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Wraight TI, Namachivayam SP, Maiden MJ, Erickson SJ, Oberender F, Singh P, Gard J, Ganeshalingham A, Millar J. Trends in Childhood Oncology Admissions to ICUs in Australia and New Zealand. Pediatr Crit Care Med 2023; 24:e487-e497. [PMID: 37133322 DOI: 10.1097/pcc.0000000000003268] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVES There are few robust, national-level reports of contemporary trends in pediatric oncology admissions, resource use, and mortality. We aimed to describe national-level data on trends in intensive care admissions, interventions, and survival for children with cancer. DESIGN Cohort study using a binational pediatric intensive care registry. SETTING Australia and New Zealand. PATIENTS Patients younger than 16 years, admitted to an ICU in Australia or New Zealand with an oncology diagnosis between January 1, 2003, and December 31, 2018. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We examined trends in oncology admissions, ICU interventions, and both crude and risk-adjusted patient-level mortality. Eight thousand four hundred ninety admissions were identified for 5,747 patients, accounting for 5.8% of PICU admissions. Absolute and population-indexed oncology admissions increased from 2003 to 2018, and median length of stay increased from 23.2 hours (interquartile range [IQR], 16.8-62 hr) to 38.8 hours (IQR, 20.9-81.1 hr) ( p < 0.001). Three hundred fifty-seven of 5,747 patients died (6.2%). There was a 45% reduction in risk-adjusted ICU mortality, which reduced from 3.3% (95% CI, 2.1-4.4) in 2003-2004 to 1.8% (95% CI, 1.1-2.5%) in 2017-2018 ( p trend = 0.02). The greatest reduction in mortality seen in hematological cancers and in nonelective admissions. Mechanical ventilation rates were unchanged from 2003 to 2018, while the use of high-flow nasal prong oxygen increased (incidence rate ratio, 2.43; 95% CI, 1.61-3.67 per 2 yr). CONCLUSIONS In Australian and New Zealand PICUs, pediatric oncology admissions are increasing steadily and such admissions are staying longer, representing a considerable proportion of ICU activity. The mortality of children with cancer who are admitted to ICU is low and falling.
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Affiliation(s)
- Tracey I Wraight
- Intensive Care Unit, Royal Children's Hospital, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Siva P Namachivayam
- Intensive Care Unit, Royal Children's Hospital, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
- Intensive Care Unit, Barwon Health, Geelong, VIC, Australia
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia
- Paediatric Critical Care, Perth Children's Hospital, Perth, WA, Australia
- Paediatric Intensive Care Unit, Monash Children's Hospital, Melbourne, VIC, Australia
- Department of Paediatrics, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
- Intensive Care Unit, Sydney Children's Hospital, Randwick, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
- Clinical Haematology Department, The Royal Children's Hospital, Melbourne, VIC, Australia
- Monash Simulation, Monash Health, Clayton, VIC, Australia
- Department of Medicine, Monash University, Melbourne, VIC, Australia
- Paediatric Intensive Care Unit, Starship Children's Hospital, Auckland, New Zealand
- Centre for Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society, Melbourne, VIC, Australia
| | - Matthew J Maiden
- Intensive Care Unit, Royal Children's Hospital, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
- Intensive Care Unit, Barwon Health, Geelong, VIC, Australia
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia
- Paediatric Critical Care, Perth Children's Hospital, Perth, WA, Australia
- Paediatric Intensive Care Unit, Monash Children's Hospital, Melbourne, VIC, Australia
- Department of Paediatrics, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
- Intensive Care Unit, Sydney Children's Hospital, Randwick, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
- Clinical Haematology Department, The Royal Children's Hospital, Melbourne, VIC, Australia
- Monash Simulation, Monash Health, Clayton, VIC, Australia
- Department of Medicine, Monash University, Melbourne, VIC, Australia
- Paediatric Intensive Care Unit, Starship Children's Hospital, Auckland, New Zealand
- Centre for Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society, Melbourne, VIC, Australia
| | - Simon J Erickson
- Paediatric Critical Care, Perth Children's Hospital, Perth, WA, Australia
| | - Felix Oberender
- Paediatric Intensive Care Unit, Monash Children's Hospital, Melbourne, VIC, Australia
- Department of Paediatrics, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
| | - Puneet Singh
- Intensive Care Unit, Sydney Children's Hospital, Randwick, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
| | - Jye Gard
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | | | - Johnny Millar
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
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Emeriaud G, López-Fernández YM, Iyer NP, Bembea MM, Agulnik A, Barbaro RP, Baudin F, Bhalla A, Brunow de Carvalho W, Carroll CL, Cheifetz IM, Chisti MJ, Cruces P, Curley MAQ, Dahmer MK, Dalton HJ, Erickson SJ, Essouri S, Fernández A, Flori HR, Grunwell JR, Jouvet P, Killien EY, Kneyber MCJ, Kudchadkar SR, Korang SK, Lee JH, Macrae DJ, Maddux A, Modesto I Alapont V, Morrow BM, Nadkarni VM, Napolitano N, Newth CJL, Pons-Odena M, Quasney MW, Rajapreyar P, Rambaud J, Randolph AG, Rimensberger P, Rowan CM, Sanchez-Pinto LN, Sapru A, Sauthier M, Shein SL, Smith LS, Steffen K, Takeuchi M, Thomas NJ, Tse SM, Valentine S, Ward S, Watson RS, Yehya N, Zimmerman JJ, Khemani RG. Executive Summary of the Second International Guidelines for the Diagnosis and Management of Pediatric Acute Respiratory Distress Syndrome (PALICC-2). Pediatr Crit Care Med 2023; 24:143-168. [PMID: 36661420 PMCID: PMC9848214 DOI: 10.1097/pcc.0000000000003147] [Citation(s) in RCA: 47] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES We sought to update our 2015 work in the Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2) guidelines for the diagnosis and management of pediatric acute respiratory distress syndrome (PARDS), considering new evidence and topic areas that were not previously addressed. DESIGN International consensus conference series involving 52 multidisciplinary international content experts in PARDS and four methodology experts from 15 countries, using consensus conference methodology, and implementation science. SETTING Not applicable. PATIENTS Patients with or at risk for PARDS. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Eleven subgroups conducted systematic or scoping reviews addressing 11 topic areas: 1) definition, incidence, and epidemiology; 2) pathobiology, severity, and risk stratification; 3) ventilatory support; 4) pulmonary-specific ancillary treatment; 5) nonpulmonary treatment; 6) monitoring; 7) noninvasive respiratory support; 8) extracorporeal support; 9) morbidity and long-term outcomes; 10) clinical informatics and data science; and 11) resource-limited settings. The search included MEDLINE, EMBASE, and CINAHL Complete (EBSCOhost) and was updated in March 2022. Grading of Recommendations, Assessment, Development, and Evaluation methodology was used to summarize evidence and develop the recommendations, which were discussed and voted on by all PALICC-2 experts. There were 146 recommendations and statements, including: 34 recommendations for clinical practice; 112 consensus-based statements with 18 on PARDS definition, 55 on good practice, seven on policy, and 32 on research. All recommendations and statements had agreement greater than 80%. CONCLUSIONS PALICC-2 recommendations and consensus-based statements should facilitate the implementation and adherence to the best clinical practice in patients with PARDS. These results will also inform the development of future programs of research that are crucially needed to provide stronger evidence to guide the pediatric critical care teams managing these patients.
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Affiliation(s)
- Guillaume Emeriaud
- Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, Montréal, QC, Canada
| | - Yolanda M López-Fernández
- Pediatric Intensive Care Unit, Department of Pediatrics, Cruces University Hospital, Biocruces-Bizkaia Health Research Institute, Bizkaia, Spain
| | - Narayan Prabhu Iyer
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Melania M Bembea
- Departments of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Asya Agulnik
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN
| | - Ryan P Barbaro
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI
| | - Florent Baudin
- Pediatric Intensive Care Unit, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Réanimation Pédiatrique, Lyon, France
| | - Anoopindar Bhalla
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles. Keck School of Medicine, University of Southern California, Los Angeles, CA
| | | | | | - Ira M Cheifetz
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Mohammod J Chisti
- Dhaka Hospital, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Pablo Cruces
- Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile
- Departamento de Pediatría, Unidad de Paciente Crítico Pediátrico, Facultad de Ciencias de la Vida, Hospital El Carmen de Maipú, Santiago, Chile
| | - Martha A Q Curley
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA
- Research Institute, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Mary K Dahmer
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI
| | - Heidi J Dalton
- Department of Pediatrics and Heart and Vascular Institute, INOVA Fairfax Medical Center, Falls Church, VA
| | - Simon J Erickson
- Department of Paediatric Critical Care, Perth Children's Hospital Western Australia, Perth, WA, Australia
| | - Sandrine Essouri
- Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, Montréal, QC, Canada
| | - Analía Fernández
- Pediatric Intensive Care Unit, Emergency Department, Hospital General de Agudos "C. Durand" Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Heidi R Flori
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI
| | - Jocelyn R Grunwell
- Division of Critical Care, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Philippe Jouvet
- Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, Montréal, QC, Canada
| | - Elizabeth Y Killien
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Martin C J Kneyber
- Department of Paediatrics, Division of Paediatric Critical Care Medicine, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sapna R Kudchadkar
- Departments of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Departments of Pediatrics, Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Steven Kwasi Korang
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles. Keck School of Medicine, University of Southern California, Los Angeles, CA
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jan Hau Lee
- KK Women's and Children's Hospital, Singapore and Duke-NUS Medical School, Singapore
| | | | - Aline Maddux
- Department of Pediatrics, Section of Pediatric Critical Care Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | | | - Brenda M Morrow
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Vinay M Nadkarni
- Department of Anesthesiology, Critical Care and Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Natalie Napolitano
- Respiratory Therapy Department, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Christopher J L Newth
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles. Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Martí Pons-Odena
- Immunological and Respiratory Disorders, Paediatric Critical Care Unit Research Group, Institut de Recerca Sant Joan de Déu, Pediatric Intensive Care and Intermediate Care Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Michael W Quasney
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI
| | | | - Jerome Rambaud
- Departement of Pediatric and Neonatal Intensive Care, Armand-Trousseau Hospital, Sorbonne University, Paris, France
| | - Adrienne G Randolph
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, and Departments of Anaesthesia and Pediatrics, Harvard Medical School, Boston, MA
| | - Peter Rimensberger
- Division of Neonatology and Paediatric Intensive Care, University of Geneva, Geneva, Switzerland
| | - Courtney M Rowan
