Snell G.,Alfred Hospital |
Herth F.J.F.,Pneumology and Critical Care Medicine |
Hopkins P.,Prince Charles Hospital |
Baker K.M.,University of Iowa |
And 8 more authors.
European Respiratory Journal | Year: 2012
The need for a less invasive procedure than surgical lung volume reduction that can produce consistent improvements with reduced morbidity remains a medical goal in patients with emphysema. We sought to determine the effect of bronchoscopic thermal vapour ablation (BTVA) on lung volumes and outcomes in patients with emphysema. 44 patients with upper lobe-predominant emphysema were treated unilaterally with BTVA. Entry criteria included: age 40-75 yrs, forced expiratory volume in 1 s (FEV 1) 15-45% predicted, previous pulmonary rehabilitation and a heterogeneity index (tissue/air ratio of lower lobe/upper lobe) from high-resolution computed tomography (HRCT) ≥1.2. Changes in FEV 1, St George's Respiratory Questionnaire (SGRQ), 6-min walk distance (6MWD), modified Medical Research Council (mMRC) dyspnoea score, and hyperinflation were measured at baseline, and 3 and 6 months post-BTVA. At 6 months, mean±SE FEV 1 improved by 141±26 mL (p<0.001) and residual volume was reduced by 406±113 mL (p<0.0001). SGRQ total score improved by 14.0±2.4 points (p<0.001), with 73% improving by ≥4 points. Improvements were observed in 6MWD (46.5±10.6 m) and mMRC dyspnoea score (0.9±0.2) (p<0.001 for both). Lower respiratory events (n=11) were the most common adverse event and occurred most often during the initial 30 days. BTVA therapy results in clinically relevant improvements in lung function, quality of life and exercise tolerance in upper lobe predominant emphysema. Copyright©ERS 2012.
Gompelmann D.,University of Heidelberg |
Herth F.J.F.,University of Heidelberg |
Slebos D.J.,University of Groningen |
Valipour A.,Otto Wagner Hospital |
And 3 more authors.
Respiration | Year: 2014
Background: Patients who achieve significant target lobe volume reduction (TLVR) following endobronchial valve (EBV) treatment may experience substantial improvements in clinical outcome measures. However, in cases of rapid TLVR, the risk of pneumothorax increases due to parenchymal rupture of the adjacent untreated lobe. Target lobe collapse may be more likely in EBV-treated patients who have low collateral ventilation. Objectives: The aim of this study was to evaluate the impact of pneumothorax on outcome following EBV treatment. Methods: Data from three prospective clinical trials (the US and European cohorts of VENT and the Multicenter Chartis study) were retrieved for the analysis. All patients had undergone chest X-ray within 24 h of EBV implantation to explore the presence of pneumothorax. TLVR was assessed at either 30 (Chartis study) or 180 days (VENT), and clinical outcome measures (forced expiratory volume in 1 s (FEV1), St. George's Respiratory Questionnaire (SGRQ) and 6-min-walk distance (6-MWD)) were assessed 180 days after implantation. Results: The overall rate of pneumothorax following valve therapy was 5.9% (25/421). Among these patients, 68% had a prolonged air leak for >7 days. However, patients who experienced a pneumothorax benefitted from EBV therapy, with a mean TLVR of 65% (n = 20). The mean percent change in FEV1 was 15 ± 15%, and the mean change in SGRQ was-7 ± 12 points. Conclusions: Although pneumothorax is a complication of EBV placement, it does not appear to have a negative impact on clinical outcome in terms of FEV1 and health-related quality of life. © 2014 S. Karger AG, Basel.
Calverley P.M.A.,University of Liverpool |
Anderson J.A.,Glaxosmithkline |
Celli B.,Caritas St Elizabeths Medical Center |
Ferguson G.T.,Pulmonary Research Institute of Southeast Michigan |
And 7 more authors.
