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Karandikar A, Solberg A, Fung A, Lee AY, Farooq A, Taylor AC, Oliveira A, Narayan A, Senter A, Majid A, Tong A, McGrath AL, Malik A, Brown AL, Roberts A, Fleischer A, Vettiyil B, Zigmund B, Park B, Curran B, Henry C, Jaimes C, Connolly C, Robson C, Meltzer CC, Phillips CH, Dove C, Glastonbury C, Pomeranz C, Kirsch CFE, Burgan CM, Scher C, Tomblinson C, Fuss C, Santillan C, Daye D, Brown DB, Young DJ, Kopans D, Vargas D, Martin D, Thompson D, Jordan DW, Shatzkes D, Sun D, Mastrodicasa D, Smith E, Korngold E, Dibble EH, Arleo EK, Hecht EM, Morris E, Maltin EP, Cooke EA, Schwartz ES, Lehrman E, Sodagari F, Shah F, Doo FX, Rigiroli F, Vilanilam GK, Landinez G, Kim GGY, Rahbar H, Choi H, Bandesha H, Ojeda-Fournier H, Ikuta I, Dragojevic I, Schroeder JLT, Ivanidze J, Katzen JT, Chiang J, Nguyen J, Robinson JD, Broder JC, Kemp J, Weaver JS, Conyers JM, Robbins JB, Leschied JR, Wen J, Park J, Mongan J, Perchik J, Barbero JPM, Jacob J, Ledbetter K, Macura KJ, Maturen KE, Frederick-Dyer K, Dodelzon K, Cort K, Kisling K, Babagbemi K, McGill KC, Chang KJ, Feigin K, Winsor KS, Seifert K, Patel K, Porter KK, Foley KM, Patel-Lippmann K, McIntosh LJ, Padilla L, Groner L, Harry LM, Ladd LM, Wang L, Spalluto LB, Mahesh M, Marx MV, Sugi MD, Sammer MBK, Sun M, Barkovich MJ, Miller MJ, Vella M, Davis MA, Englander MJ, Durst M, Oumano M, Wood MJ, McBee MP, Fischbein NJ, Kovalchuk N, Lall N, Eclov N, Madhuripan N, Ariaratnam NS, Vincoff NS, Kothary N, Yahyavi-Firouz-Abadi N, Brook OR, Glenn OA, Woodard PK, Mazaheri P, Rhyner P, Eby PR, Raghu P, Gerson RF, Patel R, Gutierrez RL, Gebhard R, Andreotti RF, Masum R, Woods R, Mandava S, Harrington SG, Parikh S, Chu S, Arora SS, Meyers SM, Prabhu S, Shams S, Pittman S, Patel SN, Payne S, Hetts SW, Hijaz TA, Chapman T, Loehfelm TW, Juang T, Clark TJ, Potigailo V, Shah V, Planz V, Kalia V, DeMartini W, Dillon WP, Gupta Y, Koethe Y, Hartley-Blossom Z, Wang ZJ, McGinty G, Haramati A, Allen LM, Germaine P. Radiologists staunchly support patient safety and autonomy, in opposition to the SCOTUS decision to overturn Roe v Wade. Clin Imaging 2023; 93:117-121. [PMID: 36064645 DOI: 10.1016/j.clinimag.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 07/26/2022] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Alice Fung
- Oregon Health & Science University (OHSU), United States of America
| | - Amie Y Lee
- University of California, San Francisco, United States of America
| | | | - Amy C Taylor
- University of Virginia, Charlottesville, VA, United States of America
| | | | - Anand Narayan
- University of Wisconsin Hospitals and Clinics, Madison, WI, United States of America
| | | | | | | | | | | | | | - Anne Roberts
- University of California San Diego, United States of America
| | | | | | - Beth Zigmund
- Larner College of Medicine at University of Vermont, United States of America
| | - Brian Park
- Oregon Health & Science University (OHSU), United States of America
| | - Bruce Curran
- Virginia Commonwealth University Health System, United States of America
| | - Cameron Henry
- Vanderbilt University Medical Center, United States of America
| | - Camilo Jaimes
- Boston Children's Hospital and Harvard Medical School, United States of America
| | - Cara Connolly
- Vanderbilt University Medical Center, United States of America
| | - Caroline Robson
- Boston Children's Hospital and Harvard Medical School, United States of America
| | - Carolyn C Meltzer
- Keck School of Medicine of the University of Southern California, United States of America
| | | | - Christine Dove
- Vanderbilt University Medical Center, United States of America
| | | | | | | | | | - Courtney Scher
- Henry Ford Health, Detroit, MI, United States of America
| | | | - Cristina Fuss
- Oregon Health & Science University (OHSU), United States of America
| | | | - Dania Daye
- Massachusetts General Hospital/Harvard Medical School, United States of America
| | - Daniel B Brown
- Vanderbilt University Medical Center, United States of America
| | - Daniel J Young
- Oregon Health & Science University (OHSU), United States of America
| | | | | | - Dann Martin
- Vanderbilt University Medical Center, United States of America
| | | | - David W Jordan
- University Hospitals Cleveland Medical Center & Case Western Reserve University, United States of America
| | | | - Derek Sun
- University of California, San Francisco, United States of America
| | | | | | - Elena Korngold
- Oregon Health & Science University (OHSU), United States of America
| | - Elizabeth H Dibble
- The Warren Alpert Medical School of Brown University, United States of America
| | | | | | | | | | - Erin A Cooke
- Vanderbilt University Medical Center, United States of America
| | - Erin Simon Schwartz
- Perelman School of Medicine, University of Pennsylvania, United States of America
| | | | - Faezeh Sodagari
- Massachusetts General Hospital, Harvard Medical School, United States of America
| | - Faisal Shah
- Radiology Partners, United States of America
| | | | | | - George K Vilanilam
- Dept of Radiology, University of Arkansas for Medical Sciences, United States of America
| | - Gina Landinez
- University of California, San Francisco, United States of America
| | | | - Habib Rahbar
- University of Washington, United States of America
| | - Hailey Choi
- University of California, San Francisco, United States of America
| | | | | | - Ichiro Ikuta
- Yale University School of Medicine, Department of Radiology & Biomedical Imaging, United States of America
| | | | | | | | | | - Jason Chiang
- Ronald Reagan UCLA Medical Center, United States of America
| | - Jeffers Nguyen
- Yale University School of Medicine, Department of Radiology & Biomedical Imaging, United States of America
| | | | - Jennifer C Broder
- Lahey Hospital and Medical Center, Burlington, MA, United States of America
| | - Jennifer Kemp
- University of Colorado School of Medicine, United States of America
| | | | | | - Jessica B Robbins
- University of Wisconsin School of Medicine and Public Health, United States of America
| | | | - Jessica Wen
- Stanford University, United States of America
| | - Jocelyn Park
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, United States of America
| | | | - Jordan Perchik
- University of Alabama at Birmingham, United States of America
| | | | - Jubin Jacob
- St Lawrence Radiology, United States of America
| | | | | | | | | | | | | | - Kelly Kisling
- University of California San Diego, United States of America
| | | | | | | | | | | | - Kimberly Seifert
- Stanford University School of Medicine, United States of America
| | - Kirang Patel
- University of Texas Southwestern Medical Center, United States of America
| | - Kristin K Porter
- University of Alabama at Birmingham Hospital, United States of America
| | | | | | | | - Laura Padilla
- University of California San Diego, United States of America
| | | | - Lauren M Harry
- Indiana University School of Medicine, United States of America
| | - Lauren M Ladd
- Indiana University School of Medicine, United States of America
| | - Lisa Wang
- Oregon Health & Science University (OHSU), United States of America
| | - Lucy B Spalluto
- Vanderbilt University Medical Center, United States of America
| | - M Mahesh
- Johns Hopkins University School of Medicine, United States of America
| | | | - Mark D Sugi
- University of California, San Francisco, United States of America
| | | | - Maryellen Sun
- Mount Auburn Hospital/Harvard Medical School, Cambridge, MA, United States of America
| | | | | | - Maya Vella
- University of California, San Francisco, United States of America
| | | | | | | | - Michael Oumano
- Rhode Island Hospital (Brown University), Providence, RI, United States of America
| | - Monica J Wood
- Mount Auburn Hospital/Harvard Medical School, Cambridge, MA, United States of America
| | - Morgan P McBee
- Medical University of South Carolina, United States of America
| | | | | | - Neil Lall
- Emory University, Atlanta, GA, United States of America
| | - Neville Eclov
- Duke University, Durham, NC, United States of America
| | | | | | - Nina S Vincoff
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, United States of America
| | - Nishita Kothary
- Stanford University School of Medicine, United States of America
| | | | - Olga R Brook
- Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Orit A Glenn
- University of California, San Francisco, United States of America
| | - Pamela K Woodard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Parisa Mazaheri
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, United States of America
| | | | - Peter R Eby
- Virginia Mason Franciscan Health, United States of America
| | - Preethi Raghu
- University of California, San Francisco, United States of America
| | - Rachel F Gerson
- Northwest Radiologists, Inc, PS, Bellingham, WA, United States of America
| | - Rina Patel
- University of California, San Francisco, United States of America
| | | | - Robyn Gebhard
- The Ohio State University, Columbus, OH, United States of America
| | | | - Rukya Masum
- The Ohio State University, Columbus, OH, United States of America
| | - Ryan Woods
- University of Wisconsin School of Medicine and Public Health, United States of America
| | - Sabala Mandava
- Henry Ford Health, Detroit, MI, United States of America
| | | | - Samir Parikh
- Henry Ford Health, Jackson, MI, United States of America
| | - Sammy Chu
- University of Washington (Seattle, WA), United States of America
| | | | - Sandra M Meyers
- University of California San Diego, United States of America
| | - Sanjay Prabhu
- Boston Children's Hospital, United States of America
| | | | - Sarah Pittman
- Stanford University School of Medicine, United States of America
| | | | | | - Steven W Hetts
- University of California, San Francisco, United States of America
| | - Tarek A Hijaz
- Northwestern Memorial Hospital/Feinberg School of Medicine of Northwestern University, Chicago, IL, United States of America
| | - Teresa Chapman
