and 2(20%) in the E and G groups respectively. None of the other outcome measures showed any between group differences. There were no re-interventions in either group., Conclusion: The only significant between group differences was for a greater reduction in uterine volume at 6 months in the E group. A larger trial (estimate 172 subjects) is required to determine whether other apparent differences are clinically and statistically significant., Trial Registration: ISRCTN67347987., Competing Interests: The study was approved by the regional ethics committee (West of Scotland REC ref. 09/S0703/108).Not applicableThe authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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- 2019
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14. Protocol for a systematic review and thematic synthesis of patient experiences of central venous access devices in anti-cancer treatment.
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Ryan C, Hesselgreaves H, Wu O, Paul J, Dixon-Hughes J, and Moss JG
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- Catheterization, Central Venous instrumentation, Catheters, Indwelling, Drug Therapy methods, Humans, Perception, Systematic Reviews as Topic, Catheterization, Central Venous methods, Neoplasms drug therapy, Outpatients psychology, Vascular Access Devices
- Abstract
Background: Three types of central venous access devices (CVADs)-peripherally inserted central catheters (PICCs), skin-tunnelled central catheters (Hickman-type devices), and implantable chest wall Ports (Ports)-are routinely used in the intravenous administration of anti-cancer treatment. These devices avoid the need for peripheral cannulation and allow for home delivery of treatment. Assessments of these devices have tended to focus on medical and economic factors, but there is increased interest in the importance of patient experiences and perspectives in this area. The aim of this systematic review is to synthesise existing research regarding patient experiences of these CVADs to help clinicians guide, prepare, and support patients receiving CVADs for the administration of anti-cancer treatment., Method: A systematic search of MEDLINE, Embase, and CINAHL research databases will be carried out along with a supplementary reference list search. This review will include quantitative, qualitative, and mixed methods studies published in peer-review journals, reporting some aspect(s) of patient experiences or perspectives regarding the use of PICC, Hickman, or Port CVADs for the administration of anti-cancer drugs. The methodological quality and risk of bias of included papers will be assessed using the Mixed Methods Appraisal Tool (MMAT). Relevant outcome data will be extracted from included studies and analysed using a thematic synthesis approach., Discussion: The results section of the review will comprise thematic synthesis of quantitative studies, thematic synthesis of qualitative studies, and the aggregation of the two. Results will aim to offer an account of current understandings of patient experiences and perspective regarding PICC, Hickman-type, and Port devices in the context of anti-cancer treatment. Confidence in cumulative evidence will be assessed using the Confidence in the Evidence from Reviews of Qualitative research (CERQual) approach., Systematic Review Registration: This systematic review protocol is registered with the International Prospective Register of Systematic Reviews (PROSPERO). Registration number: CRD42017065851 . This protocol was prepared using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols checklist (PRISMA-P) (Shamseer et al., BMJ 349: 2015).
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- 2018
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15. Executive Summary of the Joint Position Paper on Renal Denervation of the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) and the European Society of Hypertension (ESH).
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Moss JG, Belli AM, Coca A, Lee M, Mancia G, Peregrin JH, Redon J, Reekers JA, Tsioufis C, Vorwerk D, and Schmieder RE
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- Europe, Humans, Hypertension therapy, Societies, Medical, Cardiology methods, Cardiovascular Diseases therapy, Denervation methods, Kidney innervation, Neurosurgical Procedures methods, Radiology, Interventional methods
- Abstract
Competing Interests: Anna-Maria Belli is a member of the Boston Scientific Advisory Board. Giuseppe Mancia has received speaker’s or consultation fees from Actavis, Bayer, Böhringer Ingelheim, Ferrer, Lilly, Medtronic Vascular Inc, Menarini Int, Merck Serono, MSD, Novartis, Recordati, Sanofi, Servier and Takeda in the past 24 months. Costas Tsioufis has received a Research Grant from St Jude Medical and Travel Expenses and Honoraria from St. Jude Medical and Medtronic. Roland E. Schmieder has received Speaker fees, Consultancy and Advisory Board fees, etc. from Kona Medical, Medtronic and Recor. All other authors declare that they have no conflicts of interest.
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- 2016
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16. Executive summary of the joint position paper on renal denervation of the Cardiovascular and Interventional Radiological Society of Europe and the European Society of Hypertension.
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Moss JG, Belli AM, Coca A, Lee M, Mancia G, Peregrin JH, Redon J, Reekers JA, Tsioufis C, Vorwerk D, and Schmieder RE
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- Blood Pressure, Consensus, Humans, Kidney physiopathology, Practice Guidelines as Topic, Coronary Vasospasm surgery, Denervation, Hypertension surgery, Kidney innervation
- Abstract
Renal denervation (RDN) was reported as a novel exciting treatment for resistant hypertension in 2009. An initial randomized trial supported its efficacy and the technique gained rapid acceptance across the globe. However, a subsequent large blinded, sham arm randomized trial conducted in the USA (to gain Food and Drug Administration approval) failed to achieve its primary efficacy end point in reducing office blood pressure at 6 months. Published in 2014 this trial received both widespread praise and criticism. RDN has effectively stopped out with clinical trials pending further evidence. This joint consensus document representing the European Society of Hypertension and the Cardiovascular and Radiological Society of Europe attempts to distill the current evidence and provide future direction and guidance.
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- 2016
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17. Effectiveness of Embolization or Sclerotherapy of Pelvic Veins for Reducing Chronic Pelvic Pain: A Systematic Review.
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Daniels JP, Champaneria R, Shah L, Gupta JK, Birch J, and Moss JG
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- Chronic Pain diagnosis, Chronic Pain etiology, Dilatation, Pathologic, Embolization, Therapeutic adverse effects, Female, Humans, Pelvic Pain diagnosis, Pelvic Pain etiology, Regional Blood Flow, Sclerotherapy adverse effects, Syndrome, Treatment Outcome, Varicose Veins complications, Varicose Veins diagnosis, Varicose Veins physiopathology, Venous Insufficiency complications, Venous Insufficiency diagnosis, Venous Insufficiency physiopathology, Chronic Pain prevention & control, Embolization, Therapeutic methods, Pelvic Pain prevention & control, Pelvis blood supply, Sclerotherapy methods, Varicose Veins therapy, Veins pathology, Veins physiopathology, Venous Insufficiency therapy
- Abstract
Purpose: Chronic pelvic pain (CPP) in the presence of dilated and refluxing pelvic veins is often described as pelvic congestion syndrome (PCS), although the causal relationship between pelvic vein incompetence and CPP has not been established. Percutaneous embolization is the principal treatment for PCS, with high success rates cited. This study was undertaken to systematically and critically review the effectiveness of embolization of incompetent pelvic veins., Materials and Methods: A comprehensive search strategy encompassing various terms for pelvic congestion, pelvic pain, and embolization was deployed in 17 bibliographic databases, with no restriction on study design. Methodologic quality was assessed. The quality and heterogeneity generally precluded meta-analysis. Results were tabulated and described narratively., Results: Twenty-one prospective case series and one poor-quality randomized trial of embolization (involving a total of 1,308 women) were identified. Early substantial relief from pain was observed in approximately 75% of women undergoing embolization, and generally increased over time and was sustained. Significant pain reductions following treatment were observed in all studies that measured pain on a visual analog scale. Repeat intervention rates were generally low. There were few data on the impact on menstruation, ovarian reserve, or fertility, but no concerns were noted. Transient pain was common following foam embolization, and there was a < 2% risk of coil migration., Conclusions: Embolization appears to provide symptomatic relief of CPP in the majority of women and is safe, although the quality of the evidence is low., (Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.)
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- 2016
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18. Renal artery sympathetic denervation: observations from the UK experience.
