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Nassr AA, Hessami K, Berghella V, Bibbo C, Shamshirsaz AA, Shirdel Abdolmaleki A, Marsoosi V, Clark SL, Belfort MA, Shamshirsaz AA. Angle of progression measured using transperineal ultrasound for prediction of uncomplicated operative vaginal delivery: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2022; 60:338-345. [PMID: 35238424 DOI: 10.1002/uog.24886] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To determine whether intrapartum transperineal ultrasound measurement of the angle of progression (AoP) during the second stage of labor can predict uncomplicated operative vaginal delivery (OVD) using vacuum or forceps extraction. METHODS A systematic search in PubMed, EMBASE, Scopus, Web of Science and Google Scholar was performed from inception to February 2021. Studies assessing the predictive accuracy of AoP, measured using intrapartum transperineal ultrasound, for uncomplicated OVD, defined as successful vaginal delivery within three pulls using forceps or no more than two detachments of the vacuum extractor cup, were included. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Summary receiver-operating-characteristics (ROC) curves, pooled sensitivity and specificity, area under the ROC curve (AUC) and summary likelihood ratios (LRs) were calculated. RESULTS Seven studies reporting on a total of 782 patients undergoing OVD were included in this systematic review and meta-analysis. Second-stage AoP measured during maternal rest had a pooled sensitivity of 80% (95% CI, 59-92%) and specificity of 89% (95% CI, 76-95%), with a LR+ of 7.3 (95% CI, 3.1-15.8) for uncomplicated OVD. AoP measured during active pushing had a sensitivity of 91% (95% CI, 85-94%) and specificity of 83% (95% CI, 69-92%), with a LR+ of 5.4 (95% CI, 2.7-10.6) for uncomplicated OVD. The performance of AoP measured at rest was particularly high in nulliparous women, with a sensitivity of 87% (95% CI, 75-94%) and specificity of 90% (95% CI, 82-94%) for uncomplicated OVD. CONCLUSION AoP may be a reliable predictor for uncomplicated OVD when measured during the second stage of labor, especially in nulliparous women. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A A Nassr
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
- Department of Obstetrics and Gynecology, Women's Health Hospital, Assiut University, Assiut, Egypt
| | - K Hessami
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - V Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - C Bibbo
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's, Boston, MA, USA
| | - A A Shamshirsaz
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - A Shirdel Abdolmaleki
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - V Marsoosi
- Department of Obstetrics and Gynecology, Tehran University of Medical Sciences, Tehran, Iran
| | - S L Clark
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - M A Belfort
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - A A Shamshirsaz
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
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Harms HJ, Bravo PE, Bajaj NS, Zhou W, Gupta A, Tran T, Taqueti VR, Hainer J, Bibbo C, Dorbala S, Blankstein R, Mehra M, Sörensen J, Givertz MM, Di Carli MF. Cardiopulmonary transit time: A novel PET imaging biomarker of in vivo physiology for risk stratification of heart transplant recipients. J Nucl Cardiol 2022; 29:1234-1244. [PMID: 33398793 PMCID: PMC8254830 DOI: 10.1007/s12350-020-02465-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 10/12/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Myocardial blood flow (MBF) can be quantified using dynamic PET studies. These studies also inherently contain tomographic images of early bolus displacement, which can provide cardiopulmonary transit times (CPTT) as measure of cardiopulmonary physiology. The aim of this study was to assess the incremental prognostic value of CPTT in heart transplant (OHT) recipients. METHODS 94 patients (age 56 ± 16 years, 78% male) undergoing dynamic 13N-ammonia stress/rest studies were included, of which 68 underwent right-heart catherization. A recently validated cardiac allograft vasculopathy (CAV) score based on PET measures of regional perfusion, peak MBF and left-ventricular (LV) ejection fraction (LVEF) was used to identify patients with no, mild or moderate-severe CAV. Time-activity curves of the LV and right ventricular (RV) cavities were obtained and used to calculate the difference between the LV and RV bolus midpoint times, which represents the CPTT and is expressed in heartbeats. Patients were followed for a median of 2.5 years for the occurrence of major adverse cardiac events (MACE), including cardiovascular death, hospitalization for heart failure or acute coronary syndrome, or re-transplantation. RESULTS CPTT was significantly correlated with cardiac filling pressures (r = .434, P = .0002 and r = .439, P = .0002 for right atrial and pulmonary wedge pressure), cardiac output (r = - .315, P = .01) and LVEF (r = - .513, P < .0001). CPTT was prolonged in patients with MACE (19.4 ± 6.0 vs 14.5 ± 3.0 heartbeats, P < .001, N = 15) with CPTT ≥ 17.75 beats showing optimal discriminatory value in ROC analysis. CPTT ≥ 17.75 heartbeats was associated with a 10.1-fold increased risk (P < .001) of MACE and a 7.3-fold increased risk (P < .001) after adjusting for PET-CAV, age, sex and time since transplant. CONCLUSION Measurements of cardiopulmonary transit time provide incremental risk stratification in OHT recipients and enhance the value of multiparametric dynamic PET imaging, particularly in identifying high-risk patients.