- University of Washington (Seattle, WA), United States of America
| | - Thomas W Loehfelm
- University of California, Davis, Sacramento, CA, United States of America
| | | | | | | | - Vinil Shah
- University of California, San Francisco, United States of America
| | - Virginia Planz
- Vanderbilt University Medical Center, United States of America
| | - Vivek Kalia
- Texas Scottish Rite for Children Hospital, United States of America
| | - Wendy DeMartini
- Stanford University School of Medicine, United States of America
| | - William P Dillon
- University of California, San Francisco, United States of America
| | - Yasha Gupta
- Memorial Sloan Kettering Cancer Center, United States of America
| | - Yilun Koethe
- Oregon Health & Science University (OHSU), United States of America
| | | | - Zhen Jane Wang
- University of California, San Francisco, United States of America
| | | | - Adina Haramati
- Massachusetts General Hospital, Boston, MA, United States of America
| | - Laveil M Allen
- Vanderbilt University Medical Center, United States of America
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Siracusano S, Zaka A, Bassi P, Gontero P, Mearini E, Imbimbo C, Simonato A, Dal Moro F, Giannarini G, Valotto C, Montorsi F, Colombo R, Porpiglia F, Bartoletti R, Vella M, Minervini A, Rossanese M, Porcaro B, Romantini F, Vicentini C, Talamini R, Ficarra V, Racioppi M, Lonardi C. Short-term effects of bowel function on global health quality of life after radical cystectomy. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01118-1] [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: 11/05/2022] Open
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Chaudhari GR, Liu T, Chen TL, Joseph GB, Vella M, Lee YJ, Vu TH, Seo Y, Rauschecker AM, McCulloch CE, Sohn JH. Application of a Domain-specific BERT for Detection of Speech Recognition Errors in Radiology Reports. Radiol Artif Intell 2022; 4:e210185. [PMID: 35923373 PMCID: PMC9344210 DOI: 10.1148/ryai.210185] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 04/11/2022] [Accepted: 05/10/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To develop radiology domain-specific bidirectional encoder representations from transformers (BERT) models that can identify speech recognition (SR) errors and suggest corrections in radiology reports. MATERIALS AND METHODS A pretrained BERT model, Clinical BioBERT, was further pretrained on a corpus of 114 008 radiology reports between April 2016 and August 2019 that were retrospectively collected from two hospitals. Next, the model was fine-tuned on a training dataset of generated insertion, deletion, and substitution errors, creating Radiology BERT. This model was retrospectively evaluated on an independent dataset of radiology reports with generated errors (n = 18 885) and on unaltered report sentences (n = 2000) and prospectively evaluated on true clinical SR errors (n = 92). Correction Radiology BERT was separately trained to suggest corrections for detected deletion and substitution errors. Area under the receiver operating characteristic curve (AUC) and bootstrapped 95% CIs were calculated for each evaluation dataset. RESULTS Radiology-specific BERT had AUC values of >.99 (95% CI: >0.99, >0.99), 0.94 (95% CI: 0.93, 0.94), 0.98 (95% CI: 0.98, 0.98), and 0.97 (95% CI: 0.97, 0.97) for detecting insertion, deletion, substitution, and all errors, respectively, on the independently generated test set. Testing on unaltered report impressions revealed a sensitivity of 82% (28 of 34; 95% CI: 70%, 93%) and specificity of 88% (1521 of 1728; 95% CI: 87%, 90%). Testing on prospective SR errors showed an accuracy of 75% (69 of 92; 95% CI: 65%, 83%). Finally, the correct word was the top suggestion for 45.6% (475 of 1041; 95% CI: 42.5%, 49.3%) of errors. CONCLUSION Radiology-specific BERT models fine-tuned on generated errors were able to identify SR errors in radiology reports and suggest corrections.Keywords: Computer Applications, Technology Assessment Supplemental material is available for this article. © RSNA, 2022See also the commentary by Abajian and Cheung in this issue.
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Hughes R, Massie E, Saldanha J, Komolafe S, Chapman R, Kirk A, Vella M, Moug S, MacArthur C, Mackie H. 294 Implementation of Colorectal Robotic Assisted Surgical Programme During a Global Pandemic: Collaboration Between Territorial and National Waiting Times Centre. Br J Surg 2022. [DOI: 10.1093/bjs/znac039.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
Golden Jubilee National Hospital (GJNH) established a thoracic Robotic Assisted Surgical (RAS) programme in 2018. In March 2021, GJNH invested in a new elective colorectal service and in response to the Scottish Government robotic investment established a collaboration with a territorial health board to host their robot and start a RAS colorectal programme. We provide an overview of barriers and facilitators leading to establishing this new collaboration.
Method
An observational review of RAS training timeline. Demographics, surgical operations, and hospital length of stay were documented. Surgeons, perioperative team, management, and industry (Intuitive) were interviewed to provide insights into implementation and training.
Results
Boards approved RAS business case in April 2021, robot on-site with GJNH governance approval in May. First cohort of colorectal surgeons completed proctored training July 2021. To date, 17 RAS resections performed (mean age 64, 9 males: 8 female). Mean length of stay 4.65 days. No anastomotic leaks and no mortality reported. Interviews revealed key facilitators: advantage of having an established RAS perioperative team and building on pre-existing industry links; developing and strengthening collaborative working between different health boards and surgeons. Barriers included: education of all team members to ensure patient safety for new specialty; multisite collaborative working.
Conclusions
This work provides a template model for future RAS collaborations between different sites and health boards. Collaborative working in a green-hospital setting may improve equity of access for patients whilst future-proofing surgery against further waves of the pandemic.
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Affiliation(s)
- R. Hughes
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - E. Massie
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | | | | | - R. Chapman
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - A. Kirk
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - M. Vella
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - S. Moug
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - C. MacArthur
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - H. Mackie
- Golden Jubilee National Hospital, Glasgow, United Kingdom
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Baiamonte D, Altomare S, Giaimo R, Vella M, Mannone P, Pinelli M, Tulone G, Agnello L, Vidali M, Lo Sasso B, Giglio R, Gambino C, Pavan N, Ciaccio M, Simonato A. The potential role of Monocyte Distribution Width (MDW) as early post-operative sepsis biomarker. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00134-8] [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: 11/15/2022]
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Tulone G, Simonato A, Pinelli M, Vella M, Giaimo R, Baiamonte D, Mannone P, Lissiani A, Pavan N. Criss-cross hemostatic suture in nephron sparing open surgery. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01277-5] [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: 11/26/2022]
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Burns S, Vella M, Paciorek A, Zhang L, Atreya CE, Feng M, Kelley RK, Tempero MA, Van Loon K, Ko AH. Characteristics and Growth Rate of Lung Metastases in Patients With Primary Gastrointestinal Malignancies and Lung-dominant Metastatic Disease: A Retrospective Cohort Analysis. Am J Clin Oncol 2022; 45:22-27. [PMID: 34864778 DOI: 10.1097/coc.0000000000000879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION There are no formal guidelines for the management of patients with primary gastrointestinal (GI) cancers who have lung-exclusive or lung-predominant metastases. We performed a retrospective analysis to evaluate host and tumor characteristics of this patient population, model patterns and rates of growth, and describe treatment approaches. MATERIALS AND METHODS Eligible patients had a GI cancer with either synchronous or metachronous lung metastases but no other visceral or peritoneal sites of involvement. In addition to collecting detailed patient-specific and tumor-specific information, all imaging studies (computed tomography±positron emission tomography scans) were reviewed by an independent radiologist. Up to 5 lung metastases were tracked through each patient's clinical course. Growth rate was estimated using a linear mixed model analysis. RESULTS Forty patients met eligibility criteria (18 pancreatic, 15 colorectal, 6 hepatobiliary, 1 gastroesophageal; synchronous vs. metachronous, 13 and 27, respectively). Median time from original cancer diagnosis to onset of metachronous lung lesions was 16 months. Interval from first appearance of lung metastases to treatment initiation was 6.2 months. Average growth rate of the largest lesion was 0.21 mm/mo (95% confidence interval, 0.12-0.30), with substantial intrapatient and interpatient variability. Sixty percent of patients underwent locoregional interventions in addition to or in lieu of systemic therapy for their lung metastases. Median survival of the entire study cohort from first appearance of lung metastases was 54 months. CONCLUSIONS Lung metastases from primary GI cancers have a variable but overall indolent natural history and are generally associated with prolonged survival outcomes. Further efforts to define patterns of growth of lung metastases, informed by size, number, and clinical/molecular features, are needed to guide appropriate timing and selection of therapy as well as surveillance strategies.