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN
| | - L Nelson Sanchez-Pinto
- Departments of Pediatrics (Critical Care) and Preventive Medicine (Health & Biomedical Informatics), Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Anil Sapru
- Division of Pediatric Critical Care, Department of Pediatrics, University of California Los Angeles, Los Angeles, CA
| | - Michael Sauthier
- Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, Montréal, QC, Canada
| | - Steve L Shein
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Lincoln S Smith
- Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, WA
| | - Katerine Steffen
- Department of Pediatrics, Division of Pediatric Critical Care, Stanford University, Palo Alto, CA
| | - Muneyuki Takeuchi
- Department of Intensive Care Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Neal J Thomas
- Division of Pediatric Critical Care Medicine, Department of Pediatrics and Public Health Sciences, Penn State University College of Medicine, Hershey, PA
| | - Sze Man Tse
- Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, Montréal, QC, Canada
| | - Stacey Valentine
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA
| | - Shan Ward
- Department of Pediatrics, University of California San Francisco, Benioff Children's Hospitals, San Francisco and Oakland, CA
| | - R Scott Watson
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute Seattle, WA
| | - Nadir Yehya
- Department of Anesthesiology, Critical Care and Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Jerry J Zimmerman
- Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, WA
- Harborview Medical Center, University of Washington School of Medicine, Seattle, WA
| | - Robinder G Khemani
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles. Keck School of Medicine, University of Southern California, Los Angeles, CA
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3
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Begum H, Neto AS, Alliegro P, Broadley T, Trapani T, Campbell LT, Cheng AC, Cheung W, Cooper DJ, Erickson SJ, French CJ, Litton E, McAllister R, Nichol A, Palermo A, Plummer MP, Rotherham H, Ramanan M, Reddi B, Reynolds C, Webb SAR, Udy AA, Burrell A. People in intensive care with COVID-19: demographic and clinical features during the first, second, and third pandemic waves in Australia. Med J Aust 2022; 217:352-360. [PMID: 35686307 PMCID: PMC9347520 DOI: 10.5694/mja2.51590] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/21/2022] [Accepted: 03/24/2022] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To compare the demographic and clinical features, management, and outcomes for patients admitted with COVID-19 to intensive care units (ICUs) during the first, second, and third waves of the pandemic in Australia. DESIGN, SETTING, AND PARTICIPANTS People aged 16 years or more admitted with polymerase chain reaction-confirmed COVID-19 to the 78 Australian ICUs participating in the Short Period Incidence Study of Severe Acute Respiratory Infection (SPRINT-SARI) Australia project during the first (27 February - 30 June 2020), second (1 July 2020 - 25 June 2021), and third COVID-19 waves (26 June - 1 November 2021). MAIN OUTCOME MEASURES Primary outcome: in-hospital mortality. SECONDARY OUTCOMES ICU mortality; ICU and hospital lengths of stay; supportive and disease-specific therapies. RESULTS 2493 people (1535 men, 62%) were admitted to 59 ICUs: 214 during the first (9%), 296 during the second (12%), and 1983 during the third wave (80%). The median age was 64 (IQR, 54-72) years during the first wave, 58 (IQR, 49-68) years during the second, and 54 (IQR, 41-65) years during the third. The proportion without co-existing illnesses was largest during the third wave (41%; first wave, 32%; second wave, 29%). The proportion of ICU beds occupied by patients with COVID-19 was 2.8% (95% CI, 2.7-2.9%) during the first, 4.6% (95% CI, 4.3-5.1%) during the second, and 19.1% (95% CI, 17.9-20.2%) during the third wave. Non-invasive (42% v 15%) and prone ventilation strategies (63% v 15%) were used more frequently during the third wave than during the first two waves. Thirty patients (14%) died in hospital during the first wave, 35 (12%) during the second, and 281 (17%) during the third. After adjusting for age, illness severity, and other covariates, the risk of in-hospital mortality was similar for the first and second waves, but 9.60 (95% CI, 3.52-16.7) percentage points higher during the third than the first wave. CONCLUSION The demographic characteristics of patients in intensive care with COVID-19 and the treatments they received during the third pandemic wave differed from those of the first two waves. Adjusted in-hospital mortality was highest during the third wave.
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Affiliation(s)
| | - Ary S Neto
- Australian and New Zealand Intensive Care Research CentreMelbourneVIC
| | | | | | - Tony Trapani
- Monash UniversityMelbourneVIC
- Alfred HealthMelbourneVIC
| | - Lewis T Campbell
- Royal Darwin HospitalDarwinNT
- Menzies School of Health ResearchDarwinNT
| | | | | | - D James Cooper
- Monash UniversityMelbourneVIC
- Australian and New Zealand Intensive Care Research CentreMelbourneVIC
- Alfred HealthMelbourneVIC
| | | | | | | | | | | | | | | | | | - Mahesh Ramanan
- Prince Charles HospitalBrisbaneQLD
- Caboolture HospitalCabooltureQLD
| | | | | | | | - Andrew A Udy
- Monash UniversityMelbourneVIC
- Australian and New Zealand Intensive Care Research CentreMelbourneVIC
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4
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Fraile Navarro D, Tendal B, Tingay D, Vasilunas N, Anderson L, Best J, Burns P, Cheyne S, Craig SS, Erickson SJ, Fancourt NS, Goff Z, Kapuya V, Keyte C, Malyon L, McDonald S, White H, Wurzel D, Bowen AC, McMullan B. Clinical care of children and adolescents with COVID-19: recommendations from the National COVID-19 Clinical Evidence Taskforce. Med J Aust 2021; 216:255-263. [PMID: 34689329 PMCID: PMC8661691 DOI: 10.5694/mja2.51305] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The epidemiology and clinical manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are different in children and adolescents compared with adults. Although coronavirus disease 2019 (COVID-19) appears to be less common in children, with milder disease overall, severe complications may occur, including paediatric inflammatory multisystem syndrome (PIMS-TS). Recognising the distinct needs of this population, the National COVID-19 Clinical Evidence Taskforce formed a Paediatric and Adolescent Care Panel to provide living guidelines for Australian clinicians to manage children and adolescents with COVID-19 and COVID-19 complications. Living guidelines mean that these evidence-based recommendations are updated in near real time to give reliable, contemporaneous advice to Australian clinicians providing paediatric care. MAIN RECOMMENDATIONS To date, the Taskforce has made 20 specific recommendations for children and adolescents, including definitions of disease severity, recommendations for therapy, respiratory support, and venous thromboembolism prophylaxis for COVID-19 and for the management of PIMS-TS. CHANGES IN MANAGEMENT AS A RESULT OF THE GUIDELINES The Taskforce currently recommends corticosteroids as first line treatment for acute COVID-19 in children and adolescents who require oxygen. Tocilizumab could be considered, and remdesivir should not be administered routinely in this population. Non-invasive ventilation or high flow nasal cannulae should be considered in children and adolescents with hypoxaemia or respiratory distress unresponsive to low flow oxygen if appropriate infection control measures can be used. Children and adolescents with PIMS-TS should be managed by a multidisciplinary team. Intravenous immunoglobulin and corticosteroids, with concomitant aspirin and thromboprophylaxis, should be considered for the treatment of PIMS-TS. The latest updates and full recommendations are available at www.covid19evidence.net.au.
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Affiliation(s)
- David Fraile Navarro
- Cochrane Australia, Monash University, Melbourne, VIC.,Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW
| | - Britta Tendal
- Cochrane Australia, Monash University, Melbourne, VIC
| | - David Tingay
- Murdoch Children's Research Institute, Melbourne, VIC.,Royal Children's Hospital Melbourne, Melbourne, VIC
| | - Nan Vasilunas
- Women's and Children's Health Network, Women's and Children's Hospital Adelaide, Adelaide, SA
| | - Lorraine Anderson
- Kimberley Aboriginal Medical Services Council, Broome, WA.,Junction Street Family Practice, Sydney, NSW
| | - James Best
- Junction Street Family Practice, Sydney, NSW
| | - Penelope Burns
- Australian National University, Canberra, ACT.,Northern Beaches Hospital, Sydney, NSW.,Western Sydney University, Sydney, NSW
| | - Saskia Cheyne
- Cochrane Australia, Monash University, Melbourne, VIC.,NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW
| | - Simon S Craig
- Monash University, Melbourne, VIC.,Monash Medical Centre, Monash Health, Melbourne, VIC
| | | | | | - Zoy Goff
- Perth Children's Hospital, Perth, WA
| | - Vimbai Kapuya
- Charles Darwin University, Darwin, NT.,Australian College of Rural and Remote Medicine, Brisbane, QLD
| | - Catherine Keyte
- Queensland Children's Hospital, Brisbane, QLD.,Australian College of Nursing, Canberra, ACT
| | - Lorelle Malyon
- College of Emergency Nursing Australasia, Melbourne, VIC
| | | | - Heath White
- Cochrane Australia, Monash University, Melbourne, VIC
| | - Danielle Wurzel
- Murdoch Children's Research Institute, Melbourne, VIC.,Royal Children's Hospital Melbourne, Melbourne, VIC
| | - Asha C Bowen
- Perth Children's Hospital, Perth, WA.,Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA
| | - Brendan McMullan
- Sydney Children's Hospital, Randwick, Sydney, NSW.,University of New South Wales, Sydney, NSW
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5
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Burrell AJ, Neto AS, Broadley T, Trapani T, Begum H, Campbell LT, Cheng AC, Cheung W, Cooper DJ, Erickson SJ, French CJ, Kaldor JM, Litton E, Murthy S, McAllister RE, Nichol AD, Palermo A, Plummer MP, Ramanan M, Reddi BA, Reynolds C, Webb SA, Udy AA. Comparison of baseline characteristics, treatment and celinical outcomes of critically ill COVID-19 patients admitted in the first and second waves in Australia. CRIT CARE RESUSC 2021; 23:308-319. [PMID: 38046076 PMCID: PMC10692524 DOI: 10.51893/2021.3.oa8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To report longitudinal differences in baseline characteristics, treatment, and outcomes in patients with coronavirus disease 2019 (COVID-19) admitted to intensive care units (ICUs) between the first and second waves of COVID-19 in Australia. Design, setting and participants: SPRINT-SARI Australia is a multicentre, inception cohort study enrolling adult patients with COVID-19 admitted to participating ICUs. The first wave of COVID-19 was from 27 February to 30 June 2020, and the second wave was from 1 July to 22 October 2020. Results: A total of 461 patients were recruited in 53 ICUs across Australia; a higher number were admitted to the ICU during the second wave compared with the first: 255 (55.3%) versus 206 (44.7%). Patients admitted to the ICU in the second wave were younger (58.0 v 64.0 years; P = 0.001) and less commonly male (68.9% v 60.0%; P = 0.045), although Acute Physiology and Chronic Health Evaluation (APACHE) II scores were similar (14 v 14; P = 0.998). High flow oxygen use (75.2% v 43.4%; P < 0.001) and non-invasive ventilation (16.5% v 7.1%; P = 0.002) were more common in the second wave, as was steroid use (95.0% v 30.3%; P < 0.001). ICU length of stay was shorter (6.0 v 8.4 days; P = 0.003). In-hospital mortality was similar (12.2% v 14.6%; P = 0.452), but observed mortality decreased over time and patients were more likely to be discharged alive earlier in their ICU admission (hazard ratio, 1.43; 95% CI, 1.13-1.79; P = 0.002). Conclusion: During the second wave of COVID-19 in Australia, ICU length of stay and observed mortality decreased over time. Multiple factors were associated with this, including changes in clinical management, the adoption of new evidence-based treatments, and changes in patient demographic characteristics but not illness severity.
