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Fayek B, Banka A, Machan L, Bedaiwy MA. Hysteroscopic Lysis of Complex Uterine Adhesions After Interventional Radiology-Guided Access. J Minim Invasive Gynecol 2024; 31:17-18. [PMID: 37913919 DOI: 10.1016/j.jmig.2023.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/13/2023] [Accepted: 10/26/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE To demonstrate a novel surgical technique using hysteroscopic lysis of adhesions after interventional radiology (IR)-guided access in patients with severe intrauterine adhesions and challenging uterine access. DESIGN This video illustrates the technique of the safe division of intrauterine adhesions after IR-guided access. SETTING Conventional hysteroscopic adhesiolysis might be inadequate or risky in cases of severely narrowed or obstructed uterine flow tract, possibly resulting in incomplete adhesiolysis, false passages, or uterine perforation. This video presents 2 cases from a tertiary center involving a multidisciplinary team of a reproductive surgeon and an interventional radiologist. The first case involves a 38-year-old with severe Asherman syndrome, who experienced unsuccessful attempt to treat adhesions that was complicated by a false passage. The second case involves a 39-year-old with recurrent severe Asherman syndrome and a history of unsuccessful attempts at hysterosalpingogram and conventional hysteroscopic lysis of adhesions. INTERVENTIONS In the IR suite, the patient was put in a lithotomy position on the fluoroscopy table. A vaginal speculum was inserted exposing the cervix. The procedure was performed using intravenous sedation and topical anesthetic spray applied to the cervix. Using fluoroscopy, a balloon cannula was inserted through the cervix, followed by contrast injection to assess uterine access. If there is no route, transvaginal ultrasound-guided needle cannulation of the main portion of the uterine cavity would be performed, approximating as closely as possible to the expected route of the cervical canal. A guidewire followed by a locked loop catheter was advanced through adhesions into the uterine cavity. The catheter was left protruding from the cervix to guide the hysteroscope. The patient was then transferred to the operating room for the hysteroscopic procedure. Under the guidance of the intrauterine catheter, the adhesions were carefully lysed using cold scissors. The endometrial cavity and tubal openings were inspected to ensure complete adhesiolysis and exclusion of any other copathologies. CONCLUSION IR guidance can provide a safe and effective approach to hysteroscopic lysis of adhesions in patients with challenging intrauterine adhesions and difficult uterine access, such as patients with severe Asherman syndrome, intractable cervical stenosis, uterine wall agglutination, previous adhesiolysis failure, marked fixed retroverted retroflexed uteri, and previous false passage or uterine perforation.
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Affiliation(s)
- Bahi Fayek
- Department of Obstetrics and Gynaecology, Faculty of Medicine (Dr. Fayek, Ms. Banka, and Dr. Bedaiwy), The University of British Columbia, Vancouver, BC, Canada; Department of Obstetrics and Gynaecology, Faculty of Medicine (Dr. Fayek), Menoufia University, Menoufia, Egypt
| | - Azraa Banka
- Department of Obstetrics and Gynaecology, Faculty of Medicine (Dr. Fayek, Ms. Banka, and Dr. Bedaiwy), The University of British Columbia, Vancouver, BC, Canada
| | - Lindsay Machan
- Department of Radiology, Faculty of Medicine (Dr. Machan), The University of British Columbia, Vancouver, BC, Canada
| | - Mohamed A Bedaiwy
- Department of Obstetrics and Gynaecology, Faculty of Medicine (Dr. Fayek, Ms. Banka, and Dr. Bedaiwy), The University of British Columbia, Vancouver, BC, Canada.
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Tajima Y, Seow CY, Dong SJ, Tsutsui M, Cheung CY, Welch I, Mowbray L, Imlach B, Hildebrandt R, Apperloo K, Ryomoto B, Goodacre E, Myrdal C, Machan L, Wolff K, Elizur E, Vasilescu DM, Sin DD. Development of a unilateral porcine emphysema model induced by porcine pancreatic elastase. J Appl Physiol (1985) 2023; 135:1001-1011. [PMID: 37767558 DOI: 10.1152/japplphysiol.00801.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 09/05/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
Emphysema is one of the pathological hallmarks of chronic obstructive pulmonary disease. We have recently reported that radiofrequency therapy improves lung function in rodent models of emphysema. However, preclinical data using large animals is necessary for clinical translation. Here, we describe the work performed to establish a unilateral porcine emphysema model. Different doses of porcine pancreatic elastase (PPE) were instilled into the left lung of 10 Yucatan pigs. Three additional pigs were used as controls. Six weeks after instillation, lungs were harvested. Lung compliance was measured by a water displacement method and plethysmography. Systematic uniform random sampling of the left and right lungs was performed independently to measure alveolar surface area using micro-computed tomography (micro-CT) and histology. In pigs instilled with 725-750 U/kg of PPE (PPE group, n = 6), the compliance of the left lung was significantly higher by 37.6% than that of the right lung (P = 0.03) using the water displacement method. With plethysmography, the volume of the left lung was significantly larger than that of the right lung at 3, 5, and 10 cmH2O. Measurements from either micro-CT or histology images showed a significant decrease in alveolar surface area by 14.2% or 14.5% (P = 0.031) in the left lung compared with the right lung of the PPE group. A unilateral model for mild emphysema in Yucatan pigs has been established, which can now be used for evaluating novel therapeutics and interventional strategies.NEW & NOTEWORTHY For clinical translation, preclinical data using large animal models is necessary. However, papers describing an emphysema model in pigs, which are anatomically and physiologically similar to humans, are lacking. Here, we report success in creating a unilateral mild-emphysema model in pigs with only one single dose of porcine pancreatic elastase. This model will be useful in bringing novel technologies and therapies from small animals to humans with emphysema.
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Affiliation(s)
- Yuki Tajima
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chun Y Seow
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shou-Jin Dong
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- Respiratory Department, Chengdu First People's Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Mai Tsutsui
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chung Y Cheung
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ian Welch
- Centre for Comparative Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Laura Mowbray
- Centre for Comparative Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brittany Imlach
- Centre for Comparative Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rhonda Hildebrandt
- Centre for Comparative Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kayla Apperloo
- Centre for Comparative Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian Ryomoto
- Centre for Comparative Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Evan Goodacre
- Ikomed Technologies Inc, Vancouver, British Columbia, Canada
| | - Corey Myrdal
- Ikomed Technologies Inc, Vancouver, British Columbia, Canada
| | - Lindsay Machan
- Ikomed Technologies Inc, Vancouver, British Columbia, Canada
| | - Kim Wolff
- Ikomed Technologies Inc, Vancouver, British Columbia, Canada
| | - Eran Elizur
- Ikomed Technologies Inc, Vancouver, British Columbia, Canada
| | - Dragoș M Vasilescu
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Don D Sin
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Knuttinen MG, Machan L, Khilnani NM, Louie M, Caridi TM, Gupta R, Winokur RS. Diagnosis and Management of Pelvic Venous Disorders: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2023; 221:565-574. [PMID: 37095667 DOI: 10.2214/ajr.22.28796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
Pelvic venous disorders (PeVD), previously known by various imprecise terms including pelvic congestion syndrome, have historically been underdiagnosed as a cause of chronic pelvic pain (CPP), a significant health problem associated with reduced quality of life. However, progress in the field has helped to provide heightened clarity with respect to definitions relating to PeVD, and evolution in algorithms for PeVD workup and treatment has been accompanied by new insights into the causes of a pelvic venous reservoir and associated symptoms. Ovarian and pelvic vein embolization, as well as endovascular stenting of common iliac vein compression, should be considered as management options for PeVD. Both treatments have been shown to be safe and effective for patients with CPP of venous origin, regardless of age. Current therapeutic protocols for PeVD exhibit significant heterogeneity owing to limited prospective randomized data and evolving understanding of the factors driving successful outcomes; forthcoming clinical trials are anticipated to improve understanding of CPP of venous origin as well as algorithms for PeVD management. This Expert Panel Narrative Review provides a contemporary update relating to PeVD, summarizing the entity's current classification, diagnostic workup, endovascular treatments, management of persistent or recurrent symptoms, and future research directions.
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Affiliation(s)
- M-Grace Knuttinen
- Department of Radiology, Division of Interventional Radiology, Mayo Clinic Arizona, 5777 Mayo Blvd, Phoenix, AZ 85255
| | - Lindsay Machan
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Neil M Khilnani
- Department of Radiology, Weill Cornell Medicine, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY
| | - Michelle Louie
- Department of Medical and Surgical Gynecology, Mayo Clinic Arizona, Phoenix, AZ
| | - Theresa M Caridi
- Department of Radiology, Division of Interventional Radiology, UAB Medicine, The University of Alabama at Birmingham, Birmingham, AL
| | - Ramona Gupta
- Department of Radiology, Division of Vascular and Interventional Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ronald S Winokur
- Department of Radiology, Weill Cornell Medicine, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY
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Machan L, Parhar D, Flannigan R, Nigro M. Abstract No. 151 Sonographic Findings and Clinical Outcomes after Embolization of Symptomatic Varicoceles. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
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Parhar D, Baum RA, Spouge R, Yan T, Ho S, Hadjivassiliou A, Machan L, Legiehn G, Klass D, Dhatt R, Boucher LM, Liu DM. Hepatic Hilar Nerve Block for Adjunctive Analgesia during Percutaneous Thermal Ablation of Hepatic Tumors: A Retrospective Analysis. J Vasc Interv Radiol 2023; 34:370-377. [PMID: 36473614 DOI: 10.1016/j.jvir.2022.11.028] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/01/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To determine whether hepatic hilar nerve block techniques reduce analgesic and sedation requirements during percutaneous image-guided thermal ablation of hepatic tumors. MATERIALS AND METHODS A single-center retrospective cohort analysis was performed of 177 patients (median age, 67 years; range, 33-86 years) who underwent percutaneous image-guided thermal ablation of liver tumors. All patients were treated utilizing local anesthetic and moderate sedation between November 2018 and November 2021 at a tertiary level hospital, with or without the administration of a hepatic hilar nerve block. Univariable and multivariable linear regression analyses were performed to determine the relationship between the administration of the hilar nerve block and fentanyl and midazolam dosages. RESULTS A total of 114 (64%) patients received a hilar nerve block in addition to procedural sedation, and 63 (36%) patients received procedural sedation alone. There were no significant differences in the baseline demographic and tumor characteristics between the cohorts. The procedure duration was longer in the hilar block cohort than in the unblocked cohort (median, 95 vs 82 minutes; P = .0012). The technical success rate (98% in both the cohorts, P = .93) and adverse event rate (11% vs 3%, P = .14) were not significantly different between the cohorts. After adjusting for patient and tumor characteristics, ablation modality, and procedure and ablation durations, hilar nerve blocks were associated with lower fentanyl (-18.4%, P = .0045) and midazolam (-22.7%, P = .0007) dosages. CONCLUSIONS Hepatic hilar nerve blocks significantly decrease the fentanyl and midazolam requirements during thermal ablation of hepatic tumors, without a significant change in the technical success or adverse event rates.