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Affiliation(s)
- H J Harms
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital, and Harvard Medical School, 75 Francis Street, Boston, MA, USA
- Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - P E Bravo
- Division of Cardiovascular Medicine, Department of Medicine; and Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - N S Bajaj
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital, and Harvard Medical School, 75 Francis Street, Boston, MA, USA
| | - W Zhou
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital, and Harvard Medical School, 75 Francis Street, Boston, MA, USA
| | - A Gupta
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital, and Harvard Medical School, 75 Francis Street, Boston, MA, USA
| | - T Tran
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital, and Harvard Medical School, 75 Francis Street, Boston, MA, USA
| | - V R Taqueti
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital, and Harvard Medical School, 75 Francis Street, Boston, MA, USA
| | - J Hainer
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital, and Harvard Medical School, 75 Francis Street, Boston, MA, USA
| | - C Bibbo
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital, and Harvard Medical School, 75 Francis Street, Boston, MA, USA
| | - S Dorbala
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital, and Harvard Medical School, 75 Francis Street, Boston, MA, USA
| | - R Blankstein
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital, and Harvard Medical School, 75 Francis Street, Boston, MA, USA
| | - M Mehra
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital, and Harvard Medical School, 75 Francis Street, Boston, MA, USA
| | - J Sörensen
- Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Surgical Sciences, Nuclear Medicine and PET, Uppsala University, Uppsala, Sweden
| | - M M Givertz
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital, and Harvard Medical School, 75 Francis Street, Boston, MA, USA
| | - M F Di Carli
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital, and Harvard Medical School, 75 Francis Street, Boston, MA, USA.
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Wallace Z, Weber B, Parks S, Cook C, Huck D, Brown J, Divakaran S, Hainer J, Bibbo C, Taqueti V, Dorbala S, Blankenstein R, Liao K, Aghayev A, Choi H, Di Carli M. AB0624 Patients with vasculitis have a high prevalence of coronary microvascular dysfunction. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundVasculitides are a heterogenous group of diseases characterized by intense vessel wall inflammation, endothelial injury, and systemic inflammation. Several vasculitides are associated with high risk of cardiovascular (CV) disease, an important source of morbidity and mortality in this population. This excess CV risk is attributed both to a high burden of traditional risk factors and to inflammation, but this remains poorly studied. Indeed, inflammation is a known risk factor for CV disease and implicated in coronary microvascular dysfunction (CMD) which may precede obstructive coronary artery disease (CAD).ObjectivesWe sought to assess whether vasculitis is associated with CMD in the absence of obstructive CAD.MethodsWe retrospectively identified subjects with systemic vasculitis who underwent symptom prompted rest/stress myocardial perfusion PET. Patients with an abnormal myocardial perfusion study (summed stress score ≥3) or LVEF<40% were excluded. Controls were identified from the same population and matched on age, gender and cardiovascular risk factors (CAD, hypertension, dyslipidemia, diabetes mellitus, and obesity). Coronary flow reserve (CFR), was calculated as the ratio of myocardial blood flow (ml/min/g) at peak stress compared to rest. CMD was defined as CFR <2.ResultsWe studied 26 vasculitis cases and 66 matched controls. The most common vasculitides were giant cell