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Affiliation(s)
- Aidan J.C. Burrell
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, VIC, Australia
| | - Ary Serpa Neto
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Tessa Broadley
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Tony Trapani
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Husna Begum
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Lewis T. Campbell
- Intensive Care Unit, Royal Darwin Hospital, Darwin, NT, Australia
- Menzies School of Health Research, Darwin, NT, Australia
| | - Allen C. Cheng
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Melbourne, VIC, Australia
| | - Winston Cheung
- Department of Intensive Care Medicine, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - D. James Cooper
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, VIC, Australia
| | | | - Craig J. French
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Intensive Care, Western Health, Melbourne, VIC, Australia
| | - John M. Kaldor
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Edward Litton
- Intensive Care Unit, Fiona Stanley Hospital, Perth, WA, Australia
- Department of Intensive Care Medicine, St John of God Hospital Subiaco, Perth, WA, Australia
| | - Srinivas Murthy
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | | | - Alistair D. Nichol
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, VIC, Australia
| | | | - Mark P. Plummer
- Intensive Care Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Mahesh Ramanan
- Intensive Care Unit, Caboolture Hospital, Caboolture, QLD, Australia
| | - Benjamin A.J. Reddi
- Royal Adelaide Hospital, Adelaide, SA, Australia
- University of Adelaide, Adelaide, SA, Australia
| | - Claire Reynolds
- Intensive Care Unit, St Vincent’s Health Network, Sydney, NSW, Australia
| | - Steve A. Webb
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Intensive Care Medicine, St John of God Hospital Subiaco, Perth, WA, Australia
| | - Andrew A. Udy
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, VIC, Australia
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6
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Burrell AJ, Pellegrini B, Salimi F, Begum H, Broadley T, Campbell LT, Cheng AC, Cheung W, Cooper DJ, Earnest A, Erickson SJ, French CJ, Kaldor JM, Litton E, Murthy S, McAllister RE, Nichol AD, Palermo A, Plummer MP, Ramanan M, Reddi BA, Reynolds C, Trapani T, Webb SA, Udy AA. Outcomes for patients with COVID-19 admitted to Australian intensive care units during the first four months of the pandemic. Med J Aust 2020; 214:23-30. [PMID: 33325070 DOI: 10.5694/mja2.50883] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [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: 06/27/2020] [Accepted: 09/15/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To describe the characteristics and outcomes of patients with COVID-19 admitted to intensive care units (ICUs) during the initial months of the pandemic in Australia. DESIGN, SETTING Prospective, observational cohort study in 77 ICUs across Australia. PARTICIPANTS Patients admitted to participating ICUs with laboratory-confirmed COVID-19 during 27 February - 30 June 2020. MAIN OUTCOME MEASURES ICU mortality and resource use (ICU length of stay, peak bed occupancy). RESULTS The median age of the 204 patients with COVID-19 admitted to intensive care was 63.5 years (IQR, 53-72 years); 140 were men (69%). The most frequent comorbid conditions were obesity (40% of patients), diabetes (28%), hypertension treated with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (24%), and chronic cardiac disease (20%); 73 patients (36%) reported no comorbidity. The most frequent source of infection was overseas travel (114 patients, 56%). Median peak ICU bed occupancy was 14% (IQR, 9-16%). Invasive ventilation was provided for 119 patients (58%). Median length of ICU stay was greater for invasively ventilated patients than for non-ventilated patients (16 days; IQR, 9-28 days v 3 days; IQR, 2-5 days), as was ICU mortality (26 deaths, 22%; 95% CI, 15-31% v four deaths, 5%; 95% CI, 1-12%). Higher Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores on ICU day 1 (adjusted hazard ratio [aHR], 1.15; 95% CI, 1.09-1.21) and chronic cardiac disease (aHR, 3.38; 95% CI, 1.46-7.83) were each associated with higher ICU mortality. CONCLUSION Until the end of June 2020, mortality among patients with COVID-19 who required invasive ventilation in Australian ICUs was lower and their ICU stay longer than reported overseas. Our findings highlight the importance of ensuring adequate local ICU capacity, particularly as the pandemic has not yet ended.
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Affiliation(s)
- Aidan Jc Burrell
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC.,The Alfred Hospital, Melbourne, VIC
| | - Breanna Pellegrini
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC
| | - Farhad Salimi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC
| | - Husna Begum
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC.,The Alfred Hospital, Melbourne, VIC
| | - Tessa Broadley
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC.,The Alfred Hospital, Melbourne, VIC
| | - Lewis T Campbell
- Royal Darwin Hospital, Darwin, NT.,Menzies School of Health Research, Darwin, NT
| | - Allen C Cheng
- The Alfred Hospital, Melbourne, VIC.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC
| | | | - D James Cooper
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC.,The Alfred Hospital, Melbourne, VIC
| | - Arul Earnest
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC
| | | | - Craig J French
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC.,Western Health, Melbourne, VIC
| | - John M Kaldor
- The Kirby Institute, University of New South Wales, Sydney, NSW
| | - Edward Litton
- Fiona Stanley Hospital, Perth, WA.,St John of God Health Care, Perth, WA
| | | | | | - Alistair D Nichol
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC.,The Alfred Hospital, Melbourne, VIC
| | - Annamaria Palermo
- Fiona Stanley Hospital, Perth, WA.,St John of God Health Care, Perth, WA
| | | | | | - Benjamin Aj Reddi
- Royal Adelaide Hospital, Adelaide, SA.,The University of Adelaide, Adelaide, SA
| | | | - Tony Trapani
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC.,The Alfred Hospital, Melbourne, VIC
| | - Steve A Webb
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC.,St John of God Health Care, Perth, WA
| | - Andrew A Udy
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC.,The Alfred Hospital, Melbourne, VIC
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7
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Ostrowski JA, MacLaren G, Alexander J, Stewart P, Gune S, Francis JR, Ganu S, Festa M, Erickson SJ, Straney L, Schlapbach LJ. The burden of invasive infections in critically ill Indigenous children in Australia. Med J Aust 2017; 206:78-84. [PMID: 28152345 DOI: 10.5694/mja16.00595] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 08/08/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To describe the incidence and mortality of invasive infections in Indigenous children admitted to paediatric and general intensive care units (ICUs) in Australia. DESIGN Retrospective multi-centre cohort study of Australian and New Zealand Paediatric Intensive Care Registry data. PARTICIPANTS All children under 16 years of age admitted to an ICU in Australia, 1 January 2002 - 31 December 2013. Indigenous children were defined as those identified as Aboriginal and/or Torres Strait Islander in a mandatory admissions dataset. MAIN OUTCOMES Population-based ICU mortality and admission rates. RESULTS Invasive infections accounted for 23.0% of non-elective ICU admissions of Indigenous children (726 of 3150), resulting in an admission rate of 47.6 per 100 000 children per year. Staphylococcus aureus was the leading pathogen identified in children with sepsis/septic shock (incidence, 4.42 per 100 000 Indigenous children per year; 0.57 per 100 000 non-Indigenous children per year; incidence rate ratio 7.7; 95% CI, 5.8-10.1; P < 0.001). While crude and risk-adjusted ICU mortality related to invasive infections was not significantly different for Indigenous and non-Indigenous children (odds ratio, 0.75; 95% CI, 0.53-1.07; P = 0.12), the estimated population-based age-standardised mortality rate for invasive infections was significantly higher for Indigenous children (2.67 per 100 000 per year v 1.04 per 100 000 per year; crude incidence rate ratio, 2.65; 95% CI, 1.88-3.64; P < 0.001). CONCLUSIONS The ICU admission rate for severe infections was several times higher for Indigenous than for non-Indigenous children, particularly for S. aureus infections. While ICU case fatality rates were similar, the population-based mortality was more than twice as high for Indigenous children. Our study highlights an important area of inequality in health care for Indigenous children in a high income country that needs urgent attention.
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Affiliation(s)
| | | | - Janet Alexander
- Australian and New Zealand Paediatric Intensive Care Registry (CORE), Brisbane, QLD
| | | | | | | | - Subodh Ganu
- Women's and Children's Hospital Adelaide, Adelaide, SA
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8
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Young PJ, Baker S, Cavazzoni E, Erickson SJ, Krishnan A, Kruger PS, Rashid AH, Wibrow BA. A case series of critically ill patients with anti- N-methyl-D-aspartate receptor encephalitis. CRIT CARE RESUSC 2013; 15:8-14. [PMID: 23432495] [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: 06/01/2023]
Abstract
Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis causes autonomic disturbances, behavioural changes and abnormal movements. It is often a paraneoplastic phenomenon that occurs in association with ovarian teratomas and is the most common paraneoplastic encephalitis. We report nine cases of critically ill patients with anti- NMDA receptor encephalitis from Australia and New Zealand. One patient died and one had a poor neurological recovery. The remaining patients made substantial or complete neurological recoveries. This case series highlights that patients with anti-NMDA receptor encephalitis: • often require long periods of support in an intensive care unit; • may develop tracheostomy complications related to hypersalivation; • may develop life-threatening hyperthermia; • can have ovarian teratomas despite normal investigations; and • often have very abnormal movements that are difficult to control and make ongoing care difficult.
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9
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Abstract
Despite children with acute lymphoblastic leukaemia missing a significant amount of school, little empirical literature guides the optimal content, setting and timing of a school reintegration programme. We examined the feasibility of a 4-month school reintegration intervention by: (1) developing collaboration with a community-based advocacy organisation; (2) developing intervention modules and observable end points; and (3) determining how the study achieved recruitment expectations. Eight families with children aged 6-12 years diagnosed with acute lymphoblastic leukaemia and parents were enrolled in the study. An experienced advocate implemented a series of eight modules over a 4-month period (twice per month) with the families. Participants completed pre-post measures. Successful collaboration with the advocacy organisation and the development of an intervention module series were achieved. Recruitment aims proved more difficult: enrolment was extended when recruitment for the original 1- to 6-month post-diagnosis window proved difficult. The advocate was able to complete between three and seven of the modules (mean = 5.2, standard deviation = 1.5). Families preferred clinic-based intervention. Challenges faced and lessons learned include: (1) advocacy organisations may be useful resources for school reintegration interventions; (2) school reintegration interventions must be flexibly applied; and (3) measurement end points constructed to gauge programme effectiveness.