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Sharp AS, Davies JE, Lobo MD, Bent CL, Mark PB, Burchell AE, Thackray SD, Martin U, McKane WS, Gerber RT, Wilkinson JR, Antonios TF, Doulton TW, Patterson T, Clifford PC, Lindsay A, Houston GJ, Freedman J, Das N, Belli AM, Faris M, Cleveland TJ, Nightingale AK, Hameed A, Mahadevan K, Finegold JA, Mather AN, Levy T, D'Souza R, Riley P, Moss JG, Di Mario C, Redwood SR, Baumbach A, Caulfield MJ, and Dasgupta I
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- Aged, Antihypertensive Agents therapeutic use, Blood Pressure Monitoring, Ambulatory, Drug Resistance, Drug Therapy, Combination, Female, Humans, Hypertension diagnosis, Hypertension physiopathology, Male, Middle Aged, Mineralocorticoid Receptor Antagonists, Office Visits, Registries, Retrospective Studies, Sympathectomy adverse effects, Sympathetic Nervous System physiopathology, Time Factors, Treatment Outcome, United Kingdom, Blood Pressure drug effects, Hypertension surgery, Kidney blood supply, Renal Artery innervation, Sympathectomy methods, Sympathetic Nervous System surgery
- Abstract
Background: Renal denervation (RDN) may lower blood pressure (BP); however, it is unclear whether medication changes may be confounding results. Furthermore, limited data exist on pattern of ambulatory blood pressure (ABP) response-particularly in those prescribed aldosterone antagonists at the time of RDN., Methods: We examined all patients treated with RDN for treatment-resistant hypertension in 18 UK centres., Results: Results from 253 patients treated with five technologies are shown. Pre-procedural mean office BP (OBP) was 185/102 mmHg (SD 26/19; n = 253) and mean daytime ABP was 170/98 mmHg (SD 22/16; n = 186). Median number of antihypertensive drugs was 5.0: 96 % ACEi/ARB; 86 % thiazide/loop diuretic and 55 % aldosterone antagonist. OBP, available in 90 % at 11 months follow-up, was 163/93 mmHg (reduction of 22/9 mmHg). ABP, available in 70 % at 8.5 months follow-up, was 158/91 mmHg (fall of 12/7 mmHg). Mean drug changes post RDN were: 0.36 drugs added, 0.91 withdrawn. Dose changes appeared neutral. Quartile analysis by starting ABP showed mean reductions in systolic ABP after RDN of: 0.4; 6.5; 14.5 and 22.1 mmHg, respectively (p < 0.001 for trend). Use of aldosterone antagonist did not predict response (p > 0.2)., Conclusion: In 253 patients treated with RDN, office BP fell by 22/9 mmHg. Ambulatory BP fell by 12/7 mmHg, though little response was seen in the lowermost quartile of starting blood pressure. Fall in BP was not explained by medication changes and aldosterone antagonist use did not affect response.
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- 2016
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19. Can (1)H MR Spectroscopy be Used to Assess the Success of Uterine Artery Embolisation?
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Macnaught G, Ananthakrishnan G, Hinksman L, Yadavali R, Bryden F, Lassman S, Ritchie M, Gallacher K, Hay C, and Moss JG
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- Acrylic Resins administration & dosage, Female, Gelatin administration & dosage, Gelatin Sponge, Absorbable administration & dosage, Humans, Leiomyoma diagnostic imaging, Leiomyoma pathology, Magnetic Resonance Imaging, Organ Size, Pilot Projects, Treatment Outcome, Uterine Neoplasms diagnostic imaging, Uterine Neoplasms pathology, Uterus diagnostic imaging, Uterus pathology, Leiomyoma therapy, Magnetic Resonance Spectroscopy, Uterine Artery Embolization methods, Uterine Neoplasms therapy, Uterus blood supply
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Purpose: Absence of contrast on contrast enhanced MRI (CEMRI) and reduction in uterine volume at 6 months post-uterine artery embolisation (UAE) currently indicate the successful disruption of the fibroid blood supply by UAE. This study assesses whether (1)H MR spectroscopy ((1)H MRS) can also indicate the success of UAE., Method: 20 patients with symptomatic fibroids were randomised 1:1 to undergo UAE with either Gelfoam or Embospheres. CEMRI and spectra (1.5 T) were acquired pre-, 24-h and 6 months post-UAE. LCModel was used to detect significant levels of choline, creatine and lactate in fibroid spectra. Uterine volumes were measured and paired t tests (p < 0.05) assessed volume reduction over time. Qualitative assessments of CEMRI were performed., Results: Choline was detected in 17/18 spectra pre-UAE, 12/14 at 24-h and 6/16 at 6 months post-UAE. Choline was not detected in the 7/7 spectra available for the Embospheres group at 6 months. These fibroids were non-enhancing on CEMRI and associated with a significant reduction in mean uterine volume at 6 months (mean/min/max 396.5/84.1/997.5 cm(3), p = 0.003). Choline was detected in 6/9 fibroid spectra available for the Gelfoam group at 6 months. Of these fibroids, four demonstrated persistent enhancement on CEMRI and two were non-enhancing. This group did not demonstrate significant uterine volume reduction (mean/min/max 117.2/-230.6/382.6 cm(3), p = 0.15). The negative minimum value indicates fibroid growth., Conclusions: This study has demonstrated the potential of (1)H MRS to provide an additional marker of the success of UAE.
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- 2016
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20. Can ovarian vein embolization cause more harm than good?
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Hamoodi I, Hawthorn R, and Moss JG
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- Adult, Female, Humans, Chronic Pain therapy, Embolization, Therapeutic adverse effects, Ovary blood supply, Pelvic Pain therapy
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Ovarian vein embolization using embolic coils is a recognized treatment for chronic pelvic pain caused by pelvic congestion syndrome (PCS). Although it is considered a non-invasive procedure with a good safety record, there have been reported complications resulting from embolic coil migration. We present a case of embolic coil erosion of the ovarian vein discovered on laparoscopy for chronic pelvic pain., (© 2015 Japan Society of Obstetrics and Gynecology.)
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- 2015
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21. Endovascular aneurysm repair: is imaging surveillance robust, and does it influence long-term mortality?
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Waduud MA, Choong WL, Ritchie M, Williams C, Yadavali R, Lim S, Buchanan F, Bhat R, Ramanathan K, Ingram S, Cormack L, and Moss JG
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- Aged, Female, Follow-Up Studies, Humans, Kaplan-Meier Estimate, Male, Postoperative Complications mortality, Retrospective Studies, Scotland epidemiology, Treatment Outcome, Aortic Aneurysm, Abdominal mortality, Aortic Aneurysm, Abdominal surgery, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation, Endovascular Procedures methods
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Purpose: Endovascular aneurysm repair (EVAR) is the dominant treatment strategy for abdominal aortic aneurysms. However, as a result of uncertainty regarding long-term durability, an ongoing imaging surveillance program is required. The aim of the study was to assess EVAR surveillance in Scotland and its effect on all-cause and aneurysm-related mortality., Methods: A retrospective analysis of all EVAR procedures carried out in the four main Scottish vascular units. The primary outcome measure was the implementation of post-EVAR imaging surveillance across Scotland. Patients were identified locally and then categorized as having complete, incomplete, or no surveillance. Secondary outcome measures were all-cause mortality and aneurysm-related mortality. Cause of death was obtained from death certificates., Results: Data were available for 569 patients from the years 2001 to 2012. All centers had data for a minimum of 5 contiguous years. Surveillance ranged from 1.66 to 4.55 years (median 3.03 years). Overall, 53 % had complete imaging surveillance, 43 % incomplete, and 4 % none. For the whole cohort, all-cause 5-year mortality was 33.5 % (95 % confidence interval 28.0-38.6) and aneurysm-related mortality was 4.5 % (.8-7.3). All-cause mortality in patients with complete, incomplete, and no imaging was 49.9 % (39.2-58.6), 19.1 % (12.6-25.2), and 47.2 % (17.7-66.2), respectively. Aneurysm-related mortality was 3.7 % (1.8-7.4), 4.4 % (2.2-8.9), and 9.5 % (2.5-33.0), respectively. All-cause mortality was significantly higher in patients with complete compared to incomplete imaging surveillance (p < 0.001). No significant differences were observed in aneurysm-related mortality (p = 0.2)., Conclusion: Only half of EVAR patients underwent complete long-term imaging surveillance. However, incomplete imaging could not be linked to any increase in mortality. Further work is required to establish the role and deliverability of EVAR imaging surveillance.
