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Falls Church, VA, United States

Bagla S.,Inova Alexandria Hospital | Martin C.P.,Grants Management Office | Van Breda A.,Inova Alexandria Hospital | Sheridan M.J.,Inova Research Center | And 4 more authors.
Journal of Vascular and Interventional Radiology | Year: 2014

Purpose To report early findings from a prospective United States clinical trial to evaluate the efficacy and safety of prostatic artery embolization (PAE) for benign prostatic hyperplasia (BPH). Materials and Methods From January 2012 to March 2013, 72 patients were screened and 20 patients underwent treatment. Patients were evaluated at baseline and selected intervals (1, 3, and 6 mo) for the following efficacy variables: American Urological Association (AUA) symptom score, quality of life (QOL)-related symptoms, International Index of Erectile Function score, peak urine flow rate, and prostate volume (on magnetic resonance imaging at 6 mo). Complications were monitored and reported per Society of Interventional Radiology guidelines. Results Embolization was technically successful in 18 of 20 patients (90%); bilateral PAE was successful in 18 of 19 (95%). Unsuccessful embolizations were secondary to atherosclerotic occlusion of prostatic arteries. Clinical success was seen in 95% of patients (19 of 20) at 1 month, with average AUA symptom score improvements of 10.8 points at 1 month (P <.0001), 12.1 points at 3 months (P =.0003), and 9.8 points at 6 months (P =.06). QOL improved at 1 month (1.9 points; P =.0002), 3 months (1.9 points; P =.003), and 6 months (2.6 points; P =.007). Sexual function improved by 34% at 1 month (P =.11), 5% at 3 months (P =.72), and 16% at 6 months (P =.19). Prostate volume at 6 months had decreased 18% (n = 5; P =.05). No minor or major complications were reported. Conclusions Early results from this clinical trial indicate that PAE offers a safe and efficacious treatment option for men with BPH. © 2014 SIR. Source


Engh G.A.,Anderson Orthopaedic Research Institute | Sheridan M.J.,Inova Research Center | Ammeen D.J.,Anderson Orthopaedic Research Institute
Journal of Arthroplasty | Year: 2014

Questionnaires are marginally useful for objectively measuring function after knee arthroplasty. The Functional Assessment (FA) test is an easily administered, timed test of a person's ability to stand, walk and ascend/descend stairs that would be useful for quantifying a patient's function after knee arthroplasty. Four hundred forty-five individuals were included in the study: 313 without lower extremity arthritis or neurologic disease and 132 with advanced degenerative arthritis prior to knee arthroplasty. As expected, the test times were longer for individuals afflicted with knee arthritis. Arthroplasty patients were tested pre- and postoperatively to determine if their FA test time improved. The FA test takes less than a minute and is practical for use in the clinical setting as a simple means of quantifying function before and after knee arthroplasty. © 2014 Elsevier Inc. Source


Kiernan P.D.,Section of Thoracic Surgery | Khandhar S.J.,Section of Thoracic Surgery | Fortes D.L.C.,Section of Thoracic Surgery | Sheridan M.J.,Inova Research Center | Hetrick V.,Section of Thoracic Operating Room Nursing
American Surgeon | Year: 2010

The authors review their experience with thoracic esophageal perforation at Inova Fairfax Hospital, June 1, 1988, to March 1, 2009. With the exception of 6 patients with occult perforation, all of whom survived with nonoperative therapy, aggressive surgical intervention was the standard approach. Among patients treated aggressively with surgery within 24 hours of perforation, hospital survival was 97 per cent versus 89 per cent for patients treated aggressively surgically after 24 hours. In the absence of phlegmon, implacable obstruction, or delay, primary repair resulted in 100 per cent survival. Where phlegmon or resolute obstruction existed, resection and reconstruction resulted in 96 per cent survival. Even when patients were deemed too ill to undergo surgery, cervical diversion was 100 per cent effective in eradicating continuing leak and achieved 89 per cent survival. Endoesophageal stenting was applied as primary treatment or secondarily such as where leak complicated primary repair. When stenting was used as the initial and primary treatment modality, survival was 88 per cent. Targeted drainage was helpful on occasion as an adjunct to initial therapies. Comfort measures alone were appropriate when clinical circumstances merited no effort at resuscitation. Finally, survivors were asked to self-categorize their ability to swallow; 95 per cent responded good to excellent. Source


