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Korah M.P.,Emory University | Nowlan A.W.,Piedmont Hospital | Johnstone P.A.S.,Indiana University | Crocker I.R.,Emory University
International Journal of Radiation Oncology Biology Physics | Year: 2010

Purpose: To assess local control and treatment-related toxicity of single-modality radiation therapy (RT) in the treatment of imaging-defined meningiomas. Methods and Materials: The records of Emory University School of Medicine, Atlanta, GA, were reviewed between 1985 and 2003. We identified 41 patients with 42 meningiomas treated with RT alone for lesions diagnosed on imaging alone. No patients received a histologic diagnosis. Patients in whom there was uniform agreement that the tumor represented a meningioma were accepted for therapy. Of the patients, 22 were treated with stereotactic radiosurgery (SRS), 11 with fractionated stereotactic radiotherapy (FSR), and 9 with three-dimensional conformal therapy (3DCRT). The median doses of SRS, FSR, and 3DCRT were 14 Gy, 50.4 Gy, and 52.2 Gy, respectively. Results: Median follow-up was 60 months. Of 42 meningiomas, 39 were locally controlled. The 8-year actuarial local control rate by Kaplan-Meier methods was 94%. One failure occurred 6 months after 3DCRT, a second at 34 months after FSR, and a third at 125 months after SRS. A temporary symptomatic radiation-related neurologic sequela developed in 1 patient treated with SRS. No fatal treatment complications occurred. The 8-year rate for actuarial freedom from complication survival by Kaplan-Meier methods was 97%. Conclusions: RT alone is an attractive alternative to surgery for imaging-defined meningiomas without significant mass effect. It offers local control comparable to surgical resection with minimal morbidity. RT should be considered as a viable alternative to surgery for tumors in various locations. © 2010 Elsevier Inc. All rights reserved. Source

Alvarez S.,Piedmont Hospital
Journal of Diagnostic Medical Sonography | Year: 2012

Natural breast augmentation, or fat transfer, involves taking fat cells from one area of the body and injecting them into another area, such as the breast. This can be done for cosmetic reasons after a lumpectomy or other surgical procedures that affect the shape of the breast. Breast augmentation is also being used electively by some women to enhance the appearance of their breasts. Defects such as asymmetry, sagging, or indentations have been improved with fat transfers. The changes of the breast tissue from the reaction to the new fat can also change the outcome of mammograms and sonograms. The interpreting radiologist might recommend a biopsy to exclude the possibility of missing a malignant lesion. These two case reports give sonographers an idea of what additional questions they may need to ask patients to clarify their history. © Society of Diagnostic Medical Sonography 2012. Source

Gonsalves C.F.,Thomas Jefferson University | Eschelman D.J.,Thomas Jefferson University | Sullivan K.L.,Piedmont Hospital | Anne P.R.,Thomas Jefferson University | And 2 more authors.
American Journal of Roentgenology | Year: 2011

OBJECTIVE. The purpose of this study was to assess the safety and efficacy of radioembolization in the management of hepatic metastasis of uveal melanoma after failure of immunoembolization or chemoembolization. MATERIALS AND METHODS. From January 2007 through April 2009, 32 patients underwent radioembolization therapy for hepatic metastasis of uveal melanoma. Pretreatment tumor burdens were divided into three categories: less than 25% (n = 25), 25-50% (n = 5), and greater than 50% (n = 2). Toxicity, extrahepatic disease, and hepatic tumor response were assessed 1 month and then every 3 months after treatment. Best radiographic response of hepatic metastasis was determined with the Response Evaluation Criteria in Solid Tumors criteria. Overall survival and progression-free survival of hepatic metastasis were estimated by Kaplan-Meier analysis. Differences in survival between subgroups were evaluated by log-rank test in univariate analysis. RESULTS. The clinical follow-up period ranged from 1.0 to 29.0 months (median, 10.0 months). The median overall survival was 10.0 months, and the progression-free survival of hepatic metastasis, 4.7 months. Twenty-two patients died 1.0-29.0 months (median, 5.8 months) after treatment owing to progression of liver disease (n = 13), extrahepatic disease (n = 4), or both (n = 5). Patients who had a pretreatment tumor burden less than 25% had longer median overall survival (10.5 vs 3.9 months, p = 0.0003) and progression-free survival (6.4 vs 3.0 months, p = 0.03) than patients who had a pretreatment tumor burden of 25% or greater. Patients who had a complete response (n = 1), partial response (n = 1), or stable disease (n = 18) had longer median overall survival (14.7 vs 4.9 months, p = 0.0006) and progression-free survival of hepatic metastasis (7.9 vs 3.1 months, p < 0.0001) than patients with tumor progression (n = 12). Self-limiting grade 1-2 systemic toxicity included tiredness (n = 9), indigestion (n = 2), and abdominal discomfort (n = 5). Grade 3-4 hepatic toxicity was attributed to tumor progression. CONCLUSION. Radioembolization is safe and effective salvage therapy for limited metastasis of uveal melanoma. © American Roentgen Ray Society. Source

