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Burlington, MA, United States

Dolan R.W.,Lahey Clinic
Archives of Otolaryngology - Head and Neck Surgery

Objective: To determine the efficacy of a new surgical procedure to correct symptoms of nasal obstruction secondary to internal nasal valve narrowing. Design: Consecutive case series. Setting: Tertiary care multispecialty clinic. Patients: Patients with symptoms of nasal obstruction for at least 1 year, a closed but otherwise anatomically normal nasal valve, and resolution of symptoms with lateralization of the upper lateral cartilage. Intervention: Surgical correction of nasal valve stenosis by fibrocartilaginous resection and imbrication at the caudal upper lateral cartilage. Main Outcome Measure: Validated Nasal Obstruction Symptom Evaluation (NOSE) scale score. Results: Highly significant improvement was seen in nasal obstruction symptoms after the procedure. A significant correlation between the reported improvement and the preoperative NOSE scale scores was demonstrated (P<.01). There was poor correlation of symptomatic improvement with acoustic rhinometry measurements. Conclusions: The described surgical repair is highly successful in relieving symptoms of nasal obstruction due to nasal valve stenosis in this selected group of patients. Patients with more severe symptoms of obstruction derive the greatest benefit. ©2010 American Medical Association. All rights reserved. Source

Mantha S.,Lahey Clinic | Ansell J.,New Hill
Thrombosis and Haemostasis

New oral anticoagulant drugs are emerging as alternatives to warfarin for the prevention of stroke in patients with non-valvular atrial fibrillation. Two agents are direct factor Xa inhibitors (rivaroxaban and apixaban), and the third is a direct thrombin inhibitor (dabigatran). They have been separately compared to warfarin in large randomised trials. Our objective was to indirectly compare the three agents to each other for major efficacy and safety outcomes. Studies were assessed for comparability and the odds ratios of selected outcomes for each anticoagulant versus one another were estimated indirectly. The three cohorts differed significantly in terms of CHADS2 score and the number of individuals with a past history of stroke, transient ischemic attack or systemic embolism. The estimated odds ratio of stroke or systemic embolism was 1.35 for rivaroxaban vs dabigatran 150 mg (p=0.04), 0.97 for rivaroxaban versus dabigatran 110 mg (p=0.81), 1.22 for apixaban versus dabigatran 150 mg (p=0.18), 0.88 for apixaban versus dabigatran 110 mg (p=0.34) and 0.90 for apixaban versus rivaroxaban (p=0.43). The estimated odds ratio of major bleeding was 1.10 for rivaroxaban versus dabigatran 150 mg (p=0.36), 1.28 for rivaroxaban versus dabigatran 110 mg (p=0.02), 0.74 for apixaban versus dabigatran 150 mg (p=0.004), 0.87 for apixaban versus dabigatran 110 mg (p=0.17) and 0.68 for apixaban versus rivaroxaban (p<0.001). In conclusion, the available data indicate no significant difference in efficacy between dabigatran 150 mg and apixaban for the prevention of stroke or systemic embolism in patients with non-valvular atrial fibrillation. It appears however that apixaban is associated with less major bleeding than dabigatran 150 mg or rivaroxaban and that rivaroxaban is less effective than dabigatran 150 mg in preventing stroke or systemic embolism. Such an indirect comparison should be used only to generate hypotheses which need to be tested in a dedicated randomised trial comparing the three drugs directly. © Schattauer 2012. Source

Stoffel J.T.,Lahey Clinic
Urologic Clinics of North America

Urinary symptoms related to multiple sclerosis (MS) present a complex challenge for the treating physician. However, several treatment options are available for the symptomatic patient once the physician understands basic MS disease epidemiology and pathophysiology. Depending of disease status and symptoms, MS urinary symptoms may respond to directed behavioral, pharmacologic, intravesical, neuromodulation, or surgical therapies. © 2010 Elsevier Inc. Source

Scholz F.J.,Lahey Clinic

Celiac disease is now recognized as a common disease, occurring in about one in every 200 Americans. However, less than 10% of cases are currently diagnosed, with a diagnostic delay of more than 10 years from onset of symptoms. In the past, barium examination of the small bowel demonstrated a pattern of abnormal findings caused by the pathophysiologic changes induced by malabsorption, thus leading to diagnosis of celiac disease and other diseases of malabsorption. Although not specific, that pattern prompted further patient evaluation. The number of barium examinations performed and the skill necessary to interpret their results are both in decline. Abdominal pain in celiac disease is a common early complaint that often leads to computed tomography (CT). Improved CT resolution now permits better depiction of the small bowel, colon, and mesenteric lymph nodes, all of which are affected by celiac disease. Detection of celiac disease with CT will allow treatment to be initiated to prevent the significant morbidity and increased mortality associated with a delay in diagnosis. The abnormal CT findings seen over the past decade during review of more than 200 cases of celiac disease demonstrate that CT depicts more features of celiac disease than did barium examination. Pattern recognition for the diagnosis of small bowel diseases that create structural changes in the bowel wall is well accepted. Because it demonstrates features of celiac disease not detected with barium examination, CT may be more sensitive than barium examination for diagnosis of this disease. © RSNA, 2011. Source

Jacoby G.A.,Lahey Clinic | Hooper D.C.,Massachusetts General Hospital
Antimicrobial Agents and Chemotherapy

qnr genes were discovered on plasmids by their ability to reduce quinolone susceptibility, but homologs can be found in the genomes of at least 92 Gram-negative, Gram-positive, and strictly anaerobic bacterial species. The related pentapeptide repeat protein-encoding mfpA gene is present in the genome of at least 19 species of Mycobacterium and 10 other Actinobacteria species. The native function of these genes is not yet known. Copyright © 2013, American Society for Microbiology. All Rights Reserved. Source

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