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Affiliation(s)
- Dennis Parhar
- Division of Interventional Radiology, Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada; T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.
| | - Richard A Baum
- Division of Interventional Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Rebecca Spouge
- Division of Interventional Radiology, Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tyler Yan
- Division of Interventional Radiology, Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephen Ho
- Division of Interventional Radiology, Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anastasia Hadjivassiliou
- Division of Interventional Radiology, Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lindsay Machan
- Division of Interventional Radiology, Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gerald Legiehn
- Division of Interventional Radiology, Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Darren Klass
- Division of Interventional Radiology, Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ravjot Dhatt
- Division of Interventional Radiology, Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Louis-Martin Boucher
- Department of Radiology, McGill University Health Centre, Montreal, Québec, Canada
| | - David M Liu
- Division of Interventional Radiology, Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada; Faculty of Applied Science, University of British Columbia, Vancouver, British Columbia, Canada; Miller School of Medicine, University of Miami, Coral Gables, Florida
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6
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Machan L. Invited commentary: Collar Badge Lens Dose Equivalent Values among United States Physicians Performing Fluoroscopically Guided Interventional Procedures. J Vasc Interv Radiol 2022; 33:852-853. [PMID: 35777894 DOI: 10.1016/j.jvir.2022.03.601] [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] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 12/01/2022] Open
Affiliation(s)
- Lindsay Machan
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
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Parhar D, Spouge R, Yan T, Machan L, Liu D. Abstract No. 172 Hepatic hilar nerve block for percutaneous hepatic thermal ablation: a retrospective analysis. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Sharma A, Hadjivassiliou A, Machan L. Abstract No. 135 Radiologic findings in infertile women referred for selective salpingography and fallopian tube recanalization. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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9
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Cherkasova MV, Fu JF, Jarrett M, Johnson P, Abel S, Tam R, Rauscher A, Sossi V, Kolind S, Li DKB, Sadovnick AD, Machan L, Girard JM, Emond F, Vosoughi R, Traboulsee A, Stoessl AJ. Cortical morphology predicts placebo response in multiple sclerosis. Sci Rep 2022; 12:732. [PMID: 35031632 PMCID: PMC8760243 DOI: 10.1038/s41598-021-04462-7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 12/22/2021] [Indexed: 11/27/2022] Open
Abstract
Despite significant insights into the neural mechanisms of acute placebo responses, less is known about longer-term placebo responses, such as those seen in clinical trials, or their interactions with brain disease. We examined brain correlates of placebo responses in a randomized trial of a then controversial and now disproved endovascular treatment for multiple sclerosis. Patients received either balloon or sham extracranial venoplasty and were followed for 48 weeks. Venoplasty had no therapeutic effect, but a subset of both venoplasty- and sham-treated patients reported a transient improvement in health-related quality of life, suggesting a placebo response. Placebo responders did not differ from non-responders in total MRI T2 lesion load, count or location, nor were there differences in normalized brain volume, regional grey or white matter volume or cortical thickness (CT). However, responders had higher lesion activity. Graph theoretical analysis of CT covariance showed that non-responders had a more small-world-like CT architecture. In non-responders, lesion load was inversely associated with CT in somatosensory, motor and association areas, precuneus, and insula, primarily in the right hemisphere. In responders, lesion load was unrelated to CT. The neuropathological process in MS may produce in some a cortical configuration less capable of generating sustained placebo responses.
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Affiliation(s)
- Mariya V Cherkasova
- Department of Psychology, University of British Columbia, Vancouver, Canada. .,Department of Psychology, West Virginia University, 2128 Life Science Building, Morgantown, WV, 26506, USA.
| | - Jessie F Fu
- Department of Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada
| | - Michael Jarrett
- Population Data BC, University of British Columbia, Vancouver, BC, Canada
| | - Poljanka Johnson
- Department of Medicine (Division of Neurology), Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Shawna Abel
- Department of Medicine (Division of Neurology), Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Roger Tam
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada.,School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada
| | - Alexander Rauscher
- Depatment of Pediatrics (Division of Neurology), University of British Columbia, Vancouver, BC, Canada
| | - Vesna Sossi
- Department of Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada
| | - Shannon Kolind
- Department of Medicine (Division of Neurology), Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - David K B Li
- Department of Medicine (Division of Neurology), Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada.,Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - A Dessa Sadovnick
- Department of Medicine (Division of Neurology), Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada.,Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Lindsay Machan
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - J Marc Girard
- Centre Hospitalier de L'Université de Montréal, Montréal, QC, Canada
| | - Francois Emond
- CHU de Québec-Université Laval, Hôpital de L'Enfant-Jésus, Québec, Canada
| | - Reza Vosoughi
- Department of Internal Medicine (Neurology), University of Manitoba, Winnipeg, Canada
| | - Anthony Traboulsee
- Department of Medicine (Division of Neurology), Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - A Jon Stoessl
- Department of Medicine (Division of Neurology), Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
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Vasudevan T, Robinson DA, Hill AA, Ouriel K, Holden A, Gagnon J, Machan L, Nammuni I, Thomas SD, Varcoe RL. Safety and feasibility report on nonimplantable endovenous valve formation for the treatment of deep vein reflux. J Vasc Surg Venous Lymphat Disord 2021; 9:1200-1208. [PMID: 33359385 DOI: 10.1016/j.jvsv.2020.12.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Definitive treatment techniques for symptomatic deep venous reflux have been relegated to complex and invasive open surgery which is rarely performed today. The BlueLeaf System provides an endovenous method for the formation of deep venous valves without an implant, avoiding the complications associated with permanent foreign materials. The system has the adaptability to form valves within the femoral and popliteal veins at multiple levels in a single procedure. The aim was to determine the midterm safety and efficacy of this novel device in an early feasibility study. METHODS Feasibility of endovenous deep venous valve formation was assessed in patients with chronic venous insufficiency (Clinical, Etiologic, Anatomic, Pathophysiologic [CEAP] 4-6). Follow-up was completed through 1 year, assessing vein patency and reflux time (RT) with duplex ultrasound examination. Venous clinical improvement was evaluated using the revised Venous Clinical Severity Scale. RESULTS Of the 14 patients, 13 (93%) had successful formation of at least one monocuspid valve, with a mean number of 1.4 valves (range, 0-3 valves) per patient. There were no device-related serious adverse events during the index procedure. There were no deep venous thromboses reported at any time point, including 10 patients through the 1-year follow-up. In patients with at least one valve formed, site reported duplex ultrasound examination measured the average RT in the popliteal vein below valve formations, was 3.0 ± 1.0 seconds at baseline, 3.9 ± 3.1 seconds at 30 days, and 3.6 ± 2.1 seconds at 360 days. The revised Venous Clinical Severity Scale improved in all 13 successfully treated patients, decreasing from 15.0 ± 6.0 at baseline to 11.6 ± 5.5 at 30 days, 10.7 ± 5.3 at 210 days, and 9.4 ± 5.0 at 360 days (P = .0002; baseline to 360 days). Among the five patients with an ulcer who reached the 360-day follow-up visit, all (100%) healed at least one ulcer. Two patients (40%) healed all ulcers and three patients (60%) had a decrease in ulcers number but remained at C6 at 360 days. The five patients with a total of nine active ulcers at baseline had four active ulcers at 360 days. CONCLUSIONS The BlueLeaf System holds promise as a minimally invasive means to safely form fully autogenous deep venous valves. Reconstructed deep veins remained patent, without deep venous thrombosis and symptomatic improvement was consistently observed; however, a decrease in the RT was not. Incremental device design improvements have been undertaken to improve valve function. The results of these iterations await further clinical evaluation.
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Affiliation(s)
- Thodur Vasudevan
- Department of Vascular Surgery, The Alfred, Melbourne, Australia
| | - David A Robinson
- Department of Vascular Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Andrew A Hill
- Department of Vascular Surgery, Auckland City Hospital, Auckland, New Zealand
| | | | - Andrew Holden
- Department of Interventional Radiology, Auckland City Hospital, Auckland, New Zealand
| | - Joel Gagnon
- Department of Vascular Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Lindsay Machan
- Department of Interventional Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Isuru Nammuni
- Department of Vascular Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Shannon D Thomas
- Department of Surgery, Prince of Wales Hospital and Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Ramon L Varcoe
- Department of Surgery, Prince of Wales Hospital and Faculty of Medicine, University of New South Wales, Sydney, Australia.
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Wada T, Jaw JE, Tsuruta M, Moritani K, Tsutsui M, Tam A, Vasilescu DM, Cheung CY, Yamasaki K, Lichtenstein S, Machan L, Gelbart D, Man SP, Sin DD. External radiofrequency as a novel extracorporeal therapy for emphysema. Eur Respir J 2020; 56:13993003.01422-2020. [PMID: 32471932 DOI: 10.1183/13993003.01422-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 05/13/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Takeyuki Wada
- Centre for Heart Lung Innovation, St Paul's Hospital, and Division of Respiratory Medicine, University of British Columbia, Vancouver, BC, Canada.,Both authors contributed equally to this work
| | - Jen-Erh Jaw
- Centre for Heart Lung Innovation, St Paul's Hospital, and Division of Respiratory Medicine, University of British Columbia, Vancouver, BC, Canada.,Both authors contributed equally to this work
| | - Masashi Tsuruta
- Centre for Heart Lung Innovation, St Paul's Hospital, and Division of Respiratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Konosuke Moritani
- Centre for Heart Lung Innovation, St Paul's Hospital, and Division of Respiratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Mai Tsutsui
- Centre for Heart Lung Innovation, St Paul's Hospital, and Division of Respiratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Anthony Tam
- Centre for Heart Lung Innovation, St Paul's Hospital, and Division of Respiratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Dragoş M Vasilescu
- Centre for Heart Lung Innovation, St Paul's Hospital, and Division of Respiratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Chung Yan Cheung
- Centre for Heart Lung Innovation, St Paul's Hospital, and Division of Respiratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kei Yamasaki
- Centre for Heart Lung Innovation, St Paul's Hospital, and Division of Respiratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Samuel Lichtenstein
- Ikomed Technologies Inc., Vancouver, BC, Canada.,Division of Cardiac Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Lindsay Machan
- Ikomed Technologies Inc., Vancouver, BC, Canada.,Dept of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Dan Gelbart
- Ikomed Technologies Inc., Vancouver, BC, Canada
| | - S Paul Man
- Centre for Heart Lung Innovation, St Paul's Hospital, and Division of Respiratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Don D Sin
- Centre for Heart Lung Innovation, St Paul's Hospital, and Division of Respiratory Medicine, University of British Columbia, Vancouver, BC, Canada
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12
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Yang GK, Chen J, Machan L, Gagnon J. Endovenous Deep Vein Valve Creation for the Treatment of Chronic Venous Insufficiency. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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13
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Traboulsee A, Machan L. Author response: Safety and efficacy of venoplasty in MS: A randomized, double-blind, sham-controlled phase II trial. Neurology 2019; 93:320. [DOI: 10.1212/wnl.0000000000007955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Khilnani NM, Meissner MH, Learman LA, Gibson KD, Daniels JP, Winokur RS, Marvel RP, Machan L, Venbrux AC, Tu FF, Pabon-Ramos WM, Nedza SM, White SB, Rosenblatt M. Research Priorities in Pelvic Venous Disorders in Women: Recommendations from a Multidisciplinary Research Consensus Panel. J Vasc Interv Radiol 2019; 30:781-789. [PMID: 30857986 DOI: 10.1016/j.jvir.2018.10.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/08/2018] [Accepted: 10/11/2018] [Indexed: 12/17/2022] Open
Abstract
Pelvic venous disorders (PeVDs) in women can present with chronic pelvic pain, lower-extremity and vulvar varicosities, lower-extremity swelling and pain, and left-flank pain and hematuria. Multiple evidence gaps exist related to PeVDs with the consequence that nonvascular specialists rarely consider the diagnosis. Recognizing this, the Society of Interventional Radiology Foundation funded a Research Consensus Panel to prioritize a research agenda to address these gaps. This paper presents the proceedings and recommendations from that Panel.
