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Edwards Air Force Base, CA, United States

Walsh M.P.,George Mason University | Seto J.,George Mason University | Jones M.S.,David Grant Medical Center | Chodosh J.,Massachusetts Eye and Ear Infirmary | And 2 more authors.
Journal of Clinical Microbiology | Year: 2010

Novel human adenoviruses (HAdVs) arise from genome recombination. Analysis of HAdV type 55 from an outbreak in China shows a hexon recombination between HAdV-B11 and HAdV-B14, resulting in a genome that is 97.4% HAdV-B14. Sporadic appearances as a re-emergent pathogen and misidentification as "HAdV-B11a" are due to this partial hexon. Copyright © 2010, American Society for Microbiology. All Rights Reserved.

Jesinger R.A.,David Grant Medical Center | Jesinger R.A.,Uniformed Services University of the Health Sciences
Techniques in Vascular and Interventional Radiology | Year: 2014

Normal breast anatomy can be seen on a variety of imaging modalities. Knowledge of normal breast anatomy on imaging examinations is important for an interventionalist, primarily to avoid mistaking normal anatomy for a pathologic disorder, so as not to harm a patient with an unnecessary intervention. Knowledge of breast anatomy is also critical in planning safe breast interventions and unwanted procedural complications. The key anatomical structures in the breast include skin, fat, fascial layers, Cooper ligaments, fibroglandular tissue, lymphatics, and neurovascular structures, all positioned over the chest wall. In men, the breast parenchyma is usually only composed of fat, with absence of fibroglandular tissue. In women, fibroglandular tissue volumes vary with age, with many women having a predominance of fat within the breasts after menopause. Embryologically, the breast develops under genetic and hormonal influence from skin precursor cells during the fourth through twelfth weeks of gestation, and the resulting breast bud continues to lengthen and branch throughout the remainder of gestation, forming a complex network of radially arranged breast ducts that connect the nipple with the mammary lobules. The key arterial blood supply to the breast arises from the internal thoracic artery, but additional arterial blood supply is seen from intercostal and lateral thoracic arteries. The venous anatomy and lymphatic drainage of the breast generally parallels the arterial anatomy, with presence of variation in communicating channels between deep and superficial venous and lymphatic channels. Tools that assess breast vascular structures (eg, contrast-enhanced breast magnetic resonance imaging) and lymphatic structures (nuclear medicine lymphoscintigraphy) are routinely used to assess extent of breast disease and help guide breast interventions. © 2014.

Background: The Kineflex lumbar artificial disc replacement device (SpinalMotion, Mountain View, California) is a semiconstrained, posterior center of rotation, metal-on-metal intervertebral disc prosthesis. We performed a prospective, randomized, non-inferiority trial comparing the Kineflex Disc with the Food and Drug Administration (FDA)-approved Charité device (DePuy Spine, Raynham, Massachusetts). Our objective was to evaluate the Kineflex Disc's safety and efficacy using validated outcomes measures-the visual analog scale (VAS) and the Oswestry Disability Index (ODI). Methods: Sixty-four patients were randomized to receive either the Kineflex Disc or Charité device and were then followed up for up to 3 years. Patients completed VAS and ODI questionnaires and were evaluated clinically and radiologically for complication or device failure. Results were analyzed in terms of change in mean VAS score and ODI from baseline, as well as with a comparison of clinical success as defined by FDA investigational device exemption criteria. Non-inferiority was defined as a difference of less than 18 points in the VAS score and difference of less than 10 units on the ODI scale, in keeping with a previously established minimum clinically important difference. Results: The mean improvement for the Kineflex Disc group at 24 months was 56.80 for the VAS score and 37.30 for the ODI. Similarly, the mean improvement in the Charité group was 54.43 for the VAS score and 38.40 for the ODI. At 2 years of follow-up, no difference was found in VAS scores between the two groups. The Kineflex Disc group was therefore found to be non-inferior (mean difference, 2.37; 95% confidence interval, -12.5 to 17.3; P = .004). In addition, at 24 months, 83% of patients in the Kineflex Disc group and 85% of patients in the Charité group met FDA-defined criteria for clinical success, with no difference between groups (P = .802). Conclusions: This level I evidence shows the Kineflex Disc to be non-inferior to the Charité device in terms of pain reduction (VAS score) and FDA-defined clinical success at 24 months' follow-up. Both devices showed a high degree of safety. © 2011 Elsevier Inc.

Alexander A.M.,David Grant Medical Center
Current Sports Medicine Reports | Year: 2013

Atrial fibrillation (AF) is the most common arrhythmia in athletes. Evidence supports that it occurs more frequently in endurance athletes than in nonathletes and that it can result in decreased performance or even ineligibility for athletes. Although there is no clear etiology of why the increase in athletes exists, three supported mechanisms include morphologic adaptation, autonomic alteration, and chronic systemic inflammation. Although treatment in athletes can be challenging, type 1C antiarrhythmics are accepted generally as a first-line therapy in addition to risk factorbased anticoagulation. Radiofrequency catheter ablation also has become a recommended treatment for symptomatic paroxysmal AF that is refractory to at least one class 1 or 3 antiarrhythmic medication and a reasonable treatment in symptomatic paroxysmal AF prior to initiation of antiarrhythmic therapy. Copyright © 2013 by the American College of Sports Medicine.

Dunn D.P.,David Grant Medical Center | Lee K.S.,Beth Israel Deaconess Medical Center | Smith M.P.,Beth Israel Deaconess Medical Center | Mortele K.J.,Beth Israel Deaconess Medical Center
American Journal of Roentgenology | Year: 2015

Objective. The purpose of this article is to review infectious, inflammatory, and autoimmune-mediated processes in the gastrointestinal system where diffusion-weighted imaging can be helpful as well as pitfalls associated with its use. Conclusion. Diffusion-weighted imaging has become an important and widely used tool in abdominal and pelvic MRI, but it has been used primarily for oncologic applications. As more body MRI protocols are routinely including diffusion-weighted imaging, this sequence can be useful in evaluating an increasing number of nononcologic processes. © American Roentgen Ray Society.

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