arteritis (38%), ANCA-associated vasculitis (31%), and Takayasu’s arteritis (12%). Median (IQR) time between diagnosis and PET was 6.5 (2.9, 14.2) years. Seven (27%) cases had active vascultis at the time of PET. Cases and controls were well-matched on age, sex, and CV risk factors (Table 1). Despite a similar prevalence of CV risk factors, coronary flow reserve (reflected by CMD) was abnormal in 38% of vasculitis cases compared to 15% of controls (p=0.004). The mean [SD] CFR was 19% lower in vasculitis cases vs controls (2.11 [0.5] versus 2.6 [0.7], p=0.003).Table 1.The presence of coronary microvasculature dysfunction in patients with systemic vasculitis without obstructive coronary artery diseaseCohort characteristicsVasculitis (n=26)Control (n=66)P-valueAge at PET, years62 (18)61 (17)0.24Time from Vasculitis Diagnosis to PET, years (median, IQR)6.5 (2.9, 14.2)n/aFemale, n (%)18 (72%)43 (65%)0.99Vasculitis CharacteristicsLarge Vessel (e.g., giant cell arteritis, Takayasu’s), n(%)13 (50%)n/an/aMedium Vessel (e.g., polyarteritis nodosa, Kawasaki’s arteritis), n(%)2 (8%)n/an/aSmall Vessel (e.g., ANCA-associated vasculitis, Henoch-Schonlein Purpura), n(%)11 (42%)n/an/aCardiovascular Risk FactorsAt DiagnosisAt PETAt PETHypertension, n (%)12 (46%)20 (71%)47 (80%)0.47Obesity, n (%)3 (12%)2 (32%)2 (32%)0.84Diabetes, n (%)3 (12%)5 (20%)13 (20%)0.99Dyslipidemia, n (%)4 (15%)15 (58%)40 (61%)0.99Known CAD, n (%)0 (0%)1 (4%)1 (2%)0.48Imaging FindingsRest myocardial blood flow, ml/min/g1.0 (0.3)1.0 (0.3)0.8Stress myocardial blood flow, ml/min/g2.1 (0.6)2.6 (1.0)0.008Coronary Flow Reserve, ml/min/g*2.1 (0.5)2.6 (0.7)0.003Coronary Microvasculature Dysfunction** (CMD), n (%)10 (38%)11 (15%)0.004ConclusionPatients with systemic vasculitis, even in the absence of obstructive CAD, have a high prevalence of CMD compared with non-vasculitis patients. These differences were observed despite matching cases and controls on traditional CV risk factors, highlighting the importance of other factors, such as inflammation and vasculitis treatments on CMD and CV disease in this population. CMD is a known independent risk factor for CV mortality. Future prospective studies are needed to understand the relationship between vasculitis, systemic inflammation, and CMD.Disclosure of InterestsNone declared
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Weber B, Brown J, Divakaran S, Stevens E, Hainer J, Bibbo C, Taqueti V, Blankstein R, Dorbala S, Massarotti E, Costenbader K, Liao K, Dicarli M. Coronary vasomotor dysfunction is associated with worse outcomes in patients with inflammatory disease. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and psoriasis (PsO) are common inflammatory conditions with excess cardiovascular (CV) risk compared to the general population. This excess CV risk is associated with traditional risk factors, glucocorticoid treatment, and systemic inflammation. Systemic inflammation perturbs endothelial function and has been linked to coronary vasomotor dysfunction. It is not clear if coronary vasomotor dysfunction would be associated with worse clinical outcomes in systemic autoimmune inflammatory conditions.
Purpose
We tested the hypothesis that impaired coronary flow reserve (CFR), which in the absence of flow-limiting obstructive coronary artery disease (CAD) reflects vasomotor dysfunction, among patients with SLE, RA, and PsO is associated with worse clinical outcomes.
Methods
We included patients with RA, SLE, and PsO who underwent clinically indicated rest/stress myocardial perfusion positron emission tomography (PET) at a large academic medical center from 2006 to 2019. Patients with an abnormal myocardial perfusion study (summed stress score >3) or left ventricular ejection fraction <40% were excluded. CFR was calculated as the ratio of myocardial blood flow (MBF, ml/min/g) at peak stress compared to the MBF at rest and adjusted for baseline heart rate and blood pressure.