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Affiliation(s)
- Neil M Khilnani
- Division of Interventional Radiology, New York Presbyterian Hospital, Weill Cornell Medical College, 2315 Broadway, Fourth Floor, New York, New York 10128.
| | - Mark H Meissner
- Division of Vascular Surgery, University of Washington Medical Center, Seattle, Washington
| | - Lee A Learman
- Department of Obstetrics and Gynecology, Charles A. Schmidt School of Medicine, Florida Atlantic University, Boca Raton, Florida
| | | | - Jane P Daniels
- Clinical Trials Unit, University of Nottingham, Nottingham, United Kingdom
| | - Ronald S Winokur
- Division of Interventional Radiology, New York Presbyterian Hospital, Weill Cornell Medical College, 2315 Broadway, Fourth Floor, New York, New York 10128
| | | | - Lindsay Machan
- Departments of Radiology and Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anthony C Venbrux
- Division of Interventional Radiology, George Washington University School of Medicine, Washington, DC
| | - Frank F Tu
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois; Department of Obstetrics and Gynecology, North Shore University Medical Group, Skokie, Illinois
| | - Waly M Pabon-Ramos
- Division of Interventional Radiology, Duke University School of Medicine, Durham, North Carolina
| | - Susan M Nedza
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Sarah B White
- Division of Interventional Radiology, Froedtert Hopsital, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mel Rosenblatt
- Connecticut Image-Guided Surgery, Fairfield, Connecticut
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Lee E, Machan L, Ho S, Chung J, Klass D, Liu D, Thakur Y. 04:03 PM Abstract No. 60 Measurement of scatter radiation dose to the eye of interventional radiologists performing fluoroscopically guided procedures: are you sure you are protected? J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Machan L, Klass D, Siskin G, Hardy B, Traboulsee A. 03:09 PM Abstract No. 94 A multicenter prospective randomized blinded sham controlled cross-over trial of jugular venoplasty in multiple sclerosis: final results. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Klass D, De Korompay N, Jalal S, Chung J, Liu D, Ho S, Legiehn G, Machan L. 03:27 PM Abstract No. 66 Radial vs femoral: incidence of access site complications. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Hernández‐Torres E, Wiggermann V, Machan L, Sadovnick AD, Li DK, Traboulsee A, Hametner S, Rauscher A. Increased mean R2* in the deep gray matter of multiple sclerosis patients: Have we been measuring atrophy? J Magn Reson Imaging 2018; 50:201-208. [DOI: 10.1002/jmri.26561] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/13/2018] [Accepted: 10/16/2018] [Indexed: 11/09/2022] Open
Affiliation(s)
- Enedino Hernández‐Torres
- UBC MRI Research CentreUniversity of British Columbia Vancouver Canada
- Department of PediatricsUniversity of British Columbia Vancouver Canada
| | - Vanessa Wiggermann
- UBC MRI Research CentreUniversity of British Columbia Vancouver Canada
- Department of PediatricsUniversity of British Columbia Vancouver Canada
- Department of Physics and AstronomyUniversity of British Columbia Vancouver Canada
| | - Lindsay Machan
- Department of RadiologyUniversity of British Columbia Vancouver Canada
| | - A. Dessa Sadovnick
- Department of Medicine (Neurology)University of British Columbia Vancouver Canada
- Centre for Brain HealthUniversity of British Columbia Vancouver Canada
- Department of Medical GeneticsUniversity of British Columbia Vancouver Canada
| | - David K.B. Li
- UBC MRI Research CentreUniversity of British Columbia Vancouver Canada
- Department of RadiologyUniversity of British Columbia Vancouver Canada
- Department of Medicine (Neurology)University of British Columbia Vancouver Canada
| | - Anthony Traboulsee
- Department of Medicine (Neurology)University of British Columbia Vancouver Canada
- Centre for Brain HealthUniversity of British Columbia Vancouver Canada
| | - Simon Hametner
- Department of Neuroimmunology, Center for Brain ResearchMedical University of Vienna Vienna Austria
- Institute of NeuropathologyUniversity Medical Center Göttingen Germany
| | - Alexander Rauscher
- UBC MRI Research CentreUniversity of British Columbia Vancouver Canada
- Department of PediatricsUniversity of British Columbia Vancouver Canada
- Department of Physics and AstronomyUniversity of British Columbia Vancouver Canada
- Department of RadiologyUniversity of British Columbia Vancouver Canada
- BC Children's Hospital Research InstituteUniversity of British Columbia Vancouver Canada
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Mortensen C, Chung J, Liu D, Ho S, Legiehn G, Machan L, Klass D. Prospective Study on Total Fluoroscopic Time in Patients Undergoing Uterine Artery Embolization: Comparing Transradial and Transfemoral Approaches. Cardiovasc Intervent Radiol 2018; 42:441-447. [DOI: 10.1007/s00270-018-2100-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 10/17/2018] [Indexed: 10/28/2022]
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Traboulsee AL, Machan L, Girard JM, Raymond J, Vosoughi R, Hardy BW, Emond F, Gariepy JL, Bone JN, Siskin G, Klass D, Isserow S, Illes J, Sadovnick AD, Li DK. Safety and efficacy of venoplasty in MS: A randomized, double-blind, sham-controlled phase II trial. Neurology 2018; 91:e1660-e1668. [PMID: 30266886 PMCID: PMC6207414 DOI: 10.1212/wnl.0000000000006423] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 07/19/2018] [Indexed: 01/09/2023] Open
Abstract
Objective To determine the safety and efficacy of balloon vs sham venoplasty of narrowing of the extracranial jugular and azygos veins in multiple sclerosis (MS). Methods Patients with relapsing or progressive MS were screened using clinical and ultrasound criteria. After confirmation of >50% narrowing by venography, participants were randomized 1:1 to receive balloon or sham venoplasty of all stenoses and were followed for 48 weeks. Participants and research staff were blinded to intervention allocation. The primary safety outcome was the number of adverse events (AEs) during 48 weeks. The primary efficacy outcome was the change from baseline to week 48 in the patient-reported outcome MS Quality of Life–54 (MSQOL-54) questionnaire. Standardized clinical and MRI outcomes were also evaluated. Results One hundred four participants were randomized (55 sham; 49 venoplasty) and 103 completed 48 weeks of follow-up. Twenty-three sham and 21 venoplasty participants reported at least 1 AE; one sham (2%) and 5 (10%) venoplasty participants had a serious AE. The mean improvement in MSQOL-54 physical score was +1.3 (sham) and +1.4 (venoplasty) (p = 0.95); MSQOL-54 mental score was +1.2 (sham) and −0.8 (venoplasty) (p = 0.55). Conclusions Our data do not support the continued use of venoplasty of extracranial jugular and/or azygous venous narrowing to improve patient-reported outcomes, chronic MS symptoms, or the disease course of MS. ClinicalTrials.gov identifier NCT01864941. Classification of evidence This study provides Class I evidence that for patients with MS, balloon venoplasty of extracranial jugular and azygous veins is not beneficial in improving patient-reported, standardized clinical, or MRI outcomes.
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Affiliation(s)
- Anthony L Traboulsee
- From the University of British Columbia, Departments of Medicine (Neurology) (A.L.T., S.I., J.I., A.D.S.), Radiology (L.M., D.K., D.K.L.), Medical Genetics (A.D.S.), and Statistics (J.N.B.), Vancouver; Centre Hospitalier de l'Université de Montréal (J.M.G., J.R.), Hôpital Notre-Dame, Montreal; Health Sciences Centre (R.V., B.W.H.), Winnipeg; Centre Hospitalier Universitaire de Québec-Université Laval (F.E., J.-L.G.), Hôpital Enfant-Jésus, Quebec, Canada; and Albany Medical Center (G.S.), NY.