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- 2015
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22. Centrally inserted external catheters and totally implantable ports for the delivery of chemotherapy: a systematic review and meta-analysis of device-related complications.
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Kulkarni S, Wu O, Kasthuri R, and Moss JG
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- Catheterization, Central Venous instrumentation, Device Removal, Humans, Antineoplastic Agents administration & dosage, Catheterization, Central Venous adverse effects, Catheters, Indwelling adverse effects, Neoplasms drug therapy
- Abstract
Purpose: This systematic review and meta-analysis aimed to evaluate the risks of complications (infectious and non-infectious) including the need for device removal associated with centrally inserted external catheters compared with totally implantable ports in patients undergoing chemotherapy., Methods: Relevant major electronic databases were searched from inception to December 2012. All randomized controlled trials (RCT) and observational studies that compared centrally inserted external catheters with totally implantable ports in patients undergoing chemotherapy were included in the systematic review. Meta-analysis was carried out to estimate the odds ratios of device-associated complications, including infection, non-infectious complications and device removal associated with external catheters relative to implantable ports., Results: Overall, five RCTs and 25 observational studies were included in the study. The studies were heterogeneous, and included adults and children, with different types of cancer, undergoing chemotherapy. Based on the pooled estimates from included studies, external catheters were associated with approximately a three to four-fold increase in the risks of infections, non-infectious complications and device removal compared implantable ports., Conclusion: The findings of this study showed that totally implantable ports are superior to external catheters in terms of catheter-associated complications. However, a formal health technology assessment on the clinical and cost-effectiveness of the use of implantable ports compared with external catheters is needed to inform policy makers of the relative value of investing in totally implantable devices compared with external catheters.
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- 2014
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23. Mortality reporting in interventional radiology: experience of a pilot audit with the Scottish Audit of Surgical Mortality.
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White RD, Ingram S, Moss JG, Pace N, and Chakraverty S
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- Female, Humans, Male, Pilot Projects, Scotland epidemiology, Radiography, Interventional mortality, Surgical Procedures, Operative mortality
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Aim: To describe the initial pilot phase of the 2009 Scottish Audit of Surgical Mortality (SASM), which includes outcomes and difficulties that arose during any interventional radiology (IR) procedure performed on patients in this audit over an 18 month period., Materials and Methods: Approximately 40 consultant interventional radiologists from all units in Scotland elected to participate in the audit. Each response was then peer reviewed after anonymisation of the patient and institution. If a relevant ACON (area for consideration or area of concern) was generated, this was checked by one of the other reviewers before communication with the original reporting radiologist and colleagues. There was then a right of reply by the reporting unit before formal documentation was sent out., Results: Initial results were analysed after 18 months period, during which time 95 forms relating to deaths of surgical inpatients were sent to interventional radiologists identified as having been involved in an IR procedure at some time during the patient's admission. Seventy-one forms had been returned by July 2010, of which 46 had gone through the entire SASM process. From these, 10 ACONs were attributed. Anonymised case vignettes and reports from these were used as educational tools., Conclusion: Involvement with SASM is a useful process. Significant safety issues and learning points were identified in the pilot. The majority of ACONs identified by the audit were in patients who had undergone percutaneous biliary interventions., (Copyright © 2013 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)
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- 2013
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24. Randomized comparison of uterine artery embolization (UAE) with surgical treatment in patients with symptomatic uterine fibroids (REST trial): subanalysis of 5-year MRI findings.
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Ananthakrishnan G, Murray L, Ritchie M, Murray G, Bryden F, Lassman S, Lumsden MA, and Moss JG
- Subjects
- Adult, Contrast Media, Female, Humans, Hysterectomy, Leiomyoma surgery, Neoplasm Recurrence, Local, Postoperative Complications, Quality of Life, Retreatment, Treatment Outcome, Uterine Myomectomy, Uterine Neoplasms surgery, Leiomyoma therapy, Magnetic Resonance Imaging methods, Uterine Artery Embolization methods, Uterine Neoplasms therapy
- Abstract
Purpose: To report 5-year contrast-enhanced magnetic resonance imaging findings of the REST trial recruits who underwent either uterine artery embolization (UAE) or myomectomy., Methods: A total of 157 patients were randomized to UAE or surgery (hysterectomy or myomectomy). Ninety-nine patients who had UAE and eight patients who had myomectomy were analyzed. MRI scans at baseline, 6 months, and 5 years were independently interpreted by two radiologists. Dominant fibroid diameter, uterine volume, total fibroid infarction (complete 100 %, almost complete 90-99 %, partial <90 %), and new fibroid formation were the main parameters assessed and related to the need for reintervention., Results: In the UAE group, mean ± standard deviation uterine volume was 670 ± 503, 422 ± 353, and 292 ± 287 mL at baseline, 6 months, and 5 years, respectively. Mean dominant fibroid diameter was 7.6 ± 3.0, 5.8 ± 2.9, and 5 ± 2.9 cm at baseline, 6 months, and 5 years. Fibroid infarction at 6 months was complete in 35 % of women, almost complete in 29 %, and partial in 36 %. Need for reintervention was 19, 10, and 33 % in these groups, respectively (p = 0.123). No myomectomy cases had further intervention. At 5 years, the prevalence of new fibroid was 60 % in the myomectomy group and 7 % in the UAE group (p = 0.008)., Conclusion: There is a further significant reduction in both uterine volume and dominant fibroid diameter between 6 months and 5 years after UAE. Complete fibroid infarction does not translate into total freedom from a subsequent reintervention. New fibroid formation is significantly higher after myomectomy.
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- 2013
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25. Diffusion-weighted imaging in uterine artery embolisation: do findings correlate with contrast enhancement and volume reduction?
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Ananthakrishnan G, Macnaught G, Hinksman L, Gilmour H, Forbes KP, and Moss JG
- Subjects
- Adult, Female, Humans, Leiomyoma pathology, Middle Aged, Myometrium pathology, Retrospective Studies, Signal-To-Noise Ratio, Treatment Outcome, Uterus pathology, Diffusion Magnetic Resonance Imaging methods, Image Processing, Computer-Assisted methods, Leiomyoma therapy, Uterine Artery Embolization methods
- Abstract
Objectives: The objective of this study was to determine the role of diffusion-weighted imaging (DWI) in uterine artery embolisation (UAE), and to assess the apparent diffusion coefficient (ADC) of the dominant fibroid and its relationship to contrast enhancement and fibroid volume reduction., Methods: We carried out a retrospective study of 15 patients who underwent UAE. Calculations were performed at baseline and 6 months post-embolisation. Fibroid ADC (expressed in 10(-3) mm(2) s(-1)) was calculated using b=0 and b=1000 DWI values. Fibroid enhancement was compared with background myometrium by measuring signal-difference-to-noise ratio (SDNR). Fibroid volume was calculated using a prolate ellipse formula., Results: There was a significant reduction (p<0.001) in fibroid ADC at 6 months (0.48; standard deviation, SD=0.26) as compared with baseline (1.01; SD=0.39). No significant change (p=0.07) was identified in 6-month myometrial ADC (1.09; SD=0.28) as compared with baseline (1.24; SD=0.20). Moderately strong and significant positive correlation was identified between baseline ADC and 6-month percentage volume reduction of the fibroid (correlation=0.66, p=0.007). No correlation was identified between SDNR and ADC at baseline or 6 months (r=0.01, p=0.97 and r=-0.13, p=0.64, respectively) or SDNR and percentage volume reduction at 6 months (correlation r=0.18, p=0.51)., Conclusion: Baseline ADC of dominant fibroids shows a moderately strong correlation with subsequent volume reduction at 6 months following UAE. No correlation was identified between ADC values and contrast enhancement on the baseline or 6-month scans. Further prospective evaluation is needed before DWI can be utilised in clinical practice. Advances in knowledge DWI imaging may provide additional information about UAE and possibly help to predict uterine volume reduction.
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- 2012
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26. Provision of out-of-hours interventional radiology services in Scotland.