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Affiliation(s)
| | - Maya Vella
- Departments of Radiology and Biomedical Imaging
| | - Alan Paciorek
- Epidemiology and Biostatistics
- Helen Diller Family Comprehensive Cancer Center
| | - Li Zhang
- Epidemiology and Biostatistics
- Helen Diller Family Comprehensive Cancer Center
- Division of Hematology and Oncology, Departments of Medicine
| | - Chloe E Atreya
- Helen Diller Family Comprehensive Cancer Center
- Division of Hematology and Oncology, Departments of Medicine
| | - Mary Feng
- Helen Diller Family Comprehensive Cancer Center
- Radiation Oncology, University of California, San Francisco, San Francisco, CA
| | - Robin K Kelley
- Helen Diller Family Comprehensive Cancer Center
- Division of Hematology and Oncology, Departments of Medicine
| | - Margaret A Tempero
- Helen Diller Family Comprehensive Cancer Center
- Division of Hematology and Oncology, Departments of Medicine
| | - Katherine Van Loon
- Helen Diller Family Comprehensive Cancer Center
- Division of Hematology and Oncology, Departments of Medicine
| | - Andrew H Ko
- Helen Diller Family Comprehensive Cancer Center
- Division of Hematology and Oncology, Departments of Medicine
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Cenzato N, Tripicchio C, Vella M, Esposito L. L’utilizzo del succhietto può causare problematiche odontoiatriche e ortodontiche? Dental Cadmos 2021. [DOI: 10.19256/d.cadmos.2021.33] [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: 11/20/2022]
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Tulone G, Giannone S, Giuseppe A, Abrate A, Pinelli M, Mannone P, Baiamonte D, Giaimo R, Ficarra V, Vella M, Simonato A. Double-layered hand-performed intestinal anastomosis vs mechanical suturing machine in radical cystectomy: comparison of complications, operating time and costs. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00988-5] [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: 11/29/2022] Open
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Baiamonte D, Biancolini R, Aimar R, Mannone P, Di Gregorio G, Tulone G, Giannone S, Abrate A, Vella M, Serretta V, Pavone C, Giaimo R, Dalmasso E, Simonato A. The potential role of COVID-19 hygienic measures in reducing infective complications during hospitalization. Eur Urol 2021. [PMCID: PMC8263109 DOI: 10.1016/s0302-2838(21)00514-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Burns S, Vella M, Paciorek A, Zhang L, Atreya CE, Collisson EA, Feng MUS, Kelley RK, Tempero MA, Van Loon K, Ko AH. Characteristics and growth rate of lung metastases in patients with primary gastrointestinal malignancies: A retrospective cohort analysis. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.3_suppl.442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
442 Background: There are no formal guidelines for the management of GI cancer pts with lung-exclusive or lung-predominant metastases (LM), which generally take a more indolent course than metastatic disease occurring at other anatomic sites. We performed a retrospective analysis at a high-volume tertiary care center to evaluate host and tumor characteristics of this pt population, describe treatment approaches, and model patterns and rates of growth. Methods: Eligible pts were identified through Cancer Center registry data, provider recall, and electronic record review. Criteria included LM occurring either synchronously (SLM) or metachronously (MLM) w/primary cancer diagnosis; nodal, but not visceral or peritoneal, mets allowed. Data re: demographics, tumor characteristics, and rx modalities were collected. We reviewed all eligible CT +/- PET scan reports to gather data on #, location, and size of pulm mets, with all images subsequently reviewed by an independent radiologist. Up to 5 pulm mets were tracked through each pt’s clinical course. Growth rate was estimated using a linear mixed model analysis considering patients as the random. Results: Forty pts were identified between 9/2009 - 12/2019 (23 F/17 M; 28 white/7 Asian/5 other/multi; median age 62 y.o.; n = 15 w/tobacco hx). Tumor types: pancreatic (n = 18), colorectal (n = 12), hepatobiliary (n = 7), other (n = 3). SLM vs MLM:13/27; intact vs resected primary = 16/24. Median time from orig cancer dx to onset of MLM = 16 mos (range, 1 to 60 mos). No. of pulm mets at 1st appearance: 1 (n = 7); 2-5 (n = 17); 6-10 (n = 16). Median size of largest pulm met at 1st appearance = 6 mm (range, 0-39 mm); avg growth rate of largest pulm met = 0.18 mm/month (95% CI, 0.08-0.27). Avg growth rate of up to 5 largest lesions (sum) = 0.35 mm/month (95% CI, 0.07-0.64). Median f/u time prior to rx initiation for MLM = 172 days (range, 25-1547 days); 18 pts developed additional mets during their observation period. Rx modalities for LM: surg (n = 6), radiation (n = 18), systemic rx (n = 32). Addn details specific to cancer type, progression patterns, and pt outcomes will be presented at the meeting. Conclusions: The natural hx of LM varies across the spectrum of GI malignancies. Further larger-scale efforts to define patterns of growth of LM for different GI cancers, informed by size, #, and clinical/molecular features, are needed to guide appropriate timing and selection of rx as well as surveillance strategies.
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Affiliation(s)
- Shohei Burns
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Maya Vella
- UCSF Dept of Radiology and Biomedical Imaging, San Francisco, CA
| | - Alan Paciorek
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Li Zhang
- University of California San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | | | - Eric Andrew Collisson
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Mary Uan-Sian Feng
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Robin Kate Kelley
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Margaret A. Tempero
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | | | - Andrew H. Ko
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
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Webb EM, Kallianos KG, Vella M, Straus CM, Bucknor MD, Galvan J, Scoutt LM. Are Women Disproportionately Represented in Education Compared to Other Roles in Academic Radiology? Acad Radiol 2020; 27:1767-1773. [PMID: 32111467 DOI: 10.1016/j.acra.2020.01.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/29/2020] [Accepted: 01/30/2020] [Indexed: 10/24/2022]
Abstract
RATIONALE AND OBJECTIVES Women in academic medicine, and radiology specifically, are underrepresented in departmental leadership roles and achieve fewer professional metrics of success. We have observed, however, that women are more broadly represented in medical education leadership. The purpose of this study was to determine if women in academic radiology are overrepresented in educational scholarship and educational leadership compared to general research scholarship and leadership positions, and to determine if there is any difference in the distribution of women in these roles compared to internal medicine. MATERIALS AND METHODS We performed a PubMed search of education articles in radiology and internal medicine over the last 5 years, and the gender of the authors was determined. Data on gender for authorship of general research topics, departmental leaders, and society leadership was obtained via literature and internet searches and the data was aggregated. Representation ratios (RR of 1.0 = parity) were obtained via risk ratio calculation to compare education versus general scholarship, and the distribution of leadership roles within and between these fields. RESULTS Women make up 28.5% of academic radiologists and 40.1% of academic internists. A higher proportion of education articles were first authored by women than would be expected in both fields with an RR of 1.46 (p < 0.001) in radiology and 1.23 (p < 0.001) in internal medicine. This overrepresentation was significant compared to general research scholarship in both fields (p < 0.001). In both fields, women were overrepresented in the position of Medical Student Director (RR of 1.47 and 1.22, respectively). For Program Directors, women were overrepresented in radiology (RR of 1.12) and underrepresented in internal medicine (RR of 0.69-0.75). Women in radiology were overrepresented in education society leadership (RR = 1.63) compared to general society leadership (0.98, p = 0.001). CONCLUSION We found that women in radiology are overrepresented in authorship of education articles, and in departmental and society education leadership roles. This trend was also seen in internal medicine, suggesting that women are more broadly represented in medical education.