| | - Lindsay Machan
- From the University of British Columbia, Departments of Medicine (Neurology) (A.L.T., S.I., J.I., A.D.S.), Radiology (L.M., D.K., D.K.L.), Medical Genetics (A.D.S.), and Statistics (J.N.B.), Vancouver; Centre Hospitalier de l'Université de Montréal (J.M.G., J.R.), Hôpital Notre-Dame, Montreal; Health Sciences Centre (R.V., B.W.H.), Winnipeg; Centre Hospitalier Universitaire de Québec-Université Laval (F.E., J.-L.G.), Hôpital Enfant-Jésus, Quebec, Canada; and Albany Medical Center (G.S.), NY
| | - J Marc Girard
- From the University of British Columbia, Departments of Medicine (Neurology) (A.L.T., S.I., J.I., A.D.S.), Radiology (L.M., D.K., D.K.L.), Medical Genetics (A.D.S.), and Statistics (J.N.B.), Vancouver; Centre Hospitalier de l'Université de Montréal (J.M.G., J.R.), Hôpital Notre-Dame, Montreal; Health Sciences Centre (R.V., B.W.H.), Winnipeg; Centre Hospitalier Universitaire de Québec-Université Laval (F.E., J.-L.G.), Hôpital Enfant-Jésus, Quebec, Canada; and Albany Medical Center (G.S.), NY
| | - Jean Raymond
- From the University of British Columbia, Departments of Medicine (Neurology) (A.L.T., S.I., J.I., A.D.S.), Radiology (L.M., D.K., D.K.L.), Medical Genetics (A.D.S.), and Statistics (J.N.B.), Vancouver; Centre Hospitalier de l'Université de Montréal (J.M.G., J.R.), Hôpital Notre-Dame, Montreal; Health Sciences Centre (R.V., B.W.H.), Winnipeg; Centre Hospitalier Universitaire de Québec-Université Laval (F.E., J.-L.G.), Hôpital Enfant-Jésus, Quebec, Canada; and Albany Medical Center (G.S.), NY
| | - Reza Vosoughi
- From the University of British Columbia, Departments of Medicine (Neurology) (A.L.T., S.I., J.I., A.D.S.), Radiology (L.M., D.K., D.K.L.), Medical Genetics (A.D.S.), and Statistics (J.N.B.), Vancouver; Centre Hospitalier de l'Université de Montréal (J.M.G., J.R.), Hôpital Notre-Dame, Montreal; Health Sciences Centre (R.V., B.W.H.), Winnipeg; Centre Hospitalier Universitaire de Québec-Université Laval (F.E., J.-L.G.), Hôpital Enfant-Jésus, Quebec, Canada; and Albany Medical Center (G.S.), NY
| | - Brian W Hardy
- From the University of British Columbia, Departments of Medicine (Neurology) (A.L.T., S.I., J.I., A.D.S.), Radiology (L.M., D.K., D.K.L.), Medical Genetics (A.D.S.), and Statistics (J.N.B.), Vancouver; Centre Hospitalier de l'Université de Montréal (J.M.G., J.R.), Hôpital Notre-Dame, Montreal; Health Sciences Centre (R.V., B.W.H.), Winnipeg; Centre Hospitalier Universitaire de Québec-Université Laval (F.E., J.-L.G.), Hôpital Enfant-Jésus, Quebec, Canada; and Albany Medical Center (G.S.), NY
| | - Francois Emond
- From the University of British Columbia, Departments of Medicine (Neurology) (A.L.T., S.I., J.I., A.D.S.), Radiology (L.M., D.K., D.K.L.), Medical Genetics (A.D.S.), and Statistics (J.N.B.), Vancouver; Centre Hospitalier de l'Université de Montréal (J.M.G., J.R.), Hôpital Notre-Dame, Montreal; Health Sciences Centre (R.V., B.W.H.), Winnipeg; Centre Hospitalier Universitaire de Québec-Université Laval (F.E., J.-L.G.), Hôpital Enfant-Jésus, Quebec, Canada; and Albany Medical Center (G.S.), NY
| | - Jean-Luc Gariepy
- From the University of British Columbia, Departments of Medicine (Neurology) (A.L.T., S.I., J.I., A.D.S.), Radiology (L.M., D.K., D.K.L.), Medical Genetics (A.D.S.), and Statistics (J.N.B.), Vancouver; Centre Hospitalier de l'Université de Montréal (J.M.G., J.R.), Hôpital Notre-Dame, Montreal; Health Sciences Centre (R.V., B.W.H.), Winnipeg; Centre Hospitalier Universitaire de Québec-Université Laval (F.E., J.-L.G.), Hôpital Enfant-Jésus, Quebec, Canada; and Albany Medical Center (G.S.), NY
| | - Jeffrey N Bone
- From the University of British Columbia, Departments of Medicine (Neurology) (A.L.T., S.I., J.I., A.D.S.), Radiology (L.M., D.K., D.K.L.), Medical Genetics (A.D.S.), and Statistics (J.N.B.), Vancouver; Centre Hospitalier de l'Université de Montréal (J.M.G., J.R.), Hôpital Notre-Dame, Montreal; Health Sciences Centre (R.V., B.W.H.), Winnipeg; Centre Hospitalier Universitaire de Québec-Université Laval (F.E., J.-L.G.), Hôpital Enfant-Jésus, Quebec, Canada; and Albany Medical Center (G.S.), NY
| | - Gary Siskin
- From the University of British Columbia, Departments of Medicine (Neurology) (A.L.T., S.I., J.I., A.D.S.), Radiology (L.M., D.K., D.K.L.), Medical Genetics (A.D.S.), and Statistics (J.N.B.), Vancouver; Centre Hospitalier de l'Université de Montréal (J.M.G., J.R.), Hôpital Notre-Dame, Montreal; Health Sciences Centre (R.V., B.W.H.), Winnipeg; Centre Hospitalier Universitaire de Québec-Université Laval (F.E., J.-L.G.), Hôpital Enfant-Jésus, Quebec, Canada; and Albany Medical Center (G.S.), NY
| | - Darren Klass
- From the University of British Columbia, Departments of Medicine (Neurology) (A.L.T., S.I., J.I., A.D.S.), Radiology (L.M., D.K., D.K.L.), Medical Genetics (A.D.S.), and Statistics (J.N.B.), Vancouver; Centre Hospitalier de l'Université de Montréal (J.M.G., J.R.), Hôpital Notre-Dame, Montreal; Health Sciences Centre (R.V., B.W.H.), Winnipeg; Centre Hospitalier Universitaire de Québec-Université Laval (F.E., J.-L.G.), Hôpital Enfant-Jésus, Quebec, Canada; and Albany Medical Center (G.S.), NY
| | - Saul Isserow
- From the University of British Columbia, Departments of Medicine (Neurology) (A.L.T., S.I., J.I., A.D.S.), Radiology (L.M., D.K., D.K.L.), Medical Genetics (A.D.S.), and Statistics (J.N.B.), Vancouver; Centre Hospitalier de l'Université de Montréal (J.M.G., J.R.), Hôpital Notre-Dame, Montreal; Health Sciences Centre (R.V., B.W.H.), Winnipeg; Centre Hospitalier Universitaire de Québec-Université Laval (F.E., J.-L.G.), Hôpital Enfant-Jésus, Quebec, Canada; and Albany Medical Center (G.S.), NY
| | - Judy Illes
- From the University of British Columbia, Departments of Medicine (Neurology) (A.L.T., S.I., J.I., A.D.S.), Radiology (L.M., D.K., D.K.L.), Medical Genetics (A.D.S.), and Statistics (J.N.B.), Vancouver; Centre Hospitalier de l'Université de Montréal (J.M.G., J.R.), Hôpital Notre-Dame, Montreal; Health Sciences Centre (R.V., B.W.H.), Winnipeg; Centre Hospitalier Universitaire de Québec-Université Laval (F.E., J.-L.G.), Hôpital Enfant-Jésus, Quebec, Canada; and Albany Medical Center (G.S.), NY
| | - A Dessa Sadovnick
- From the University of British Columbia, Departments of Medicine (Neurology) (A.L.T., S.I., J.I., A.D.S.), Radiology (L.M., D.K., D.K.L.), Medical Genetics (A.D.S.), and Statistics (J.N.B.), Vancouver; Centre Hospitalier de l'Université de Montréal (J.M.G., J.R.), Hôpital Notre-Dame, Montreal; Health Sciences Centre (R.V., B.W.H.), Winnipeg; Centre Hospitalier Universitaire de Québec-Université Laval (F.E., J.-L.G.), Hôpital Enfant-Jésus, Quebec, Canada; and Albany Medical Center (G.S.), NY
| | - David K Li
- From the University of British Columbia, Departments of Medicine (Neurology) (A.L.T., S.I., J.I., A.D.S.), Radiology (L.M., D.K., D.K.L.), Medical Genetics (A.D.S.), and Statistics (J.N.B.), Vancouver; Centre Hospitalier de l'Université de Montréal (J.M.G., J.R.), Hôpital Notre-Dame, Montreal; Health Sciences Centre (R.V., B.W.H.), Winnipeg; Centre Hospitalier Universitaire de Québec-Université Laval (F.E., J.-L.G.), Hôpital Enfant-Jésus, Quebec, Canada; and Albany Medical Center (G.S.), NY
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Shan A, Conway ME, Machan L, Cormack L, Branco N, Todd N. Management and Outcomes of Interstitial Ectopic Pregnancies at a Tertiary Care Centre: a Retrospective Case Series. Journal of Obstetrics and Gynaecology Canada 2018. [DOI: 10.1016/j.jogc.2018.03.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Ghavimi S, Abdi H, Waterhouse J, Savdie R, Chang S, Harris A, Machan L, Gleave M, So AI, Goldenberg L, Black PC. Natural history of prostatic lesions on serial multiparametric magnetic resonance imaging. Can Urol Assoc J 2018; 12:270-275. [PMID: 30139428 DOI: 10.4859/cuaj.4859] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The natural history of prostatic lesions identified on multiparametric magnetic resonance imaging (mpMRI) is largely unknown. We aimed to describe changes observed over time on serial MRI. METHODS All patients with ≥2 MRI studies between 2008 and 2015 at our institution were identified. MRI progression was defined as an increase in Prostate Imaging Reporting and Data System (PI-RADS; version 2) or size of existing lesions, or the appearance of a new lesion PIRADS ≥4. Patients on active surveillance (AS) were analyzed for correlation of MRI progression to biopsy reclassification. RESULTS A total of 83 patients (54 on AS and 29 for diagnostic purposes) underwent serial MRI, with a mean interval of 1.9 years between scans. At baseline, 115 lesions (66 index, 49 non-index) were identified. Index lesions were more likely than non-index lesions to increase in size ≥2 mm (36.2 vs. 7.3 %; p=0.002). Overall progression was more likely to be seen among the index cohort (34.8 vs. 7.6%; p<0.001). New lesions with PI-RADS ≥4 were seen on second imaging in 13 (16.5%) men, and became the index lesion in 29 cases (34.9%). Eighteen men on AS showed evidence of MRI progression (five with new lesions, 13 with progression of a previous lesion). Biopsy reclassification was present in three men (16.7%) with and seven men without MRI progression (19.4%). CONCLUSIONS Overall changes in size and PI-RADS scores of index lesions on MRI were small. New lesions were common, but usually did not alter management.
