Medicine and Health Sciences Commons^™

Youtube Atherectomy Videos: What Industry Is Telling Us About This Endovascular Procedure, Dongjin Suh B.S., Michael F. Amendola Md, Associate Professor Of Surgery

VCU Health Publications

BACKGROUND:

Patients are turning to the Internet and YouTube for information about their providers, disease states and potential interventions. Endovascular atherectomy is a common procedure undertaken in the treatment of peripheral vascular disease especially in outpatient treatment centers despite its cost. Little is known how this procedure is portrayed in online video content. We set forth to search YouTube to gain insight to how industry and non-industry portrays this endovascular technology.

METHODS:

YouTube (www.youtube.com) website was accessed in July 2017 with a cleared cached web browser for the key search word “atherectomy”. The top 100 videos with greater than 100 …

Vedolizumab: An Α4Β7 Integrin Antagonist For Ulcerative Colitis And Crohn’S Disease, Lauren N. Cherry, Nancy S. Yunker, Erika R. Lambert, Dalemarie Vaughan, Denise K. Lowe

VCU Health Publications

Ulcerative colitis (UC) and Crohn’s disease (CD) are chronic, relapsing inflammatory bowel diseases associated with significant morbidity. Conventional therapies for these diseases include corticosteroids, aminosalicylates, immunomodulators, and monoclonal antibodies. Over the years tumor necrosis factor (TNF)-α antagonists alone or in combination with other therapies have emerged as the cornerstone of treatment for induction and maintenance of remission of moderate to severe UC and CD. Unfortunately, some patients with moderate to severe UC and CD are unable to attain or maintain remission with TNF-α antagonist treatment. Vedolizumab, a humanized monoclonal antibody, is the first integrin receptor antagonist approved that selectively antagonizes …

Perceived Stress Levels, Chemotherapy, Radiation Treatment And Tumor Characteristics Are Associated With A Persistent Increased Frequency Of Somatic Chromosomal Instability In Women Diagnosed With Breast Cancer: A One Year Longitudinal Study, Noran Aboalela, Debra E. Lyon, R. K. Elswick Jr., Debra Lynch Kelly, Jenni Brumelle, Harry D. Bear, Colleen Jackson-Cook

VCU Health Publications

While advances in therapeutic approaches have resulted in improved survival rates for women diagnosed with breast cancer, subsets of these survivors develop persistent psychoneurological symptoms (fatigue, depression/anxiety, cognitive dysfunction) that compromise their quality of life. The biological basis for these persistent symptoms is unclear, but could reflect the acquisition of soma-wide chromosomal instability following the multiple biological/psychological exposures associated with the diagnosis/treatment of breast cancer. An essential first step toward testing this hypothesis is to determine if these cancer-related exposures are indeed associated with somatic chromosomal instability frequencies. Towards this end, we longitudinally studied 71 women (ages 23-71) with early-stage …

Using An In-Vitro Biofilm Model To Assess The Virulence Potential Of Bacterial Vaginosis Or Non-Bacterial Vaginosis Gardnerella Vaginalis Isolates, Joana Castro, Patricia Alves, Cármen Sousa, Tatiana Cereija, Ângela França, Kimberly K. Jefferson, Nuno Cerca

VCU Health Publications

Gardnerella vaginalis is the most common species found in bacterial vaginosis (BV). However, it is also present in a significant proportion of healthy women and G. vaginalis vaginal colonization does not always lead to BV. In an effort to better understand the differences between G. vaginalis isolated from women with a positive (BV) versus a negative (non-BV) diagnosis of BV, we compared the virulence potential of 7 BV and 7 non-BV G. vaginalis isolates and assessed the virulence factors related to biofilm formation, namely: initial adhesion and cytotoxic effect, biofilm accumulation, susceptibility to antibiotics, and transcript levels of the known …

Novel Zno Hollow-Nanocarriers Containing Paclitaxel Targeting Folate-Receptors In A Malignant Ph-Microenvironment For Effective Monitoring And Promoting Breast Tumor Regression, Nagaprasad Puvvada, Shashi Rajput, B. N. Prashanth Kumar, Siddik Sarkar, Suraj Konar, Keith R. Brunt, Raj R. Rao, Abhijit Mazumdar, Swadesh K. Das, Ranadhir Basu, Paul B. Fisher, Mahitosh Mandal, Amita Pathak