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Affiliation(s)
- R D Annett
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM.
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10
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Blyth CC, Jayakumar I, Richmond P, Bullock AM, Erickson SJ. Finding pneumo: purulent pericarditis presenting with pulsus paradoxus. CRIT CARE RESUSC 2007; 9:106. [PMID: 17415946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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11
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Erickson SJ, Grauaug A, Gurrin L, Swaminathan M. Hypocarbia in the ventilated preterm infant and its effect on intraventricular haemorrhage and bronchopulmonary dysplasia. J Paediatr Child Health 2002; 38:560-2. [PMID: 12410866 DOI: 10.1046/j.1440-1754.2002.00041.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.7] [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: 11/20/2022]
Abstract
OBJECTIVE To examine the relationship between PaCO2 levels in ventilated very preterm infants and (i) the incidence of severe intraventricular haemorrhage (IVH) and periventricular leukomalacia (PVL); and (ii) bronchopulmonary dysplasia (BPD). METHODS A retrospective cohort analysis of preterm infants comparing PaCO2 levels with the incidence of severe IVH/PVL and BPD was carried out on patients born at less than 29 weeks gestation from 1992 to 1994 and admitted to the tertiary neonatal intensive care unit at the King Edward Memorial Hospital (314 infants). During the first 96 h, PaCO2 levels were examined including lowest and highest PaCO2 levels, mean PaCO2 levels and duration of hypocarbia both pre- and post-surfactant administration. RESULTS Of the 314 infants, there were 40 early neonatal deaths (less than 48 h) who were not included in the analysis. Of the 274 surviving infants, 72 (26%) infants had severe IVH. Infants whose PaCO2 fell below 30 mmHg at any stage in the first 48 h of life had an increased risk of severe IVH or PVL (odds ratio 2.38; 95% CI 1.27-4.49; P = 0.007). Of the 265 survivors to 36 weeks corrected gestational age, 134 (51%) had BPD. Infants with at least three PaCO2 values less than 30 mmHg in the first 24 h of life had an increased risk of BPD (odds ratio 2.21; 95% CI 1.05-4.57; P = 0.036). CONCLUSIONS The risk of severe IVH/PVL was significantly increased by hypocarbia. There was also an association between hypocarbia and BPD, particularly when hypocarbia was prolonged. These findings suggest that avoidance of hypocarbia may reduce the incidence of severe IVH/PVL and BPD in preterm infants.
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Affiliation(s)
- S J Erickson
- Princess Margaret Hospital for Children and King Edward Memorial Hospital for Women, Subiaco, Western Australia, Australia.
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12
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Abstract
Magnetic resonance (MR) angiography is a widely used, noninvasive tool for evaluating the aorta and its branches. It is particularly useful in renal transplant recipients because it provides anatomic detail of the transplant artery without nephrotoxic effects. Volume rendering is underutilized in MR angiography, but this technique affords high-quality three-dimensional MR angiograms, especially in cases of tortuous or complex vascular anatomy. An imaging protocol was developed that includes gadolinium-enhanced MR angiography of the transplant renal artery with volume rendering and multiplanar reformation postprocessing techniques. Axial T2-weighted and contrast material-enhanced T1-weighted MR images are also obtained to examine the renal parenchyma itself and to evaluate for hydronephrosis or peritransplant fluid collections. This imaging protocol allows rapid global assessment of the renal transplant arterial system, renal parenchyma, and peritransplant region. It can also help detect or exclude many of the various causes of renal transplant dysfunction (eg, stenosis or occlusion of a transplant vessel, peritransplant fluid collections, ureteral obstruction). Conventional angiography can thus be avoided in patients with normal findings and reserved for those with MR angiographic evidence of stenosis.
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Affiliation(s)
- M D Hohenwalter
- Department of Radiology, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI 53226, USA.
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13
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Abstract
Proton magnetic resonance spectroscopy (MRS) may be a useful tool in both the initial diagnosis of cervical carcinoma and the subsequent surveillance after radiation therapy, particularly when other standard diagnostic methods are inconclusive. Single voxel magnetic resonance (MR) spectral data were acquired from 8 normal volunteers, 16 patients with cervical cancer before radiation therapy, and 18 patients with cervical cancer after radiation therapy using an external pelvic coil at a 1.5-T on a Signa system. The presence or absence of various resonances within each spectrum was evaluated for similarities within each patient group and for spectral differences between groups. Resonances corresponding to lipid and creatine dominated the spectrum for the eight normal volunteers without detection of a choline resonance. Spectra from 16 pretreatment patients with biopsy-proven cervical cancer revealed strong resonances at a chemical shift of 3.25 ppm corresponding to choline. Data acquired from the 18 posttreatment setting studies was variable, but often correlated well with the clinical findings. Biopsy confirmation was obtained in seven patients. H1 MRS of the cervix using a noninvasive pelvic coil consistently demonstrates reproducible spectral differences between normal and neoplastic cervical tissue in vivo. However, signal is still poor for minimal disease recurrence. Further study is needed at intervals before, during, and after definitive irradiation with biopsy confirmation to validate the accuracy of MRS in distinguishing persistence or recurrence of disease from necrosis and fibrosis.
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Affiliation(s)
- J R Allen
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA
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14
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Romero AJ, Robinson TN, Kraemer HC, Erickson SJ, Haydel KF, Mendoza F, Killen JD. Are perceived neighborhood hazards a barrier to physical activity in children? Arch Pediatr Adolesc Med 2001; 155:1143-8. [PMID: 11576010 DOI: 10.1001/archpedi.155.10.1143] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND We hypothesized that children's perceptions of more neighborhood hazards would be associated with less physical activity, less aerobic fitness, and a higher body mass index. OBJECTIVE To examine the association between a hazardous neighborhood context and physical activity in children. METHODS Fourth-grade students (n = 796) of diverse ethnic and economic backgrounds completed measures of neighborhood hazards, self-reported physical activity, physical fitness, height, and weight. Parents (n = 518) completed telephone interviews and provided data on their education level and occupation. RESULTS As expected, children from families of lower socioeconomic status perceived significantly more neighborhood hazards. Contrary to our hypothesis, the perception of more hazards was significantly associated with more reported physical activity. This finding was not explained by school heterogeneity, alteration of the hazards measure, or differences in socioeconomic status. CONCLUSION To further examine the relationship between neighborhood hazards and physical activity, we suggest that future studies include assessments of sedentary behavior, parental fear of violence, parental regulation of children's leisure activities, and cost and quality of available play areas and organized sports.
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Affiliation(s)
- A J Romero
- Mexican American Studies and Research Center, University of Arizona, Economics Bldg, Rm 208, Tucson, AZ 85721, USA.
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15
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Abstract
To explore the relationship between PTSD and trauma-spectrum symptoms, including personality and functional correlates, in long term pediatric cancer survivors (N = 40), we assessed these constructs with a structured interview for PTSD, a clinical interview, and self-report questionnaires. Thirty-five out of 40 participants (88%) currently met at least one trauma symptom at a functionally significant level. These survivors demonstrate high levels of restraint and low levels of distress, representative of a repressive adaptive style. After more than 5 years since treatment completion, the relatively high levels of current trauma-spectrum symptoms may reflect the long-term deleterious impact of childhood cancer.
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Affiliation(s)
- S J Erickson
- Department of Psychology, Logan Hall, University of New Mexico, Albuquerque, NM 87131, USA.
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16
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Park TA, Welshofer JA, Dzwierzynski WW, Erickson SJ, Del Toro DR. Median "pseudoneurapraxia" at the wrist: reassessment of palmar stimulation of the recurrent median nerve. Arch Phys Med Rehabil 2001; 82:190-7. [PMID: 11239309 DOI: 10.1053/apmr.2001.18704] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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
OBJECTIVE To determine the occurrence and effect of incidental deep ulnar nerve (DUN) costimulation during palmar stimulation of the recurrent median nerve (RMN). DESIGN Observational. SETTING Electromyography laboratory. PARTICIPANTS Seventeen asymptomatic adult volunteers (34 hands) and 4 fresh cadaver hands. MAIN OUTCOME MEASURES Median nerve stimulation at the wrist and careful incremental surface and subcutaneous (needle) palmar stimulation were performed while recording thenar and first dorsal interosseous manus compound muscle action potentials. Thenar palm-to-wrist amplitude difference (P -- W Delta) and palm-to-wrist amplitude ratio (P/W) were compared with published values. Correlation of DUN costimulation with falsely elevated P -- W Delta and P/W values was assessed. Multiplanar magnetic resonance imaging (MRI) and subsequent dissection of 4 fresh cadaver hands was done to measure the distance between the RMN and DUN at the palmar stimulation site. RESULTS Two groups emerged: Group I (63%), with DUN stimulation, and II (37%), with no DUN stimulation. When DUN costimulation occurred (Group I), there was a statistically significant increase in P -- W Delta (p =.002 percutaneous, p =.02 subcutaneous) and P/W (p =.004 percutaneous, p =.007 subcutaneous) when compared with previously published data. Combining all trials on all hands, 53% and 25% had P -- W Delta values and P/W values that exceeded previously published normative data, respectively. The mean distance between the DUN and RMN at the palmar stimulation site was determined by dissection (1.2cm) and MRI (1.5cm). CONCLUSIONS Close proximity of the DUN to the RMN causes frequent and often unavoidable DUN activation during palmar stimulation of the RMN. This inadvertent stimulation may cause a false diagnosis of median neurapraxia at the wrist.
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Affiliation(s)
- T A Park
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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17
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Erickson SJ, Robinson TN, Haydel KF, Killen JD. Are overweight children unhappy?: Body mass index, depressive symptoms, and overweight concerns in elementary school children. Arch Pediatr Adolesc Med 2000; 154:931-5. [PMID: 10980798 DOI: 10.1001/archpedi.154.9.931] [Citation(s) in RCA: 252] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND It is commonly believed that overweight children are unhappy with their weight. However, population-based data addressing this association are lacking. OBJECTIVES To evaluate the association between obesity and depressive symptoms in a diverse, school-based sample of preadolescent children, and to examine whether overweight concerns play a role in this association. DESIGN, SETTING, AND PARTICIPANTS Third-grade students (N = 868, mean age, 8.4 years) attending 13 public elementary schools in Northern California were measured for weight and height, and were asked to complete self-report assessments of depressive symptoms and overweight concerns. RESULTS A modest association between depressive symptoms and body mass index (BMI; calculated as weight in kilograms divided by the square of height in meters) was found for girls (r = 0.14, P<.01), but not for boys (r = 0.01, P<.78). Among girls, depressive symptoms were strongly associated with overweight concerns (r = 0.32, P<.001). After controlling for level of overweight concerns, BMI was no longer significantly associated with depressive symptoms among girls. In contrast, after controlling for BMI, overweight concerns remained significantly associated with depressive symptoms. CONCLUSIONS This study provides cross-sectional evidence for a relationship between depressive symptoms and BMI in preadolescent girls, but not in preadolescent boys. This relationship seems to be explained by an excess of overweight concerns. Assessing overweight concerns may be a useful method to identify those overweight girls who are at highest risk for associated depressive symptoms.
