Dallas Veterans Affairs Medical Center

Dallas, TX, United States

Dallas Veterans Affairs Medical Center

Dallas, TX, United States
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Ding Y.,University of Texas Southwestern Medical Center | Mason R.P.,University of Texas Southwestern Medical Center | McColl R.W.,University of Texas Southwestern Medical Center | Yuan Q.,University of Texas Southwestern Medical Center | And 3 more authors.
Journal of Magnetic Resonance Imaging | Year: 2013

Purpose To assess oxygenation in abdominal organs with magnetic resonance imaging (MRI), a novel approach is presented to simultaneously measure both T1- and T2*-maps serially during a single dynamic MRI scan in response to an oxygen challenge. Materials and Methods The proposed acquisition scheme consists of a multishot multiecho gradient echo planar imaging sequence (ms-GEPI) interleaved with a multishot inversion recovery echo planar imaging (ms-IR-EPI) sequence. Respiratory motion compensation was accomplished with standard belt triggering and by acquiring all image data at the same phase of expiration. This respiratory-triggered, free-breathing, interleaved tissue oxygenation level-dependent (TOLD) and blood oxygenation level-dependent (BOLD) acquisition technique was validated on phantoms and seven healthy volunteers in response to an oxygen challenge. Results Measurements of relaxation times both in vitro and in vivo were in good agreement with those obtained using conventional pulse sequences and reported in the literature. The interleaved sequence was able to measure oxygen-induced relaxation time changes in human abdominal organs. Conclusion The free-breathing respiratory-triggered interleaved T1 and T2* sequence successfully provided relaxation time maps of abdominal organs in a dynamic scan without the need for image registration. The simultaneous monitoring of tissue and blood oxygenation improves time efficiency and should enhance studies comparing dynamic T 1 and T2* data within the abdomen. J. Magn. Reson. Imaging 2013;38:1230-1236. © 2013 Wiley Periodicals, Inc. Copyright © 2013 Wiley Periodicals, Inc.

Kieseier B.C.,Heinrich Heine University Düsseldorf | Wiendl H.,University of Munster | Hartung H.-P.,Heinrich Heine University Düsseldorf | Leussink V.-I.,Heinrich Heine University Düsseldorf | And 2 more authors.
Current Opinion in Neurology | Year: 2011

Purpose of Review: The aim is to describe and discuss the ongoing debate on how to balance an increase in clinical efficacy against a heightened risk of developing serious side-effects, as has surfaced recently with some novel therapies for relapsing forms of multiple sclerosis. Recent Findings: New therapies are emerging that differ with regard to their mechanism of action, their mode of administration, their side-effect profile and the clinical benefits that they offer to patients in comparison with established therapeutic modalities in multiple sclerosis. Treating physicians will need to make choices on the best treatments for their patients on the basis of limited experience. This process requires optimal assessment of risks and benefits. Summary: Careful assessment of the risk-benefit profile of the various options may allow treatment choices and perhaps ensure that patients obtain the most benefit from treatment without being exposed to unnecessary risk. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Ibrahim H.M.,University of Texas Southwestern Medical Center | Ibrahim H.M.,Dallas Veterans Affairs Medical Center | Tamminga C.A.,University of Texas Southwestern Medical Center
Current Pharmaceutical Biotechnology | Year: 2012

Cognitive impairment is a core feature of schizophrenia that substantially accounts for poor functional outcomes associated with this disease in areas such as work, independent living and social relationships. Until recently, drug development in schizophrenia has focused on developing compounds that mainly target the positive psychotic symptoms of the illness. Although current antipsychotic drugs treat psychosis in schizophrenia rather well, their impact on cognitive dysfunction is minimal. In recent years there has been growing interest in developing novel treatments for cognitive deficits in schizophrenia. In this review we discuss pharmacologic strategies considered most likely to improve cognition. These putative molecular targets include receptors for acetylcholine, dopamine, glutamate, g-aminobutyric acid (GABA), serotonin and histamine. In addition, we propose that not only pharmacological, but also psychological treatments should be considered to enhance cognition in schizophrenia. © 2012 Bentham Science Publishers.

Collinge C.A.,Harris Methodist Fort Worth Hospital | Kelly K.C.,Dallas Veterans Affairs Medical Center | Little B.,Tarleton State University | Weaver T.,Orthopedic Specialty Associates | Schuster R.D.,Cooks Childrenss Hospital
Journal of Orthopaedic Trauma | Year: 2012