Thorax | Year: 2010
Background: Previous studies have suggested that long-term use of β agonists to treat chronic obstructive pulmonary disease (COPD) may increase the risk of cardiovascular adverse events. In this post hoc analysis, data from the TOwards a Revolution in COPD Health (TORCH) study were used to investigate whether use of the long-acting β2 agonist salmeterol over 3 years increased the risk of cardiovascular adverse events in patients with moderate to severe COPD. Methods: TORCH was a randomised, double-blind, placebo controlled study conducted at 444 centres in 42 countries. Patients (n=6184; safety population) received twice daily combined salmeterol 50 mg plus fluticasone propionate 500 μg (SFC), either component alone, or placebo. Adverse events were recorded every 12 weeks for 3 years. Results: The probability of having a cardiovascular adverse event by 3 years was 24.2% for placebo, 22.7% for salmeterol, 24.3% for fluticasone propionate and 20.8% for SFC. Although a history of myocardial infarction doubled the probability of cardiovascular adverse events, the event rates remained similar across treatment groups. Conclusion: Post hoc analysis of the 3-year TORCH dataset showed that salmeterol alone or in combination (SFC) did not increase the risk of cardiovascular events in patients with moderate to severe COPD.
Vlahakos D.V.,National and Kapodistrian University of Athens |
Marathias K.P.,Intensive Care Unit |
Madias N.E.,Tufts University |
Madias N.E.,Caritas St Elizabeths Medical Center
American Journal of Kidney Diseases | Year: 2010
The renin-angiotensin system is the major regulator of blood pressure by virtue of controlling vascular resistance and plasma volume. Much less recognition exists for the role of the renin-angiotensin system in regulating erythropoiesis, a biological function critical for oxygen delivery to tissues. In this review, we present evidence that angiotensin II (Ang II) is a physiologically important regulator of erythropoiesis with 2 key actions. First, Ang II is a growth factor of erythroid progenitors and, in cooperation with erythropoietin, increases red blood cell mass. Second, Ang II acts as an erythropoietin secretagogue to maintain increased erythropoietin levels despite increments in hematocrit. Among a multitude of physiologic and pathophysiologic implications, these lines of evidence provide an explanation for the effect of angiotensin-converting enzyme inhibitors and Ang II type 1 receptor blockers to decrease hematocrit or cause anemia in various clinical conditions. © 2010 National Kidney Foundation, Inc.
Tashkin D.P.,University of California at Los Angeles |
Celli B.,Caritas St Elizabeths Medical Center |
Kesten S.,Boehringer Ingelheim Pharmaceuticals |
Lystig T.,Boehringer Ingelheim Pharmaceuticals |
And 2 more authors.
European Respiratory Journal | Year: 2010
UPLIFT (Understanding Potential Long-Term Improvements in Function with Tiotropium), a 4-yr trial of tiotropium in chronic obstructive pulmonary disease, allowed for assessment of smoking status on long-term responses to maintenance bronchodilator therapy. 5,993 patients were randomised (tiotropium/placebo). Lung function, St George's Respiratory Questionnaire, exacerbations and adverse events were followed. Patients were characterised as continuing smokers (CS), continuing ex-smokers (CE), or intermittent smokers (IS) based on self-reporting smoking behaviour. 60%, 14% and 26% of patients were CE, CS and IS, respectively. The rate of forced expiratory volume in 1 s (FEV1) decline for placebo patients was most rapid in CS (-51±4, -36±2 and -23±2 mL•yr-1 in CS, IS, and CE, respectively). Tiotropium did not alter FEV1 decline, but was associated with significant improvements in pre- and post-bronchodilator FEV1 over placebo that persisted throughout the 4-yr trial for each smoking status (pre-bronchodilator: 125, 55 and 97 mL at 48 months in CS, IS and CE, respectively; p≤0.0003). Tiotropium reduced exacerbation risk in CS (HR (95%CI) 0.81 (0.68-0.97)), in CE (0.86 (0.79-0.93)) and trended towards significance in IS (0.89 (0.80-1.01)). At 4 yrs, St George's Respiratory Questionnaire for tiotropium patients improved the most in CS (-4.62 units, p=0.0006) and the least in IS (-0.54 units, p=0.55), compared with control. Tiotropium provided long-term benefits irrespective of smoking status, although differences among categories were observed. Copyright ©ERS Journals Ltd 2010.