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Abrate A, Sessa F, Sessa M, Campi R, Sebastianelli A, Preto M, Olivero A, Varca V, Benelli A, Pavone C, Serretta V, Vella M, Brunocilla E, Serni S, Trombetta C, Terrone C, Gregori A, Lissiani A, Gontero P, Schiavina R, Gacci M, Simonato A. Segmental ureterectomy vs radical nephroureterectomy in elderly patients treated for upper tract urothelial carcinoma. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33732-0] [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: 11/26/2022] Open
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14
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Vella M, Alexander MD, Mabray MC, Cooke DL, Amans MR, Glastonbury CM, Kim H, Wilson MW, Langston DE, Conrad MB, Hetts SW. Comparison of MRI, MRA, and DSA for Detection of Cerebral Arteriovenous Malformations in Hereditary Hemorrhagic Telangiectasia. AJNR Am J Neuroradiol 2020; 41:969-975. [PMID: 32381546 DOI: 10.3174/ajnr.a6549] [Citation(s) in RCA: 8] [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] [Received: 01/30/2020] [Accepted: 03/26/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Patients with hereditary hemorrhagic telangiectasia (HHT) have a high prevalence of brain vascular malformations, putting them at risk for brain hemorrhage and other complications. Our aim was to evaluate the relative utility of MR imaging and MRA compared with DSA in detecting cerebral AVMs in the HHT population. MATERIALS AND METHODS Of 343 consecutive patients evaluated at the University of California, San Francisco HTT Center of Excellence, 63 met the study inclusion criteria: definite or probable hereditary hemorrhagic telangiectasia defined by meeting at least 2 Curacao criteria or positive genetic testing, as well as having at least 1 brain MR imaging and 1 DSA. MRIs were retrospectively reviewed, and the number of AVMs identified was compared with the number of AVMs identified on DSA. RESULTS Of 63 patients, 45 (71%) had AVMs on DSA with a total of 92 AVMs identified. Of those, 24 (26%) were seen only on DSA; 68 (74%), on both DSA and MR imaging; and 5 additional lesions were seen only on MR imaging. Of the 92 lesions confirmed on DSA, 49 (53.3%) were seen on the 3D-T1 postgadolinium sequence, 52 (56.5%) were seen on the 2D-T1 postgadolinium sequence, 35 (38.0%) were seen on the SWI sequence, 24 (26.1%) were seen on T2 sequence, and 25 (27.2%) were seen on MRA. The sensitivity and specificity of MR imaging as a whole in detecting AVMs then confirmed on DSA were 80.0% and 94.4%, respectively, and the positive and negative predictive values were 97.3% and 65.4%, respectively. CONCLUSIONS This study reinforces the use of MR imaging as a primary screening tool for cerebral AVMs in patients with hereditary hemorrhagic telangiectasia and suggests that 3D-T1 postgadolinium and 2D-T1 postgadolinium performed at 3T are the highest yield sequences.
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Affiliation(s)
- M Vella
- From the Departments of Radiology and Biomedical Imaging (M.V.)
| | - M D Alexander
- Department of Radiology, Division of Interventional Neuroradiology (M.D.A.), University of Utah, Salt Lake City, Utah
| | - M C Mabray
- Department of Radiology, Division of Neuroradiology (M.C.M.), University of New Mexico, Albuquerque, New Mexico
| | - D L Cooke
- Division of Neurointerventional Radiology (D.L.C., M.R.A., D.E.L., S.W.H.)
| | - M R Amans
- Division of Neurointerventional Radiology (D.L.C., M.R.A., D.E.L., S.W.H.)
| | | | - H Kim
- Hereditary Hemorrhagic Telangiectasia Center of Excellence (H.K., D.E.L., M.B.C., S.W.H.).,Anesthesia and Perioperative Care (H.K.), University of California, San Francisco, San Francisco, California
| | - M W Wilson
- Division of Interventional Radiology (M.W.W., M.B.C.)
| | - D E Langston
- Division of Neurointerventional Radiology (D.L.C., M.R.A., D.E.L., S.W.H.).,Hereditary Hemorrhagic Telangiectasia Center of Excellence (H.K., D.E.L., M.B.C., S.W.H.)
| | - M B Conrad
- Division of Interventional Radiology (M.W.W., M.B.C.).,Hereditary Hemorrhagic Telangiectasia Center of Excellence (H.K., D.E.L., M.B.C., S.W.H.)
| | - S W Hetts
- Division of Neurointerventional Radiology (D.L.C., M.R.A., D.E.L., S.W.H.) .,Hereditary Hemorrhagic Telangiectasia Center of Excellence (H.K., D.E.L., M.B.C., S.W.H.)
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Vella M, Meyer CS, Zhang N, Cohen BE, Whooley MA, Wang S, Hope MD. Association of Receipt of Positron Emission Tomography-Computed Tomography With Non-Small Cell Lung Cancer Mortality in the Veterans Affairs Health Care System. JAMA Netw Open 2019; 2:e1915828. [PMID: 31747036 PMCID: PMC6902817 DOI: 10.1001/jamanetworkopen.2019.15828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Positron emission tomography-computed tomography (PET-CT) has been increasingly used in the management of lung cancer, but its association with survival has not been convincingly documented. OBJECTIVE To examine the association of the use of PET-CT with non-small cell lung cancer (NSCLC) mortality in the US Department of Veterans Affairs (VA) health care system from 2000 to 2013. DESIGN, SETTING, AND PARTICIPANTS This cohort study included 64 103 veterans receiving care in the VA health care system who were diagnosed with incident NSCLC between September 2000 and December 2013. Data analysis took place in October 2018. EXPOSURE Use of PET-CT before and/or after diagnosis. MAIN OUTCOMES AND MEASURES All-cause and NSCLC-specific 5-year mortality; secondary outcome was receipt of stage-appropriate treatment. RESULTS A total of 64 103 veterans with the diagnosis of NSCLC were evaluated; 62 838 (98.0%) were men, and 50 584 (78.9%) were white individuals. Among these, 51 844 (80.9%) had a PET-CT performed: 25 735 (40.1%) in the 12 months before diagnosis and 41 242 (64.3%) in the 5 years after diagnosis. Increased PET-CT use (597 of 978 veterans [59.2%] in 2000 vs 3649 of 3915 [93.2%] in 2013) and decreased NSCLC-specific 5-year mortality (879 of 978 veterans [89.9%] in 2000 vs 3226 of 3915 veterans [82.4%] in 2013) were found over time. Increased use of stage-appropriate therapy was also seen over time, from 346 of 978 veterans (35.4%) in 2000 to 2062 of 3915 (52.7%) in 2013 (P < .001). Increased PET-CT use was associated with higher-complexity level VA facilities (26 127 veterans [82.3%] at level 1a vs 1289 [75.2%] at level 3 facilities; P < .001) and facilities with on-site PET-CT compared with facilities without on-site PET-CT (33 081 [82.2%] vs 17 443 [80.3%]; P < .001). Use of PET-CT before diagnosis was associated with increased likelihood of stage-appropriate treatment for all stages of NSCLC (eg, veterans with stage 1 disease: 4837 of 7870 veterans [61.5%] who received PET-CT underwent surgical resection vs 4042 of 7938 veterans [50.9%] who did not receive PET-CT; P < .001) and decreased mortality in a risk-adjusted model among all participants and among veterans undergoing stage-appropriate treatment (all-cause mortality: hazard ratio [HR], 0.78; 95% CI, 0.77-0.79; NSCLC-specific mortality: HR, 0.78; 95% CI, 0.76-0.80). Facilities with on-site PET-CT and higher-complexity level facilities were associated with a mortality benefit, with 16% decreased mortality at level 1a vs level 3 facilities (HR, 0.84; 95% CI, 0.80-0.89) and a 3% decrease in all-cause mortality in facilities with on-site PET-CT (HR, 0.97; 95% CI, 0.96-0.99). CONCLUSIONS In this study, the use of PET-CT among veterans with NSCLC significantly increased from 2000 to 2013, coinciding with decreased 5-year mortality and an increase in stage-appropriate treatment. Variation in use of PET-CT was found, with the highest use at higher-complexity level facilities and those with PET-CT on-site. These facilities were associated with reduced all-cause and NSCLC-specific mortality.