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Affiliation(s)
- S J Erickson
- Department of Psychology, Logan Hall, University of New Mexico, Albuquerque, NM 87131-1161, USA.
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18
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Abstract
The authors assessed somatic symptoms and the degree of association among somatic symptoms, global adjustment, trauma symptoms, and personality characteristics in long-term pediatric cancer survivors. Forty cancer survivors completed self-report questionnaires and clinical interviews. Participants' level of somatic symptoms fell between nonclinic and psychiatric populations. Somatic symptom scores correlated with general adjustment in the negative direction and with posttraumatic stress disorder (PTSD) scores in the positive direction. The majority of participants met at least partial current PTSD criteria. Because these survivors demonstrate a repressive adaptive style but endorse somatic symptoms, the latter may represent a method for detecting trauma-related distress in this population.
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Affiliation(s)
- S J Erickson
- Department of Psychology, University of New Mexico, Albuquerque 87131-1161, USA.
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19
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Erickson SJ. Sonography of the foot and ankle. Foot Ankle Clin 2000; 5:29-48, v. [PMID: 11232080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Sonography of the foot and ankle is a quick, relatively inexpensive imaging modality that can be used to diagnose a variety of pathologic conditions. Sonography is particularly well suited for the assessment of tendons, soft-tissue masses, and suspected foreign bodies. Visualization of internal structural detail typically equals or exceeds that of MR imaging. Diagnostic accuracy, however, requires meticulous attention to technical parameters and proficiency with the transducer.
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Affiliation(s)
- S J Erickson
- Department of Radiology, Section of Digital Imaging, Froedtert Memorial Lutheran Hospital and Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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20
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Abstract
Magnetic resonance (MR) and ultrasound (US) imaging are currently touted for assessment of rotator cuff disease. Optimum clinical imaging techniques include use of (a) a 1.5-T MR imaging unit with small planar coils, proton-density-weighted and T2-weighted fast spin-echo sequences, and 10-12-cm fields of view (yielding 400-470 x 500-625-microm in-plane spatial resolution) and (b) a state-of-the-art commercial US unit with insonation frequencies of 9-13 MHz (yielding 200-400-microm axial and lateral resolution). Proper diagnosis requires familiarity with normal anatomic characteristics and imaging pitfalls. Care must be taken to avoid sonographic tendon anisotropy and MR imaging magic angle effects, which can be misinterpreted as rotator cuff tear. At MR imaging, a complete cuff tear typically appears as either a hyperintense defect or a tendinous avulsion that extends from the bursal to the articular side of the cuff; a partial cuff tear typically appears as a focal hyperintense region that contacts only one surface of the cuff. Complete and partial tears manifest with a wide spectrum of findings at US. MR imaging and US are effective for evaluating rotator cuff injuries, with high reported accuracies for detection of complete tears but more disparate results for detection of partial tears.
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Affiliation(s)
- C J Seibold
- Department of Radiology, Froedtert Memorial Lutheran Hospital, Milwaukee, WI, USA
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21
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Holtzman EJ, Kumar S, Faaland CA, Warner F, Logue PJ, Erickson SJ, Ricken G, Waldman J, Kumar S, Dunham PB. Cloning, characterization, and gene organization of K-Cl cotransporter from pig and human kidney and C. elegans. Am J Physiol Renal Physiol 1998; 275:F550-64. [PMID: 9755127 DOI: 10.1152/ajprenal.1998.275.4.f550] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We isolated and characterized the cDNAs for the human, pig, and Caenorhabditis elegans K-Cl cotransporters. The pig and human homologs are 94% identical and contain 1,085 and 1,086 amino acids, respectively. The deduced protein of the C. elegans K-Cl cotransporter clone (CE-KCC1) contains 1,003 amino acids. The mammalian K-Cl cotransporters share approximately 45% similarity with CE-KCC1. Hydropathy analyses of the three clones indicate typical KCC topology patterns with 12 transmembrane segments, large extracellular loops between transmembrane domains 5 and 6 (unique to KCC), and large COOH-terminal domains. Human KCC1 is widely expressed among various tissues. This KCC1 gene spans 23 kb and is organized in 24 exons, whereas the CE-KCC1 gene spans 3.5 kb and contains 10 exons. Transiently and stably transfected human embryonic kidney cells (HEK-293) expressing the human, pig, and C. elegans K-Cl cotransporter fulfilled two (pig) or five (human and C. elegans) criteria for increased expression of the K-Cl cotransporter. The criteria employed were basal K-Cl cotransport; stimulation of cotransport by swelling, N-ethylmaleimide, staurosporine, and reduced cell Mg concentration; and secondary stimulation of Na-K-Cl cotransport.
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Affiliation(s)
- E J Holtzman
- Renal Division, Department of Medicine, State University of New York-Health Science Center, Syracuse, New York 13210, USA
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22
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Abstract
OBJECTIVE To ascertain whether the incidence of clonidine poisoning in children has increased given the probable increase in clonidine use for treatment of childhood behavioural disorders. METHODS Cases of clonidine poisoning requiring hospital admission between 1985-95 inclusive were reviewed and demographic data pertinent to each admission were recorded. A literature review was also performed, with particular emphasis on incidence, clinical presentation and management of clonidine poisoning. RESULTS There were 14 cases of clonidine poisoning during the specified period eight cases presenting in the last 2 years. These eight children or their siblings had been prescribed clonidine for behavioural disorders. The most common signs at presentation were alteration of conscious state (71%) and bradycardia (50%). Nine children were given activated charcoal while seven cases underwent gastric lavage or induced emesis. Although six children were admitted to intensive care, length of hospital stay was less than 24 h in all cases and all had a favourable outcome. CONCLUSION We concluded that the incidence of clonidine poisoning had increased over the specified period and that, based on our results, this was likely to be due to an increase in clonidine use in childhood behavioural disorders. Based on our data and that from literature review it was evident that there are inconsistencies in the management of clonidine poisoning and that safety measures, namely packaging and education, are inadequate given the increasing profile of clonidine use.
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Affiliation(s)
- S J Erickson
- Paediatric Intensive Care Unit, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
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23
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Lipman BT, Collier BD, Carrera GF, Timins ME, Erickson SJ, Johnson JE, Mitchell JR, Hoffmann RG, Finger WA, Krasnow AZ, Hellman RS. Detection of osteomyelitis in the neuropathic foot: nuclear medicine, MRI and conventional radiography. Clin Nucl Med 1998; 23:77-82. [PMID: 9481493 DOI: 10.1097/00003072-199802000-00003] [Citation(s) in RCA: 73] [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] [Indexed: 02/06/2023]
Abstract
The diagnostic efficacy of (1) combined three-phase bone scintigraphy and In-111 labeled WBC scintigraphy (Bone/WBC), (2) MRI, and (3) conventional radiography in detecting osteomyelitis of the neuropathic foot was compared. Conventional radiography was comparable to MRI for detection of osteomyelitis. MRI best depicted the presence of osteomyelitis in the forefoot. Particularly in the setting of Charcot joints, Bone/WBC was more specific than conventional radiography or MRI.
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Affiliation(s)
- B T Lipman
- Department of Radiology, Medical College of Wisconsin, Milwaukee, USA
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24
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Affiliation(s)
- D L Daniels
- Department of Radiology, Froedtert Memorial Lutheran Hospital and Medical College of Wisconsin, Milwaukee 53226, USA
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25
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Affiliation(s)
- S J Erickson
- Department of Radiology, Froedtert Memorial Lutheran Hospital, Milwaukee, WI 53226, USA
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26
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Waldschmidt JG, Rilling RJ, Kajdacsy-Balla AA, Boynton MD, Erickson SJ. In vitro and in vivo MR imaging of hyaline cartilage: zonal anatomy, imaging pitfalls, and pathologic conditions. Radiographics 1997; 17:1387-402. [PMID: 9397453 DOI: 10.1148/radiographics.17.6.9397453] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.5] [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: 02/05/2023]
Abstract
Hyaline cartilage plays an essential role in the maintenance of normal synovial joint function by reducing friction and distributing loads. Histologic analysis of hyaline cartilage reveals zonal variation in cellular morphology, proteoglycan concentration, and collagen fiber size and orientation. High-resolution magnetic resonance (MR) imaging reveals an analogous laminar anatomy that is often visible on clinical images obtained with proper attention to technique. In vitro and in vivo pulse sequences show three distinct laminae: a hypointense superficial lamina, a hyperintense intermediate lamina, and a heterogeneous deep lamina that consists of alternating hyperintense and hypointense bands perpendicular to the subchondral bone. Imaging pitfalls include magic angle effects, truncation artifact, partial volume effect, regional anatomic variation, chemical shift, and magnetic susceptibility effects. Pathologic conditions that affect articular cartilage include chondromalacia patellae, osteoarthritis, and localized traumatic lesions. Although detection of early cartilage disease remains elusive, MR imaging can demonstrate intermediate and advanced lesions.
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Affiliation(s)
- J G Waldschmidt
- Department of Radiology, Medical College of Wisconsin, Milwaukee, USA
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27
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Tjoa BA, Erickson SJ, Bowes VA, Ragde H, Kenny GM, Cobb OE, Ireton RC, Troychak MJ, Boynton AL, Murphy GP. Follow-up evaluation of prostate cancer patients infused with autologous dendritic cells pulsed with PSMA peptides. Prostate 1997; 32:272-8. [PMID: 9288186 DOI: 10.1002/(sici)1097-0045(19970901)32:4<272::aid-pros7>3.0.co;2-l] [Citation(s) in RCA: 96] [Impact Index Per Article: 3.6] [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: 02/05/2023]
Abstract
BACKGROUND We recently conducted a phase I clinical trial administering autologous dendritic cells pulsed with prostate-specific membrane antigen (PSMA) peptides to advanced prostate cancer patients. Participants were divided into 5 groups receiving 4 or 5 infusions of peptides alone (PSM-P1 or -P2; groups 1 and 2, respectively), autologous DC (group 3), or DC pulsed with PSM-P1 or -P2 (groups 4 and 5, respectively). Seven partial responders were observed. Follow-up evaluation of these responders is presented in this report. METHODS Clinical monitoring for hematological studies and prostate markers was conducted up to 370 days from the start of the phase I study. Data collected include: lymphocyte, hematocrit, alkaline phosphatase, prostate-specific antigen (PSA), free PSA, and PSMA levels. RESULTS Groups 4 and 5 (patients infused with DC pulsed with PSM-P1 or -P2) represented 5/7 responders. The length of response was between 100 days (1 patient) to 200 days or above (6 patients). Four patients still remained responsive at the end of the period of observation. CONCLUSIONS The responses observed in this phase I clinical trial are significant and of long duration. Most of the responders were in treatment groups infused with DC pulsed with PSM-P1 or -P2, suggesting the requirement of both components for effective immunotherapy.