OBJECTIVE: Risk for bleeding complications during and after early hip fracture surgery for patients taking clopidogrel and other anticoagulants have not been defined. The purpose of this study is to assess the perioperative bleeding risks and clinical outcome after early hip fracture surgery performed on patients taking clopidogrel (Plavix) and other oral anticoagulants. DESIGN: Study design is a retrospective cohort analysis using data extracted from hospital records and state death records. SETTING: Regional medical center (level II trauma). METHODS: Data for 1118 patients >60 years of age who had surgical treatment for a hip fracture between 2004 and 2008 were reviewed. Eighty-two patients undergoing late surgery (>3 days after admission) were excluded. Patients taking clopidogrel were compared against those not taking clopidogrel. In addition, patients taking clopidogrel only were compared against cohorts of patients taking both clopidogrel and aspirin, aspirin only, warfarin only, or no anticoagulant. RESULTS: Seventy-four of 1036 patients (7%) were taking clopidogrel, although control groups included 253 patients on aspirin alone, 90 patients on warfarin, and 619 taking no anticoagulants. No significant differences were noted between patients taking clopidogrel and those not taking clopidogrel in estimated blood loss, transfusion requirement, final blood count, hematoma evacuation, hospital length of stay (LOS), or mortality while in hospital or at 1 year. A higher American Society of Anesthesiologists score was seen in the clopidogrel and warfarin groups (P = 0.05 each), increased LOS in the clopidogrel group (P = 0.05), and higher rate of deep vein thrombosis seen in those patients taking warfarin (P = 0.05). Clopidogrel only versus aspirin versus both aspirin and clopidogrel, versus no anticoagulant versus warfarin showed no significant differences in estimated blood loss, transfusion requirement, final blood count, bleeding or perioperative complications, or mortality. CONCLUSIONS: Patients undergoing early hip fracture surgery who are taking clopidogrel, aspirin, or warfarin (with regulated international normalized ratio) are not at substantially increased risk for bleeding, bleeding complications, or mortality. Comorbidities and American Society of Anesthesiologists scores were significantly higher in the clopidogrel group, which may have resulted in the increased postoperative LOS in this group. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence. © 2012 by Lippincott Williams & Wilkins.

Ahn D.H.,University of Texas Southwestern Medical Center | Illum H.B.,Dallas Veterans Affairs Medical Center | Wang D.H.,Dallas Veterans Affairs Medical Center | Sharma A.,Dallas Veterans Affairs Medical Center | Dowell J.E.,Dallas Veterans Affairs Medical Center
Journal of Oncology Practice | Year: 2013

Purpose: Peripherally inserted central catheters (PICCs) are often used in place of mediport catheters because of cost and lack of operating room time and to prevent delays in therapy. One common complication associated with their use is upper extremity venous thrombosis (UEVT). The purpose of this study was to ascertain risk factors associated with an increased risk of PICCassociated UEVT in patients with cancer. Methods: Retrospective analysis identified 237 patients with cancer who received PICCs at the Dallas Veterans Affairs Medical Center from 2006 to 2009. We analyzed many risk factors, including PICC infection (PI), use of erythropoiesis-stimulating agents (ESAs), antiplatelet agents (APAs), treatment dose anticoagulation (TDA), and bevacizumab. Results: Of 237 patients, 36 (15%) were found to have UEVT. Stepwise logistic regression analysis showed risk factors positively associated with UEVT were use of ESAs (odds ratio [OR], 10.66; 95% CI, 2.25 to 50.49), hospitalization (OR, 2.38; 95% CI, 1.05 to 5.39), PI (OR, 2.46; 95% CI, 1.03 to 5.86), and TDA (OR, 8.34; 95% CI, 2.98 to 23.33), whereas patients receiving APAs had a lower risk of UEVT (OR, 0.25; 95% CI, 0.07 to 0.92). Conclusion: Specific factors significantly increase the risk of UEVT in patients with cancer with PICCs, whereas use of APAs seems to have a protective effect against UEVT. These results may aid in the development of a predictive model for identifying patients at high risk of UEVT who may benefit from APAs, as well as in determining preventive strategies for reducing the risk of PICC-associated UEVT. Copyright © 2013 American Society of Clinical Oncology. All rights reserved.

Zwischenberger B.A.,University of Texas Southwestern Medical Center | Jacobe H.T.,University of Texas Southwestern Medical Center | Jacobe H.T.,Dallas Veterans Affairs Medical Center
Journal of the American Academy of Dermatology | Year: 2011

Background: Morphea (localized scleroderma) is a skin disorder with significant morbidity. No consistent recommendations exist for therapy, impeding patient care. Objective: We sought to create an evidence-based therapeutic algorithm. Methods: We reviewed English-language literature using search engines and hand searches for therapeutic interventions in morphea. Results were summarized. Results: Narrowband ultraviolet B is appropriate for progressive or widespread superficial dermal lesions; broadband ultraviolet A/ultraviolet A-1 is appropriate for widespread or progressive deeper dermal lesions. Systemic treatment with methotrexate, corticosteroids, or both is indicated for deep or function-impairing lesions and rapidly progressive or widespread (severe) disease. Topical treatment with calcipotriene or tacrolimus is supported for limited, superficial, inflammatory lesions. Use of oral calcipotriol, D-penicillamine, interferon gamma, and antimalarials is not supported. Limitations: Limitations are publication bias; lack of adequately powered, controlled trials; and no validated outcome measures. Conclusion: Phototherapy, methotrexate/systemic corticosteroids, calcipotriene, and topical tacrolimus have the most evidence for efficacy in morphea. Treatment works best in inflammatory disease. Disease activity, severity, progression, and depth should play a role in therapeutic decision making. © 2010 by the American Academy of Dermatology, Inc.