VCU Health Publications

Low pH in the tumor micromilieu is a recognized pathological feature of cancer. This attribute of cancerous cells has been targeted herein for the controlled release of chemotherapeutics at the tumour site, while sparing healthy tissues. To this end, pH-sensitive, hollow ZnO-nanocarriers loaded with paclitaxel were synthesized and their efficacy studied in breast cancer in vitro and in vivo. The nanocarriers were surface functionalized with folate using click-chemistry to improve targeted uptake by the malignant cells that over-express folate-receptors. The nanocarriers released ~75% of the paclitaxel payload within six hours in acidic pH, which was accompanied by switching of …

Identification Of Novel Regulatory Cholesterol Metabolite, 5-Cholesten, 3Β,25-Diol, Disulfate, Shunlin Ren, Jin Koung Kim, Genta Kakiyama, Daniel Rodriguez-Agudo, William M. Pandak, Hae-Ki Min, Yanxia Ning

VCU Health Publications

Oxysterol sulfation plays an important role in regulation of lipid metabolism and inflammatory responses. In the present study, we report the discovery of a novel regulatory sulfated oxysterol in nuclei of primary rat hepatocytes after overexpression of the gene encoding mitochondrial cholesterol delivery protein (StarD1). Forty-eight hours after infection of the hepatocytes with recombinant StarD1 adenovirus, a water-soluble oxysterol product was isolated and purified by chemical extraction and reverse-phase HPLC. Tandem mass spectrometry analysis identified the oxysterol as 5-cholesten-3β, 25-diol, disulfate (25HCDS), and confirmed the structure by comparing with a chemically synthesized compound. Administration of 25HCDS to human THP-1-derived macrophages …

Clinical And Microbiologic Efficacy Of A Water Filter Program In A Rural Honduran Community, Jaclyn Arquiette, Michael P. Stevens, Jean M. Rabb, Kakotan Sanogo, Patrick Mason, Gonzalo Bearman

VCU Health Publications

Water purification in the rural Honduras is a focus of the nonprofit organization Honduras Outreach Medical Brigade Relief Effort (HOMBRE). We assessed water filter use and tested filter microbiologic and clinical efficacy. A 22-item questionnaire assessed water sources, obtainment/storage, purification, and incidence of gastrointestinal disease. Samples from home clay-based filters in La Hicaca were obtained and paired with surveys from the same home. We counted bacterial colonies of four bacterial classifications from each sample. Sixty-five surveys were completed. Forty-five (69%) individuals used a filter. Fifteen respondents reported diarrhea in their home in the last 30 days; this incidence was higher …

Abnormal Downward Gaze And Cold Caloric Examination Due To Propofol: A Case Study, Thuy-Anh Vu, Alia O'Meara, Jean Teasley

VCU Health Publications

Background: Adolescent patient with isolated abnormal downward gaze and oculovestibular (cold caloric) testing during propofol administration prompting concern of brainstem injury. PATIENT: An otherwise healthy 16 year old female presented after an intentional hanging. Brainstem reflexes were normal except that both eyes were in tonic downgaze on initial examination. Propofol was suspended for 30 minutes to evaluate level of responsiveness with eyes normalizing to midposition from tonic downgaze. With reinitiation of propofol, the eyes returned to the former position. C-collar stabilization prohibited oculocephalic (doll’s eyes) evaluation, and with cold caloric testing, eye movements were as follows: right sided cold water …

Comparative Cardiac Toxicity Of Anthracyclines In Vitro And In Vivo In The Mouse, Stefano Toldo, Rachel W. Goehe, Marzia Lotrionte, Eleonora Mezzaroma, Evan T. Sumner, Giuseppe G. L. Biondi-Zoccai, Ignacio M. Seropian, Benjamin W. Van Tassell, Francesco Loperfido, Giovanni Palazzoni, Norbert F. Voelkel, Antonio Abbate, David A. Gewirtz

VCU Health Publications

Purpose

The antineoplastic efficacy of anthracyclines is limited by their cardiac toxicity. In this study, we evaluated the toxicity of doxorubicin, non-pegylated liposomal-delivered doxorubicin, and epirubicin in HL-1 adult cardiomyocytes in culture as well as in the mouse in vivo.