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Affiliation(s)
- B A Tjoa
- Pacific Northwest Cancer Foundation, Cancer Research Division, Northwest Hospital, Seattle, Washington 98125, USA
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28
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Mallisee TA, Boynton MD, Erickson SJ, Daniels DL. Normal MR imaging anatomy of the elbow. Magn Reson Imaging Clin N Am 1997; 5:451-79. [PMID: 9219713] [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: 02/04/2023]
Abstract
This article discusses the normal, clinically relevant MR imaging anatomy of the elbow. A compartmental approach is utilized to help simplify this anatomically complex region. Imaging techniques, common anatomic variants, and imaging pitfalls are also briefly discussed.
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Affiliation(s)
- T A Mallisee
- Department of Radiology, Medical College of Wisconsin, Froedtert Memorial Lutheran Hospital, Milwaukee, Wisconsin 53226, USA
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29
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Kahn CE, Michalski TA, Erickson SJ, Foley WD, Krasnow AZ, Lofgren RP, Quiroz FA, Rand SD. Appropriateness of imaging procedure requests: do radiologists agree? AJR Am J Roentgenol 1997; 169:11-4. [PMID: 9207492 DOI: 10.2214/ajr.169.1.9207492] [Citation(s) in RCA: 12] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE We explored the agreement among radiologists in their evaluation of the appropriateness of individual requests for imaging procedures. MATERIALS AND METHODS We reviewed 318 noninterventional CT, sonographic, MR imaging, and nuclear medicine procedures ordered at a general internal medicine clinic during 8 months in 1995. Five subspecialty radiologists used data from the radiology request from and clinic notes to independently rate the appropriateness of each requested imaging procedure on a four-point scale. The radiologists were unaware of the results achieved by each procedure. Each case was reviewed by at least three radiologists, of whom at least one had relevant subspecialty expertise. Agreement among radiologists was analyzed using Cohen's kappa statistic and weighted kappa statistics and Cronbach's alpha statistic. RESULTS Nonchance agreement (kappa) was .19 +/- .05; weighted kappa was .24 +/- .05. Interrater agreement was significantly greater than that expected from chance alone (p < .01). The composite score, defined as the average of the radiologists' scores for each case, showed moderate reliability, as evidenced by a value for Cronbach's alpha of 70. CONCLUSION In the absence of explicit criteria, we found modest but statistically significant agreement among radiologists about the appropriateness of individual requests for imaging procedures. The disagreement among radiologists highlights the importance of developing well-reasoned, explicit criteria by which to judge the appropriateness of diagnostic radiology procedures. Further study is needed to elucidate the relationship between appropriateness and actual patient outcomes.
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Affiliation(s)
- C E Kahn
- Department of Radiology, Medical College of Wisconsin, Milwaukee 53226, USA
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30
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Oneson SR, Timins ME, Scales LM, Erickson SJ, Chamoy L. MR imaging diagnosis of triangular fibrocartilage pathology with arthroscopic correlation. AJR Am J Roentgenol 1997; 168:1513-8. [PMID: 9168716 DOI: 10.2214/ajr.168.6.9168716] [Citation(s) in RCA: 93] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The goal of this study was to compare MR imaging with arthroscopy in evaluating triangular fibrocartilage (TFC) pathology. MATERIALS AND METHODS The results of 178 MR imaging examinations of the wrist were independently reviewed by two musculoskeletal radiologists who were unaware of the the clinical history, including any subsequent surgery. One hundred forty-nine of these studies were obtained from symptomatic patients. Of these patients, 56 underwent arthroscopic evaluation of the TFC. The remaining 29 studies were obtained from control volunteers and duplicate cases to reduce bias. The data were divided into categories based on Palmer's classification of TFC injury. Diagnostic sensitivity, specificity, and accuracy were calculated for each category. RESULTS Of the 56 patients who underwent arthroscopic evaluation of the TFC, 27 had TFCs that were intact at surgery. Also, 27 complete perforations and two partial defects were found at surgery. Sensitivity for detecting central degenerative perforations was 91% for both observers I and II. Sensitivity for detecting radial slitlike tears was 100% and 86% for observers I and II, respectively. Sensitivity for detecting ulnar-sided avulsions was 25% and 50% for observers I and II, respectively. CONCLUSION MR imaging is accurate in revealing TFC perforations.
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Affiliation(s)
- S R Oneson
- Department of Radiology, Medical College of Wisconsin, Froedtert Memorial Lutheran Hospital, Milwaukee 53226, USA
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31
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Erickson SJ, Johnson JE. MR imaging of the ankle and foot. Radiol Clin North Am 1997; 35:163-92. [PMID: 8998214] [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: 02/03/2023]
Abstract
Optimal MR imaging of the ankle and foot demands attention to coil selection, patient positioning, and prescription of the imaging parameters. Though useful in the evaluation of many osseous conditions, MR imaging is perhaps most frequently used in the evaluation of osteochondral lesions and suspected osteomyelitis. Soft-tissue masses with a predilection for the foot and ankle include plantar fibromatosis, ganglion cysts, and interdigital neuromas.
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Affiliation(s)
- S J Erickson
- Department of Radiology, Froedtert Memorial Lutheran Hospital, Milwaukee, Wisconsin, USA
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32
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Abstract
To determine the ability of fast gradient-recalled echo (GRE), breath-hold magnetic resonance imaging (MRI) to depict all regions of the diaphragm, 13 volunteers were scanned in coronal and sagittal planes. The central to anterior left hemidiaphragm and the posterior lumbar portions were each demonstrated in 12 subjects (92%). The crura were visible crossing anterior to the aorta in the sagittal plane in eight subjects (62%) and in the coronal plane in six subjects (46%). In the sagittal plane, the right crus was evident in eight subjects (62%). Muscular portions of the diaphragm in contact with the liver or body wall were less frequently discernible, and the central tendon could not be confidently resolved. Several artifacts occurred that interfered with visualization of the diaphragm. These observations indicate that many regions of the diaphragm can be seen with fast GRE, breath-hold MRI, but there are some limitations in depicting the diaphragm in its entirety.
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Affiliation(s)
- D S Gierada
- Department of Radiology, Medical College of Wisconsin, Milwaukee, USA
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33
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Abstract
BACKGROUND Cirsoid aneurysms are uncommon arteriovenous fistulas of the scalp. Surgery for these lesions can be difficult; transarterial embolization is rarely curative, while embolization of the venous pouch with permanent agents usually necessitates subsequent surgical removal of the embolic material. The ideal embolic agent would be one that is safe and effective, commercially available, and would not require subsequent removal. METHODS We treated an arteriovenous fistula of the scalp with direct puncture and injection of sodium tetradecyl sulfate, a commercially available sclerosing agent. RESULTS Control angiography immediately following percutaneous injection of sotradecol into the fistula showed decreased flow but not complete closure of the lesion. However, within several days of the embolization, the patient's scalp pain and mass resolved. Four months after embolization, MRA demonstrated no evidence of residual or recurrent fistula. Color doppler flow imaging demonstrated only slightly decreased vascular resistance in the distal superficial temporal artery, possibly indirect evidence of persistent micro-fistulae. Twenty-three months after the procedure, the patient continued to be asymptomatic and had no palpable lesion. CONCLUSIONS Percutaneous injection of sotradecol can be considered as one of the treatment options for arteriovenous fistula of the scalp. Further experience is needed to compare the safety and effectiveness of sotradecol with other agents currently used in the treatment of scalp arteriovenous fistulae.
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Affiliation(s)
- L E Hendrix
- Department of Radiology, Medical College of Wisconsin, Milwaukee 53226, USA
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34
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Erickson SJ, Waldschmidt JG, Czervionke LF, Prost RW. Hyaline cartilage: truncation artifact as a cause of trilaminar appearance with fat-suppressed three-dimensional spoiled gradient-recalled sequences. Radiology 1996; 201:260-4. [PMID: 8816555 DOI: 10.1148/radiology.201.1.8816555] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the cause of the trilaminar appearance within hyaline cartilage observed on magnetic resonance (MR) images obtained with a fat-suppressed three-dimensional spoiled gradient-recalled sequence. MATERIALS AND METHODS The knees of three asymptomatic volunteers were imaged with a fat-suppressed, three-dimensional, spoiled gradient-recalled sequence. The field of view, number of phase-encoding steps, and phase-encoding direction were varied. On each image, the thickness of the patellar and trochlear cartilage was measured in millimeters and divided by the pixel dimension, which effectively expressed the thickness as the number of pixels. Finally, the number of pixels was compared with the number of alternating hyperintense and hypointense lines depicted. RESULTS The number of truncation lines increased as pixel dimension was reduced by either decreasing the field of view or increasing the number of phase-encoding steps. The accuracy for predicting more than three lines with use of an anteroposterior phase-encoding direction varied between 83% and 92%. The appearance of the cartilage was altered when phase- and frequency-encoding directions were exchanged, but truncation lines were still evident. CONCLUSION The trilaminar appearance depicted within hyaline cartilage on MR images obtained with this sequence is predominantly attributable to truncation artifact rather than to histologic zonal anatomy.
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Affiliation(s)
- S J Erickson
- Department of Radiology, Medical College of Wisconsin, Milwaukee 53226, USA
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35
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Abstract
Magnetic resonance (MR) imaging is an effective method for helping determine the cause of wrist pain by demonstrating a broad spectrum of abnormalities, including those of bone, cartilage, ligaments, and tendons. MR imaging is useful in the detection, characterization, and staging of osseous injury and disease, although computed tomography provides superior detail in the depiction of bone. MR imaging may demonstrate irregular cartilage loss in noninflammatory arthropathies such as osteoarthritis, and its superior soft-tissue contrast makes it the method of choice for evaluating the synovial processes. Although arthrography remains the standard of reference in the detection of perforations of the principal intrinsic ligaments of the wrist, three-dimensional MR imaging has shown promise in depicting the small interosseous ligaments. Tendinitis, tenosynovitis, ganglia, and anatomic variants can be diagnosed and accurately assessed with MR imaging. Radiologists need to be aware of the full spectrum of wrist abnormalities and the characteristic MR imaging findings that accompany them.