Results
Among the 175 patients (median age 65.1 years, 80% female) in the cohort, 24% had SLE, 35% PsO, and 41% RA. There was no difference in mean CFR between patients with RA, SLE, or PsO. Over a median follow-up of 8.5 years after PET, there were 47 deaths. Patients in the lowest and middle tertile (CFR <2.18) had a higher all-cause mortality when compared with the highest (Figure 1), and this association remained significant after adjusting for age and a composite clinical score incorporating sex, symptoms, and CV risk factors (lowest vs. highest tertile: HR 2.8; 95% confidence interval 1.2–6.5; p=0.01). CV risk factors such as diabetes, hypertension, obesity, tobacco use, and a family history of CAD were not significantly different across CFR tertiles, suggesting that inflammatory-disease specific risk factors may contribute to coronary vasomotor dysfunction.
Conclusions
In patients with systemic inflammatory disease, coronary vasomotor dysfunction was associated with worse outcomes independent of traditional CV risk factors and may have utility as a marker of CV risk among patients with inflammatory disease.
Figure 1
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): 1. 5T32HL094301-02 NIH T32 Training Grant, “Noninvasive Cardiovascular Imaging Research Training Program”
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Affiliation(s)
- B Weber
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - J.M Brown
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - S Divakaran
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - E Stevens
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - J Hainer
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - C Bibbo
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - V Taqueti
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - R Blankstein
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - S Dorbala
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - E Massarotti
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - K Costenbader
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - K Liao
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - M Dicarli
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
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Do Amaral Henrique De Souza A, Harms H, Campbell L, Bibbo C, Harrington M, Hainer J, Dorbala S, Blankstein R, Taqueti V, Kijewski M, Barbagelata A, Breault C, Park M, Di Carli M. P361 Assessment of accuracy and reproducibility of coronary flow reserve measured by SPECT in patients with known or suspected coronary artery disease. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Spectrum Dynamics
Background
Traditional relative assessment of regional myocardial perfusion by single photon emission computed tomography (SPECT) has limited ability to identify multivessel coronary artery disease, as well as diffuse atherosclerosis and coronary microvascular dysfunction. Current gamma cameras with cadmium-zinc-telluride (CZT) detectors have higher temporal resolution and sensitivity and allow the acquisition of multi-frame images and quantification of absolute myocardial blood flow (MBF) and coronary flow reserve (CFR
Purpose
The aim of this study was to assess the accuracy and reproducibility of quantitative measurements of MBF and CFR obtained with a CZT SPECT system compared to PET in a cohort of patients with known or suspected coronary artery disease.
Methods
Accuracy was assessed in 22 patients who underwent dynamic rest/stress 99mTc-sestamibi-SPECT and 13N-ammonia PET myocardial perfusion imaging within two weeks of each other. Fourteen patients comprised the reproducibility cohort and underwent two dynamic 99mTc-sestamibi SPECT scans within two weeks. A rest/pharmacological stress single-day SPECT protocol was performed, using a 1:3 dose ratio. SPECT image reconstruction was performed using a spline-fitting method and SPECT MBF was quantified using a net retention kinetic model in commercially available software. Rest MBF and CFR were adjusted for heart-rate pressure product.
Results
Global MBF at rest and stress showed a good correlation between SPECT and PET (r = 0.814, p < 0.001). For global rest MBF the mean difference between the two techniques was -0.25 ± 0.24 ml/min/g, while for stress MBF mean difference was -0.21 ± 0.40 ml/min/g. We also observed a significant correlation between global SPECT and PET CFR measurements (r = 0.745, p < 0.001), with no significant difference between the two (mean difference: 0.16 ± 0.50). Regarding the reproducibility cohort, the correlation between global CFR measured by two SPECT scans was also significant (r = 0.616, p = 0.019), with a mean difference of 0.14 ±0.51. The mean difference between scans for rest MBF (-0.05 ± 0.19) and stress MBF (0.01 ± 0.42) were also not significant.
Conclusion
MBF and CFR quantification is feasible using a CZT gamma camera and provides accurate and reproducible results that correlate with 13N-ammonia PET. This may be of special relevance in sites where PET is not available, enabling MBF and CFR quantification with CZT SPECT cameras.
Abstract P361 Figure.