Nathan S.D.,Inova Heart and Vascular Institute | Reffett T.,Inova Heart and Vascular Institute | Brown A.W.,Inova Heart and Vascular Institute | Fischer C.P.,Inova Heart and Vascular Institute | And 4 more authors.
Chest | Year: 2013

Background: The course of idiopathic pulmonary fibrosis (IPF) is characterized by variable patterns of disease progression. The red cell distribution width (RDW) is a parameter that is routinely reported with all CBC counts. We sought to test the prognostic usefulness of this parameter in a well-defined cohort of patients with IPF. Methods: CBCs, demographics, and pulmonary function data from patients with IPF evaluated between January 1997 and June 2011 were collated. Patient outcomes were ascertained from the program's database and the Social Security Death Index. Results: There were 319 patients with IPF evaluated in whom baseline CBCs were available. The range in the RDW was 11.9 to 21.9 (median 14.1). There were 228 subjects with RDW values ≤ 15 (normal) and 91 patients with RDW values > 15. Patients with normal RDW values had a median survival of 43.1 months compared with 16.3 months for those whose RDW was > 15 (P=.001). There were 198 patients with available serial RDW data. Those patients who had a change in the RDW of less or greater than +0.010/mo had median survivals of 43.0 and 23.9 months, respectively (P=.0246). Conclusions: The RDW is a readily available laboratory test result that may provide important, independent prognostic information at baseline and follow-up in patients with IPF. Further studies are warranted to validate this as a biomarker for IPF outcomes, as well as to define the biologic basis for this association. © 2013 American College of Chest Physicians. Source


Kiernan P.D.,Section of Thoracic Surgery | Khandhar S.J.,Section of Thoracic Surgery | Fortes D.L.C.,Section of Thoracic Surgery | Schmidt K.,INOVA Fairfax Hospital | And 2 more authors.
American Surgeon | Year: 2011

With an increasing proportion of U.S. individuals 80 years of age or older, the authors examined their surgical experience with octogenarians undergoing major, curative-intent thoracic surgery. Between January 1, 1990, and September 1, 2009, 102 octogenarians underwent curative-intent resection for nonsmall cell carcinoma of the lung (NSCCL), esophageal carcinoma (EC), or related surgery for thoracic esophageal perforation (EP). Analysis and reporting followed the guidelines of the Nationwide Inpatient Sample database study (1994 to 2003). Eighty-six patients underwent curative-intent resection for NSCCL, 12 for EC, and four for surgery for EP. Hospital and 30-day mortalities were 0 per cent. Overall 1-, 2-, and 5-year survival rates were: 78, 58, and 32 per cent. Within the NSCCL cohort, minimally invasive exposures (video-assisted thoracic surgery [VATS] and video thoracoscopy [VT]) were associated with fewer and shorter duration of air leaks, leading to shorter length of stay. Since we began using minimally invasive exposure for NSCCL in 2007, the percentage of octogenarians discharged within 5 days of surgery has increased from 35.5 to 66.7 per cent (P = 0.01), and the percentage of patients discharged within 3 days of surgery has increased from 8.1 to 33.3 per cent (P = 0.006). Of 24 patients undergoing surgery for NSCCL since 2007, 18 (75%) underwent minimally invasive (VATS or VT) exposures, of which 15 patients (83.3%) were discharged home within 5 days and eight (44.4%) within 3 days of their procedure. Excellent, short- and longer-term results can be achieved in elderly patients if risks, exposures, and resections are appropriately matched to patient performance. Source

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