Methods

The cardiomyocytes were incubated with the three anthracyclines (1 µM) to assess reactive oxygen generation, DNA damage and apoptotic cell death. CF-1 mice (10/group) received doxorubicin, epirubicin or non-pegylated liposomal-doxorubicin (10 mg/kg) and cardiac function was monitored by Doppler echocardiography to measure left ventricular ejection fraction (LVEF), heart rate (HR) and cardiac output (CO) both prior to and …

Intracellular Function Of Interleukin-1 Receptor Antagonist In Ischemic Cardiomyocytes, Elena Vecile, Aldo Dobrina, Fadi N. Salloum, Benjamin W. Van Tassell, Antonella Falcione, Edorado Gustini, Samuele Secchiero, Sergio Crovella, Gianfranco Sinagra, Nicoletta Finato, Martin J. Nicklin, Antonio Abbate

VCU Health Publications

Background

Loss of cardiac myocytes due to apoptosis is a relevant feature of ischemic heart disease. It has been described in infarct and peri-infarct regions of the myocardium in coronary syndromes and in ischemia-linked heart remodeling. Previous studies have provided protection against ischemia-induced cardiomyocyte apoptosis by the anti-inflammatory cytokine interleukin-1 receptor-antagonist (IL-1Ra). Mitochondria triggering of caspases plays a central role in ischemia-induced apoptosis. We examined the production of IL-1Ra in the ischemic heart and, based on dual intra/extracellular function of some other interleukins, we hypothesized that IL-1Ra may also directly inhibit mitochondria-activated caspases and cardiomyocyte apoptosis.

Methodology/Principal Findings

Synthesis of …

Microbes Bind Complement Inhibitor Factor H Via A Common Site, T. Meri, H. Amdahl, M. J. Lehtinen, S. Hyvarinen, J. V. Mcdowell, A. Bhattachargee, S. Meri, R. Marconi, A. Goldman, T. S. Jokiranta

VCU Health Publications

To cause infections microbes need to evade host defense systems, one of these being the evolutionarily old and important arm of innate immunity, the alternative pathway of complement. It can attack all kinds of targets and is tightly controlled in plasma and on host cells by plasma complement regulator factor H (FH). FH binds simultaneously to host cell surface structures such as heparin or glycosaminoglycans via domain 20 and to the main complement opsonin C3b via domain 19. Many pathogenic microbes protect themselves from complement by recruiting host FH. We analyzed how and why different microbes bind FH via domains …

Effect Of Daily Chlorhexidine Bathing On Hospital-Acquired Infection, Michael W. Climo, Edward S. Wong, Kakotan Sanogo, Deborah S. Yokoe, David K. Warren, Trish M. Perl, Maureen Bolon, Robert A. Weinstein, Loreen A. Herwaldt, Kent A. Sepkowitz, John A. Jernigan

VCU Health Publications

BACKGROUND

Results of previous single-center, observational studies suggest that daily bathing of patients with chlorhexidine may prevent hospital-acquired bloodstream infections and the acquisition of multidrug-resistant organisms (MDROs).

METHODS

We conducted a multicenter, cluster-randomized, nonblinded crossover trial to evaluate the effect of daily bathing with chlorhexidine-impregnated washcloths on the acquisition of MDROs and the incidence of hospital-acquired bloodstream infections. Nine intensive care and bone marrow transplantation units in six hospitals were randomly assigned to bathe patients either with no-rinse 2% chlorhexidine– impregnated washcloths or with nonantimicrobial washcloths for a 6-month period, exchanged for the alternate product during the subsequent 6 months. …

Antibiotic Prevention Of Acute Exacerbations Of Copd, Richard P. Wenzel, Alpha A. Fowler, Michael B. Edmond