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Affiliation(s)
- Samrad Ghavimi
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Hamidreza Abdi
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer Waterhouse
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Richard Savdie
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Silvia Chang
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Alison Harris
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Lindsay Machan
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Martin Gleave
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Alan I So
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Larry Goldenberg
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
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Ghavimi S, Abdi H, Waterhouse J, Savdie R, Chang S, Harris A, Machan L, Gleave M, So A, Goldenberg L, Black PC. Natural history of prostatic lesions on serial multiparametric magnetic resonance imaging. Can Urol Assoc J 2018; 12:cuaj.4859. [PMID: 29629864 DOI: 10.5489/cuaj.4859] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
INTRODUCTION The natural history of prostatic lesions identified on multiparametric magnetic resonance imaging (mpMRI) is largely unknown. We aimed to describe changes observed over time on serial MRI. METHODS All patients with ≥2 MRI studies between 2008 and 2015 at our institution were identified. MRI progression was defined as an increase in Prostate Imaging Reporting and Data System (PI-RADS; version 2) or size of existing lesions, or the appearance of a new lesion PIRADS ≥4. Patients on active surveillance (AS) were analyzed for correlation of MRI progression to biopsy reclassification. RESULTS A total of 83 patients (54 on AS and 29 for diagnostic purposes) underwent serial MRI, with a mean interval of 1.9 years between scans. At baseline, 115 lesions (66 index, 49 non-index) were identified. Index lesions were more likely than non-index lesions to increase in size ≥2 mm (36.2 vs. 7.3 %; p=0.002). Overall progression was more likely to be seen among the index cohort (34.8 vs. 7.6%; p<0.001). New lesions with PIRADS ≥4 were seen on second imaging in 13 (16.5%) men, and became the index lesion in 29 cases (34.9%). Eighteen men on AS showed evidence of MRI progression (five with new lesions, 13 with progression of a previous lesion). Biopsy reclassification was present in three men (16.7%) with and seven men without MRI progression (19.4%). CONCLUSIONS Overall changes in size and PIRADS scores of index lesions on MRI were small. New lesions were common, but usually did not alter management.
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Affiliation(s)
| | | | - Jennifer Waterhouse
- Department of Radiology; University of British Columbia, Vancouver, BC, Canada
| | | | - Silvia Chang
- Department of Radiology; University of British Columbia, Vancouver, BC, Canada
| | - Alison Harris
- Department of Radiology; University of British Columbia, Vancouver, BC, Canada
| | - Lindsay Machan
- Department of Radiology; University of British Columbia, Vancouver, BC, Canada
| | | | - Alan So
- Department of Urologic Sciences
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Abstract
The ocular lens is one of the most susceptible structures in the body to radiation damage. Unfortunately, much of the traditional academic and regulatory thinking on thresholds to develop radiation-induced opacities or cataracts has proven to be false. Individual vulnerability to the effects of radiation is extremely variable, largely because each individual is variably genetically equipped to repair the damage caused by radiation. Therefore many people, including some unsuspecting interventional radiologists may have no, or almost no, threshold at all for cataract development after radiation injury. For most others, if there is a threshold it is a fraction of what was previously thought. These new data have become apparent during the same time period when unprecedented numbers of physicians and medical staff have been exposed to unprecedented doses of scatter radiation as the number and complexity of fluoroscopic guided procedures has exploded. Increased rates of radiation lens damage have already been documented in physicians and support staff working in interventional medicine. As there is a latency period of years to decades for lens injury to fully evolve it is quite possible the true incidence will not be known for some time. Strategies to minimize the potential risks encountered in interventional medicine include radiation safety best practices, passive and personal barrier protection, and philosophical approach to interventional radiology practice. Ignore this article at your peril.
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Affiliation(s)
- Lindsay Machan
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
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Traboulsee A, Machan L, Girard M, Raymond J, Vosoughi R, Hardy B, Edmond F, Bone J, Gariepy J, Tam R, Klass D, Isserow S, Rauscher A, Sadovnick A, Li D, Illes J, Siskin G. Venoplasty of chronic cerebral spinal venous insufficiency to improve MS patient reported outcomes is not superior to sham treatment at week 2 or week 12. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.3012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Thakor AS, Alshammari MT, Liu DM, Chung J, Ho SGF, Legiehn GM, Machan L, Fischman AM, Patel RS, Klass D. Transradial Access for Interventional Radiology: Single-Centre Procedural and Clinical Outcome Analysis. Can Assoc Radiol J 2017; 68:318-327. [PMID: 28396005 DOI: 10.1016/j.carj.2016.09.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 08/16/2016] [Accepted: 09/11/2016] [Indexed: 01/23/2023] Open
Abstract
PURPOSE The study sought to describe a single centre's technical approach to transradial intervention and report on clinical outcomes and safety. METHODS A total of 749 transradial access (TRA) procedures were performed at a single hospital in 562 patients (174 women and 388 men). Procedures included 445 bland embolizations or chemoembolizations of the liver, 88 uterine artery embolizations, and 148 procedures for Selective Internal Radiation Therapy (Y90), which included mapping and administration. The mean age of the patients was 62 years (range 27-96 years). RESULTS Four cases (0.5%) required crossover to transfemoral (tortuous anatomy, inability to secure a stable position for embolization, vessel spasm and base catheter not being of a sufficient length). A single asymptomatic, short-segment radial artery occlusion occurred (0.3%), 3 patients (0.4%) developed small hematomas postprocedurally, and 2 patients (0.7%) had transient neurological pain, which was resolved within a week without treatment. It was found that 98% of patients who had a previous femoral access procedure would choose radial access for subsequent procedures. CONCLUSIONS Transradial access is a safe, effective technique, with a learning curve; however, this procedure has the potential to significantly improve departmental workflow and cost savings for the department and patient experience.
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Affiliation(s)
- Avnesh S Thakor
- Department of Interventional Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada; Department of Radiology, Stanford University Medical Center, Palo Alto, California, USA
| | - Mohammed T Alshammari
- Department of Interventional Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada; Department of Interventional Radiology, Security Forces Hospital, Riyadh, Saudi Arabia
| | - David M Liu
- Department of Interventional Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - John Chung
- Department of Interventional Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephen G F Ho
- Department of Interventional Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gerald M Legiehn
- Department of Interventional Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lindsay Machan
- Department of Interventional Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Aaron M Fischman
- Department of Interventional Radiology, The Mount Sinai Health System, New York, New York, USA
| | - Rahul S Patel
- Department of Interventional Radiology, The Mount Sinai Health System, New York, New York, USA
| | - Darren Klass
- Department of Interventional Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
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Lian K, Lee L, Machan L. Syphilitic Aortitis with Coronary Ostial Involvement: AIRP Best Cases in Radiologic-Pathologic Correlation. Radiographics 2017; 37:407-412. [PMID: 28287939 DOI: 10.1148/rg.2017160168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kevin Lian
- From the Department of Radiology (K.L., L.M.) and Department of Pathology and Laboratory Medicine (L.L.), University of British Columbia, 3350-950 W 10th Ave, Vancouver, BC, Canada V5Z 1M9
| | - Lawrence Lee
- From the Department of Radiology (K.L., L.M.) and Department of Pathology and Laboratory Medicine (L.L.), University of British Columbia, 3350-950 W 10th Ave, Vancouver, BC, Canada V5Z 1M9
| | - Lindsay Machan
- From the Department of Radiology (K.L., L.M.) and Department of Pathology and Laboratory Medicine (L.L.), University of British Columbia, 3350-950 W 10th Ave, Vancouver, BC, Canada V5Z 1M9
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Hernández-Torres E, Kassner N, Forkert ND, Wei L, Wiggermann V, Daemen M, Machan L, Traboulsee A, Li D, Rauscher A. Anisotropic cerebral vascular architecture causes orientation dependency in cerebral blood flow and volume measured with dynamic susceptibility contrast magnetic resonance imaging. J Cereb Blood Flow Metab 2017; 37:1108-1119. [PMID: 27259344 PMCID: PMC5363485 DOI: 10.1177/0271678x16653134] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Measurements of cerebral perfusion using dynamic susceptibility contrast magnetic resonance imaging rely on the assumption of isotropic vascular architecture. However, a considerable fraction of vessels runs in parallel with white matter tracts. Here, we investigate the effects of tissue orientation on dynamic susceptibility contrast magnetic resonance imaging. Tissue orientation was measured using diffusion tensor imaging and dynamic susceptibility contrast was performed with gradient echo planar imaging. Perfusion parameters and the raw dynamic susceptibility contrast signals were correlated with tissue orientation. Additionally, numerical simulations were performed for a range of vascular volumes of both the isotropic vascular bed and anisotropic vessel components, as well as for a range of contrast agent concentrations. The effect of the contrast agent was much larger in white matter tissue perpendicular to the main magnetic field compared to white matter parallel to the main magnetic field. In addition, cerebral blood flow and cerebral blood volume were affected in the same way with angle-dependent variations of up to 130%. Mean transit time and time to maximum of the residual curve exhibited weak orientation dependency of 10%. Numerical simulations agreed with the measured data, showing that one-third of the white matter vascular volume is comprised of vessels running in parallel with the fibre tracts.
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Affiliation(s)
- Enedino Hernández-Torres
- 1 Department of Pediatrics, Division of Neurology, University of British Columbia, Vancouver, Canada.,2 UBC MRI Research Centre, University of British Columbia, Vancouver, Canada
| | - Nora Kassner
- 3 Department of Physics, University of Heidelberg, Heidelberg, Germany
| | - Nils Daniel Forkert
- 4 Department of Radiology and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Luxi Wei
- 2 UBC MRI Research Centre, University of British Columbia, Vancouver, Canada.,5 Department of Physics and Astronomy, University of British Columbia, Vancouver, Canada
| | - Vanessa Wiggermann
- 1 Department of Pediatrics, Division of Neurology, University of British Columbia, Vancouver, Canada.,2 UBC MRI Research Centre, University of British Columbia, Vancouver, Canada.,5 Department of Physics and Astronomy, University of British Columbia, Vancouver, Canada
| | - Madeleine Daemen
- 6 Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Lindsay Machan
- 7 Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Anthony Traboulsee
- 8 Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - David Li
- 2 UBC MRI Research Centre, University of British Columbia, Vancouver, Canada.,7 Department of Radiology, University of British Columbia, Vancouver, Canada.,8 Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Alexander Rauscher
- 1 Department of Pediatrics, Division of Neurology, University of British Columbia, Vancouver, Canada.,2 UBC MRI Research Centre, University of British Columbia, Vancouver, Canada
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29
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De Korompay N, Chung J, Liu D, Ho S, Legiehn G, Machan L, Klass D. Safety and efficacy of a rapid deflation algorithm for patent hemostasis following radial intervention (PROTEA). J Vasc Interv Radiol 2017. [DOI: 10.1016/j.jvir.2016.12.915] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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30
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Martin N, Traboulsee AL, Machan L, Klass D, Ellchuk T, Zhao Y, Knox KB, Kopriva D, Lala S, Nickel D, Otani R, Perera WR, Rauscher A, Sadovnick AD, Szkup P, Li DK. Prevalence of Extracranial Venous Narrowing on Magnetic Resonance Venography Is Similar in People With Multiple Sclerosis, Their Siblings, and Unrelated Healthy Controls: A Blinded, Case-Control Study. Can Assoc Radiol J 2016; 68:202-209. [PMID: 27887935 DOI: 10.1016/j.carj.2016.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 01/09/2016] [Accepted: 07/06/2016] [Indexed: 10/20/2022] Open
Abstract
PURPOSE The study sought to assess and compare the prevalence of narrowing of the major extracranial veins in subjects with multiple sclerosis and controls, and to assess the sensitivity and specificity of magnetic resonance venography (MRV) for describing extracranial venous narrowing as it applies to the chronic cerebrospinal venous insufficiency theory, using catheter venography (CV) as the gold standard. METHODS The jugular and azygos veins were assessed with time-of-flight MRV in this assessor-blinded, case-control study of subjects with multiple sclerosis, their unaffected siblings, and unrelated controls. The veins were evaluated by diameter and area, and compared with CV. Collateral vessels were also analyzed for maximal diameter, as a potential indicator of compensatory flow. RESULTS A high prevalence of extracranial venous narrowing was demonstrated in all study groups, collectively up to 84% by diameter criteria and 90% by area, with no significant difference between the groups when assessed independently (P = .34 and .63, respectively). There was high interobserver variability in the reporting of vessel narrowing (kappa = 0.32), and poor vessel per vessel correlation between narrowing on MRV and CV (kappa = 0.064). Collateral neck veins demonstrated no convincing difference in maximum size or correlation with jugular narrowing. CONCLUSION There is a high prevalence of narrowing of the major extracranial veins on MRV in all 3 study groups, with no significant difference between them. These findings do not support the chronic cerebrospinal venous insufficiency theory. Although MRV has shown a high sensitivity for identifying venous narrowing, time-of-flight imaging demonstrates poor interobserver agreement and poor specificity when compared with the gold standard CV.