Orlov M.V.,Caritas St Elizabeths Medical Center |
Gardin J.M.,St John Medical Center |
Slawsky M.,BayState Medical Center |
Bess R.L.,St John Medical Center |
And 5 more authors.
American Heart Journal | Year: 2010
Background: Randomized trials have demonstrated benefits of biventricular (BiV) pacing in patients with advanced heart failure, intraventricular conduction delay, and atrial fibrillation (AF) postatrioventricular (AV) node ablation. The AV Node Ablation with CLS and CRT Pacing Therapies for Treatment of AF trial (AVAIL CLS/CRT) was designed to demonstrate superiority of BiV pacing in patients with AF after AV node ablation, to evaluate its effects on cardiac structure and function, and to investigate additional benefits of Closed Loop Stimulation ® (CLS) (BIOTRONIK, Berlin, Germany). Methods: Patients with refractory AF underwent AV node ablation and were randomized (2:2:1) to BiV pacing with CLS, BiV pacing with accelerometer, or right ventricular (RV) pacing. Echocardiography was performed at baseline and 6 months, with paired data available for 108 patients. Results: The RV pacing contributed to significant increase in left atrial volume, left ventricular (LV) end-systolic volume, and LV mass compared to BiV pacing. Ejection fraction decreased insignificantly with RV pacing compared to significant increase with BiV pacing. Interventricular dyssynchrony significantly decreased with BiV compared with RV pacing. Closed Loop Stimulation ® did not result in additional echocardiographic changes; heart rate distribution was significantly wider with CLS. All groups showed significant improvement in 6-minute walk distance, quality-of-life score, and New York Heart Association class. Conclusion: In conclusion, RV pacing results in significant increase in left atrial volume, LV mass, and worsening of LV contractility compared to patients receiving BiV pacing post-AV node ablation for refractory AF. Closed Loop Stimulation ® was not associated with additional structural changes but resulted in significantly wider heart rate distribution. © 2010 Mosby, Inc. All rights reserved.
Loupasakis K.,Caritas St Elizabeths Medical Center |
Derk C.T.,Thomas Jefferson University
Journal of Clinical Rheumatology | Year: 2010
We report the case of a pediatric patient with eosinophilic fasciitis, who was successfully treated with early high dose corticosteroids and subsequent use of mycophenolate mofetil. We believe that the early institution of corticosteroids helped to suppress the early inflammatory part of the disease and the subsequent use of mycophenolate mofetil maintained this and may have also helped prevent fibrotic skin changes. Copyright © 2010 by Lippincott Williams & Wilkins.
Madias N.E.,Caritas St Elizabeths Medical Center |
Madias N.E.,Tufts University
Journal of Nephrology | Year: 2010
Respiratory acid-base disorders are those abnormalities in acid-base equilibrium that are expressed as primary changes in the arterial carbon dioxide tension (PaCO2). An increase in PaCO2 (hypercapnia) acidifies body fluids and initiates the acid-base disturbance known as respiratory acidosis. By contrast, a decrease in PaCO2 (hypocapnia) alkalinizes body fluids and initiates the acid-base disturbance known as respiratory alkalosis. The impact on systemic acidity of these primary changes in PaCO2 is ameliorated by secondary, directional changes in plasma [HCO3 -] that occur in 2 stages. Acutely, hypercapnia or hypocapnia yields relatively small changes in plasma [HCO3 -] that originate virtually exclusively from titration of the body's nonbicarbonate buffers. During sustained hypercapnia or hypocapnia, much larger changes in plasma [HCO3 -] occur that reflect adjustments in renal acidification mechanisms. Consequently, the deviation of systemic acidity from normal is smaller in the chronic forms of these disorders. Here we provide an overview of the renal acidification responses to respiratory acid-base disorders. We also identify gaps in knowledge that require further research. © 2010 Società Italiana di Nefrologia - ISSN 1121-8428.
