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Goldstein H.B.,Johnson University | MacCarone J.,Johnson University | Naughton M.J.,St Marys Regional Medical Center | Aguirre O.A.,Milestone Inc.
BMC Urology | Year: 2010

Background. A prospective multicenter clinical study was performed to evaluate the safety and efficacy of a bovine dermal graft (Xenform Matrix, Boston Scientific, Natick, MA, USA) during vaginal reconstructive surgery. Methods. Forty-five women with ICS stage 2 or higher pelvic organ prolapse (POP) were enrolled at 4 centers. POP-Q, pelvic floor function (PFDI-20), sexual function (PISQ-12), and patient satisfaction tools were used to assess subjects at baseline, and at 2 and 6 weeks, and 3, 6 and 12 months post surgery. The significance of symptom score changes at 6 months and 1 year were determined by the t-test for paired data. Forty-three of the 45 patients completed the 12 month study. Results. The majority of the subjects had cystocele (98%) and/or rectocele (84%) defects at study entry. At 12 months, 74% of the defects had improved to a stage 0 or 1. Mean PFDI-20 scores improved by 72% (p < 0.001) at 12 months, and PISQ-12 scores were maintained during the follow-up period indicating no decline in sexual function. Three subjects experienced one serious adverse event each; one of the adverse events (constipation) was deemed by the study physician to be unrelated to Xenform®. One subject had severe pyelonephritis resulting in dialysis. This subject had a previous history of pyelonephritis, sepsis and acute renal failure. The third subject had a reported recurrent cystocele of moderate severity, possibly related to the device. No graft related erosions or pain lasting more than 30 days were reported. No subjects withdrew due to an adverse event. Conclusion. This study is the first to investigate the use of Xenform® Matrix in vaginal reconstructive surgery among patients with POP. Significant improvement was maintained at 12 months utilizing both objective and subjective assessment tools, confirming the safety and efficacy of this material in vaginal surgery. Trial Registration. © 2010 Goldstein et al; licensee BioMed Central Ltd. Source

Knightly D.V.,St Marys Regional Medical Center
Radiology management | Year: 2010

St. Mary's Regional Medical Center in Lewiston, ME, was a recipient of the Putting Patients First grant program offered by AHRA and Toshiba. This article presents an overview of the grant activities and the salient findings. The dual focus of the best practice initiative was to promote the physician use of the evidence-based appropriateness criteria developed by the American College of Radiology and to determine ways to improve patient safety with an eye toward incorporating any best practice reported in the literature or recommended by bona fide experts in CT. Some of the resulting best practices consist of: optimizing scanning protocols and scanner settings, utilizing supplemental approaches to dose reduction, and referring patients to excellent online resources. Source

Mnatsakanyan E.,Northern Nevada Medical Center | Tung W.-C.,University of Nevada, Reno | Caine B.,St Marys Regional Medical Center | Smith-Gagen J.,University of Nevada, Reno
Cancer Causes and Control | Year: 2014

Purpose: To describe the epidemiological features and trends of cancer of unknown primary (CUP) in a large and diverse US population. Methods: The Surveillance Epidemiology and End Results registry was used to examine incidence rates, adjusted to the World Segi 1960 population, by demographic and tumor characteristics among patients diagnosed with CUP between 1973 and 2010. Annual percent changes in incidence rates were estimated using Joinpoint regression. Results: The incidence rate of pathologically investigated CUP was 4.1 per 100,000 and is consistent with reports from other countries. In the USA, CUP incidence rates have been decreasing since the early 1980s, 3.6 % per year in the last two decades. The USA experienced decreases earlier than other countries. US males and African Americans had the highest rates of CUP. The rates of non-microscopically confirmed CUP have dropped 2.6 % per year since 1973, but 24 % of CUP patients do not receive microscopic confirmation and 21 % of those with microscopically investigated cancer receive a vague histology (i.e., epithelial) diagnosis. Twenty percent of patients with pathological investigation receive radiation. Patients were twice as likely to be diagnosed with a non-pathologically investigated CUP if they were living in areas with the lowest income quartile relative to areas with the highest income quartile. Conclusion: Although the incidence of CUP is decreasing, we document CUP that may be due to insufficient diagnostic inquiry. Questions raised by the findings in this data provide hypotheses for further epidemiological and biological studies in the elucidation of CUP incidence and treatment. © 2014 Springer International Publishing Switzerland. Source

Hatheway J.A.,Northwest Pain Care Inc. | Caraway D.,St Marys Regional Medical Center | David G.,University of Pennsylvania | Gunnarsson C.,CTI Clinical Trial and Consulting | And 3 more authors.
Neuromodulation | Year: 2015

Objective To compare health-care expenditures over a 12-month horizon for chronic pain patients with implanted intrathecal drug delivery systems (IDDS) who eliminated or continued systemic opioids postimplant. Methods Claims data from commercial and Medicare databases were searched for patients who had an IDDS, used systemic opioids before implant, and had 12 months pre- and 13 months postimplant continuous medical and pharmacy coverage. The number and characteristics of patients who eliminated or continued systemic opioids were determined at four times postimplant: 30 days (allowing a systemic opioid washout period), 120 days, 150 days, and 210 days. Multivariable models evaluated the effect of eliminating opioids on health-care expenditures at each of those times. Results Three hundred eighty-nine patients met inclusion criteria, and 51% completely eliminated systemic opioids (12% within the 30-day washout and an additional 39% by the end of the one-year horizon). Systemic opioid elimination within 120 to 210 days postimplant was associated with a reduction of $3,388 to $4,465 in inpatient and outpatient expenditures, and $4,689 to $5,571 in inpatient, outpatient, and drug expenditures. Conclusions Fifty-one percent of patients completely eliminated systemic opioids in the year after IDDS implant. This elimination resulted in a 10% to 17% reduction in yearly inpatient, outpatient, and drug expenditures. © 2015 International Neuromodulation Society. Source

Chrysant G.S.,Baptist Medical Center | Horstmanshof D.A.,Baptist Medical Center | Guniganti U.M.,St Marys Regional Medical Center
Texas Heart Institute Journal | Year: 2011

Cardiac tumors are rare and usually indicate metastatic disease. Characterizing a tumor and reaching an exact diagnosis can be difficult. Diagnosis has been aided greatly by advances in imaging, such as cardiovascular magnetic resonance with the use of gadolinium-pentetic acid. Carcinoid tumors are neuroendocrine neoplasms that are found most often in the intestinal tract, although they can also develop in the lung, stomach, or heart. Herein, we report the case of a 72-year-old woman with a history of intestinal carcinoid disease and presenting symptoms of dizziness, fatigue, and chest pain. We used cardiovascular magnetic resonance with gadolinium enhancement to identify a large mass obstructing left ventricular outflow. The histopathologic results of an endomyocardial biopsy confirmed that the mass was a left-sided metastatic carcinoid cardiac tumor. To our knowledge, we are reporting the 1st combined use of clinical evaluation, cardiovascular magnetic resonance, and histopathologic studies to reach such a diagnosis. © 2011 by the Texas Heart ® Institute, Houston. Source

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