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Affiliation(s)
- Nancy Martin
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Anthony L Traboulsee
- Department of Medicine (Neurology), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lindsay Machan
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Darren Klass
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tasha Ellchuk
- Department of Medical Imaging, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Yinshan Zhao
- Department of Medicine (Neurology), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Katherine B Knox
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - David Kopriva
- Department of Surgery, College of Medicine, University of Saskatchewan and Regina Qu'Appelle Health Region (Section of Vascular Surgery), Regina, Saskatchewan, Canada
| | - Shantilal Lala
- Department of Medical Imaging, College of Medicine, University of Saskatchewan and Regina Qu-Appelle Health Region, Regina, Saskatchewan, Canada
| | - Darren Nickel
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Robert Otani
- Department of Medical Imaging, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Warren R Perera
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexander Rauscher
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - A Dessa Sadovnick
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter Szkup
- Department of Medical Imaging, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - David K Li
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Saw J, Bezerra H, Gornik HL, Machan L, Mancini GBJ. Angiographic and Intracoronary Manifestations of Coronary Fibromuscular Dysplasia. Circulation 2016; 133:1548-59. [PMID: 26957531 DOI: 10.1161/circulationaha.115.020282] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 03/03/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND We previously described a strong association between fibromuscular dysplasia (FMD) and spontaneous coronary artery dissection. Angiographic manifestations of coronary FMD aside from dissection were considered rare. However, we observed several coronary FMD angiographic abnormalities with corresponding optical coherence tomography abnormalities. METHODS AND RESULTS Baseline demographics and imaging of patients with suspected coronary FMD at Vancouver General Hospital were reviewed. Presence of multifocal (string-of-beads) extracoronary FMD was confirmed by 2 specialists. In these patients, coronary angiographic findings (excluding dissected segments) were reviewed and classified by 2 experienced angiographers for irregular stenosis, that is, stenosis with irregular borders in a focal or diffuse pattern with/without systolic accentuation; smooth stenosis, diffuse or focal; segmental dilatation/ectasia; and tortuosity. Optical coherence tomography was performed in a subset of patients. Of 32 patients with extracoronary FMD and suspected coronary involvement, 28 were women (88%), and their mean age was 59.4±9.9 years. Nineteen presented with myocardial infarction (13 caused by spontaneous coronary artery dissection), and 13 had stable symptoms. The observed coronary angiographic abnormalities included tortuosity in all cases (91% were moderate to severe), irregular stenosis in 59%, smooth stenosis in 19%, and segmental dilatation/ectasia in 56%. Fifteen patients had optical coherence tomography of the abnormal segments showing abnormalities, including multiple areas of patchy or diffuse intimal, medial or adventitial abnormalities with thickening/accumulation of varied reflectivities, macrophage infiltration, loss/duplication of elastic membranes, and cavitation. CONCLUSIONS This is the first case series describing findings suggestive of angiographic and intracoronary manifestations of coronary FMD. Future studies should prospectively review these features in patients with extracoronary FMD.
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Affiliation(s)
- Jacqueline Saw
- From Divisions of Cardiology (J.S., J.M.) and Radiology (L.M.), Vancouver General Hospital, BC, Canada; Division of Cardiology, Harrington Heart and Vascular Institute, University Hospital Case Medical Center, Cleveland, OH (H.B.); and Heart and Vascular Institute, Cleveland Clinic Foundation, OH (H.L.G.).
| | - Hiram Bezerra
- From Divisions of Cardiology (J.S., J.M.) and Radiology (L.M.), Vancouver General Hospital, BC, Canada; Division of Cardiology, Harrington Heart and Vascular Institute, University Hospital Case Medical Center, Cleveland, OH (H.B.); and Heart and Vascular Institute, Cleveland Clinic Foundation, OH (H.L.G.)
| | - Heather L Gornik
- From Divisions of Cardiology (J.S., J.M.) and Radiology (L.M.), Vancouver General Hospital, BC, Canada; Division of Cardiology, Harrington Heart and Vascular Institute, University Hospital Case Medical Center, Cleveland, OH (H.B.); and Heart and Vascular Institute, Cleveland Clinic Foundation, OH (H.L.G.)
| | - Lindsay Machan
- From Divisions of Cardiology (J.S., J.M.) and Radiology (L.M.), Vancouver General Hospital, BC, Canada; Division of Cardiology, Harrington Heart and Vascular Institute, University Hospital Case Medical Center, Cleveland, OH (H.B.); and Heart and Vascular Institute, Cleveland Clinic Foundation, OH (H.L.G.)
| | - G B John Mancini
- From Divisions of Cardiology (J.S., J.M.) and Radiology (L.M.), Vancouver General Hospital, BC, Canada; Division of Cardiology, Harrington Heart and Vascular Institute, University Hospital Case Medical Center, Cleveland, OH (H.B.); and Heart and Vascular Institute, Cleveland Clinic Foundation, OH (H.L.G.)
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Hernández-Torres E, Wiggermann V, Hametner S, Baumeister TR, Sadovnick AD, Zhao Y, Machan L, Li DKB, Traboulsee A, Rauscher A. Orientation Dependent MR Signal Decay Differentiates between People with MS, Their Asymptomatic Siblings and Unrelated Healthy Controls. PLoS One 2015; 10:e0140956. [PMID: 26489078 PMCID: PMC4619399 DOI: 10.1371/journal.pone.0140956] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 10/02/2015] [Indexed: 11/19/2022] Open
Abstract
R2* relaxometry of the brain is a quantitative magnetic resonance technique which is influenced by iron and myelin content across different brain regions. Multiple sclerosis (MS) is a common inflammatory, demyelinating disease affecting both white and grey matter regions of the CNS. Using R2*, increased iron deposition has been described in deep gray matter of MS patients. Iron accumulation might promote oxidative stress in the brain, which can lead to cell death and neurodegeneration. However, recent histological work indicates that iron may be reduced within the normal appearing white matter (WM) in MS. In the present study we analyzed the R2* signal across the white matter in 39 patients with MS, 31 asymptomatic age matched siblings of patients and 30 age-matched controls. The measurement of R2* in white matter is affected by the signal's dependency on white matter fibre orientation with respect to the main magnetic field which can be accounted using diffusion tensor imaging. We observed a clear separation of the three study groups in R2*. The values in the MS group were significantly lower compared to the siblings and controls, while the siblings group presented with significantly higher R2* values than both unrelated healthy controls and patients. Furthermore, we found significantly decreased normal-appearing white matter R2* values in patients with more severe disease course. Angle resolved analysis of R2* improves the sensitivity for detecting subtle differences in WM R2* compared to standard histogram based analyses. Our findings suggest that the decreased R2* values in MS are due to diffuse tissue damage and decreased myelin in the normal appearing and diffusely abnormal WM. The increased R2* in unaffected siblings may identify a predisposition to increased iron and the potential for oxidative stress as a risk factor for developing MS.
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Affiliation(s)
- Enedino Hernández-Torres
- UBC MRI Research Centre, University of British Columbia, Vancouver, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Vanessa Wiggermann
- UBC MRI Research Centre, University of British Columbia, Vancouver, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
- Department of Physics and Astronomy, University of British Columbia, Vancouver, Canada
| | - Simon Hametner
- Department of Neuroimmunology, Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Tobias R. Baumeister
- UBC MRI Research Centre, University of British Columbia, Vancouver, Canada
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, Canada
- Pacific Parkinson's Research Centre, University of British Columbia, Vancouver, Canada
| | - A. Dessa Sadovnick
- Department of Medicine (Neurology), University of British Columbia, Vancouver, Canada
- Centre for Brain Health, University of British Columbia, Vancouver, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - Yinshan Zhao
- Department of Medicine (Neurology), University of British Columbia, Vancouver, Canada
| | - Lindsay Machan
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - David K. B. Li
- UBC MRI Research Centre, University of British Columbia, Vancouver, Canada
- Department of Medicine (Neurology), University of British Columbia, Vancouver, Canada
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Anthony Traboulsee
- Department of Medicine (Neurology), University of British Columbia, Vancouver, Canada
- Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Alexander Rauscher
- UBC MRI Research Centre, University of British Columbia, Vancouver, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
- Centre for Brain Health, University of British Columbia, Vancouver, Canada
- Child and Family Research Institute, University of British Columbia, Vancouver, Canada
- * E-mail:
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Abdi H, Zargar H, Goldenberg SL, Walshe T, Pourmalek F, Eddy C, Chang SD, Gleave ME, Harris AC, So AI, Machan L, Black PC. Multiparametric magnetic resonance imaging-targeted biopsy for the detection of prostate cancer in patients with prior negative biopsy results. Urol Oncol 2015; 33:165.e1-7. [PMID: 25665509 DOI: 10.1016/j.urolonc.2015.01.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 01/07/2015] [Accepted: 01/07/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE We aimed to determine the performance of multiparametric magnetic resonance imaging (mpMRI) in the detection of prostate cancer (PCa) in patients with prior negative transrectal ultrasound-guided prostate biopsy (TRUS-B) results. MATERIALS AND METHODS Between 2010 and 2013, 2,416 men underwent TRUS-B or an mpMRI or both at Vancouver General Hospital. Among these, 283 men had persistent suspicion of PCa despite prior negative TRUS-B finding. An MRI was obtained in 112, and a lesion (prostate imaging reporting and data system score ≥ 3) was identified in 88 cases (78%). A subsequent combined MRI-targeted and standard template biopsy was performed in 86 cases. A matching cohort of 86 patients was selected using a one-nearest neighbor method without replacement. The end points were the rate of diagnosis of PCa and significant PCa (sPCa) (Gleason > 6, or > 2 cores, or > 50% of any core). RESULTS MRI-targeted TRUS-B detected PCa and sPCa in 36 (41.9%) and 30 (34.9%) men when compared with 19 (22.1%) and 14 (16.3%), respectively, men without mpMRI (P = 0.005 for both). In 9 cases (10.4%), MRI-targeted TRUS-B detected sPCa that was missed on standard cores. sPCa was present in 6 cases (6.9%) on standard cores but not the targeted cores. Multivariate analysis revealed that prostate imaging reporting and data system score and prostate-specific antigen density > 0.15 ng/ml(2) were statistically significant predictors of significant cancer detection (odds ratio = 14.93, P < 0.001 and odds ratio = 6.19, P = 0.02, respectively). CONCLUSION In patients with prior negative TRUS-B finding, MRI-targeted TRUS-B improves the detection rate of all PCa and sPCa.