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Affiliation(s)
- S R Oneson
- Department of Radiology, Froedtert Memorial Lutheran Hospital, Milwaukee, WI 53226, USA
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36
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Abstract
Twenty-six normal wrists in young adults were studied with magnetic resonance (MR) imaging. The following conclusions were drawn regarding normal anatomic features: (a) Multiple slips of the abductor pollicis longus tendon simulate longitudinal tears; (b) the extensor pollicis longus and extensor carpi ulnaris tendons normally demonstrate increased signal intensity simulating tendinitis; (c) small quantities of fluid in the extensor tendon sheaths may be normal and not indicative of tenosynovitis; (d) the triangular fibrocartilage normally demonstrates increased signal intensity simulating tears at its radial and ulnar attachment sites; (e) the volar ulnocarpal ligaments are often indistinct, thereby simulating injury; and (f) the median nerve has signal intensity equivalent to that of fat, nor of muscle as commonly believed. Awareness of these normal features is critical in making the correct interpretation of MR images of the wrist.
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Affiliation(s)
- M E Timins
- Department of Radiology, Medical College of Wisconsin, Froedtert Memorial Lutheran Hospital, Milwaukee 53226, USA
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37
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Murphy GP, Barren RJ, Erickson SJ, Bowes VA, Wolfert RL, Bartsch G, Klocker H, Pointner J, Reissigl A, McLeod DG, Douglas T, Morgan T, Kenny GM, Ragde H, Boynton AL, Holmes EH. Evaluation and comparison of two new prostate carcinoma markers. Free-prostate specific antigen and prostate specific membrane antigen. Cancer 1996; 78:809-18. [PMID: 8756376 DOI: 10.1002/(sici)1097-0142(19960815)78:4<809::aid-cncr18>3.0.co;2-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Two new prostate cancer markers, free-prostate specific antigen (f-PSA) and prostate specific membrane antigen (PSMA) were recently introduced. This report summarizes a prospective two-year multicenter test of their diagnostic or prognostic capabilities. Total PSA was also measured. METHODS There were four clinical groups studied: (1) 226 individuals from a screening project undergoing ultrasound and biopsy evaluation had markers obtained: (2) 68 patients suspected of having prostate cancer and undergoing 2 or more biopsies had the markers obtained on multiple occasions: (3) 100 patients undergoing radical prostatectomy had markers obtained pre- and post-operatively: and (4) 31 patients with metastatic prostate cancer each had multiple samples for marker assay obtained over a 2-year period. In all, 465 patients had one or more samples obtained and studied. RESULTS Free-PSA affords little additional diagnostic advantage compared with total PSA in the screening population. The receiver operating characteristic curves for diagnostic accuracy were ranked: (1) PSA density; (2) total PSA; (3) f-PSA; and (4) PSMA, PSMA showed the best correlation with stage of the primary tumor in the screened group. In the multiple negative biopsy group, f-PSA varied from 12 to 21%. PSMA values were evaluated in all histologic categories. PSA density was > or = 0.15 in all categories. In the prostatectomy cases PSA values postoperatively were quite low in Stage II; f-PSA was of no value. Later, f-PSA was increased in association with elevated total PSA values. Mean PSMA values were above normal in all postoperative time periods except in Stage III patients at 6 months to 1 year postoperatively. PSA densities were all > or = 0.15. In patients with metastatic carcinoma, elevated PSMA values correlated best with a poor prognosis (clinical progression), as has been described. CONCLUSIONS These data suggest that f-PSA values do not provide additional diagnostic benefit compared with total PSA in screening populations, in the presence of suspected cancer, postprostatectomy, or in metastatic disease. PSMA is of prognostic significance, especially in the presence of metastatic disease, and correlates well with the stage of disease in cancers detected in a screened population.
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Affiliation(s)
- G P Murphy
- Pacific Northwest Cancer Foundation, Northwest Hospital, Seattle, Washington 98125-7001, USA
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38
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Abstract
OBJECTIVE This study compared self-perception of defense patterns with objective and independent ratings of general adjustment in normal adolescents. METHOD Self-perception of defense utilization by 140 high school students was measured by an adolescent version of Bond's Defense Style Questionnaire. The DSM-III-R Global Assessment of Functioning Scale was used by clinicians in determining general adjustment. RESULTS Defense style and adjustment were significantly related; greater maturity of defense style was associated with better global adjustment, and conversely, greater immaturity of defense style was associated with a lower level of functioning. CONCLUSIONS Adolescents' self-perceived defense patterns have conscious correlates associated with general adjustment. This study extends the validity of the defense mechanism paradigm to the adolescent age group.
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Affiliation(s)
- S J Erickson
- Department of Psychiatry, Stanford University School of Medicine, CA 94305-5540, USA
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39
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Murphy GP, Tino WT, Holmes EH, Boynton AL, Erickson SJ, Bowes VA, Barren RJ, Tjoa BA, Misrock SL, Ragde H, Kenny GM. Measurement of prostate-specific membrane antigen in the serum with a new antibody. Prostate 1996; 28:266-71. [PMID: 8602402 DOI: 10.1002/(sici)1097-0045(199604)28:4<266::aid-pros7>3.0.co;2-b] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [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: 01/31/2023]
Abstract
Work to date has identified prostate-specific membrane antigen (PSMA) as a membrane-bound glycoprotein with high specificity for prostatic epithelial cells. PSMA reacts with the monoclonal antibody 7E11.C5, which is present in serum, seminal fluid, and prostatic epithelial cells, and is increased in its expression in the presence of a hormone refractory state associated with prostatic cancer. This report confirms these results and further documents the presence of the monoclonal antibody 3F5.4G6, which reacts with the extracellular domain of PSMA. This region of PSMA is also an element present in a truncated version of the protein, so-called PSM'. Immune precipitation with either 7E11.C5 or 3F5.4G6 yields an isolated protein species that are reactive with the reciprocal antibody in Western blot analysis. Thus, 3F5.4G6 recognizes the same PSMA protein as does 7E11.C5, but at different epitopes on essentially opposite ends of the molecule. These two antibodies are well suited for use in a sandwich immunoassay, either one as a capture or detection antibody. Current work on this is underway. This report also confirms that 7E11.C5 Western blots for PSMA are negative with normal human brain tissue. The monoclonal antibody 9H10 does not react with 3F5.4G6 or with 7E11.C5 in studies conducted herein. Moreover, 3F5.4G6 reacts with PSMA found in the LNCaP cell line, but not DU-145 or PC3, which lack PSMA.
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Affiliation(s)
- G P Murphy
- Pacific Northwest Cancer Foundation, Cancer Research Division, Northwest Hospital, Seattle, Washington, USA
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40
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Abstract
This study demonstrates magnetic resonance findings in 16 patients (25 heels) with heel pain. Sixteen of 25 (64%) studies demonstrated abnormalities which could be related to the etiology of their heel pain. Eleven of 16 abnormal scans demonstrated thickening of the plantar aponeurosis with associated fibrosis (7 of 11), and a tear of the flexor digitorum brevis (1 of 11). One study demonstrated changes in the heel pad consistent with fluid. The other four abnormal studies demonstrated changes thought to be consistent with bilateral fibrous calcaneonavicular coalitions, subtalar arthrosis and tenosynovitis of the posterior tibial, flexor digitorum longus, and flexor hallucis longus tendons.
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Affiliation(s)
- R L Hall
- Division of Orthopedic Surgery, Duke University Medical Center, Durham, NC 27710, USA
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41
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Oneson SR, Scales LM, Timins ME, Erickson SJ, Chamoy L. MR imaging interpretation of the Palmer classification of triangular fibrocartilage complex lesions. Radiographics 1996; 16:97-106. [PMID: 10946693 DOI: 10.1148/radiographics.16.1.97] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.5] [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: 11/11/2022]
Abstract
The triangular fibrocartilage complex (TFCC) is a complex anatomic and biomechanical structure. Injury to the TFCC is a recognized cause of ulnar wrist pain. The TFCC may be injured in its horizontal portion, in its peripheral portions, or at its attachments. In the Palmer classification, TFCC lesions are categorized as traumatic or degenerative. Traumatic lesions are subclassified according to the location of the injury; degenerative lesions are subclassified according to the extent of degeneration. This classification is helpful in determining the mechanism of injury and directing clinical management. Magnetic resonance (MR) imaging may be more useful than arthrography in prospective evaluation of TFCC lesions. MR images accurately demonstrate the structural abnormalities that contribute to ulnocarpal instability and pain. The presence or absence of chondromalacia is a factor in the Palmer classification and is also considered in treatment planning. However, only advanced cases of chondromalacia are reliably detected with MR imaging.
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Affiliation(s)
- S R Oneson
- Department of Radiology, Froedtert Memorial Lutheran Hospital, Milwaukee 53226, USA
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42
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Douglas TH, Connelly RR, McLeod DG, Erickson SJ, Barren R, Murphy GP. Effect of exogenous testosterone replacement on prostate-specific antigen and prostate-specific membrane antigen levels in hypogonadal men. J Surg Oncol 1995; 59:246-50. [PMID: 7543173 DOI: 10.1002/jso.2930590410] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [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: 01/25/2023]
Abstract
Previous studies have suggested that serum prostate-specific antigen (PSA) levels are under androgenic influence, especially in patients with adenocarcinoma of the prostate. PSMA (prostate-specific membrane antigen) is thought to reflect hormonal or clonal resistance or an independence with respect to testosterone regulation. The influence of testosterone on serum PSA expression in normal men is not clear. We studied the effect of exogenous testosterone administration on the serum levels of PSA and PSMA in hypogonadal men. Serial serum PSA, serum PSMA by Western blot, and serum total testosterone levels were obtained at intervals of every 2-4 weeks in 10 hypogonadal men undergoing treatment with exogenous testosterone, delivered as testosterone enanthate injection or by testosterone patch. Linear and quadratic orthogonal polynomial scores were calculated for PSMA, PSA, and testosterone. A 2-tailed, paired t-test failed to demonstrate a significant correlation between serum PSA (linear P = 0.432, quadratic P = 0.290) or PSMA (linear P = 0.162, quadratic P = 0.973) and serum testosterone levels. This study suggests that in hypogonadal men, neither PSMA nor PSA expression is testosterone-dependent.