Estep J.D.,Methodist key Heart and Vascular Center | Starling R.C.,Cleveland Clinic | Horstmanshof D.A.,Baptist Medical Center | Milano C.A.,Duke University | And 12 more authors.
Journal of the American College of Cardiology | Year: 2015

Background Data for left ventricular assist devices (LVADs) in patients with noninotrope-dependent heart failure (HF) are limited. Objectives The goal of this study was to evaluate HeartMate II (HMII) LVAD support versus optimal medical management (OMM) in ambulatory New York Heart Association functional class IIIB/IV patients meeting indications for LVAD destination therapy but not dependent on intravenous inotropic support. Methods This was a prospective, multicenter (N = 41), observational study of 200 patients (97 LVAD, 103 OMM). Entry criteria included ≥ 1 hospitalization for HF in the last 12 months and 6-min walk distance (6MWD) <300 m. The primary composite endpoint was survival on original therapy with improvement in 6MWD ≥ 75 m at 12 months. Results LVAD patients were more severely ill, with more patients classified as Interagency Registry for Mechanically Assisted Circulatory Support profile 4 (65% LVAD vs. 34% OMM; p < 0.001) than 5 to 7. More LVAD patients met the primary endpoint (39% LVAD vs. 21% OMM; odds ratio: 2.4 [95% confidence interval: 1.2 to 4.8]; p = 0.012). On the basis of as-treated analysis, 12-month survival was greater for LVAD versus OMM (80 ± 4% vs. 63 ± 5%; p = 0.022) patients. Adverse events were higher in LVAD patients, at 1.89 events/patient-year (EPPY), primarily driven by bleeding (1.22 EPPY), than with OMM, at 0.83 EPPY, primarily driven by worsening HF (0.68 EPPY). Most patients (80% LVAD vs. 62% OMM; p < 0.001) required hospitalizations. Health-related quality of life (HRQol) and depression improved from baseline more significantly with LVADs than with OMM (Δ visual analog scale: 29 ± 25 vs. 10 ± 22 [p < 0.001]; Δ Patient Health Questionnaire-9: -5 ± 7 vs. -1 ± 5 [p < 0.001]). Conclusions Survival with improved functional status was better with HMII LVAD compared with OMM. Despite experiencing more frequent adverse events, LVAD patients improved more in HRQol and depression. The results support HMII use in functionally limited, noninotrope-dependent HF patients with poor HRQoL. (Risk Assessment and Comparative Effectiveness of Left Ventricular Assist Device [LVAD] and Medical Management [ROADMAP]; NCT01452802) © 2015 American College of Cardiology Foundation. Source

Barry Lee W.,Piedmont Hospital | Gotay A.,Eye Consultants of Atlanta
Eye and Contact Lens | Year: 2010

Objective: To report three cases of bilateral Acanthamoeba keratitis in association with Synergeyes hybrid contact lens wear. Methods: Retrospective case series of six eyes of three patients that developed Acanthamoeba keratitis with Synergeyes hybrid contact lens wear. Results: Acanthamoeba keratitis was diagnosed in six eyes with a previous misdiagnosis of Herpes simplex keratitis in two patients and a misdiagnosis of corneal graft rejection in the third patient. Misdiagnosis in all three patients led to inappropriate topical corticosteroid use. All cases were diagnosed with Acanthamoeba castellanii by culture on nonnutrient agar, corneal scraping, and/or confocal microscopy. The infection ultimately cleared in all eyes with topical therapy using chlorhexidine, propamidine, and antibiotic ointment with neomycin. Cornea transplantation was required in two of six eyes for dense central corneal scarring. Conclusions: Acanthamoeba keratitis can occur in association with SynergEyes contact lens wear. Eye care professionals must take care to avoid potential misdiagnosis of Herpes simplex keratitis, avoid topical corticosteroids in contact lens wearers with an unknown keratitis, and pay special attention to the fellow eye for potential bilateral infection when Acanthamoeba has been diagnosed in one eye. Copyright © Contact Lens Association of Ophthalmologists, Inc. Source

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