VCU Health Publications

An estimated 24 million persons in the United States have COPD on the basis of lung-function testing.1 Globally, COPD is the fourth leading cause of death,2 and in the United States it is the third most common cause of death and chronic complications.3 The average person with COPD has one to two acute exacerbations each year, with wide variation from patient to patient.4 In 2000 in the United States, 726,000 patients were hospitalized with acute exacerbations of COPD.1 During an acute exacerbation, antibiotics are generally administered for 5 to 10 days,5 creating a national burden of 120 million to 480 …

Right Ventricular Dysfunction Following Acute Myocardial Infarction In The Absence Of Pulmonary Hypertension In The Mouse, Stefano Toldo, Herman J. Bogaard, Benjamin W. Van Tassell, Eleonora Mezzaroma, Ignacio M. Seropian, Roshanak Robati, Fadi N. Salloum, Norbert F. Voelkel, Antonio Abbate

VCU Health Publications

Background

Cardiac remodelling after AMI is characterized by molecular and cellular mechanisms involving both the ischemic and non-ischemic myocardium. The extent of right ventricular (RV) dilatation and dysfunction and its relation to pulmonary hypertension (PH) following AMI are unknown. The aim of the current study was to evaluate changes in dimensions and function of the RV following acute myocardial infarction (AMI) involving the left ventricle (LV).

Methods

We assessed changes in RV dimensions and function 1 week following experimental AMI involving the LV free wall in 10 mice and assessed for LV and RV dimensions and function and for the …

Alterations In The Interleukin-1/Interleukin-1 Receptor Antagonist Balance Modulate Cardiac Remodeling Following Myocardial Infarction In The Mouse, Antonio Abbate, Fadi N. Salloum, Benjamin W. Van Tassell, Elena Vecile, Stefano Toldo, Ignacio M. Seropian, Eleonora Mezzaroma, Aldo Dobrina

VCU Health Publications

Background

Healing after acute myocardial infarction (AMI) is characterized by an intense inflammatory response and increased Interleukin-1 (IL-1) tissue activity. Genetically engineered mice lacking the IL-1 receptor (IL-1R1-/-, not responsive to IL-1) or the IL-1 receptor antagonist (IL-1Ra, enhanced response to IL-1) have an altered IL-1/IL-1Ra balance that we hypothesize modulates infarct healing and cardiac remodeling after AMI.

Methods

IL-1R1-/- and IL-1Ra-/- male mice and their correspondent wild-types (WT) were subjected to permanent coronary artery ligation or sham surgery. Infarct size (trichrome scar size), apoptotic cell death (TUNEL) and left ventricular (LV) dimensions and function (echocardiography) were measured prior to …

Endothelial Cells And Pulmonary Arterial Hypertension: Apoptosis, Proliferation, Interaction And Transdifferentiation, Seiichiro Sakao, Koichiro Tatsumi, Norbert F. Voelkel

VCU Health Publications

Severe pulmonary arterial hypertension, whether idiopathic or secondary, is characterized by structural alterations of microscopically small pulmonary arterioles. The vascular lesions in this group of pulmonary hypertensive diseases show actively proliferating endothelial cells without evidence of apoptosis. In this article, we review pathogenetic concepts of severe pulmonary arterial hypertension and explain the term "complex vascular lesion ", commonly named "plexiform lesion", with endothelial cell dysfunction, i.e., apoptosis, proliferation, interaction with smooth muscle cells and transdifferentiation.

Chaotic Signatures Of Heart Rate Variability And Its Power Spectrum In Health, Aging And Heart Failure, Guo-Qiang Wu, Natalia M. Arzeno, Lin-Lin Shen, Da-Kan Tang, Da-An Zheng, Nai-Qing Zhao, Dwain L. Eckberg, Chi-Sang Poon

VCU Health Publications

A paradox regarding the classic power spectral analysis of heart rate variability (HRV) is whether the characteristic high- (HF) and low-frequency (LF) spectral peaks represent stochastic or chaotic phenomena. Resolution of this fundamental issue is key to unraveling the mechanisms of HRV, which is critical to its proper use as a noninvasive marker for cardiac mortality risk assessment and stratification in congestive heart failure (CHF) and other cardiac dysfunctions. However, conventional techniques of nonlinear time series analysis generally lack sufficient sensitivity, specificity and robustness to discriminate chaos from random noise, much less quantify the chaos level. Here, we apply a …