Nicole Lamb M.,Caritas St Elizabeths Medical Center |
Trabinino L.,Caritas St Elizabeths Medical Center |
Hackford A.,Caritas St Elizabeths Medical Center
Diseases of the Colon and Rectum | Year: 2011
BACKGROUND: When a patient is deciding between treatment options for localized prostate cancer, brachytherapy is commonly chosen for its perceived low complication profile. Brachytherapy can frequently be complicated by the development of fecal incontinence. The potential long-term impact of this dysfunction on a patient's life should be discussed. OBJECTIVE: This study aimed to assess the long-term impact of brachytherapy for localized prostate cancer on fecal incontinence and to determine the impact and severity of the incontinence on patients' ability to engage in activities of daily living. DESIGN: A retrospective observational study was performed. A questionnaire packet was mailed to patients who had received brachytherapy treatment for localized prostate cancer and were now more than 2 years out from initial seed implantation. Each packet contained the Colon and Ano-Rectal Impact Questionnaire (assessing quality of life), the Colon and Ano-Rectal Distress Inventory, and the Cleveland Clinic Fecal Incontinence Score (both measured existence and severity of fecal incontinence). SETTINGS: This study was conducted at Caritas Christi St. Elizabeth's Medical Center, a tertiary referral center in Boston, Massachusetts from January 1, 1998 to December 31, 2007. PATIENTS: One hundred forty-three of 568 patients (a 25% response rate) responded and were analyzed. INTERVENTIONS: No interventions were performed. MAIN OUTCOME MEASURES: The main outcome was impact of fecal incontinence on quality of life. RESULTS: Of the responses to the Colon and Ano-Rectal Impact Questionnaire, 13.2% (19 patients) (P <.001) stated that fecal incontinence was impacting their ability to participate in their daily activities. Sixty-three percent (12 patients) (P <.001) of patients described the impact of the incontinence as slight, 21% (4 patients) (P <.001) described it as moderate, and 15.8% (3 patients) (P <.001) described it as severe. LIMITATIONS: There were no case-matched controls and the response rate to the surveys was low. CONCLUSIONS: Postbrachytherapy fecal incontinence leaves a long-term impact on patients' ability to engage in activities of daily living. © 2011 The ASCRS.
Kelesidis T.,Caritas St Elizabeths Medical Center |
Tozzi S.,Caritas St Elizabeths Medical Center |
Mitty R.,Caritas St Elizabeths Medical Center |
Worthington M.,Caritas St Elizabeths Medical Center |
Fleisher J.,Caritas St Elizabeths Medical Center
International Journal of Infectious Diseases | Year: 2010
Background: Cytomegalovirus (CMV) is a common pathogen affecting the gastrointestinal tract in patients with AIDS. We report a case of CMV-induced pseudotumor of the duodenum in a patient with AIDS and review other reported cases of CMV-induced pseudotumors in the gastrointestinal tract. CMV-induced pseudotumor in patients with AIDS is an exceptionally rare clinical entity, and to our knowledge no reports have previously summarized this clinical entity. Methods: All previous cases included in our literature review were found using a PubMed search (1980-November 2008) of the English-language medical literature applying the terms 'CMV infection', 'inflammatory mass', 'pseudotumor', and 'gastrointestinal tract'. The references cited in these articles were examined to identify additional reports. Results: Although CMV-induced duodenitis has been described in patients with HIV infection, to our knowledge CMV-induced pseudotumor of the duodenum has not been previously reported in the literature. We describe the first case of an AIDS patient with CMV pseudotumor responding to oral treatment with valganciclovir with complete resolution of the CMV mass. Among reports of non-duodenal pseudotumor reported in the English literature, we found only 14 cases of CMV-induced gastrointestinal pseudotumors in HIV-positive patients. The clinical manifestations, pathologic findings of the CMV pseudotumors, as well as the treatment and outcome of these HIV patients are reviewed. Conclusion: CMV pseudotumor should be included in the differential diagnosis of gastrointestinal mass lesions in AIDS patients and in other immunocompromised patients. The tumor often responds to antiviral therapy, but resolution of a CMV mass as a result of oral antiviral therapy has not been previously described. Since pseudotumors secondary to CMV often respond to medical treatment, it is important that the physicians treating severely immunocompromised patients are aware of this entity. © 2009 International Society for Infectious Diseases.