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Affiliation(s)
| | - H Harms
- Brigham and Women"s Hospital, Boston, United States of America
| | - L Campbell
- Brigham and Women"s Hospital, Boston, United States of America
| | - C Bibbo
- Brigham and Women"s Hospital, Boston, United States of America
| | - M Harrington
- Brigham and Women"s Hospital, Boston, United States of America
| | - J Hainer
- Brigham and Women"s Hospital, Boston, United States of America
| | - S Dorbala
- Brigham and Women"s Hospital, Boston, United States of America
| | - R Blankstein
- Brigham and Women"s Hospital, Boston, United States of America
| | - V Taqueti
- Brigham and Women"s Hospital, Boston, United States of America
| | - M Kijewski
- Brigham and Women"s Hospital, Boston, United States of America
| | - A Barbagelata
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | | | - M Park
- Brigham and Women"s Hospital, Boston, United States of America
| | - M Di Carli
- Brigham and Women"s Hospital, Boston, United States of America
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Vita TS, Murphy D, Osborne M, Bajaj N, Abhishek K, Jacob S, Diaz A, Nodoushani A, Bravo P, Bibbo C, Steigner M, Taqueti V, Blankstein R, Di Carli M, Dorbala S. P2769Nonalcoholic fatty liver disease: a marker of coronary microvascular dysfunction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- T S Vita
- Brigham and Women's Hospital, Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Boston, United States of America
| | - D Murphy
- Brigham and Women's Hospital, Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Boston, United States of America
| | - M Osborne
- Brigham and Women's Hospital, Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Boston, United States of America
| | - N Bajaj
- Brigham and Women's Hospital, Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Boston, United States of America
| | - K Abhishek
- Brigham and Women's Hospital, Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Boston, United States of America
| | - S Jacob
- Brigham and Women's Hospital, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology,, Boston, United States of America
| | - A Diaz
- Brigham and Women's Hospital, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology,, Boston, United States of America
| | - A Nodoushani
- Brigham and Women's Hospital, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology,, Boston, United States of America
| | - P Bravo
- Brigham and Women's Hospital, Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Boston, United States of America
| | - C Bibbo
- Brigham and Women's Hospital, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology,, Boston, United States of America
| | - M Steigner
- Brigham and Women's Hospital, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology,, Boston, United States of America
| | - V Taqueti
- Brigham and Women's Hospital, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology,, Boston, United States of America
| | - R Blankstein
- Brigham and Women's Hospital, Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Boston, United States of America
| | - M Di Carli
- Brigham and Women's Hospital, Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Boston, United States of America
| | - S Dorbala
- Brigham and Women's Hospital, Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Boston, United States of America
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Bibbo C, Deluca L, Gibbs KA, Saltzman DH, Rebarber A, Green RS, Fox NS. Rescue corticosteroids in twin pregnancies and short-term neonatal outcomes. BJOG 2012; 120:58-63. [DOI: 10.1111/1471-0528.12021] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Midfoot and hindfoot arthrodeses traditionally have been done to treat deformities resulting from paralytic disorders, residual clubfoot deformity, and posttraumatic arthritis. The surgical indications for midfoot and hindfoot arthrodeses more recently have been expanded to include painful arthritic deformities associated with neuroarthropathy, seropositive or seronegative arthropathies, and neurologic disorders. Regardless of the joint fused or the technique used, the goal of each remains similar: the creation of a painless, plantigrade foot capable of being fitted into, at the very least, a custom shoe. The aim of the current study is to describe the major complications associated with midfoot and hindfoot fusions in adults, and the prevention and the treatment of these complications.
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Affiliation(s)
- C Bibbo
- Department of Orthopaedic Surgery, Marshfield Clinic, WI 54449-5777, USA
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Abstract
Subtalar joint dislocation (STJD) is an uncommon injury, but carries with it a potential for significant functional disability. We hypothesized that a significant number of injuries associated with subtalar joint dislocation may be unrecognized by plain radiographic examination. Therefore, we reviewed the records of all STJDs over a three-year period, identifying nine cases. The majority of injuries occurred in men (78%) with a mean age of 29 years. Overall, the mean age at injury was 32 years. The right lower extremity was most frequently injured (87.5%). Plain films initially diagnosed a STJ dislocation in all patients. A CT scan was performed in all cases. In 100% of patients, CT identified additional injuries missed on initial plain radiographs. In 44% of patient, new information gathered by CT dictated a change in treatment. Based on our findings, we conclude that CT is an invaluable tool to assess for associated injuries in STJ dislocation, and should be performed in all cases of STJ dislocation.