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Affiliation(s)
- Maya Vella
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Craig S. Meyer
- Department of Medicine, University of California, San Francisco
| | - Ning Zhang
- Department of Medicine, University of California, San Francisco
| | - Beth E. Cohen
- Department of Medicine, University of California, San Francisco
- San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Mary A. Whooley
- Department of Medicine, University of California, San Francisco
- San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Sunny Wang
- San Francisco Veterans Affairs Health Care System, San Francisco, California
- Division of Hematology and Oncology, University of California, San Francisco
| | - Michael D. Hope
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
- San Francisco Veterans Affairs Health Care System, San Francisco, California
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McIlveen EC, Wright E, Shaw `M, Edwards J, Vella M, Quasim T, Moug SJ. A prospective cohort study characterising patients declined emergency laparotomy: survival in the ‘NoLap’ population. Anaesthesia 2019; 75:54-62. [DOI: 10.1111/anae.14839] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2019] [Indexed: 02/06/2023]
Affiliation(s)
- E. C. McIlveen
- Department of General Surgery Royal Alexandra Hospital Paisley UK
| | - E. Wright
- Department of General Surgery Royal Alexandra Hospital Paisley UK
| | - `M. Shaw
- School of Medicine University of Glasgow UK
| | - J. Edwards
- Department of Anaesthesia Royal Alexandra Hospital PaisleyUK
| | - M. Vella
- Department of General Surgery Royal Alexandra Hospital Paisley UK
| | - T. Quasim
- Department of Anaesthesia, Critical Care and Pain Medicine Glasgow Royal Infirmary UK
| | - S. J. Moug
- Department of General Surgery Royal Alexandra Hospital Paisley UK
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Vella M, Abela R, Scerri J, Xerri de Caro J. An investigation into the skin surface temperatures using ice bag application and local immersion techniques at the ankle. Physiotherapy 2016. [DOI: 10.1016/j.physio.2016.10.224] [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: 11/25/2022]
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Vella J, Vella M, Cassar K, Azzopardi LM, Serracino-Inglott A, LaFerla G. CP-129 Concentration of ciprofloxacin in tissue of patients suffering from peripheral arterial disease. Eur J Hosp Pharm 2016. [DOI: 10.1136/ejhpharm-2016-000875.129] [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: 11/03/2022] Open
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Johnston A, McCuthcheon C, Vella M, Renwick A. A designated eras nurse consistently achieves ERAS goals with significant cost reductions for the NHS. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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Webb EM, Vella M, Straus CM, Phelps A, Naeger DM. Interpretive versus noninterpretive content in top-selling radiology textbooks: what are we teaching medical students? Acad Radiol 2015; 22:520-6. [PMID: 25601307 DOI: 10.1016/j.acra.2014.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 07/22/2014] [Revised: 10/21/2014] [Accepted: 11/04/2014] [Indexed: 11/28/2022]
Abstract
RATIONALE AND OBJECTIVES There are little data as to whether appropriate, cost effective, and safe ordering of imaging examinations are adequately taught in US medical school curricula. We sought to determine the proportion of noninterpretive content (such as appropriate ordering) versus interpretive content (such as reading a chest x-ray) in the top-selling medical student radiology textbooks. MATERIALS AND METHODS We performed an online search to identify a ranked list of the six top-selling general radiology textbooks for medical students. Each textbook was reviewed including content in the text, tables, images, figures, appendices, practice questions, question explanations, and glossaries. Individual pages of text and individual images were semiquantitatively scored on a six-level scale as to the percentage of material that was interpretive versus noninterpretive. The predominant imaging modality addressed in each was also recorded. Descriptive statistical analysis was performed. RESULTS All six books had more interpretive content. On average, 1.4 pages of text focused on interpretation for every one page focused on noninterpretive content. Seventeen images/figures were dedicated to interpretive skills for every one focused on noninterpretive skills. In all books, the largest proportion of text and image content was dedicated to plain films (51.2%), with computed tomography (CT) a distant second (16%). The content on radiographs (3.1:1) and CT (1.6:1) was more interpretive than not. CONCLUSIONS The current six top-selling medical student radiology textbooks contain a preponderance of material teaching image interpretation compared to material teaching noninterpretive skills, such as appropriate imaging examination selection, rational utilization, and patient safety.
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Affiliation(s)
- Emily M Webb
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, M-391, San Francisco, CA 94143-0628.
| | - Maya Vella
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, M-391, San Francisco, CA 94143-0628
| | | | - Andrew Phelps
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, M-391, San Francisco, CA 94143-0628
| | - David M Naeger
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, M-391, San Francisco, CA 94143-0628
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Amans MR, Cooke DL, Vella M, Dowd CF, Halbach VV, Higashida RT, Hetts SW. Contrast staining on CT after DSA in ischemic stroke patients progresses to infarction and rarely hemorrhages. Interv Neuroradiol 2014; 20:106-15. [PMID: 24556308 DOI: 10.15274/inr-2014-10016] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [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: 07/25/2013] [Accepted: 09/08/2013] [Indexed: 11/12/2022] Open
Abstract
Contrast staining of brain parenchyma identified on non-contrast CT performed after DSA in patients with acute ischemic stroke (AIS) is an incompletely understood imaging finding. We hypothesize contrast staining to be an indicator of brain injury and suspect the fate of involved parenchyma to be cerebral infarction. Seventeen years of AIS data were retrospectively analyzed for contrast staining. Charts were reviewed and outcomes of the stained parenchyma were identified on subsequent CT and MRI. Thirty-six of 67 patients meeting inclusion criteria (53.7%) had contrast staining on CT obtained within 72 hours after DSA. Brain parenchyma with contrast staining in patients with AIS most often evolved into cerebral infarction (81%). Hemorrhagic transformation was less likely in cases with staining compared with hemorrhagic transformation in the cohort that did not have contrast staining of the parenchyma on post DSA CT (6% versus 25%, respectively, OR 0.17, 95% CI 0.017 - 0.98, p = 0.02). Brain parenchyma with contrast staining on CT after DSA in AIS patients was likely to infarct and unlikely to hemorrhage.
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Affiliation(s)
- Matthew R Amans
- Department of Radiology and Biomedical Imaging, University of California; San Francisco, California, USA -
| | - Daniel L Cooke
- Department of Radiology and Biomedical Imaging, University of California; San Francisco, California, USA
| | - Maya Vella
- Department of Radiology and Biomedical Imaging, University of California; San Francisco, California, USA
| | - Christopher F Dowd
- Department of Radiology and Biomedical Imaging, University of California; San Francisco, California, USA
| | - Van V Halbach
- Department of Radiology and Biomedical Imaging, University of California; San Francisco, California, USA
| | - Randall T Higashida
- Department of Radiology and Biomedical Imaging, University of California; San Francisco, California, USA
| | - Steven W Hetts
- Department of Radiology and Biomedical Imaging, University of California; San Francisco, California, USA
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Chircop C, Vella M. Bilateral ptosis with complete ophthalmoplegia. Case Reports 2013; 2013:bcr-2013-008852. [DOI: 10.1136/bcr-2013-008852] [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: 11/04/2022] Open
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Amans MR, Vella M, Cooke DL, Hetts SW. Abstract WP24: Improvement In Collateral Score And Level Of Occlusion Are Early Angiographic Indicators Of The Degree of Infarction In Acute Ischemic Stroke. Stroke 2013. [DOI: 10.1161/str.44.suppl_1.awp24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION:
Brain parenchyma contrast staining on CT after recanalization therapy and digital subtraction angiography (DSA) in large vessel occlusion acute ischemic stroke (LVO-AIS) patients has been demonstrated to be a marker for significant brain injury, possibly indicating blood brain barrier breakdown or no-reflow phenomena at the capillary level. Most often stained parenchyma undergoes infarction. We evaluated several DSA parameters in order to determine if findings on DSA at the time of LVO-AIS intervention can predict postintervention parenchymal contrast staining on CT and, thus, serve as early prognostic factors for brain infarction.
HYPOTHESIS:
Point of cerebral arterial occlusion, TICI score, and degree of pial collateraliation correlate with presence of parenchymal contrast staining on post-intervention CT in LVO-AIS patients.
METHODS:
Our institution’s CHR approved this analysis of imaging and patient charts. We reviewed 17 years of LVO-AIS intervention at our institution, and 67 patients met inclusion criteria. Angiograms were evaluated for level of occlusion, TICI scores before and after intervention, and level of collateralization before and after intervention. Statistical analysis was performed using Fisher’s exact test and ANOVA.
RESULTS:
More proximal sites of cerebral arterial occlusion were more likely patients to have post-intervention staining (p=0.08). Preprocedure TICI, postprocedure TICI and improvement in TICI score did not predict contrast staining on post procedure CT (p=0.34, 0.54, and 0.52). Preprocedure collateral score, post procedure collateral score were similarly not predictive (p=0.28 and 0.93). Decreasing collateral score (i.e., increased antegrade flow with decreased need for collateral supply) was predictive of contrast staining (p=0.09).
CONCLUSION:
Improvement in pial collateral score was more predictive of postprocedure contrast staining than was change in TICI grade, and thus may serve as a complement to TICI in the assessment of revascularization efficacy at the time of stroke intervention.
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Mastoroudes H, Giarenis I, Cardozo L, Srikrishna S, Vella M, Robinson D, Kazkaz H, Grahame R. Prolapse and sexual function in women with benign joint hypermobility syndrome. BJOG 2012; 120:187-192. [DOI: 10.1111/1471-0528.12082] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2012] [Indexed: 11/26/2022]
Affiliation(s)
- H Mastoroudes
- King's College Hospital NHS Foundation Trust; London UK
| | - I Giarenis
- King's College Hospital NHS Foundation Trust; London UK
| | - L Cardozo
- King's College Hospital NHS Foundation Trust; London UK
| | - S Srikrishna
- King's College Hospital NHS Foundation Trust; London UK
| | - M Vella
- King's College Hospital NHS Foundation Trust; London UK
| | - D Robinson
- University College Hospital NHS Foundation Trust; London UK
| | - H Kazkaz
- University College Hospital NHS Foundation Trust; London UK
| | - R Grahame
- University College Hospital NHS Foundation Trust; London UK
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Vella M, Cardozo L, Duckett J. Prognostic research and its potential role in modern gynaecology: a call for more prognostic research in urogynaecology. J OBSTET GYNAECOL 2012; 32:730-2. [PMID: 23075342 DOI: 10.3109/01443615.2012.707257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Over the last 30 years, many researchers have focussed on therapeutic and aetiological studies. Randomised controlled trials (RCT) are considered the 'gold standard' in research circles ( Ward et al. 2004 ). Prognostic research has been neglected probably due to a combination of a lack of perception of its importance and also a failure to produce good quality trials. The word 'prognosis' means the ability to foresee or predict an outcome or an event. Prognostic research in medicine is the ability to predict the likelihood of outcomes from a number of clinical variables. There are two main forms of prognostic research. One form identifies the prognostic value of a single risk factor (e.g. a tumour marker). The second one focuses on the development of a model based on multiple variables and is called multivariable prognostic modelling. The planning and powering of prognostic studies is managed differently from traditional randomised controlled trials.