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Zealley IA, Gordon TJ, Robertson I, Moss JG, and Gillespie IN
- Subjects
- Humans, Interviews as Topic, Population Surveillance, Radiology, Interventional methods, Scotland, After-Hours Care methods, After-Hours Care statistics & numerical data, Hospitals statistics & numerical data, Radiology, Interventional statistics & numerical data
- Abstract
Aim: To evaluate the availability of out-of-hours (OOH) interventional radiology (IR) services in Scotland and discuss implications for service redesign., Materials and Methods: Data were gathered via a survey conducted by telephone/e-mail interview. The setting was hospitals in Scotland with acute medical and/or surgical beds. The interviewees were consultant interventional radiologists representing each of the 14 geographical Health Boards in Scotland., Results: Three of the 14 geographical Health Boards provided a formal, prospectively planned OOH IR service in at least one hospital. Fourteen of the 34 acute hospitals provided an in-hours IR service, which includes endovascular haemorrhage control. Eight of the 34 acute hospitals had formal, prospectively planned on-call IR arrangements, 12 had an ad-hoc service, and 20 transferred patients to other facilities. Thirty-eight of the 223 consultant radiologists in Scotland were able to perform endovascular haemorrhage control procedures: only 18 of these 38 (47%) were included in on-call rotas. A further 42 radiologists were able to perform nephrostomy and a further 61 were able to perform abscess drainage. Eighty-two radiologists did not perform any interventional procedures., Conclusions: The provision of OOH IR services in Scotland is limited and available resources, both skills and equipment, are being underutilized. These data will be used to inform a process of OOH IR service redesign in Scotland., (Copyright © 2012 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2012
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27. The effects of uterine artery embolisation and surgical treatment on ovarian function in women with uterine fibroids.
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Rashid S, Khaund A, Murray LS, Moss JG, Cooper K, Lyons D, Murray GD, and Lumsden MA
- Subjects
- Adult, Combined Modality Therapy methods, Female, Follicle Stimulating Hormone metabolism, Humans, Leiomyoma physiopathology, Leiomyoma surgery, Length of Stay, Menstrual Cycle physiology, Middle Aged, Quality of Life, Uterine Neoplasms physiopathology, Uterine Neoplasms surgery, Leiomyoma therapy, Uterine Artery Embolization methods, Uterine Neoplasms therapy
- Abstract
Objective: The aim of this study was to evaluate and compare both ovarian function and menstrual characteristics following uterine artery embolisation (UAE) and surgery., Design: Subgroup of women from a randomised controlled trial., Setting: Gynaecology and radiology units in Scotland, UK., Population: Ninety-six women from the randomised controlled trial comparing embolisation with surgery as a treatment for fibroids (REST), which recruited 157 patients (106 UAE; 51 surgery)., Methods: Seventy-three women undergoing UAE and 23 women undergoing surgery (with ovarian conservation) had serum follicle-stimulating hormone (FSH) measurements taken on day 3 of the menstrual cycle prior to treatment, and at 6 and 12 months post-treatment. Data on menstrual cycle characteristics was also collected., Main Outcome Measures: Ovarian failure, as defined by an FSH level of >40 iu/l, and change in duration of menses and length of menstrual cycle., Results: There was no significant difference in the rate of ovarian failure at 12 months between UAE (11%) and surgical patients (18%) (P = 0.44). This finding was not influenced by age. The mean duration of menstrual flow decreased significantly, from baseline to 12 months, by 1.7 days (SD 3.8), (95% CI 0.8-2.6). There was no statistically significant change in mean cycle length at 12 months (0.7 days [SD 4.9]; 95% CI [-0.5, 1.9])., Conclusions: There is no evidence for UAE accelerating a deterioration in ovarian function at 1 year, when compared with surgery. UAE is associated with a decrease in the duration of menstrual flow at 1 year.
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- 2010
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28. Revascularization versus medical therapy for renal-artery stenosis.
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Wheatley K, Ives N, Gray R, Kalra PA, Moss JG, Baigent C, Carr S, Chalmers N, Eadington D, Hamilton G, Lipkin G, Nicholson A, and Scoble J
- Subjects
- Adult, Aged, Aged, 80 and over, Blood Pressure, Combined Modality Therapy, Drug Therapy, Combination, Female, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Kaplan-Meier Estimate, Male, Middle Aged, Platelet Aggregation Inhibitors therapeutic use, Renal Artery Obstruction drug therapy, Renal Artery Obstruction mortality, Renal Artery Obstruction physiopathology, Stents, Treatment Outcome, Angioplasty, Balloon adverse effects, Antihypertensive Agents therapeutic use, Renal Artery Obstruction therapy
- Abstract
Background: Percutaneous revascularization of the renal arteries improves patency in atherosclerotic renovascular disease, yet evidence of a clinical benefit is limited., Methods: In a randomized, unblinded trial, we assigned 806 patients with atherosclerotic renovascular disease either to undergo revascularization in addition to receiving medical therapy or to receive medical therapy alone. The primary outcome was renal function, as measured by the reciprocal of the serum creatinine level (a measure that has a linear relationship with creatinine clearance). Secondary outcomes were blood pressure, the time to renal and major cardiovascular events, and mortality. The median follow-up was 34 months., Results: During a 5-year period, the rate of progression of renal impairment (as shown by the slope of the reciprocal of the serum creatinine level) was -0.07x10(-3) liters per micromole per year in the revascularization group, as compared with -0.13x10(-3) liters per micromole per year in the medical-therapy group, a difference favoring revascularization of 0.06x10(-3) liters per micromole per year (95% confidence interval [CI], -0.002 to 0.13; P=0.06). Over the same time, the mean serum creatinine level was 1.6 micromol per liter (95% CI, -8.4 to 5.2 [0.02 mg per deciliter; 95% CI, -0.10 to 0.06]) lower in the revascularization group than in the medical-therapy group. There was no significant between-group difference in systolic blood pressure; the decrease in diastolic blood pressure was smaller in the revascularization group than in the medical-therapy group. The two study groups had similar rates of renal events (hazard ratio in the revascularization group, 0.97; 95% CI, 0.67 to 1.40; P=0.88), major cardiovascular events (hazard ratio, 0.94; 95% CI, 0.75 to 1.19; P=0.61), and death (hazard ratio, 0.90; 95% CI, 0.69 to 1.18; P=0.46). Serious complications associated with revascularization occurred in 23 patients, including 2 deaths and 3 amputations of toes or limbs., Conclusions: We found substantial risks but no evidence of a worthwhile clinical benefit from revascularization in patients with atherosclerotic renovascular disease. (Current Controlled Trials number, ISRCTN59586944.), (2009 Massachusetts Medical Society)
- Published
- 2009
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29. The transjugular intrahepatic portosystemic shunt (TIPS).
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Owen AR, Stanley AJ, Vijayananthan A, and Moss JG
- Subjects
- Ascites surgery, Humans, Patient Selection, Portasystemic Shunt, Transjugular Intrahepatic adverse effects, Portography, Postoperative Complications, Tomography, X-Ray Computed, Treatment Outcome, Hypertension, Portal surgery, Portasystemic Shunt, Transjugular Intrahepatic methods, Radiography, Interventional methods
- Abstract
The creation of an intrahepatic portosystemic shunt via a transjugular approach (TIPS) is an interventional radiological procedure used to treat the complications of portal hypertension. TIPS insertion is principally indicated to prevent or arrest variceal bleeding when medical or endoscopic treatments fail, and in the management refractory ascites. This review discusses the development and execution of the technique, with focus on its clinical efficacy. Patient selection, imaging surveillance, revision techniques, and complications are also discussed.
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- 2009
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30. Critical lower-limb ischemia: the diagnostic performance of dual-phase injection MR angiography (including high-resolution distal imaging) compared with digital subtraction angiography.