Prolonged Therapy Of Advanced Chronic Hepatitis C With Low-Dose Peginterferon, Adrian M. Di Bisceglie, Mitchell L. Shiffman, Gregory T. Everson, Karen L. Lindsay, James E. Everhart, Elizabeth C. Wright, William M. Lee, Anna S. Lok, Herbert L. Bonkovsky, Timothy R. Morgan, Marc G. Ghany, Chihiro Morishima, Kristin K. Snow, Jules L. Dienstag

VCU Health Publications

Background

In patients with chronic hepatitis C who do not have a response to antiviral treatment, the disease may progress to cirrhosis, liver failure, hepatocellular carcinoma, and death. Whether long-term antiviral therapy can prevent progressive liver disease in such patients remains uncertain.

Methods

We conducted a randomized, controlled trial of peginterferon alfa-2a at a dosage of 90 μg per week for 3.5 years, as compared with no treatment, in 1050 patients with chronic hepatitis C and advanced fibrosis who had not had a response to previous therapy with peginterferon and ribavirin. The patients, who were stratified according to stage of …

Peginterferon Alfa-2a And Ribavirin For 16 Or 24 Weeks In Hcv Genotype 2 Or 3, Mitchell L. Shiffman, Fredy Suter, Bruce R. Bacon, David Nelson, Hugh Harley, Richard Sola, Stephen D. Shafran, Karl Barange, Amy Lin, Ash Soman, Stefan Zeuzem

VCU Health Publications

Background

Patients infected with hepatitis C virus (HCV) genotype 2 or 3 have sustained virologic response rates of approximately 80% after receiving treatment with peginterferon and ribavirin for 24 weeks. We conducted a large, randomized, multinational, noninferiority trial to determine whether similar efficacy could be achieved with only 16 weeks of treatment with peginterferon alfa-2a and ribavirin.

Methods

We randomly assigned 1469 patients with HCV genotype 2 or 3 to receive 180 μg of peginterferon alfa-2a weekly, plus 800 mg of ribavirin daily, for either 16 or 24 weeks. A sustained virologic response was defined as an undetectable serum HCV …

Eltrombopag For Thrombocytopenia In Patients With Cirrhosis Associated With Hepatitis C, John G. Mchutchison, Geoffrey Dusheiko, Mitchell L. Shiffman, Maribel Rodriguez-Torres, Samuel Sigal, Marc Bourliere, Thomas Berg, Stuart C. Gordon, Fiona M. Campbell, Dickens Theodore, Nicole Blackman, Julian Jenkins, Nezam H. Afdhal

VCU Health Publications

Background

Eltrombopag is a new, orally active thrombopoietin-receptor agonist that stimulates thrombopoiesis. We evaluated its ability to increase platelet counts and facilitate treatment for hepatitis C virus (HCV) infection in patients with thrombocytopenia associated with HCV-related cirrhosis.

Methods

Seventy-four patients with HCV-related cirrhosis and platelet counts of 20,000 to less than 70,000 per cubic millimeter were randomly assigned to receive eltrombopag (30, 50, or 75 mg daily) or placebo daily for 4 weeks. The primary end point was a platelet count of 100,000 per cubic millimeter or more at week 4. Peginterferon and ribavirin could then be initiated, with continuation …

Deficiency Of Cartilage-Associated Protein In Recessive Lethal Osteogenesis Imperfecta, Aileen M. Barnes, Weizhong Chang, Roy Morello, Wayne A. Cabral, Maryann Weis, David R. Eyre, Sergey Leikin, Elena Makareeva, Natalia Kuznetsova, Thomas E. Uveges, Aarthi Ashok, Armando W. Flor, John J. Mulvihill, Patrick L. Wilson, Usha T. Sundaram, Brendan Lee, Joan C. Marini