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Affiliation(s)
- M Vella
- Department of Urogynaecology, Kings College Hospital NHS Foundation Trust, London, UK
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Lu W, Bacino CA, Richards BS, Alvarez C, VanderMeer JE, Vella M, Ahituv N, Sikka N, Dietz FR, Blanton SH, Hecht JT. Studies of TBX4 and chromosome 17q23.1q23.2: an uncommon cause of nonsyndromic clubfoot. Am J Med Genet A 2012; 158A:1620-7. [PMID: 22678995 DOI: 10.1002/ajmg.a.35418] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 03/21/2012] [Indexed: 01/28/2023]
Abstract
Clubfoot is a common birth defect characterized by inward posturing and rigid downward displacement of one or both feet. The etiology of syndromic forms of clubfoot is varied and the causes of isolated clubfoot are not well understood. A microduplication of 2.2 Mb on chromosome 17q23.1q23.2 which includes T-box 4 (TBX4), a hindlimb-specific gene, and 16 other genes was recently identified in 3 of 66 families reported as nonsyndromic clubfoot, but additional non-foot malformations place them in the syndromic clubfoot category. Our study assesses whether variation in or around TBX4 contributes to nonsyndromic clubfoot. To determine whether this microduplication was a common cause of nonsyndromic clubfoot, 605 probands (from 148 multiplex and 457 simplex families) with nonsyndromic clubfoot were evaluated by copy number and oligonucleotide array CGH testing modalities. Only one multiplex family (0.68%) that had 16 with clubfoot and 9 with other foot anomalies, had a 350 kb microduplication, which included the complete duplication of TBX4 and NACA2 and partial duplication of BRIP1. The microduplication was transmitted in an autosomal dominant pattern and all with the microduplication had a range of phenotypes from short wide feet and toes to bilateral clubfoot. Minimal evidence was found for an association between TBX4 and clubfoot and no pathogenic sequence variants were identified in the two known TBX4 hindlimb enhancer elements. Altogether, these results demonstrate that variation in and around the TBX4 gene and the 17q23.1q23.2 microduplication are not a frequent cause of this common orthopedic birth defect and narrows the 17q23.1q23.2 nonsyndromic clubfoot-associated region.
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Affiliation(s)
- W Lu
- Department of Pediatrics, University of Texas Medical School at Houston, Houston, Texas 77030, USA
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Vella M, Robinson D, Cardozo L, Mastoroudes H, Vig M. The bladder diary: do women perceive it as a useful investigation? Eur J Obstet Gynecol Reprod Biol 2012; 162:221-3. [DOI: 10.1016/j.ejogrb.2012.02.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 12/22/2011] [Accepted: 02/09/2012] [Indexed: 11/27/2022]
Affiliation(s)
- M Vella
- Department of Urogynaecology, King's College Hospital, Denmark Hill, London SE5 9RS, United Kingdom.
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Vella M, Duckett J. An unusual case of surgical emphysema following TVT. J OBSTET GYNAECOL 2011; 31:195-6. [PMID: 21281050 DOI: 10.3109/01443615.2010.529963] [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: 11/13/2022]
Affiliation(s)
- M Vella
- Department of Urogynaecology King's College Hospital, London, UK.
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Vella M, Cartwright R, Cardozo L, Parsons M, Madge S, Burns Y. Prevalence of incontinence and incontinence-specific quality of life impairment in women with cystic fibrosis. Neurourol Urodyn 2009; 28:986-9. [DOI: 10.1002/nau.20732] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Savona-Ventura C, Buttigieg G, Grima S, Vella M. Anthropomorphic characteristics as obstetric risk determinants. International Journal of Risk and Safety in Medicine 2008. [DOI: 10.3233/jrs-2008-0438] [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]
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Dean G, Yeo TW, Goris A, Taylor CJ, Goodman RS, Elian M, Galea-Debono A, Aquilina A, Felice A, Vella M, Sawcer S, Compston D. HLA-DRB1 and multiple sclerosis in Malta. Neurology 2007; 70:101-5. [DOI: 10.1212/01.wnl.0000284598.98525.d7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [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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Duckett J, Aggarwal I, Patil A, Vella M. Effect of tension-free vaginal tape position on the resolution of irritative bladder symptoms in women with mixed incontinence. Int Urogynecol J 2007; 19:237-9. [PMID: 17571197 DOI: 10.1007/s00192-007-0409-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [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: 03/23/2007] [Accepted: 05/21/2007] [Indexed: 10/23/2022]
Abstract
The aim of this study was to determine whether the position of the tension-free vaginal tape (TVT) has an effect on the resolution of irritative symptoms in women undergoing the TVT operation. Initial audit suggested that more distally placed tapes were more likely to result in the resolution of irritative symptoms. An appropriately powered study was designed to test this theory. Seventy-seven women with urodynamic evidence of detrusor overactivity and urodynamic stress incontinence underwent a transperineal ultrasound scan to ascertain the position of the tape after a TVT. The tape was categorised as proximal, middle or distal urethra. The resolution of irritative symptoms was assessed compared to the TVT position. Forty-five women had distal tapes, 30 had mid-urethral tapes and two had proximal tapes. Women with the TVT placed on the distal urethra were no more likely to experience resolution of their irritative symptoms than women with tapes on the mid-urethra (p > 0.05). Placement of the TVT on any one part of the urethra is not more likely to result in resolution of irritative bladder symptoms.
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Affiliation(s)
- J Duckett
- Medway Maritime Hospital, Windmill Road, Gillingham, Kent ME7 5NY, UK.
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Duckett J, Aggarwal I, Basu M, Vella M, Patil A. The value of cystoscopy and bladder biopsy taken at the time of tension-free vaginal tape insertion. J OBSTET GYNAECOL 2007; 27:297-9. [PMID: 17464816 DOI: 10.1080/01443610701227935] [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] [Indexed: 10/23/2022]
Abstract
The primary aim of this study was to determine if a cystoscopy performed at the time of a tension-free vaginal tape (TVT) insertion is useful in finding unexpected pathology. A secondary outcome measure was to assess whether a bladder biopsy and cystoscopy performed during the TVT operation provide useful information about the outcome of surgery. The findings in 100 consecutive women were reviewed. A total of 42 women demonstrated mixed detrusor overactivity (DO) and urodynamic stress incontinence (USI); 32 women had abnormal biopsies. Women with DO were no more likely to have abnormal bladder biopsies than women without DO (p > 0.05). An abnormal bladder biopsy or cystoscopy failed to predict postoperative irritable symptoms (p > 0.05). The presence of preoperative DO correctly predicted postoperative irritable symptoms (p < 0.01). Cystoscopic abnormalities were noted in 14 women including one carcinoma, and one case of dysplasia was discovered on biopsy. In five women, the cystoscopy showed a bladder perforation. Cystoscopy should be performed in all women undergoing continence procedures.
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Affiliation(s)
- J Duckett
- Department of Obstetrics and Gynaecology, Medway Maritime Hospital, Gillingham, Kent, UK.
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Abstract
OBJECTIVE To assess the tolerability and efficacy of duloxetine in a nontrial situation. DESIGN Prospective observational study. SETTING Urogynaecology Unit, District General Hospital, UK. POPULATION Two hundred and twenty-two women with a diagnosis of urodynamic stress incontinence (USI) or mixed USI and detrusor overactivity (DOA) took duloxetine for 4 weeks. METHODS The results of therapy were assessed with a Patient Global Impression of Improvement (PGI-I) questionnaire. One hundred and forty-eight (67%) women were initially treated with 40 mg twice a day, 67 (30%) women were treated with an escalating dose initially at 20 mg twice a day increasing to 40 mg twice a day after 2 weeks and seven (3%) women were started on a dose of 20 mg twice a day which they continued. MAIN OUTCOME MEASURES Discontinuation rates and PGI-I scores. RESULTS Overall 146/222 (66%) women discontinued therapy due to adverse effects or lack of efficacy. Significantly more women starting on the 40 mg twice a day dose stopped due to adverse effects when compared with the escalating dose (P < 0.025). Of the women who tolerated therapy, 80 out of 120 (67%) had a PGI-I score indicating an improvement. However, the overall rate of improvement was 37%. PGI-I scores and discontinuation rates were not significantly different between the group with USI and the group with mixed USI and DOA (P > 0.05). CONCLUSION In a nontrial situation duloxetine is poorly tolerated. Introducing an escalating dose may improve tolerability. A similar number of women with USI and mixed incontinence had a PGI-I score indicating improvement.
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Affiliation(s)
- J R A Duckett
- Department of Obstetrics and Gynaecology, Medway Maritime Hospital, Gillingham, Kent, UK.