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Affiliation(s)
- C Bibbo
- Department of Orthopaedics, UMDNJ-New Jersey Medical School, Newark 07103, USA
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10
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Abstract
Ankle fracture in patients with DM mandates a stepwise protocol to minimize the potential complications of delayed fracture healing, wound complications, and development of Charcot arthropathy. For nondisplaced ankle fracture, a nonoperative approach with increased duration of immobilization seems successful based on experience of the limited series. A displaced ankle fracture in a patient with DM requires a surgical intervention. The authors advocate tight glucose control in both groups to improve the fracture milieu and to ameliorate the potential complications. Appropriate stable fixation with adequate length of immobilization is crucial for successful fracture resolution.
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Affiliation(s)
- C Bibbo
- Department of Orthopaedics, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark 07103, USA
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Abstract
Preoperative assessment of patients with metastatic bone disease includes a history and physical examination, laboratory evaluation, and standard radiographs. Perioperative diagnostics include technetium bone scan, CT scans, MR imaging, positron emission tomography, and biopsy. The role of preoperative tumor embolization and vena cava filter placement is discussed in this article. Guidelines for pain control are provided. Surgical planning and instrument considerations for long bone lesions, periarticular lesions, and pelvis and acetabular lesions are addressed. The importance of rehabilitation for patients with metastatic bone disease is emphasized.
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Affiliation(s)
- C Bibbo
- Department of Orthopaedics, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, USA
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12
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Abstract
Pyomyositis, although uncommon, is being reported with greater frequency in temperate climates. The presentation is similar to a number of infectious processes, and when associated with a traumatic event, the clinical picture may be confused with that of a musculoskeletal injury. This, coupled with an unfamiliarity of the disease, may result in a delay in diagnosis. Early antibiotic therapy may obviate surgery. Progression to the suppurative stage requires surgical drainage along with antibiotics. CT guided drainage may be accomplished in certain cases. In immunocompromised patients, progression to the septicemic stage is associated with high morbidity and mortality.
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Affiliation(s)
- C Bibbo
- Department of Orthopaedic Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, USA.
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13
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Affiliation(s)
- C Bibbo
- Department of Orthopaedics, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, USA
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14
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Abstract
Acute traumatic compartment syndrome of the foot is a sequelae of serious injury to the foot, which, if unrecognized, may result in significant motor and sensory deficits, pain, stiffness, and deformity. It is nearly always associated with fractures, dislocations, and crush injuries to the foot. Vascular injuries and coagulopathic states are also risk factors for the development of an acute foot compartment syndrome. In children, the presentation of an acute foot compartment syndrome may be masked by the pain and edema caused by associated fractures and dislocations. A high index of suspicion is warranted in children presenting with foot injuries that are associated with foot compartment syndrome. Recognition of the signs and symptoms of compartment syndrome in the emergency room are paramount; the diagnosis is best confirmed by multiple compartment pressure readings. The urgency of diagnosis of a compartment syndrome must be underscored, as the complications of a missed foot compartment syndrome includes contractures, claw toe deformity, sensory loss, stiffness, and chronic pain. Prompt orthopaedic consultation is mandatory; urgent compartment fasciotomies are associated with a good clinical outcome.
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Affiliation(s)
- C Bibbo
- Department of Orthopaedics, U.M.D.N.J.-New Jersey Medical School, Newark, New Jersey, USA.
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15
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Lin SS, Sabharwal S, Bibbo C. Orthotic and bracing principles in neuromuscular foot and ankle problems. Foot Ankle Clin 2000; 5:235-64. [PMID: 11232229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The gait cycle involves a closely linked interplay among the joints of the lower extremity, notably the complex joints of the foot and ankle. The goals of bracing and orthoses in the management of neuromuscular foot and ankle problems are to prevent further deformity, passively correct deformity, and modulate motor tone. Tone-reducing AFO, in effect, improves the position of the lower extremity and facilitates the pathologic gait. The type of deformity present and its natural history by virtue of the pathologic origin must be considered when embarking on a conservative nonoperative course. Associated issues and thought processes are elaborated in the article. The biomaterials of which the orthotic brace is constructed, the design considerations, and expected goals of an orthosis must be appropriate to accommodate the pathomechanical forces encountered in the face of the cutaneous insensitivity. It is evident from the multiple facets of rehabilitative care that a team of professionals, including the orthopedist, physical therapist, and orthotist, along with involved health care workers, must be in communication and agreement to manage the challenges of these patients successfully.