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Owen AR, Robertson IR, Annamalai G, Roditi GH, Edwards RD, Murray LS, and Moss JG
- Subjects
- Adult, Aged, Aged, 80 and over, Contrast Media, Female, Humans, Leg diagnostic imaging, Leg pathology, Male, Middle Aged, Observer Variation, Reproducibility of Results, Sensitivity and Specificity, Angiography, Digital Subtraction methods, Gadolinium DTPA, Ischemia diagnosis, Leg blood supply, Magnetic Resonance Angiography methods
- Abstract
Purpose: To prospectively compare contrast-enhanced (CE) magnetic resonance (MR) angiography against digital subtraction angiography (DSA) in patients with critical lower-limb ischemia., Materials and Methods: Thirty patients with critical lower limb ischemia underwent both CE MR angiography and DSA. CE MR angiography commenced with a dedicated high-resolution study of the below-knee arteries followed by a three-station bolus-chase examination. Two blinded observers recorded the severity of the most significant stenosis within each arterial segment. Interobserver agreement was calculated and, with DSA as the reference standard, the sensitivity and specificity of CE MR angiography for the detection of significant stenosis (>or=50% luminal narrowing) or occlusion was calculated., Results: All 390 arterial segments were scored by both observers. Sensitivity was higher in the distal segments (92%-96%) compared with the proximal segments (69%-79%). Specificity was similar in distal (90%-91%) and more proximal segments (86%-96%). Overall, interobserver agreement was excellent (kappa = 0.95 for CE MR angiography and DSA) and was superior within the distal segments. Twenty-eight segments that were considered occluded on DSA were shown to be patent on CE MR angiography and 16 segments that were considered occluded on CE MR angiography were shown to be patent on DSA., Conclusions: In patients with critical lower-limb ischemia, CE MR angiography with high-resolution distal imaging is highly accurate for assessment of the below-knee arteries. Both DSA and CE MR angiography may identify patent vessels that are considered occluded based on the other modality.
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- 2009
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31. Uterine-artery embolization versus surgery for symptomatic uterine fibroids.
- Author
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Edwards RD, Moss JG, Lumsden MA, Wu O, Murray LS, Twaddle S, and Murray GD
- Subjects
- Adult, Female, Follow-Up Studies, Humans, Leiomyoma surgery, Length of Stay, Postoperative Complications, Quality of Life, Reoperation, Treatment Failure, Uterine Neoplasms surgery, Embolization, Therapeutic adverse effects, Embolization, Therapeutic economics, Hysterectomy economics, Leiomyoma therapy, Uterine Neoplasms therapy
- Abstract
Background: The efficacy and safety of uterine-artery embolization, as compared with standard surgical methods, for the treatment of symptomatic uterine fibroids remain uncertain., Methods: We conducted a randomized trial comparing uterine-artery embolization and surgery in women with symptomatic uterine fibroids. The primary outcome was quality of life at 1 year of follow-up, as measured by the Medical Outcomes Study 36-Item Short-Form General Health Survey (SF-36)., Results: Patients were randomly assigned in a 2:1 ratio to undergo either uterine-artery embolization or surgery, with 106 patients undergoing embolization and 51 undergoing surgery (43 hysterectomies and 8 myomectomies). There were no significant differences between groups in any of the eight components of the SF-36 scores at 1 year. The embolization group had a shorter median duration of hospitalization than the surgical group (1 day vs. 5 days, P<0.001) and a shorter time before returning to work (P<0.001). At 1 year, symptom scores were better in the surgical group (P=0.03). During the first year of follow-up, there were 13 major adverse events in the embolization group (12%) and 10 in the surgical group (20%) (P=0.22), mostly related to the intervention. Ten patients in the embolization group (9%) required repeated embolization or hysterectomy for inadequate symptom control. After the first year of follow-up, 14 women in the embolization group (13%) required hospitalization, 3 of them for major adverse events and 11 for reintervention for treatment failure., Conclusions: In women with symptomatic fibroids, the faster recovery after embolization must be weighed against the need for further treatment in a minority of patients. (ISRCTN.org number, ISRCTN23023665 [controlled-trials.com].), (Copyright 2007 Massachusetts Medical Society.)
- Published
- 2007
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32. Uterine fibroid embolization: more evidence is required.
- Author
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Moss JG
- Subjects
- Animals, Arteries, Disease Models, Animal, Female, Humans, Randomized Controlled Trials as Topic, Safety, Treatment Outcome, Embolization, Therapeutic adverse effects, Embolization, Therapeutic methods, Embolization, Therapeutic standards, Leiomyoma therapy, Uterine Neoplasms therapy, Uterus blood supply
- Published
- 2005
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33. Results of a retrospective multicenter trial of the Viatorr expanded polytetrafluoroethylene-covered stent-graft for transjugular intrahepatic portosystemic shunt creation.
- Author
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Charon JP, Alaeddin FH, Pimpalwar SA, Fay DM, Olliff SP, Jackson RW, Edwards RD, Robertson IR, Rose JD, and Moss JG
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Follow-Up Studies, Graft Occlusion, Vascular etiology, Hepatic Encephalopathy etiology, Humans, Hypertension, Portal surgery, Male, Middle Aged, Phlebography methods, Portasystemic Shunt, Transjugular Intrahepatic adverse effects, Portasystemic Shunt, Transjugular Intrahepatic statistics & numerical data, Postoperative Complications etiology, Retreatment methods, Retrospective Studies, Survival Rate, Treatment Outcome, United Kingdom, Vascular Patency physiology, Polytetrafluoroethylene adverse effects, Polytetrafluoroethylene therapeutic use, Portasystemic Shunt, Transjugular Intrahepatic instrumentation, Stents adverse effects, Stents statistics & numerical data
- Abstract
Purpose: To report the results of a multicenter experience with the Viatorr expanded polytetrafluoroethylene-covered stent-graft for transjugular intrahepatic portosystemic shunt (TIPS) creation in which patency and clinical outcome were evaluated., Materials and Methods: One hundred consecutive patients with portal hypertension, with a mean age of 52 years (range, 22-86 years), underwent implantation of the Viatorr TIPS stent-graft at one of three hospital centers. The indications for TIPS creation were variceal bleeding (n = 81) and refractory ascites (n = 19). Twenty patients had Child-Pugh class A disease, 46 had class B disease, and 34 had class C disease. Eighty-seven patients underwent de novo TIPS placements, with 13 treated for recurrent TIPS stenosis. Sixty-two patients were available for follow-up portal venography and portosystemic pressure gradient (PSG) measurement commencing 6 months after Viatorr stent-graft placement., Results: The technical success rate was 100%. TIPS creation resulted in an immediate decrease in mean PSG (+/-SD) from 21 mm Hg +/- 6 to 7 mm Hg +/- 3. Acute repeat intervention (within 30 days) was required for portal vein thrombosis (n = 1), continued bleeding (n = 3), and encephalopathy (n = 1). The all-cause 30-day mortality rate was 12%. Two patients developed acute severe refractory encephalopathy, which led to death in one case. New or worsening encephalopathy was identified in 14% of patients. The incidence of recurrent bleeding was 8%. The cumulative survival rate at 1 year was 65%. Sixty-two patients available for venographic follow-up had a mean PSG of 9 mm Hg +/- 5 at a mean interval of 343 days (range, 56-967 days). There were four stent-graft occlusions (6%) and seven hemodynamically significant stenoses (11%), four within the stent-graft and three in the non-stent-implanted hepatic vein. The primary patency rate at 1 year by Kaplan-Meier analysis was 84%., Conclusions: This retrospective multicenter experience with the Viatorr stent-graft confirms the preliminary findings of other investigators of good technical results and improved patency compared with bare stents. Early mortality and symptomatic recurrence rates are low by historical standards. The theoretical increase in TIPS-related encephalopathy was not demonstrated. Longer-term follow-up will be required to determine whether the additional cost of the Viatorr stent-graft will be offset by reduced surveillance and repeat intervention.
- Published
- 2004
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34. Evaluation of the effect of uterine artery embolisation on menstrual blood loss and uterine volume.