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Affiliation(s)
- Hamidreza Abdi
- Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - Homayoun Zargar
- Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - S Larry Goldenberg
- Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - Triona Walshe
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Farshad Pourmalek
- Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - Christopher Eddy
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Silvia D Chang
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Martin E Gleave
- Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - Alison C Harris
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Alan I So
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Lindsay Machan
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, Canada.
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Abstract
Patients with pelvic congestion syndrome present with otherwise unexplained chronic pelvic pain that has been present for greater than 6 months, and anatomic findings that include pelvic venous insufficiency and pelvic varicosities. It remains an underdiagnosed explanation for pelvic pain in young, premenopausal, usually multiparous females. Symptoms include noncyclical, positional lower back, pelvic and upper thigh pain, dyspareunia, and prolonged postcoital discomfort. Symptoms worsen throughout the day and are exacerbated by activity or prolonged standing. Examination may reveal ovarian tenderness and unusual varicosities-vulvoperineal, posterior thigh, and gluteal. Diagnosis is suspected by clinical history and imaging that demonstrates pelvic varicosities. Venography is usually necessary to confirm ovarian vein reflux, although transvaginal ultrasound may be useful in documenting this finding. Endovascular therapy has been validated by several large patient series with long-term follow-up using standardized pain assessment surveys. Embolization has been shown to be significantly more effective than surgical therapy in improving symptoms in patients who fail hormonal therapy. Although there has been variation in approaches between investigators, the goal is elimination of ovarian vein reflux with or without direct sclerosis of enlarged pelvic varicosities. Symptom reduction is seen in 70 to 90% of the treated females despite technical variation.
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Affiliation(s)
- Janette D Durham
- Department of Radiology, University of Colorado Denver, Aurora, Colorado
| | - Lindsay Machan
- Department of Radiology, University of British Columbia Hospital, Vancouver, BC, Canada
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Traboulsee A, Knox K, Machan L. Prevalence of extracranial venous narrowing on catheter venography in people with multiple sclerosis, their siblings, and unrelated healthy controls: a blinded, case-control study. J Vasc Surg 2014. [DOI: 10.1016/j.jvs.2014.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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36
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Abdi H, Walshe T, Pourmalek F, Aning J, Zargar H, Harris AC, Chang SD, So AI, Gleave ME, Machan L, Black PC, Goldenberg SL. MP51-20 MULTI-PARAMETRIC MRI ENHANCES DETECTION OF SIGNIFICANT TUMOR IN PATIENTS ON ACTIVE SURVEILLANCE FOR PROSTATE CANCER. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.1676] [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] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Traboulsee AL, Knox KB, Machan L, Zhao Y, Yee I, Rauscher A, Klass D, Szkup P, Otani R, Kopriva D, Lala S, Li DK, Sadovnick D. Prevalence of extracranial venous narrowing on catheter venography in people with multiple sclerosis, their siblings, and unrelated healthy controls: a blinded, case-control study. Lancet 2014; 383:138-45. [PMID: 24119384 DOI: 10.1016/s0140-6736(13)61747-x] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Chronic cerebrospinal venous insufficiency has been proposed as a unique combination of extracranial venous blockages and haemodynamic flow abnormalities that occurs only in patients with multiple sclerosis and not in healthy people. Initial reports indicated that all patients with multiple sclerosis had chronic cerebrospinal venous insufficiency. We aimed to establish the prevalence of venous narrowing in people with multiple sclerosis, unaffected full siblings, and unrelated healthy volunteers. METHODS We did an assessor-blinded, case-control, multicentre study of people with multiple sclerosis, unaffected siblings, and unrelated healthy volunteers. We enrolled the study participants between January, 2011 and March, 2012, and they comprised 177 adults: 79 with multiple sclerosis, 55 siblings, and 43 unrelated controls, from three centres in Canada. We assessed narrowing of the internal jugular and azygous veins with catheter venography and ultrasound criteria for chronic cerebrospinal venous insufficiency proposed by Zamboni and colleagues. Catheter venography data were available for 149 participants and ultrasound data for 171 participants. FINDINGS Catheter venography criteria for chronic cerebrospinal venous insufficiency were positive for one of 65 (2%) people with multiple sclerosis, one of 46 (2%) siblings, and one of 32 (3%) unrelated controls (p=1·0 for all comparisons). Greater than 50% narrowing of any major vein was present in 48 of 65 (74%) people with multiple sclerosis, 31 of 47 (66%) siblings (p=0·41 for comparison with patients with multiple sclerosis), and 26 of 37 (70%) unrelated controls (p=0·82). The ultrasound criteria for chronic cerebrospinal venous insufficiency were fulfilled in 35 of 79 (44%) participants with multiple sclerosis, 17 of 54 (31%) siblings (p=0·15 for comparison with patients with multiple sclerosis) and 17 of 38 (45%) unrelated controls (p=0·98). The sensitivity of the ultrasound criteria for detection of greater than 50% narrowing on catheter venography was 0·406 (95% CI 0·311-0·508), and specificity was 0·643 (0·480-0·780). INTERPRETATION This study shows that chronic cerebrospinal venous insufficiency occurs rarely in both patients with multiple sclerosis and in healthy people. Extracranial venous narrowing of greater than 50% is a frequent finding in patients with multiple sclerosis, unaffected siblings, and unrelated controls. The ultrasound criteria are neither sensitive nor specific for narrowing on catheter venography. The significance of venous narrowing to multiple sclerosis symptomatology remains unknown. FUNDING MS Society of Canada, Saskatoon City Hospital Foundation, Lotte and John Hecht Memorial Foundation, Vancouver Coastal Health Foundation, and the Wolridge Foundation.
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Affiliation(s)
| | - Katherine B Knox
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Lindsay Machan
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Yinshan Zhao
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Irene Yee
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Alexander Rauscher
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Darren Klass
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Peter Szkup
- Department of Medical Imaging, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Robert Otani
- Department of Medical Imaging, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - David Kopriva
- Department of Surgery, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Shanti Lala
- Department of Surgery, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - David K Li
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Dessa Sadovnick
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
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Taylor S, Margolick J, Abughosh Z, Goldenberg SL, Lange D, Bowie WR, Bell R, Roscoe D, Machan L, Black P. Ciprofloxacin resistance in the faecal carriage of patients undergoing transrectal ultrasound guided prostate biopsy. BJU Int 2013; 111:946-53. [PMID: 23464844 DOI: 10.1111/j.1464-410x.2012.11637.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
UNLABELLED WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Transrectal ultrasound guided prostate biopsies (TRUSBx) are associated with a spectrum of complications, including most significantly infection, which affects up to 5% of patients. In the most severe cases, infection leads to sepsis, a life-threatening complication. Escherichia coli is the primary responsible pathogen. Although antibiotic prophylaxis with fluoroquinolones is routinely used, there is evidence that the infection rate after TRUSBx is increasing, and this appears to be due to an increasing prevalence of ciprofloxacin-resistant rectal flora. This is the largest prospective clinical trial to date analysing the rectal flora of men undergoing prostate biopsies. We determined the microbial and antibiotic sensitivity profiles from 849 patients. Ciprofloxacin-resistant Gram-negative organisms were identified in the rectal flora of 19.0% of men. Furthermore, fluoroquinolone use within 6 months preceding a TRUSBx and the presence of a prosthetic heart valve were significant predictors of ciprofloxacin resistance on rectal swab. Determining the prevalence of rectal fluoroquinolone resistance has important implications in evaluation of the suitability of prophylactic regimens. Antimicrobial profiles derived from rectal swabs pre-biopsy may prove useful in guiding targeted antibiotic prophylaxis. OBJECTIVES To establish the prevalence of ciprofloxacin-resistant bacteria in patients undergoing transrectal ultrasound guided prostate biopsies (TRUSBx) and to determine whether this predicts subsequent infectious complications. To identify risk factors for harbouring ciprofloxacin-resistant flora. PATIENTS AND METHODS Any patient undergoing a TRUSBx from 2009 to 2011 was eligible for enrolment in this prospective study. Pre-biopsy rectal and urine cultures and post-biopsy urine cultures were obtained and antimicrobial susceptibility was determined. Univariate and multivariate analyses were performed to identify independent patient risk factors associated with ciprofloxacin-resistant rectal flora. RESULTS A total of 865 patients underwent TRUSBx, of whom 19.0% were found to have ciprofloxacin-resistant Gram-negative coliforms. Escherichia coli was the most prevalent Gram-negative rectal isolate (80.9%) and accounted for 90.6% of ciprofloxacin resistance. Patient characteristics that conferred an increased risk of harbouring ciprofloxacin-resistant organisms included a history of a heart valve replacement (P < 0.05) and ciprofloxacin use in the past 3 months (P < 0.05). Infectious complications were observed in 3.6% (n = 31) of the patient population and 48% of these patients grew ciprofloxacin-resistant organisms on the pre-biopsy rectal swab (P < 0.001). CONCLUSIONS Antimicrobial resistance to ciprofloxacin in the rectal flora was common, particularly in patients with recent ciprofloxacin use and a heart valve replacement. Despite a significant correlation between those patients who developed infections and the detection of ciprofloxacin-resistant organisms, only 9.0% (n = 15) of the total group with ciprofloxacin resistance developed an infectious complication. Future studies will need to evaluate the cost effectiveness and clinical utility of a pre-biopsy rectal culture in targeting antibiotic prophylaxis.