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Abstract
Urine is a complex balanced solution containing dissociated and non-dissociated solutes. Any variation in urine saturation grade (number of crystals dissolved in a volume of urine), urinary pH and the concentration of crystallization inhibitors can break the normal existing balance and lead to urolithiasis. In the present article we analyze the principal mechanisms (absorptive, renal, resorptive) of hypercalciuria. It will be also shown how heredity directly influences the clinical aspects of cystine, xanthine and oxalate lithiasis and how diet, in association with metabolic disorders, interferes in uric acid and oxalate stone formation. Finally, we report on the roles of urinary tract malformations, urinary tract infections and drugs in the clinical characterization of urolithiasis.
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Affiliation(s)
- M Vella
- Department of Urology, University of Palermo, Palermo, Italy
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Abstract
Based on our own experiences and a review of the recent literature, this article evaluates recent developments in predicting outcomes and failures of shockwave lithotripsy when treating patients with urinary tract stones. After a detailed MEDLINE research, the authors identified several variables that influence and predict extracorporeal shockwave lithotripsy (ESWL) success. These variables may be categorized as stone variables, patient variables and operator variables. Only multivariate analysis on a large number of homogenous patients may offer an objective evaluation of the factors conditioning ESWL outcome.
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Affiliation(s)
- M Vella
- Extracorporeal Lithotripsy Division, University of Palermo, Palermo, Italy.
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Vella M, Robinson D, Cardozo L, Cartwright R. New developments in the treatment of urinary incontinence. MINERVA UROL NEFROL 2006; 58:299-310. [PMID: 17268395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Urinary incontinence is a common and distressing condition. The two main types of incontinence in the developed world are urodynamic stress incontinence and detrusor overactivity. Recent advances have focussed on the development of a drug for stress incontinence and on the production of newer more M3 specific anticholinergics. Duloxetine, a relatively balanced and potent serotonin noradrenaline reuptake inhibitor, is the first drug to be licensed for stress incontinence. Until recently, the pharmacological treatment options for stress urinary incontinence (SUI) have been limited to the off-the label use of several medications including oestrogens, alfa adrenergic receptor agonists, beta adrenergic receptor antagonists, tricyclic antidepressants and anticholinergics. However, these medications have questionable efficacy which may be associated with adverse effects. Randomised trials have shown duloxetine to be effective at reducing incontinence episode frequency and improving quality of life scores. Hence medical management has now become a more realistic option for treatment of patients with sui. Recently newer more M3 receptor selective anticholinergics have come on to the market. Their increased bladder receptor selectivity implies that they have improved efficacy with a lower side effect profile. Both solifenacin and more recently darifenacin have been marketed and have the above described properties. The oxybutynin patch is now also available adding a new route of delivery. Because it is absorbed transdermally, its manufacturers claim it also has a better efficacy/tolerability ratio then conventional oxybutynin. This review article gives a detailed description of these new pharmacologic developments.
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Affiliation(s)
- M Vella
- Department of Urogynaecology, King's College Hospital , Denmark Hill, London, UK.
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Ruggirello A, Serretta V, Galuffo A, Vella M, Pavone C, Macaluso MP. Microwave-Induced Hyperthermia and Cytostatic Agent for Superficial Bladder Cancer. Urologia 2005. [DOI: 10.1177/039156030507200404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The efficacy and local toxicity of the intravesical combination of microwave-induced hyperthermia with a cytostatic agent in patients affected by superficial bladder cancer is presented. Between 1994 and 2002, two studies were performed on ablative and adjuvant intravesical thermo-chemotherapy. The ablative study demonstrated complete tumor eradication in 88% of patients who should have undergone cystectomy due to diffuse multiple papillary tumors non-responsive TUR and intravescical adjuvant therapy. In a randomized study, comparing adjuvant thermo-chemotherapy vs. standard chemotherapy with mitomycin C, recurrence-free survival analysis at 24 months revealed a significant difference in favor of thermo-chemotherapy. Our preliminary experience confirmed that local side effects, mainly cystitis, suprapubic pain and thermal reaction of the posterior bladder wall, were transitory and did not require treatment interruption.
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Affiliation(s)
- A. Ruggirello
- Sezione di Urologia, Dipartimento di Medicina Interna, Malattie Cardiovascolari e Nefrourologiche, Università di Palermo
| | - V. Serretta
- Sezione di Urologia, Dipartimento di Medicina Interna, Malattie Cardiovascolari e Nefrourologiche, Università di Palermo
| | - A. Galuffo
- Sezione di Urologia, Dipartimento di Medicina Interna, Malattie Cardiovascolari e Nefrourologiche, Università di Palermo
| | - M. Vella
- Sezione di Urologia, Dipartimento di Medicina Interna, Malattie Cardiovascolari e Nefrourologiche, Università di Palermo
| | - C. Pavone
- Sezione di Urologia, Dipartimento di Medicina Interna, Malattie Cardiovascolari e Nefrourologiche, Università di Palermo
| | - M. Pavone Macaluso
- Sezione di Urologia, Dipartimento di Medicina Interna, Malattie Cardiovascolari e Nefrourologiche, Università di Palermo
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Vella M, Cardozo L. New developments in the management of urinary incontinence. Minerva Ginecol 2005; 57:485-500. [PMID: 16205595] [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] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Urinary incontinence is a common and distressing condition known to adversely affect quality of life. In this article the authors aim to highlight developments in the methods of classification, investigation and the treatment of incontinence. It gives a detailed description of the newer drugs and their mode of action, that have recently come on to the market. These include duloxetine for the treatment of stress incontinence and the newer M3 selective antagonists. It also describes the latest surgical procedures, for example the newer slings and injectables used to treat stress incontinence. They are compared with the standard forms of treatment used and the evidence in favour and against these have been given.
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Affiliation(s)
- M Vella
- Department of Urogynaecology, King's College Hospital, London, UK.
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Pavone C, Serretta V, Galuffo A, Vella M, Allegro R, Morello V, Porcasi R, Tomasino R, Pavone-Macaluso M. The Prognostic Value of P53 in Predicting of Bladder Carcinoma. Urologia 2005. [DOI: 10.1177/039156030507200143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The prognostic value of p53 in predicting recurrence and progression of superficial transitional cell carcinoma of the bladder (TCCB) is still uncertain. Materials and methods P53 expression was retrospectively assessed in 160 patients. At a median follow-up of 45 months, (up to years) 84 patients (53%) recurred and 13 (8%) progressed. Adjuvant intravesical chemotherapy after TUR was adopted in 51 patients (32%). The correlations between p53 and G-grade, T-category, risk of recurrence and progression, and intravesical chemotherapy were investigated. Similarly, the correlations between variations in grade and stage at recurrence and modifications in p53 expression were also studied. Results Seventy-nine patients (49%) were negative for p53. P53 was expressed in 84% of G3 tumors and in 65% of T1 lesions. A significant correlation between p53 expression and G-grade (p<0.0001) and T-category (p<0.0001) of the tumor was found. Eight-four patients (53%) recurred and 13 (8%) progressed. No correlation was found with recurrence and response to intravesical chemotherapy. P53 expression resulted correlated to progression in T1 tumors (although was not independent from G-grade). Conclusion According to our experience, p53 expression is not independent from grade and stage of superficial TCCB. A significant correlation between p53 expression and progression, not independent from G-grade, was detected only in T1 tumors.
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Affiliation(s)
- C. Pavone
- Sezione di Urologia, Dipartimento di Medicina Interna, Malattie Cardiovascolari e Nefro-Urologiche
| | - V. Serretta
- Sezione di Urologia, Dipartimento di Medicina Interna, Malattie Cardiovascolari e Nefro-Urologiche
| | - A. Galuffo
- Sezione di Urologia, Dipartimento di Medicina Interna, Malattie Cardiovascolari e Nefro-Urologiche
| | - M. Vella
- Sezione di Urologia, Dipartimento di Medicina Interna, Malattie Cardiovascolari e Nefro-Urologiche
| | - R. Allegro
- Sezione di Urologia, Dipartimento di Medicina Interna, Malattie Cardiovascolari e Nefro-Urologiche
| | - V. Morello
- Istituto di Anatomia Patologica, Università di Palermo, Palermo
| | - R. Porcasi
- Istituto di Anatomia Patologica, Università di Palermo, Palermo
| | - R.M. Tomasino
- Istituto di Anatomia Patologica, Università di Palermo, Palermo
| | - M. Pavone-Macaluso
- Sezione di Urologia, Dipartimento di Medicina Interna, Malattie Cardiovascolari e Nefro-Urologiche
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Vella M, MacKenzie S, Young IE, Molloy RG, O'Dwyer PJ. Impact of video colonoscopy on stage and outcome of patients with symptomatic colorectal cancer. Surg Endosc 2004; 18:1268-71. [PMID: 15164279 DOI: 10.1007/s00464-003-9125-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 05/14/2003] [Accepted: 12/09/2003] [Indexed: 11/28/2022]
Abstract
BACKGROUND Double-contrast barium enema still is regarded by many as the investigation of choice for patients with large bowel symptoms. The aim of this study was to compare the stage and outcome of patients with colorectal cancer diagnosed by video colonoscopy (VC) and barium enema (BE) in a single institution. METHODS Between July 1997 and December 2001, data were gathered prospectively in a series of 489 patients presenting consecutively with symptomatic colorectal cancer. Selection of patients for either VC or BE investigation was made by the clinician who examined the patient in the clinic. Of the 489 patients, 82 were excluded because they presented acutely or other methods were used for the diagnosis. RESULTS A diagnosis of colorectal cancer was determined by VC for 292 patients and by BE for 115 patients. The patients in both groups were similar in terms of age, gender, and site of disease. Stage 1 disease (T1/2NO) was diagnosed for 87 (29.8%) patients in the VC group, as compared with 10 (8.7%) in the BE group (p < 0.0001). Early colorectal cancer (T1) was diagnosed for 43 patients in the VC group as compared to 1 patient in the BE group (p < 0.0001). During a median follow-up period of 33 months, 8.2% of the patients in the VC group had experienced recurrence after curative resection, as compared with 17.4% of the patients in the BE group p = 0.018). Freedom from disease (p = 0.02) and overall survival (p = 0.03) were significantly increased in the VC group. CONCLUSIONS Videocolonoscopy used as the investigation of choice for patients with large bowel symptoms detects colorectal cancer at an earlier stage and has a significant impact on the outcome for this condition.