- Author
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Khaund A, Moss JG, McMillan N, and Lumsden MA
- Subjects
- Adult, Arteries, Embolization, Therapeutic adverse effects, Female, Humans, Leiomyoma diagnosis, Magnetic Resonance Imaging methods, Menopause, Menorrhagia therapy, Middle Aged, Pregnancy statistics & numerical data, Prospective Studies, Treatment Outcome, Uterine Neoplasms diagnosis, Uterus blood supply, Embolization, Therapeutic methods, Leiomyoma therapy, Menstruation physiology, Uterine Neoplasms therapy
- Abstract
Objective: To evaluate the effect of uterine artery embolisation (UAE) on menstrual blood loss (MBL) and uterine volume in women with symptomatic uterine fibroids., Design: Prospective observational study., Setting: West of Scotland gynaecology and radiology departments., Population: Fifty women (mean age 43 years) with symptomatic fibroids undergoing UAE between January 1999 and June 2003., Methods: Women collected sanitary protection from one menses pre-embolisation and at regular intervals thereafter. This allowed objective measurement of MBL using the alkaline haematin technique. Uterine volume was calculated using magnetic resonance imaging (MRI) before and six months following embolisation. Interventional radiologists performed bilateral UAE. The Wilcoxon's signed rank test was used for statistical analysis of data., Main Outcome Measures: Post-embolisation MBL and uterine volume changes., Results: Median pretreatment MBL was 162 mL (mean 234, range 9-1339). The median MBL decreased to 60 mL at 3 months (n= 34, range 0-767, P < 0.001), 70 mL at 6-9 months (n= 34, range 0-1283, P < 0.001), 37 mL at 12-24 months (n= 25, range 0-265, P < 0.001), 18 mL at 24-36 months (n= 17, range 0-205, P < 0.001) and 41 mL at 36-48 months (n= 6, range 0-66, P < 0.05). The median reduction in uterine volume was 40% (n= 46, 95% CI 33.0-49.7, P < 0.001)., Conclusions: UAE causes a statistically significant reduction in objectively measured MBL. UAE is also associated with a statistically significant reduction in uterine volume at six months. There was no relationship between the changes in uterine volume and MBL.
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- 2004
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35. Randomized clinical trial comparing self-expanding metallic stents with plastic endoprostheses in the palliation of oesophageal cancer.
- Author
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O'Donnell CA, Fullarton GM, Watt E, Lennon K, Murray GD, and Moss JG
- Subjects
- Adult, Aged, Cost-Benefit Analysis, Deglutition Disorders economics, Esophageal Neoplasms economics, Follow-Up Studies, Humans, Middle Aged, Pilot Projects, Quality of Life, Survival Analysis, Treatment Outcome, Deglutition Disorders surgery, Esophageal Neoplasms complications, Stents
- Abstract
Background: There is little evidence of the clinical and cost effectiveness of self-expanding metallic stents in the palliation of oesophageal cancer. The aims of this randomized trial were to evaluate the immediate and medium-term clinical outcomes following palliative intubation, examine patient quality of life, and evaluate costs and benefits from the perspective of the health service., Methods: Fifty patients with inoperable oesophageal cancer were randomly allocated a metallic stent (n = 25) or plastic endoprosthesis (n = 25). Patients were followed up monthly until death., Results: There was no significant difference in procedure-related complications or mortality rate between the two groups. There was a trend towards significance in favour of metallic stents with respect to quality of life and survival (median survival 62 versus 107 days for plastic prosthesis and metallic stent respectively). The cost of the initial placement of metallic stents was significantly higher than that of plastic endoprostheses ( pound 983 versus pound 296). After 4 weeks, cost differences were no longer significant., Conclusion: Metallic stents may contribute to improved survival and quality of life in patients with oesophageal cancer. Although initially more expensive, this cost difference does not last beyond 4 weeks. A larger trial involving approximately 300 patients would be required to detect a quality of life benefit of the magnitude observed in this trial.
- Published
- 2002
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36. Common iliac artery access during endovascular thoracic aortic repair facilitated by a transabdominal wall tunnel.
- Author
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Macdonald S, Byrne D, Rogers P, Moss JG, and Edwards RD
- Subjects
- Humans, Abdominal Muscles surgery, Aorta, Thoracic surgery, Iliac Artery surgery, Vascular Surgical Procedures instrumentation
- Abstract
Purpose: To describe a technique for common iliac artery (CIA) access during endovascular aortic aneurysm repair when unfavorable angulation between the CIA and the delivery sheath precludes direct arterial access., Technique: After retroperitoneal exposure of the CIA, a puncture site is chosen inferolateral to the surgical incision, and an 18-G trocar/cannula is advanced in alignment with the CIA through the anterior abdominal wall or skin of the upper thigh into the retroperitoneal space. Serial dilatation is performed over a guidewire placed through the cannula to create the subcutaneous tract. The trocar/cannula is replaced over the wire, and the CIA is punctured under direct vision. The guidewire is then advanced into the proximal aorta. A CIA arteriotomy is performed and the delivery system introduced over the guidewire through the tunnel into the iliac artery., Conclusions: Retroperitoneal exposure of the CIA with tunneled transabdominal wall delivery of the stent-graft avoids both external iliac artery injury and creation of a temporary access conduit in patients with iliac tortuosity and/or occlusive disease.
- Published
- 2001
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37. Percutaneous transluminal angioplasty and stenting of coeliac artery stenosis in the treatment of mesenteric angina: a case report and review of therapeutic options.
- Author
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Mohammed A, Teo NB, Pickford IR, and Moss JG
- Subjects
- Aged, Arteriosclerosis diagnosis, Arteriosclerosis surgery, Celiac Artery diagnostic imaging, Celiac Artery pathology, Colic etiology, Constriction, Pathologic complications, Constriction, Pathologic surgery, Diagnosis, Differential, Humans, Ischemia complications, Male, Radiography, Vascular Surgical Procedures, Angioplasty, Balloon methods, Celiac Artery surgery, Ischemia surgery, Stents
- Abstract
We report the case of a 72-year-old gentleman with mesenteric angina who was successfully treated with stenting of a coeliac artery stenosis using a Palmaz stent, and review the therapeutic options in the management of mesenteric angina.
- Published
- 2000
38. Patient tolerance of cervical esophageal metallic stents.
- Author
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Macdonald S, Edwards RD, and Moss JG
- Subjects
- Adult, Aged, Deglutition physiology, Deglutition Disorders therapy, Esophageal Neoplasms complications, Esophageal Stenosis etiology, Female, Follow-Up Studies, Foreign Bodies physiopathology, Humans, Male, Middle Aged, Palliative Care, Patient Satisfaction, Radiation Injuries complications, Recurrence, Retrospective Studies, Sensation physiology, Statistics, Nonparametric, Survival Rate, Treatment Outcome, Esophageal Stenosis therapy, Esophagus injuries, Esophagus radiation effects, Metals, Stents adverse effects, Tracheoesophageal Fistula therapy
- Abstract
Purpose: To demonstrate that proximal esophageal stenoses and tracheoesophageal fistulas can be adequately palliated with use of metallic stents without significant foreign-body sensation., Materials and Methods: Between June 1994 and March 1999, 22 patients with lesions within 3 cm of the cricopharyngeus were treated by placement of metallic stents. The series was reviewed retrospectively. Twenty patients had surgically unresectable malignant lesions, two patients had benign disease. Ten patients had associated tracheoesophageal fistulas. In all, the upper limit of the stent was between C5 vertebral body inferior endplate and the T2 vertebral body superior endplate. The case-notes were reviewed until patient death (range, 6-198 days), or to date in the two surviving patients with benign disease., Results: Immediate technical success was 93% (27 of 29). Dysphagia scores improved from a median of 3 to 2 after stent placement. Eighteen of 22 (82%) patients reported no foreign-body sensation. There have been no cases of proximal migration, periprocedural perforation, or deaths. The two patients with benign disease experienced significant complications., Conclusion: Lesions in proximity to the cricopharyngeus can be successfully palliated without significant foreign-body sensation in the majority of patients with use of metallic stents. The authors urge caution in placing stents in patients with benign disease.
- Published
- 2000
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39. Comparison of technical success and outcome of tunneled catheters inserted via the jugular and subclavian approaches.