VCU Health Publications

Classic osteogenesis imperfecta, an autosomal dominant disorder associated with osteoporosis and bone fragility, is caused by mutations in the genes for type I collagen. A recessive form of the disorder has long been suspected. Since the loss of cartilage-associated protein (CRTAP), which is required for post-translational prolyl 3-hydroxylation of collagen, causes severe osteoporosis in mice, we investigated whether CRTAP deficiency is associated with recessive osteogenesis imperfecta. Three of 10 children with lethal or severe osteogenesis imperfecta, who did not have a primary collagen defect yet had excess post-translational modification of collagen, were found to have a recessive condition resulting in …

Public-Access Defibrillation And Survival After Out-Of-Hospital Cardiac Arrest, Alfred Hallstrom, Joseph P. Ornato

VCU Health Publications

BACKGROUND

The rate of survival after out-of-hospital cardiac arrest is low. It is not known whether this rate will increase if laypersons are trained to attempt defibrillation with the use of automated external defibrillators (AEDs).

Full Text of Background...

METHODS

We conducted a prospective, community-based, multicenter clinical trial in which we randomly assigned community units (e.g., shopping malls and apartment complexes) to a structured and monitored emergency-response system involving lay volunteers trained in cardiopulmonary resuscitation (CPR) alone or in CPR and the use of AEDs. The primary outcome was survival to hospital discharge.

Full Text of Methods...

RESULTS

More than …

Voriconazole Compared With Liposomal Amphotericin B For Empirical Antifungal Therapy In Patients With Neutropenia And Persistent Fever, Thomas J. Walsh, Peter Pappas, Drew J. Winston, Hillard M. Lazarus, Finn Petersen, John Raffalli, Saul Yanovich, Patric Stiff, Richard Greenberg, Gerald Donowitz, Jeanette Lee

VCU Health Publications

Background

Patients with neutropenia and persistent fever are often treated empirically with amphotericin B or liposomal amphotericin B to prevent invasive fungal infections. Antifungal triazoles offer a potentially safer and effective alternative.

Methods

In a randomized, international, multicenter trial, we compared voriconazole, a new second-generation triazole, with liposomal amphotericin B for empirical antifungal therapy.

Results

A total of 837 patients (415 assigned to voriconazole and 422 to liposomal amphotericin B) were evaluated for success of treatment. The overall success rates were 26.0 percent with voriconazole and 30.6 percent with liposomal amphotericin B (95 percent confidence interval for the difference, –10.6 …

Control Of Vancomycin-Resistant Enterococcus In Health Care Facilities In A Region, Belinda E. Ostrowsky , M.D., M.P.H., William E. Trick, Annette H. Sohn, Stephen B. Quirk, Stacey Holt , B.S., Loretta A. Carson , M.S., Bertha C. Hill, Mathew J. Arduino, Mathew J. Kuehnert, William R. Jarvis

VCU Health Publications

Background

In late 1996, vancomycin-resistant enterococci were first detected in the Siouxland region of Iowa, Nebraska, and South Dakota. A task force was created, and in 1997 the assistance of the Centers for Disease Control and Prevention was sought in assessing the prevalence of vancomycin-resistant enterococci in the region’s facilities and implementing recommendations for screening, infection control, and education at all 32 health care facilities in the region.

Methods

The infection-control intervention was evaluated in October 1998 and October 1999. We performed point-prevalence surveys, conducted a case– control study of gastrointestinal colonization with vancomycin-resistant enterococci, and compared infection-control practices and …

Peginterferon Alfa-2a In Patients With Chronic Hepatitis C And Cirrhosis, E. Jenny Heathcote, Mitchell L. Shiffman, W. Graham E. Cooksley, Geoffrey M. Dusheiko, Samuel S. Lee, Luis Balart, Robert Reindollar, Rajender K. Reddy, Teresa L. Wright, Amy Lin, Joseph Hoffman, Jean De Pamphilis

VCU Health Publications

Background

Chronic hepatitis C virus (HCV) infection in patients with cirrhosis is difficult to treat. In patients with chronic hepatitis C but without cirrhosis, once-weekly administration of interferon modified by the attachment of a 40-kd branched-chain polyethylene glycol moiety (peginterferon alfa-2a) is more efficacious than a regimen of unmodified interferon. We examined the efficacy and safety of peginterferon alfa-2a in patients with HCV-related cirrhosis or bridging fibrosis.