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Affiliation(s)
- Stephen Taylor
- Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
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Abughosh Z, Margolick J, Goldenberg SL, Taylor SA, Afshar K, Bell R, Lange D, Bowie WR, Roscoe D, Machan L, Black PC. A prospective randomized trial of povidone-iodine prophylactic cleansing of the rectum before transrectal ultrasound guided prostate biopsy. J Urol 2012; 189:1326-31. [PMID: 23041343 DOI: 10.1016/j.juro.2012.09.121] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2012] [Indexed: 11/28/2022]
Abstract
PURPOSE Transrectal ultrasound guided prostate biopsy can lead to urinary tract infections in 3% to 11% and sepsis in 0.1% to 5% of patients. We investigated the efficacy of rectal cleansing with povidone-iodine before transrectal ultrasound guided prostate biopsy to reduce infectious complications. MATERIALS AND METHODS Between 2009 and 2011, 865 men were prospectively randomized to rectal cleansing (421) or no cleansing (444) before transrectal ultrasound guided prostate biopsy. Patients received ciprofloxacin prophylaxis and rectal swab cultures were obtained before transrectal ultrasound guided prostate biopsy. Patients completed a telephone interview 7 days after undergoing the biopsy. The primary end point was the rate of infectious complications, a composite end point of 1 or more of 1) fever greater than 38.0C, 2) urinary tract infection or 3) sepsis (standardized definition). Chi-square significance testing was performed for differences between groups and a multivariate analysis was performed to assess risk factors for infectious complications. RESULTS Infectious complications were observed in 31 (3.5%) patients, including 11 (2.6%) treated and 20 (4.5%) control patients (p = 0.15). Sepsis was observed in 4 (1.0%) treated and 7 (1.6%) control patients (p = 0.55). On multivariate analysis resistance to ciprofloxacin in the rectal swab culture (p = 0.002) and a history of taking ciprofloxacin in the 3 months preceding transrectal ultrasound guided prostate biopsy (p = 0.009) predicted infectious complications. CONCLUSIONS Rectal cleansing with povidone-iodine before transrectal ultrasound guided prostate biopsy was safe, but the 42% relative risk reduction of infectious complications was not statistically significant. Patients who have received ciprofloxacin within 3 months of transrectal ultrasound guided prostate biopsy should be considered for alternate prophylaxis or possibly a delay of biopsy beyond 3 months.
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Affiliation(s)
- Zeid Abughosh
- Department of Urologic Sciences, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Abughosh Z, Margolick J, Goldenberg SL, Afshar K, Taylor S, Lange D, Chew B, Gleave M, So A, McLoughlin M, Bowie W, Roscoe D, Machan L, Black P. 1080 A PROSPECTIVE RANDOMIZED TRIAL OF POVIDONE-IODINE PROPHYLACTIC CLEANSING OF THE RECTUM PRIOR TO TRANSRECTAL ULTRASOUND-GUIDED PROSTATE BIOPSY. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.1187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Stuart S, Klass D, Ling A, Power M, Wan J, Munk P, Ho S, Machan L, Legiehn G, Liu D. Abstract No. 83: Does fellowship training in an interventional radiology program improve procedural skill in uterine artery embolization? J Vasc Interv Radiol 2012. [DOI: 10.1016/j.jvir.2011.12.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Abstract
At present, there are no widely accepted surgical or percutaneous treatment options for chronic venous insufficiency of the deep venous system. The small intestinal submucosa square stent bicuspid venous valve (BVV) has shown the most promising results of artificial venous valves developed to date. In experimental long-term studies in sheep jugular veins, 88% of implanted valves exhibited good function; 12% had decreased function related to valve tilting, of which only 4% had partial thrombosis. BVVs were also placed in three patients and have remained patent without thrombosis or other complications since 2002. At present, 3 years after BVV placement, symptoms in two patients are decreased. Proper sizing and proper placement of the valves were critical to their function. To eliminate occasional tilting of the original BVV, a second-generation BVV has been developed and tested.
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Affiliation(s)
- Dusan Pavcnik
- Dotter Interventional Institute, Oregon Health Sciences University, Portland, Oregon
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Machan L, Gill K, Abel‡ P, Jager H, Williams G, Allison D. Prostatic Urethroplasty Results at the Royal Postgraduate Medical School. Semin Intervent Radiol 2008. [DOI: 10.1055/s-2008-1075898] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Machan L. Medical invention: transforming your idea into a product. Can Assoc Radiol J 2008; 59:16-18. [PMID: 18386752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Affiliation(s)
- Lindsay Machan
- Department of Radiology, University of British Columbia Hospital, 2211 Wesbrook Mall, Vancouver, BC.
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Machan L. Clinical experience and applications of drug-eluting stents in the noncoronary vasculature, bile duct and esophagus. Adv Drug Deliv Rev 2006; 58:447-62. [PMID: 16713011 DOI: 10.1016/j.addr.2006.01.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2005] [Accepted: 01/31/2006] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To review the use of drug-eluting stents outside the coronary artery. FINDINGS The vast majority of research and clinical data on drug-eluting stents are from their use in coronary artery atherosclerosis; however, these devices can be used outside the coronary circulation in both vascular and nonvascular structures. In noncoronary arteries the principle indication for drug-eluting vascular stents is the same as in the coronary circulation, prevention of restenosis. Human experience has been essentially limited to trials or compassionate use; two small controlled studies and a number of small observational single center reports have been published, and there are trials in progress. To date the data have not been as compelling as in the coronary circulation. The physical characteristics of each vascular bed such as external compressive forces, blood flow rates, wall thickness relative to lumen size, and vessel wall composition differ significantly from the coronary circulation and each presents unique challenges to local drug delivery. Outside the vascular bed, the principle expected use is the prevention of tissue ingrowth after stent insertion in tubular structures such as the trachea, esophagus or bile ducts. CONCLUSIONS Considerable further study of drug-eluting stents will be required in each anatomic region to determine the ideal stent/drug combination and clinical appropriateness.
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Affiliation(s)
- Lindsay Machan
- Angiography and Interventional Radiology, Department of Radiology, Vancouver Hospital and Health Sciences Centre, Vancouver, BC, Canada.
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Schwartz RS, Edelman ER, Carter A, Chronos NA, Rogers C, Robinson KA, Waksman R, Machan L, Weinberger J, Wilensky RL, Goode JL, Hottenstein OD, Zuckerman BD, Virmani R. Preclinical Evaluation of Drug-Eluting Stents for Peripheral Applications. Circulation 2004; 110:2498-505. [PMID: 15492330 DOI: 10.1161/01.cir.0000145164.85178.2e] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Robert S Schwartz
- Minneapolis Heart Institute Foundation, Minnesota Cardiovascular Research Institute, 920 E 28th St, Minneapolis, MN 55407, USA.
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Jackson JK, Smith J, Letchford K, Babiuk KA, Machan L, Signore P, Hunter WL, Wang K, Burt HM. Characterization of perivascular poly(lactic-co-glycolic acid) films containing paclitaxel. Int J Pharm 2004; 283:97-109. [PMID: 15363506 DOI: 10.1016/j.ijpharm.2004.06.025] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2004] [Revised: 06/30/2004] [Accepted: 06/30/2004] [Indexed: 11/16/2022]
Abstract
The objectives of this study were to investigate the use of poly(lactic-co-glycolic acid) (PLGA) for the formulation of paclitaxel loaded films and to characterize these films for potential application as perivascular "wraps" to prevent restenosis. Films were manufactured from PLGA blended with either methoxypolyethylene glycol (MePEG) or a diblock copolymer composed of poly(D,L-lactic acid)-block-methoxypolyethylene glycol, PDLLA-MePEG (diblock) by solvent evaporation on teflon discs. Elasticity was determined by gravimetric stress/strain analysis. Thermal analysis was determined using differential scanning calorimetry (DSC). Changes in film composition and degradation in aqueous media were determined using gel permeation chromatography (GPC). Paclitaxel release from films was measured by incubation of the films in phosphate buffered saline (PBS) with drug analysis by HPLC methods. The addition of MePEG or diblock to PLGA caused a concentration dependent increase in the elasticity of films, due to plasticizing effects. DSC analysis showed that MePEG and diblock caused a concentration dependent decrease in the glass transition temperature (Tg) of PLGA indicating miscibility of the polymers. When placed in aqueous media, more than 75% of MePEG dissolved out of the PLGA films within 2 days, whereas diblock partitioned slowly and in a controlled manner out of the films. Paclitaxel release from PLGA/MePEG films was very slow with less than 5% of the encapsulated drug being released over 2 weeks. The addition of 30% diblock to paclitaxel loaded PLGA films caused a substantial increase (five- to eight-fold) in the release rate of paclitaxel. PLGA films containing 30% diblock and either 1% or 5% paclitaxel were partially or completely degraded following perivascular implantation in rats.
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Affiliation(s)
- John K Jackson
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2146 East Mall, Vancouver, BC, Canada V6T 1Z3
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Abstract
The short-term efficacy of drug-eluting stents has been validated in the coronary circulation, particularly with the drugs rapamycin and paclitaxel. The physical environment of the infrainguinal arteries is very different from the coronary circulation. Self-expanding stents are necessary in the femoropopliteal segment, which is subject to recurrent external forces. These include flexion at the knee, compression within the adductor hiatus, rotation and longitudinal compression. Thus, the properties required of a drug coating is likely be very different from those used in coronary arteries. This would appear to be borne out by SIROCCO, the only published study to date evaluating drug-eluting stents in the noncoronary circulation. SIROCCO began as a prospective randomized 36 patient trial comparing rapamycin coated to uncoated self-expanding SMART stents in the femoropopliteal segment. The first phase of SIROCCO demonstrated reduction of intimal hyperplasia by rapamycin. However, the study is being repeated to optimize the rate of drug elution, and multiple stent fractures seen in the first phase of the study necessitated modification of stent design. Considerable further study of drug eluting stents will be required in each vascular bed to determine the ideal stent/drug combination, and to establish clinical efficacy.
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Affiliation(s)
- Lindsay Machan
- Head Angiography and Interventional Radiology, Department of Radiology, Vancouver Hospital and Health Sciences Center, Vancouver, BC, Canada
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Machan L. Pelvic Pain: Modern Imaging and Differential Diagnosis (CC). J Vasc Interv Radiol 2004. [DOI: 10.1016/s1051-0443(04)70157-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Machan L. Overview of Chronic Pelvic Pain. J Vasc Interv Radiol 2004. [DOI: 10.1016/s1051-0443(04)70178-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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