- Author
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Macdonald S, Watt AJ, McNally D, Edwards RD, and Moss JG
- Subjects
- Cohort Studies, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prospective Studies, Time Factors, Catheterization, Central Venous instrumentation, Catheterization, Central Venous methods, Jugular Veins, Subclavian Vein
- Abstract
Purpose: To compare the technical success and immediate and long-term outcomes of tunneled central venous catheters placed in comparative cohorts via the subclavian vein (SCV) and the internal jugular vein (IJV) routes., Materials and Methods: This was a prospective observational single-center study of consecutive procedures. Between November 1993 and June 1995, 99 catheters were placed via the SCV and between December 1997 and July 1998, 109 catheters were placed via the IJV. Procedural data were recorded in both cohorts by completion of a proforma by the primary operator., Results: Follow-up data were available in 96% of the SCV and 87% of the IJV cohorts. The average procedure time was significantly shorter in the IJV group and technical success was 100% versus 97% in the SCV group, but this did not reach statistical significance. The procedure-related pneumothorax rate and the rate of symptomatic venous thrombosis were significantly lower in the IJV cohort (P = .023, P = .015). Fewer catheters were removed prematurely due to sepsis in the IJV group (P = .043)., Conclusions: The IJV route is associated with comparable technical success, and lower major procedural complication and venous thrombosis rates, with fewer catheters removed prematurely. The right IJV approach with ultrasound guidance is recommended as the route of choice for the placement of tunneled central venous catheters.
- Published
- 2000
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40. The Erasme study: a multicenter study on the safety and technical results of the Palmaz stent used for the treatment of atherosclerotic ostial renal artery stenosis.
- Author
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Bakker J, Goffette PP, Henry M, Mali WP, Melki JP, Moss JG, Rabbia C, Therasse E, Thomson KR, Thurnher S, and Vignali C
- Subjects
- Aged, Angioplasty, Balloon, Female, Humans, Male, Prospective Studies, Radiography, Recurrence, Renal Artery diagnostic imaging, Safety, Arteriosclerosis therapy, Renal Artery Obstruction therapy, Stents adverse effects
- Abstract
Purpose: To assess, in a multicenter setting, safety, technical results, and restenosis rate of the Palmaz stent for treatment of atherosclerotic ostial renal artery stenosis., Methods: Ten centers enrolled 106 patients (120 treated renal artery stenoses) in the study. Patient selection was based on unsuccessful percutaneous transluminal renal angioplasty (residual stenosis >/= 20%) performed for treatment of ostial stenosis >/= 50%, in patients with hypertension and/or impaired renal function. Safety was assessed by means of the complication rate, and technical results by the number of successful stent placements and occurrence of restenosis (>50%) at intraarterial angiographic follow-up., Results: Stent placement was successful (n = 112) or partially successful (n = 5) in 117 (98%) arteries. Complications occurred in 19 procedures; seven were of serious clinical significance. Angiographic follow-up was performed in 89 of 117 (76%) cases, at a mean of 8 months (range 2. 5-18 months). Fifteen stents (16.9%) showed restenosis (at a mean of 8.5 months), of which 10 were successfully redilated., Conclusion: Renal artery stenting has a high technical success rate, a complication rate comparable to percutaneous transluminal renal angioplasty, and a low rate of restenosis at 8 months angiographic follow-up.
- Published
- 1999
- Full Text
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41. Salvage of the solitary kidney by insertion of a renal artery stent.
- Author
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Shannon HM, Gillespie IN, and Moss JG
- Subjects
- Arteriosclerosis mortality, Arteriosclerosis physiopathology, Female, Follow-Up Studies, Humans, Kidney Function Tests, Male, Middle Aged, Renal Artery Obstruction mortality, Renal Artery Obstruction physiopathology, Renal Dialysis, Survival Rate, Time Factors, Treatment Outcome, Arteriosclerosis therapy, Kidney physiopathology, Renal Artery, Renal Artery Obstruction therapy, Stents
- Abstract
Objective: The purpose of the study was to evaluate the use of renal artery stents in the solitary functioning kidney of patients who have impaired renal function as a result of atherosclerotic renovascular disease by assessing primary patency, renal function outcome, and complication rates during a mean follow-up period of 15 months., Materials and Methods: The Palmaz stent was placed in the arteries of 21 patients with solitary functioning kidneys. All patients had impaired renal function (creatinine level >150 micromol/l), and four patients were undergoing renal dialysis. Indications for stenting were recoil after percutaneous transluminal angioplasty (n = 12), arterial dissection after angioplasty (n = 2), restenosis after angioplasty (n = 1), and as the primary intervention (n = 6). Follow-up angiography was performed in 16 patients (76%)., Results: Initial technical success was achieved in all patients (residual stenosis, <5%). At follow-up (range, 6-25 months), renal function had returned to normal in five patients (24%), improved in four patients (19%), stabilized in six patients (29%), and deteriorated in six patients (29%). Dialysis has been discontinued in all four dialysis patients. Major complications occurred in four patients (19%), including one death within 30 days of stenting. No significant restenoses were seen on follow-up angiography., Conclusion: Placement of renal artery stents in the solitary kidney led to benefits in 70% of patients treated, including improved renal function in nine patients (43%) and stabilization in six patients (29%). In this high-risk group of patients, we advocate renal artery stenting as a relatively safe procedure to salvage the solitary kidney.
- Published
- 1998
- Full Text
- View/download PDF
42. Case report: palliative treatment of a rectal tumour with a self-expanding metallic stent.
- Author
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Maclennan AC and Moss JG
- Subjects
- Aged, Aged, 80 and over, Humans, Male, Radiography, Interventional methods, Adenocarcinoma therapy, Palliative Care methods, Rectal Neoplasms therapy, Stents
- Published
- 1997
- Full Text
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43. Renal artery stent placement in renal artery stenosis: technical and early clinical results.
- Author
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Taylor A, Sheppard D, Macleod MJ, Harden P, Baxter GM, Edwards RD, and Moss JG
- Subjects
- Adult, Aged, Blood Pressure, Female, Follow-Up Studies, Humans, Kidney physiopathology, Male, Middle Aged, Radiography, Recurrence, Renal Artery Obstruction diagnostic imaging, Renal Artery Obstruction physiopathology, Survival Rate, Vascular Patency, Angioplasty, Balloon, Renal Artery Obstruction therapy, Stents adverse effects
- Abstract
We report the technical and early clinical results of renal artery stent placement in 29 consecutive patients treated at a single centre over a 30-month period, employing the Palmaz balloon-expandable stent. Of 32 arteries treated, 23 (72%) were atheromatous, ostial stenoses. Immediate technical success was achieved in all 29 patients. Follow-up angiography was performed on 25 patients at 6.7 months (mean) and demonstrated a patient restenosis rate of 16%. All surviving patients were followed up for a minimum of 6 months. Blood pressure control was improved in eight (50%) of hypertensive patients, and renal function improved in seven (33%) and stabilized in six (29%) patients with chronic renal impairment (serum creatinine > 150 mumols/l). Complications occurred in seven (24%) of patients, including one procedure-related death. Our experience indicates that stent placement has an initial high technical success rate in renal artery stenosis and that this patency is maintained at repeat angiography with a low restenosis rate. Renal artery stenting is likely to extend the role of percutaneous renal revascularization especially in atheromatous ostial lesions. A randomized trial will be required to evaluate its role compared with balloon angioplasty.
- Published
- 1997
- Full Text
- View/download PDF
44. Colour Doppler ultrasound in renal artery stenosis: intrarenal waveform analysis.
- Author
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Baxter GM, Aitchison F, Sheppard D, Moss JG, McLeod MJ, Harden PN, Love JG, Robertson M, and Taylor G
- Subjects
- Adult, Aged, Aged, 80 and over, Angiography, Female, Humans, Male, Middle Aged, Prospective Studies, Renal Artery Obstruction diagnostic imaging, Renal Artery Obstruction diagnosis, Ultrasonography, Doppler, Color
- Abstract
Renal artery stenosis (RAS) is the commonest secondary cause of hypertension and may result in renal ischaemia with resultant renal failure. Recent studies hve suggested that colour Doppler ultrasound, with spectral analysis of the intrarenal waveforms, can identify those patients with a significant RAS. A prospective study was performed in which colour Doppler ultrasound was compared with angiography in 73 patients (143 kidneys) presenting for renal angiography. Colour Doppler ultrasound was unsuccessful in 16% of kidneys due to a combination of technical failures and small kidney size. Accessory renal vessels were present in 14% of kidneys on angiography but none was detected by ultrasound. Of the 120 kidneys that had both examinations, no significant difference in intrarenal pulsatility or resistive index was noted between the angiographically stenosed and normal arteries. There were significant differences for intrarenal peak and end diastolic velocities, and acceleration time and index. Of these measurements, acceleration time was the best indicator of RAS. The probability of detecting a high grade RAS in an individual patient did not reach 90% until the acceleration time was prolonged to more than 0.12 s. Intrarenal colour Doppler ultrasound is not a general screening test for RAS and it should be reserved for selected patient groups where the incidence of disease is high. Patients with prolonged acceleration times of more than 0.12 s have a high likelihood of at least 70% RAS and should proceed directly to angiography.