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Affiliation(s)
- S S Lin
- Department of Orthopedics, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, New Jersey, USA.
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16
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Abstract
The purpose of these experiments was to evaluate two methods of bowel viability assessment in two distinct models of intestinal ischemia. Bowel viability was assessed in 32 dogs by means of three methods: (1) a probe that quantified the intestinal electromyographic (EMG) measurements in millivolts (mV), (2) Doppler ultrasonography, and (3) perfusion fluorometry, which quantified serosal blood flow in indexed dye fluorescence units (dfi). Ischemia was created using one of two methods: (1) a chronic model in which the blood supply to 40 cm of ileum was ligated and viability assessed 24 hours later, or (2) an acute model in which the main superior mesenteric artery was occluded for 3 1/2 hours and then released. Viability parameters were assessed every 5 minutes for 30 minutes after release. After viability assessment was completed, the ischemic bowel was resected and anastomosed at the site where the EMG measurements approximated 50% of the values obtained in normal bowel. In the chronic group 3 of 20 dogs died of necrosis in contrast to none of 12 dogs in the acute reperfusion group. In the acute model EMG values steadily increased after reperfusion, stabilizing by 15 minutes after release. Mean EMG values at 15 through 30 minutes after release were significantly greater than the 5- and 10-minute postrelease and prerelease values, suggesting that the electromyogram is affected by reperfusion. Conversely, postrelease fluorometry measurements rapidly increased to levels that exceeded measurements obtained in normal bowel. There was a significant difference in the number of audible Doppler signals in the marginal artery of survivors of the acute vs. the chronic model. Fluorometry measurements in survivors of the acute model (99+/-9 dfi) were significantly greater than measurements in the chronic model (54+/-4 dfi, P<or=0.004). Conversely, intermodel differences in the EMG measurements were not significant. These results show significant differences in the magnitude of ischemic damage induced by reperfusion vs. mesenteric ligation, which had a significant impact on the objective blood flow measurements that were used to predict bowel viability. The results also suggest that intestinal reperfusion injury in dogs has a negligible impact on bowel survival.
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Affiliation(s)
- R E Brolin
- Department of Surgery, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA
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17
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Abstract
These experiments were designed to determine the relationship between translocation of Escherichia coli and viability of ischemic small bowel. Twenty beagles were gavaged with 14C-labeled E. coli at two time intervals (3 and 24 h) prior to ligation of the blood supply to a 40-cm segment of ileum. Mesenteric lymph node (MLN) biopsies and bacterial cultures of the peritoneal fluid, peripheral arterial blood, and splanchnic venous blood were taken immediately prior to ligation and 24 h later both before and after the ischemic bowel was resected and anastomosed. Biopsies of each resection margin were taken to measure translocation of E. coli into the bowel wall. Several hemodynamic hemodynamic parameters were also measured before and 24 h after ligation. Seven of the 20 dogs died of further bowel necrosis. In survivors A-alpha DO2 was significantly decreased 24 h after mesenteric ligation vs. preligation, whereas in dogs that died DO2 was significantly increased after ligation vs. preligation. The incidence of mesenteric venous cultures positive for E. coli was significantly higher 24 h after ligation vs. preligation. However, there was no correlation between survival and the incidence of positive E. coli cultures in the blood or peritoneal fluid. Mean MLN counts were significantly higher in dogs gavaged at 3 h vs. those gavaged 24 h prior to laparotomy. However, there was no correlation between survival and translocation into either the bowel wall or MLN at either time interval. Viability of ischemic small bowel in this canine model was not affected by translocation of E. coli. Hemodynamic parameters that are altered during the course of sepsis also did not correlate with survival.