Methods

We randomly assigned 271 patients with cirrhosis or bridging fibrosis to receive subcutaneous treatment with 3 million units of interferon alfa-2a three times weekly (88 patients), 90 µg of peginterferon alfa-2a once …

A Comparison Of Four Treatments For Generalized Convulsive Status Epilepticus, David M. Treiman , M.D., Patti D. Meyers , M.P.A., Nancy Y. Walton , Ph.D., Joseph F. Collins , Sc.D., Cindy Colling , R.Ph., M.S., A. James Rowan , M.D., Adrian Handforth , M.D., Edward Faught , M.D., Vincent P. Calabrese , M.D., Basim M. Uthman , M.D., R. Eugene Ramsay , M.D., Meenal B. Mamdani , M.D., Pratap Yagnik , M.D., John C. Jones , M.D., Elizabeth Barry , M.D., Jane G. Boggs , M.D., Andres M. Kanner , M.D.

VCU Health Publications

ABSTRACT

Background and Methods Although generalized convulsive status epilepticus is a life-threatening emergency, the best initial drug treatment is uncertain. We conducted a five-year randomized, doubleblind, multicenter trial of four intravenous regimens: diazepam (0.15 mg per kilogram of body weight) followed by phenytoin (18 mg per kilogram), lorazepam (0.1 mg per kilogram), phenobarbital (15 mg per kilogram), and phenytoin (18 mg per kilogram). Patients were classified as having either overt generalized status epilepticus (defined as easily visible generalized convulsions) or subtle status epilepticus (indicated by coma and ictal discharges on the electroencephalogram, with or without subtle convulsive movements such as …

Cellular Dna Content As A Predictor Of Response To Chemotherapy In Infants With Unresectable Neuroblastoma, A. Thomas Look, F. Ann Hayes, Ruprecht Nitschke, Nancy B. Mcwilliams, Alexander A. Green

VCU Health Publications

We studied the relation between the DNA content of neuroblastoma cells and the response to therapy in 35 infants under one year of age with a diagnosis of neuroblastoma. Using flow cytometric techniques, we found that in 27 cases the primary malignant stem line consisted of neuroblasts with hyperdiploid DNA content, ranging from 1.07 to 2.42 times the finding in normal diploid cells. All remaining cases had diploid stem lines. Diploidy was more common in infants with clinical Stage D neuroblastoma (metastases beyond regional lymph nodes) than in those with other, less advanced stages: 6 of 10 as compared with …

Ventriculostomy-Related Infections, C. Glen Mayhall, Nancy H. Archer, V. Archer Lamb, Alice C. Spadora, Jane W. Baggett, John D. Ward, Raj K. Narayan

VCU Health Publications

We conducted a prospective epidemiologic study of ventriculostomy-related infections (ventriculitis or meningitis) in 172 consecutive neurosurgical patients over a two-year period to determine the incidence, risk factors, and clinical characteristics of the infections. Ventriculitis or meningitis developed in 19 of 172 patients (11 per cent) undergoing a total of 213 ventriculostomies. When data from all these cases plus five cases of nonventriculostomy-related infection were combined, cerebrospinal-fluid pleocytosis was more significantly associated with the diagnosis of ventriculitis or meningitis (P<0.0001) than were fever and leukocytosis (P = 0.07). Risk factors for ventriculostomy-related infections included intracerebral hemorrhage with intraventricular hemorrhage (P = 0.027), neurosurgical operations (P = 0.016), intracranial pressure of 20 mm Hg or more (P = 0.019), ventricular catheterization for more than five days (P = 0.017), and irrigation of the system (P = 0.021). Previous ventriculostomy did not increase the risk of infection with subsequent procedures. We conclude that ventriculostomy-related infections may be prevented by maintenance of a closed drainage system and by early removal of the ventricular catheter. If monitoring is required for more than five days, the catheter should be removed and inserted at a different site. (N Engl J Med 1984; 310:553–9.)