- Published
- 1996
- Full Text
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45. Colour Doppler ultrasound in renal transplant artery stenosis: which Doppler index?
- Author
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Baxter GM, Ireland H, Moss JG, Harden PN, Junor BJ, Rodger RS, and Briggs JD
- Subjects
- Blood Flow Velocity, Female, Humans, Male, Prospective Studies, Renal Artery diagnostic imaging, Sensitivity and Specificity, Ultrasonography, Doppler, Color, Ultrasonography, Interventional, Angiography, Digital Subtraction, Graft Occlusion, Vascular diagnostic imaging, Kidney Transplantation, Renal Artery Obstruction diagnostic imaging
- Abstract
A prospective study comparing colour Doppler ultrasound (US) with the 'gold standard' of intra-arterial digital subtraction angiography in the evaluation of renal transplant artery stenosis was performed. Both the intrarenal vessels and the transplant renal artery were examined by Doppler US. Diagnostic arteriography was performed only if, on Doppler, the peak systolic velocity in the transplant renal artery exceeded 1.5 ms-1. Of 109 patients, the transplant artery could not be visualized using colour Doppler US in three, and these were omitted from statistical analysis. Of the remaining 106 patients, 31 had a peak systolic velocity greater than 1.5 ms-1 in the transplant renal artery and were referred for DSA. Of the multiple renal Doppler indices recorded, the peak systolic velocity in the transplant artery was the best discriminating measurement for the detection of renal artery stenosis. A peak systolic velocity of > or = 2.5 ms-1 in the transplant renal artery had a sensitivity of 100% and a specificity of 95% for the detection of renal artery stenosis ( > 50% diameter reduction). Although a significant difference in Pulsatility Index, Resistive Index, Acceleration Index and Acceleration Time was recorded from the intrarenal vessels in the angiographically normal and stenosed groups with Doppler, these measurements were less useful as discriminating diagnostic tests. In conclusion, the peak systolic velocity in the transplant renal artery is the most sensitive Doppler criterion for renal artery stenosis and is sensitive and specific enough to be used as a screening test. The intrarenal acceleration time and index should not be used in isolation.
- Published
- 1995
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46. Vascular occlusion with a balloon-expandable stent occluder.
- Author
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Moss JG, Laborde JC, Clem MC, Rivera FJ, Encarnacion CE, Meyer KB, and Palmaz JC
- Subjects
- Angioplasty, Balloon instrumentation, Animals, Arteries, Arteriovenous Fistula therapy, Dogs, Equipment Design, In Vitro Techniques, Models, Cardiovascular, Models, Structural, Embolization, Therapeutic instrumentation, Silicones, Stents
- Abstract
Purpose: To evaluate the effectiveness of a new vascular occlusion device., Materials and Methods: The device was created by coating a balloon-expandable stent with a silicone sleeve that tapers to a blind-ended nozzle at its leading end. Once crimp-mounted on an angioplasty balloon catheter, the device is introduced over a guide wire through a small end hole in the nozzle., Results: The device was tested for stability and occlusive ability. No migration was measured over a pulsatile pulse range of 50-300 mm Hg, and mean flow rate in the occluded vessel was reduced from 443 mL/min +/- 99 (standard deviation) to 1.9 mL/min +/- 2.7. Subsequently, 12 arteries were occluded in three dogs, and immediate vascular occlusion was achieved in all vessels. An arteriovenous fistula was created in another six dogs and was successfully occluded with the device. Follow-up arteriography at 3 months demonstrated persistent occlusion with no migration of the device., Conclusion: This new occlusive device offers immediate vascular occlusion with excellent stability.
- Published
- 1994
- Full Text
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47. Stenting of the iliac arteries with the Palmaz stent: experience from a multicenter trial.
- Author
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Palmaz JC, Laborde JC, Rivera FJ, Encarnacion CE, Lutz JD, and Moss JG
- Subjects
- Arteriosclerosis diagnostic imaging, Arteriosclerosis epidemiology, Equipment Design, Female, Follow-Up Studies, Humans, Male, Middle Aged, Radiography, Risk Factors, Time Factors, Vascular Patency physiology, Arteriosclerosis therapy, Iliac Artery, Stents adverse effects
- Abstract
Balloon-expandable, intraluminal stenting of the iliac arteries with the Palmaz stent was the subject of a multicenter study for 4 years. A total of 486 patients underwent 587 procedures. Four hundred and five patients had unilateral and 81 had bilateral iliac stent placements. Follow-up ranged from 1 to 48 months (mean 13.3 +/- 11 months). Sustained clinical benefit of the treated patients was obtained in 90.9% at 1 year, 84.1% at 2 years, and 68.6% at 43 months. Angiographic patency rate was 92%. Diabetes mellitus and poor runoff had significant negative influence on the clinical outcome. The 10% incidence of procedural complications was not altered by operator experience.
- Published
- 1992
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- View/download PDF
48. Is radiology a 'nine to five' specialty?
- Author
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Moss JG and Murchison JT
- Subjects
- Medical Audit, Prospective Studies, Radiology Department, Hospital statistics & numerical data, Scotland, Time Factors, Tomography, X-Ray Computed, Ultrasonography, Professional Practice, Radiology, Workload
- Abstract
The role of the radiologist in 'out of hours' radiology was prospectively studied in a single Scottish Health Board for a continuous 6 month period. Six hundred and sixty seven procedures were performed by radiologists. Computed tomography (CT) (274, 41%), ultrasound scans (190, 28.5%) and vascular/interventional procedures (60, 9%) were the most frequently performed procedures. Trauma accounted for 139 (24%) of all 'out of hours' work and overall 365 (54.7%) procedures yielded an abnormality. The workload varied widely between hospitals from two procedures per 100 beds to 137 procedures per 100 beds. Similarly the input from individual radiologists was very variable. A registrar was present for 227 (34%) procedures, a senior registrar for 360 (54%) and a consultant for 138 (20%) (there being two radiologists present for 8.7% of procedures). 'Consultant only' radiology departments offering a full radiological service may expect a substantial 'out of hours' commitment.
- Published
- 1992
- Full Text
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49. Percutaneous gastrostomy: a simpler technique.
- Author
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Moss JG and McDermott V
- Subjects
- Humans, Technology, Radiologic, Gastrostomy methods
- Published
- 1991
50. Comparison of temperature profiles (DeVeTherm) and conventional venography in suspected lower limb thrombosis.
- Author
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Stevenson AJ, Moss JG, and Kirkpatrick AE
- Subjects
- Adult, Aged, Aged, 80 and over, Body Temperature, False Positive Reactions, Female, Humans, Male, Middle Aged, Sensitivity and Specificity, Thrombophlebitis diagnostic imaging, Thrombophlebitis physiopathology, Phlebography, Thermography standards, Thrombophlebitis diagnosis
- Abstract
In 124 patients admitted with suspected acute deep venous thrombosis, the screening value of a new thermographic scanner, DeVeTherm, was evaluated using conventional venography as a reference. The sensitivity of the scanner was calculated at 92% and the specificity at 25%. The predictive value of positive temperature profiles was 0.48, and that of negative temperature profiles, 0.82. On the basis of these results neither the accuracy nor the potential savings justify using temperature profiles alone as a screening test for this condition.
- Published
- 1990
- Full Text
- View/download PDF
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