Hasan M.S.,Dallas Veterans Affairs Medical Center | Revankar V.S.,Southwestern Medical Center | Sobel J.D.,Wayne State University
European Journal of Clinical Microbiology and Infectious Diseases | Year: 2011

Candiduria is commonly encountered in hospitalized patients, particularly those with indwelling urinary catheters. While risk factors and therapy are well described in previous studies, little is known about long-term outcomes and recurrence rates of candiduria. We studied 188 patients with candiduria in a retrospective chart review at a single institution from January 1999 to December 2000. Data were collected regarding risk factors and underlying disease, therapy, follow-up cultures until December 2003, and mortality. Ninety-one patients with at least one follow-up culture >1 month after the initial culture (range 2-48) were available for further study. In this group, patients receiving antifungal therapy for asymptomatic candiduria were paradoxically more likely to have subsequent positive urine cultures than patients who never received antifungal therapy. Six patients developed candidemia during follow-up, although in none was this considered to represent a consequence of candiduria. Mortality rate at the end of the follow-up period (mean of 18 months) was 43%, including one death attributed to candidemia. Therapy for candiduria does not appear to reduce candiduria recurrence rates through 48 months of follow-up and little evidence of treatment benefit was identified. © 2010 Springer-Verlag.

Friedly J.L.,University of Washington | Comstock B.A.,University of Washington | Turner J.A.,University of Washington | Heagerty P.J.,University of Washington | And 27 more authors.
New England Journal of Medicine | Year: 2014

BACKGROUND: Epidural glucocorticoid injections are widely used to treat symptoms of lumbar spinal stenosis, a common cause of pain and disability in older adults. However, rigorous data are lacking regarding the effectiveness and safety of these injections. METHODS: In a double-blind, multisite trial, we randomly assigned 400 patients who had lumbar central spinal stenosis and moderate-to-severe leg pain and disability to receive epidural injections of glucocorticoids plus lidocaine or lidocaine alone. The patients received one or two injections before the primary outcome evaluation, performed 6 weeks after randomization and the first injection. The primary outcomes were the score on the Roland-Morris Disability Questionnaire (RMDQ, in which scores range from 0 to 24, with higher scores indicating greater physical disability) and the rating of the intensity of leg pain (on a scale from 0 to 10, with 0 indicating no pain and 10 indicating "pain as bad as you can imagine"). RESULTS: At 6 weeks, there were no significant between-group differences in the RMDQ score (adjusted difference in the average treatment effect between the glucocorticoid-lidocaine group and the lidocaine-alone group, -1.0 points; 95% confidence interval [CI], -2.1 to 0.1; P = 0.07) or the intensity of leg pain (adjusted difference in the average treatment effect, -0.2 points; 95% CI, -0.8 to 0.4; P = 0.48). A prespecified secondary subgroup analysis with stratification according to type of injection (interlaminar vs. transforaminal) likewise showed no significant differences at 6 weeks. CONCLUSIONS: In the treatment of lumbar spinal stenosis, epidural injection of glucocorticoids plus lidocaine offered minimal or no short-term benefit as compared with epidural injection of lidocaine alone. Copyright © 2014 Massachusetts Medical Society.

Siddiqui A.A.,Dallas Veterans Affairs Medical Center | Siddiqui A.A.,University of Texas Southwestern Medical Center
American Journal of the Medical Sciences | Year: 2011

Currently, significant amount of epidemiologic evidence is present to suggest that metabolic syndrome increases the risk of developing colorectal cancer. This evidence is based on studies of the evaluate determinants of the metabolic syndrome (obesity), clinical consequences of metabolic syndrome (type 2 diabetes and hypertension) and serum component of metabolic syndrome (hypertriglyceridemia, hyperglycemia and low high-density lipoprotein cholesterol), as well as markers of hyperinsulinemia. Although the exact pathogenesis of this relationship is unknown, it seems that hyperinsulinemia may play a pivotal role in increasing CRC risk. © 2011 Lippincott Williams & Wilkins.

Spechler S.J.,Veterans Affairs North Texas Healthcare System | Spechler S.J.,University of Texas Southwestern Medical Center | Spechler S.J.,Dallas Veterans Affairs Medical Center
Gastrointestinal Endoscopy Clinics of North America | Year: 2011

Barrett's esophagus has been defined conceptually as the condition in which any extent of metaplastic columnar epithelium that predisposes to cancer development replaces the stratified squamous epithelium that normally lines the distal esophagus. The condition develops as a consequence of gastroesophageal reflux disease. Barrett's metaplasia has clinical importance primarily because of its malignant predisposition, and virtually all of the contentious clinical issues in Barrett's esophagus are related in some way to its cancer risk. This article considers some key clinical issues that impact the management of patients with Barrett's esophagus. © 2011.

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