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Affiliation(s)
- M Vella
- University Department of Surgery, Western Infirmary, G11 6NT, Glasgow, UK.
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MacKenzie S, Norrie J, Vella M, Drummond I, Walker A, Molloy R, Galloway DJ, O'Dwyer PJ. Randomized clinical trial comparing consultant-led or open access investigation for large bowel symptoms. Br J Surg 2003; 90:941-7. [PMID: 12905545 DOI: 10.1002/bjs.4212] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Referral of patients with large bowel symptoms is common and increasing. Currently most of these referrals are assessed at an outpatient clinic to determine the need and priority for investigation. METHODS Over 21 months, 1131 patients referred by the general practitioner with large bowel symptoms were randomized. Patients in the consultant-led group were assessed by surgeons with a colorectal interest while those in the open access group underwent colonoscopy if they were 55 years or older and flexible sigmoidoscopy if younger. RESULTS The most common symptom among referred patients was rectal bleeding (69.1 per cent) followed by change in bowel habit (48.8 per cent) and abdominal pain (32.3 per cent). There was a significant trend (P < 0.001) for patients in the consultant-led to have more investigations, and more patients in this group had no investigations (P < 0.001). Despite this, the percentage of patients with colonic or other pathology diagnosed was the same in both groups, 63.6 per cent in the consultant-led group compared with 61.8 per cent in the open access group (P = 0.558). Likewise the percentage of patients with cancer or other significant pathology was similar in both groups (13.9 versus 15.4 per cent; P = 0.532). The mean(s.d.) time to diagnose cancer or other significant pathology was 55.1(39.2) days in the consultant-led group compared with 57.4(33.6) days in the open access group (P = 0.514). The cost per patient was almost pound 105 more for patients in the consultant-led group. CONCLUSION Patients referred by the general practitioner with large bowel symptoms should go directly to a properly managed and staffed open access large bowel investigation unit. This would enable most patients to have their investigations completed at one hospital attendance.
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Affiliation(s)
- S MacKenzie
- University Department of Surgery, Western Infirmary and Gartnavel General Hospital, Glasgow, UK
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Vella M, Slater E, Abu-Safieh L, Hussein AS, Greenwell P. The application of databases and PCR in the cloning of glycosidase genes from the protozoan Tritrichomonas foetus. Mol Biotechnol 2000; 15:1-10. [PMID: 10911617 DOI: 10.1385/mb:15:1:1] [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] [Indexed: 11/11/2022]
Abstract
Conserved sequence amplification (CSA) has been used to obtain sequence data for two glycosidase genes from the primitive eukaryote Tritrichomonas foetus. Few genes have been cloned from this organism, and there is little information concerning protein sequence. CSA is reliant on the use of database searches to identify short sequences of 3-9 amino acids conserved within a protein across a wide range of species. PCR primers are then constructed based on this sequence data and the DNA is amplified and sequenced. In the case of the beta-galactosidase gene, N-terminal amino acid sequence data were used to construct a primer that replaced the upstream primer to ensure the amplified product was related to beta-D-galactosidase. CSA was also applied to the gene encoding the enzyme beta-N-acetyl-D-glucosaminidase from T. foetus, but in this case a segment of DNA was amplified, which, if correct, should contain a third conserved motif. The products of the CSA were sequenced, and the data obtained were compared to data in the SwissProt database. The results obtained suggest that this approach is useful for the cloning of genes to obtain novel sequence data from organisms where little genetic information is available.
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Abstract
The work presented in this paper describes the purification and properties of a beta-galactosidase from the protozoan Tritrichomonas foetus. An inexpensive and straightforward method for extraction of the enzyme involving ammonium sulphate precipitation, ion exchange and affinity chromatography resulted in a high level of purification. After purification beta-N-acetylglucosaminidase was the only enzyme present as a contaminant at a significant level. The beta-galactosidase isolated had a pH optimum of 5.8. The Km determined at pH 5.8 was found to be 2.2 mM. Interesting results were obtained when studies were carried out to determine the effect of various metal ions on enzyme activity. Of the metal ions used in this study only manganese ions were found to activate the enzyme. This seems to be a characteristic of trichomonad enzymes, as N-acetyl-beta-glucosaminidase, alpha-galactosidase and N-acetyl-alpha-galactosaminidase are also activated by manganese ions. The strongest inhibition was recorded with lead and to a lesser extent by zinc. The result with lead is not unexpected as the heavy metal is known to cause irreversible inhibition by binding to the amino-acid backbone of the enzyme. The result with zinc is interesting as high levels of zinc are present and trichomonads are known to be apathogenic in semen. The purified beta-galactosidase was found to have the capacity to hydrolyse lactose (Gal beta1-4 Glc), lacto-N-biose 1 (Gal beta1-3 GlcNAc) and N-acetyllactosamine (Gal beta1-4 GlcNAc). When the enzyme was applied to a non-denaturing polyacrylamide gel a single band was observed when stained with Coomassie brilliant blue. This band coincided with that obtained when the gel was stained with p-nitrophenyl beta-galactopyranoside. When the same gel was incubated with p-nitrophenyl N-acetyl beta-glucopyranoside a band was detected which did not coincide with that of beta-galactosidase. Since the beta-N-acetylglucosaminidase enzyme does not move to the same position on a non-denaturing gel as the beta-galactosidase, we will use this technique to isolate the latter enzyme and determine the N-terminal sequence as a prelude to cloning and further study of the gene.
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Affiliation(s)
- M Vella
- School of Biological and Health Sciences, University of Westminster, London, UK
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Cigna RM, Vella M, Rosella V, De Grazia E. [Conservative treatment of dysplastic multicystic kidney]. Minerva Pediatr 1997; 49:193-6. [PMID: 9340480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Recent developments regarding the conservative management of multicystic dysplastic kidney disease (MDKD) have shown a reduction in the well-established practice of elective surgical treatment. It has been seen that in the majority of cases the evolution of MDKD is either partial or complete atrophy. The incidence of complications due to MDKD is very low. The aim was to study the ultrasound changes of MDKD in a group of patients from 1990, since this date the elective surgical procedure had been eliminated. MATERIALS AND METHODS This group consisted of 16 patients. The diagnosis in each patient was confirmed by ultrasound and isotopic examinations. Other investigations were performed where there was a suspect of associated contralateral renal abnormalities or when a urinary tract infection occurred. RESULTS Ultrasound follow-up revealed: no enlargement whatsoever in the kidney size in any patient; in 10 patients a reduction in the size of the MDK; in 3 patients a complete atrophy of MDK; in 3 patients there was no change at all. Five patients were found to have contralateral renal abnormalities. Compensatory hypertrophy of the contralateral kidney was present in all patients. No complications occurred. A nephrectomy was performed only in one patient aged 6 due to the express wishes of his parents. CONCLUSIONS The results agree with recently published literature that routine surgical removal of the MDK is unnecessary.
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Affiliation(s)
- R M Cigna
- Cattedra di Chirurgia Pediatrica, Università degli Studi, Palermo
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Vella M, Camilleri G, Trapani DD, Lamartina M, Pavone-Macaluso M. Patterns urodinamici in pazienti con prostatodinia. Urologia 1995. [DOI: 10.1177/039156039506200422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Authors report their experience on 24 patients with prostatodynia. The Adynamic alterations, which occur in most cases, show the usefulness of cystomanometry and pressure-flow study for providing a better nosological picture and therapeutic management.
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Affiliation(s)
- M. Vella
- Istituto di Urologia - Università di Palermo
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Abstract
Survey data from several countries indicate that many people believe that hypnosis may increase the accuracy of an eyewitness's memory; most experimental research, however, suggests that this belief is inaccurate. This study examined whether the belief could influence judgments of guilt and innocence in a simulated criminal trial. The results indicated that British undergraduates were more likely to find a male defendant guilty when told that the testimony against him had been elicited under hypnosis. Results concerning a nonhypnotic memory facilitation technique were found to be inconclusive, and the salience of hypnotically elicited testimony was ruled out as a contributory element.
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Affiliation(s)
- G F Wagstaff
- Department of Psychology, University of Liverpool, United Kingdom
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