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Affiliation(s)
- C Bibbo
- Department of Surgery, Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
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18
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Brolin RE, Orland PJ, Bibbo C, Reddell MT, Fedorciw B, Gazi G, Semmlow JL. Comparison of blood flow and myoelectric measurements in two chronic models of mesenteric ligation. Arch Surg 1995; 130:147-52. [PMID: 7848083 DOI: 10.1001/archsurg.1995.01430020037004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To determine whether the predictive accuracy of intestinal motility and blood flow measurements is altered by the magnitude of ischemic damage. DESIGN Inception cohort study (dogs). Motility was measured using a probe that quantifies both the electromyographic (EMG) measurements and the magnitude of evoked contractile response (ECR). Intestinal blood flow was assessed using Doppler ultrasonography in the marginal artery and perfusion fluorometry, which quantifies fluorescein in the bowel wall in dye fluorescence units. SETTING Vivarium animal research facilities at a medical school. INTERVENTIONS The blood supply of a 40-cm length of ileum was ligated in 102 dogs: 52 in which the marginal artery was ligated at two points 8 cm apart (severe model), and 50 in which the marginal artery was ligated only once (moderate model). Twenty-four hours after ligation, the motility and blood flow parameters were measured in normal bowel and at 2-cm intervals within the 40-cm ischemic segment. Resection and anastomosis of ischemic bowel was then performed using either EMG, ECR, or fluorometry to determine the site of resection. OUTCOME MEASURE Anastomotic leak from progressive ischemia. RESULTS There were 26 fatal anastomotic leaks, all due to necrosis at the anastomosis. Perfusion fluorometry and ECR measurements did not correlate with survival in either model. An audible Doppler pulse in the marginal artery correlated with survival in the moderate (P < or = .02) but not the severe model (P = .59). The EMG measurements were significantly greater in survivors vs nonsurvivors in both models. CONCLUSIONS The EMG measurements may be useful in bowel viability assessment. Correlation of Doppler ultrasonographic findings with survival in the moderate model suggests that blood flow measurements may be more reliable in predicting viability in less ischemic bowel.
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Affiliation(s)
- R E Brolin
- Department of Surgery, UMDNJ, Robert Wood Johnson Medical School, New Brunswick
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19
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Abstract
The records of 26 patients who underwent cholecystostomy procedures for presumed acute cholecystitis during a 6-year period were reviewed. Nine patients had operative tube cholecystostomy (OC), and 17 patients had radiologic percutaneous cholecystostomy (PC). A correct diagnosis of acute cholecystitis was made in 22 of 26 patients (84%), including 14 of 17 PC patients and 8 of 9 in the OC group. The rate of resolution of cholecystitis was the same in each group (75% OC versus 78% PC). APACHE II scores prior to treatment were significantly higher in OC patients (20.9 OC versus 12.4 PC, p < 0.01). There were 5 deaths, including 3 in the OC groups and 2 in the PC group. Nonfatal complications were more frequent in the PC group. Two of the 14 correctly diagnosed PC patients (14%) subsequently required emergency cholecystectomy for persistent biliary sepsis, and 6 patients (43%) required at least 1 tube exchange for occlusion or dislodgement. Overall, only 5 of the 14 patients (36%) in the PC group were successfully treated without complications compared with 5 of 8 patients (63%) in the OC group. Despite its theoretical advantages, PC was no more effective than OC in the treatment of acute cholecystitis. These data suggest that OC remains a viable treatment option in critically ill patients with acute cholecystitis.
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Affiliation(s)
- D A Spain
- Department of Surgery, UMDNJ-Robert Wood Johnson Medical School, New Brunswick 08903
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20
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Bibbo C, Warren AM. Fibrolipomatous hamartoma of nerve. J Foot Ankle Surg 1994; 33:64-71. [PMID: 8161996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Fibrolipomatous hamartomas of nerve are rare, benign, fibrofatty malformations of peripheral nerves, most commonly affecting the median nerve. Lower extremity cases are extremely rare. The authors present a very rare case of a fibrolipomatous hamartoma involving the superficial peroneal nerve, and review the literature regarding its clinical presentation and surgical management.
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Affiliation(s)
- C Bibbo
- Department of Surgery, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey
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Bibbo C, Brolin RE, Warren AM, Franklin ID. Current therapy for subungual melanoma. J Foot Ankle Surg 1994; 33:184-93. [PMID: 8019543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Malignant subungual melanoma is an infrequently encountered but often misdiagnosed clinical entity. The podiatric surgeon plays a major role in the early diagnosis and surgical management. An illustrative case report of its clinical presentation and a thorough review of current therapeutic modalities are presented.
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Affiliation(s)
- C Bibbo
- Department of Surgery, University of Medicine and Dentistry of New Jersey - Robert Wood Johnson Medical School, New Brunswick
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