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Affiliation(s)
- T H Douglas
- Department of Surgery, Walter Reed Army Medical Center, Washington, D.C. 20307-5001, USA
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43
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Timins ME, Erickson SJ, Estkowski LD, Carrera GF, Komorowski RA. Increased signal in the normal supraspinatus tendon on MR imaging: diagnostic pitfall caused by the magic-angle effect. AJR Am J Roentgenol 1995; 165:109-14. [PMID: 7785568 DOI: 10.2214/ajr.165.1.7785568] [Citation(s) in RCA: 35] [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] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Increased signal intensity within the distal portion of the supraspinatus tendon during MR imaging is a frequent observation even in healthy subjects. This finding has been variously attributed to the presence of fat, muscle, connective tissue, abnormal vascularity, or degenerative changes. More recently, the effect of tendon orientation in the static magnetic field (Bo) has been implicated. It has been shown that tendons at the magic angle of 55 degrees to Bo show markedly increased signal. This study was designed to determine the contribution of the magic-angle effect to the MR signal in the distal portion of the supraspinatus tendon. SUBJECTS AND METHODS Five healthy volunteers were imaged in a 1.5-T unit using short TR/TE sequences in standard supine position; they were then reimaged laterally flexed at the waist to reorient the plane of the distal portion of the supraspinatus tendon by approximately 20 degrees relative to Bo. In the second part of the study, three cadaveric shoulders were similarly imaged, first in standard position and then reoriented approximately 35 degrees by simple rotation of the specimen. The supraspinatus tendon was evaluated in each subject by noting the length of the segment with increased signal and the position of this segment relative to the insertion of the tendon on the greater tuberosity. Comparisons were made for each live and cadaveric subject between neutral and rotated positions. RESULTS Segments of increased signal changed in length and position for each live and cadaveric subject from the neutral to the reoriented position. CONCLUSION Our study suggests that tendon orientation contributes significantly to the presence of increased signal within the supraspinatus tendon, as caused by the magic-angle effect. Failure to recognize this effect may lead to diagnostic inaccuracy when evaluating the rotator cuff on short TR/TE sequences.
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Affiliation(s)
- M E Timins
- Department of Radiology, Medical College of Wisconsin, John L. Doyne Hospital, Milwaukee 53226, USA
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44
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Abstract
The integrity of the ligamentous network of the wrist is critical, as disruption of this network may result in carpal instability and pain. The extrinsic (radiocarpal) and intrinsic (intercarpal) ligaments that maintain carpal stability can be evaluated with magnetic resonance (MR) imaging. The major extrinsic ligaments are the radioscaphocapitate, radiolunotriquetral, short radiolunate, and dorsal radiocarpal ligaments. The scapholunate and lunotriquetral ligaments are the most important intrinsic ligaments and the primary wrist stabilizers. The most common causes of carpal instability are unstable fracture of the scaphoid, scapholunate dissociation, and lunotriquetral dissociation. Carpal instability can be diagnosed from the sagittal MR image that includes the capitate, lunate, and radius and from the sagittal MR image that includes the scaphoid and radius. Knowledge of the MR imaging appearances of the major carpal stabilizing ligaments and common patterns of carpal instability allows more precise diagnosis in cases of wrist pain.
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Affiliation(s)
- M E Timins
- Department of Radiology, Medical College of Wisconsin, Doyne Clinic, Milwaukee 53226, USA
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45
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Murphy GP, Holmes EH, Boynton AL, Kenny GM, Ostenson RC, Erickson SJ, Barren RJ. Comparison of prostate specific antigen, prostate specific membrane antigen, and LNCaP-based enzyme-linked immunosorbent assays in prostatic cancer patients and patients with benign prostatic enlargement. Prostate 1995; 26:164-8. [PMID: 7534919 DOI: 10.1002/pros.2990260308] [Citation(s) in RCA: 36] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Serum assays for prostate specific antigen (PSA; monoclonal), for prostate specific membrane antigen (PSM; Western blot), and a LNCaP/7E11.C5-based competitive enzyme-linked immunosorbent assay (ELISA) were evaluated in a small number of prostate cancer patients with localized or disseminated disease, and judged to be in clinical progression or remission based on National Prostate Cancer Project (NPCP) criteria. PSA values recognized the presence of clinical progression in localized disease (B1-C) and to a lesser degree disseminated disease (D1-D2). In contrast, to a limited degree the ELISA test recognized clinical progression mainly in disseminated disease and chiefly in stage D2. PSM values were elevated in both D1 and D2 but not in a linear fashion as observed with PSA. The ELISA and PSM results may be assessing a different clinical response to prostatic cancer than that recognized by PSA. This could reflect a developing clone of resistant prostatic cells as previously postulated. To further pursue this possibility a secondary generation of monoclonal antibodies to PSM is being developed. The ELISA levels for benign prostatic enlargement were not elevated above normal. In contrast both with PSA and PSM the assays reflected levels significantly above the normal range in benign prostatic hypertrophy (BPH).
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Affiliation(s)
- G P Murphy
- Pacific Northwest Research Foundation, Seattle, WA 98125
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46
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Abstract
PURPOSE To investigate the feasibility of imaging diaphragmatic motion with a fast gradient-recalled-echo (GRE) magnetic resonance (MR) pulse sequence. MATERIALS AND METHODS Fast GRE pulse sequences in sagittal and coronal planes were used to acquire repeated, single-level, 1.2-second scans in 10 healthy volunteers during deliberately slowed, approximate-vital-capacity breathing. Motion was analyzed subjectively by viewing the image sequences as cine loops and quantitatively by measuring the displacement of different points on the diaphragm at a workstation. RESULTS Temporal and spatial resolutions were adequate in all subjects. Absolute excursion of the domes was 4.4 cm on the right and 4.2 cm on the left. Analysis of diaphragmatic displacement at different locations revealed a gradient of excursion that increased from anterior to middle to posterior (P < .05-.001; paired t test). Excursion of the lateral aspects was greater than that of the medial aspect (P < .001). CONCLUSION Fast GRE MR imaging can be reliably used to demonstrate diaphragmatic motion and may prove useful in the investigation of normal and abnormal respiratory mechanics.
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Affiliation(s)
- D S Gierada
- Department of Radiology, Medical College of Wisconsin, Milwaukee 53226
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47
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Hinke DH, Erickson SJ, Chamoy L, Timins ME. Ulnar collateral ligament of the thumb: MR findings in cadavers, volunteers, and patients with ligamentous injury (gamekeeper's thumb). AJR Am J Roentgenol 1994; 163:1431-4. [PMID: 7992741 DOI: 10.2214/ajr.163.6.7992741] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The ulnar collateral ligament bridges the ulnar aspect of the first metacarpal and the proximal phalanx and functions as a major stabilizer of the first metacarpophalangeal joint. Acute or chronic injury of this ligament is referred to as gamekeeper's thumb. The objectives of this study were to (1) determine the MR appearance of the ulnar collateral ligament of the thumb in cadavers and volunteers and (2) analyze the MR findings in patients with gamekeeper's thumb, especially with regard to the value of MR in detecting clinically significant displacement of the ligament (Stener lesion). MATERIALS AND METHODS MR imaging of the first metacarpophalangeal joint was performed in three volunteers, two cadaveric specimens, and 11 patients with acute injury. In the patients, the mechanism of injury was an abrupt abductive force on the thumb resulting in rupture of the ulnar collateral ligament. The diagnosis was confirmed by surgery in five patients and by clinical follow-up in the remaining six. Cryomicrotome sectioning of the cadaveric tissue blocks was performed to correlate pathologic and MR findings. Images were interpreted by one radiologist. RESULTS MR images showed rupture of the ulnar collateral ligament in all 11 patients. Prospectively, Stener lesions (n = 3) could be differentiated from non-Stener lesions (n = 8) in eight of 11 patients. Retrospectively, the correct diagnosis could be made in all 11 patients once the importance of determining the position of the ulnar collateral ligament relative to the adductor aponeurosis was understood. CONCLUSION MR imaging of the first metacarpophalangeal joint depicts the ulnar collateral ligament and adductor aponeurosis to good advantage. It can also accurately show tears of the ulnar collateral ligament and thus be used to differentiate a rupture without significant retraction from a Stener lesion. This information is important in determining whether surgical or conservative management is indicated.
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Affiliation(s)
- D H Hinke
- Department of Radiology, John L. Doyne Hospital, Doyne Clinic, Milwaukee, WI 53226
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48
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Rochon YP, Horoszewicz JS, Boynton AL, Holmes EH, Barren RJ, Erickson SJ, Kenny GM, Murphy GP. Western blot assay for prostate-specific membrane antigen in serum of prostate cancer patients. Prostate 1994; 25:219-23. [PMID: 8084837 DOI: 10.1002/pros.2990250408] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.5] [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: 01/28/2023]
Abstract
There is a need for the development of new diagnostic tools for the early detection of prostate cancer. A candidate molecule for a new screening test is a prostate-specific membrane antigen (PSM) recognized by the monoclonal antibody 7E11.C5. We carried out studies aimed at identifying PSM in the serum of normal and benign prostatic hyperplasia (BPH) donors and patients with adenocarcinoma of the prostate, in order to judge whether the development of a serum assay using this marker was feasible. By Western blotting, we found significant levels of PSM in serum samples from prostatic cancer patients, in the seminal fluid of pooled normal donors, in BPH patients, and in normal male sera. Similar to prostate-specific antigen (PSA), PSM was present in seminal plasma in higher concentrations than in serum, and PSM levels in prostatic cancer patients were significantly higher than in normal controls. These data suggest that the development of an assay utilizing the PSM and new monoclonal antibodies directed against the antigen, could provide a feasible test for prostatic cancers.
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Affiliation(s)
- Y P Rochon
- Pacific Northwest Research Foundation, Seattle, WA 98122
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49
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Taylor AJ, Carmody TJ, Quiroz FA, Erickson SJ, Varma RR, Komorowski RA, Foley WD. Focal masses in cirrhotic liver: CT and MR imaging features. AJR Am J Roentgenol 1994; 163:857-62. [PMID: 8092023 DOI: 10.2214/ajr.163.4.8092023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [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: 01/28/2023]
Abstract
The development of hepatic cirrhosis triggers attempted repair through regenerative nodules of parenchyma among bands of scar tissue. Some authors believe that this regeneration initiates an evolutionary process that may lead to nodular enlargement and cellular dedifferentiation to malignancy. Both the destructive and reparative processes in cirrhosis produce changes that the radiologist must recognize when imaging the cirrhotic liver. This essay describes the CT and MR features of masses and masslike lesions in the cirrhotic liver, including the identifying characteristics and overlapping appearances of CT and MR.
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Affiliation(s)
- A J Taylor
- Department of Radiology, Medical College of Wisconsin, Milwaukee 53226
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50
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Ruiz ME, Erickson SJ. Medial and lateral supporting structures of the knee. Normal MR imaging anatomy and pathologic findings. Magn Reson Imaging Clin N Am 1994; 2:381-99. [PMID: 7489294] [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: 01/25/2023]
Abstract
The supporting structures of the knee can be divided into several layers: fascial boundaries, the collateral ligaments and tendons, and the joint capsule. MR imaging's ability to demonstrate these findings has helped to validate this anatomic concept. An appreciation for the organization of the medial and lateral compartments facilitates MR imaging interpretation.
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Affiliation(s)
- M E Ruiz
- Department of Radiology, Medical College of Wisconsin, John L. Doyne Hospital-Doyne Clinic, Milwaukee, USA
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