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Biomedical subjects

John L Nosher

Publications and source records attributed to John L Nosher.

8 recordsLinked to original sources
PubMed2006

Uterine artery embolization versus myomectomy: a multicenter comparative study.

OBJECTIVE: To determine whether there is significant quality of life score improvement after uterine artery embolization (UAE) and to compare UAE and myomectomy outcomes. DESIGN: Prospective cohort controlled study. SETTING: Sixteen medical centers in the United States. PATIENT(S): One hundred forty-nine UAE patients and 60 myomectomy patients. Patients were assigned to myomectomy or UAE on the basis of a best treatment decision made by the patient and her physician. All patients were observed for 6 months. The UAE patients also had follow-up examinations at 1 year. INTERVENTION(S): Myomectomy or UAE. MAIN OUTCOME MEASURE(S): Quality of life score changes, menstrual bleeding score changes, uterine size differences, time off, and adverse events. RESULT(S): Both groups experienced statistically significant improvements in the uterine fibroid quality of life score, menstrual bleeding, uterine volume, and overall postoperative quality of life. The mean hospital stay was 1 day for the UAE patients, compared with 2.5 days for the myomectomy patients. The UAE and myomectomy patients returned to their normal activities in 15 days and 44 days, respectively, and returned to work in 10 days and 37 days, respectively. At least one adverse event occurred in 40.1% of the myomectomy patients, compared with 22.1% in the UAE group. CONCLUSION(S): The uterine fibroid quality of life score was significantly improved in both groups. No significant differences were observed in bleeding improvement, uterine volume reduction, uterine fibroid quality of life score improvement, and overall quality of life score improvement between groups. Patients receiving UAE required fewer days off work, fewer hospital days, and experienced fewer adverse events.

Adult↗
PubMed2006

A prospective multicenter comparative study between myomectomy and uterine artery embolization with polyvinyl alcohol microspheres: long-term clinical outcomes in patients with symptomatic uterine fibroids.

PURPOSE: To prospectively evaluate the safety and effectiveness of polyvinyl alcohol (PVA) microspheres in patients undergoing uterine artery embolization (UAE) to treat uterine fibroid tumors and to compare the long-term changes in health-related quality of life (QOL) after UAE with the changes seen after myomectomy. MATERIALS AND METHODS: One hundred forty-six patients with uterine myomas were enrolled into this multicenter study, with 77 patients undergoing UAE with PVA and 69 patients undergoing myomectomy. Six-month follow-up was completed for the myomectomy, whereas 2-year follow-up was completed for the UAE group. Outcomes were assessed with the Uterine Fibroid QOL Questionnaire and based on adverse event incidence, time to return to normal activity, and changes in tumor symptom scores, QOL scores, and menorrhagia bleeding scores. For the UAE cohort, changes in total uterine volume and dominant tumor size on magnetic resonance (MR) imaging were assessed. RESULTS: In the UAE cohort, 88.3% of patients experienced a reduction of tumor-related symptoms (increase >or=5 points from baseline measurement) at 6 months, with 75.4% of patients in the myomectomy group experiencing similar improvement. Median QOL questionnaire scores at 6 months were found to be significantly higher in patients treated with UAE (P = .041), with sustained improvement seen at 12 and 24 months. Both procedures resulted in significant reductions in 6-month menorrhagia bleeding scores, with sustained improvement in the UAE cohort at 12 and 24 months. MR imaging at 6 months revealed significant uterine and tumor volume reductions after UAE (P < .05). At least one adverse event occurred in 42% of patients in the myomectomy group, compared with 26% in the UAE group (P < .05). CONCLUSIONS: UAE performed with PVA microspheres was associated with greater sustained improvements in symptom severity and health-related QOL and with fewer complications compared with myomectomy. Six-month MR imaging data demonstrated significant reductions in uterine and tumor volumes, although the degree of tissue infarction after UAE was not assessed with contrast medium-enhanced MR imaging.

Adult↗
PubMed2004

Percutaneous gastrostomy for treating dilatation of the bypassed stomach after bariatric surgery for morbid obesity.

OBJECTIVE: Retrospective analysis was performed to determine the safety and effectiveness of percutaneous gastrostomy for treating distention of the bypassed stomach after gastric bypass for morbid obesity. MATERIALS AND METHODS: Eight patients with morbid obesity and Roux-en-Y gastric bypass underwent percutaneous radiologic gastrostomy for postoperative decompression of the bypassed stomach. Four patients underwent gastrostomy on the fourth day after surgery: two in the early postoperative period (< or = 30 days after surgery) and two in the late postoperative period (6, 11 months after the procedure). Procedures were performed using combinations of fluoroscopic, CT, and sonographic guidance. T-tacks and a variety of locking pigtail drainage catheters were placed in seven patients. RESULTS: Gastrostomy placement was technically successful in all patients. Seven of eight patients experienced resolution of symptoms. Gastrostomy catheters were in place for a mean of 31 days. Two complications occurred. Periprocedural peritonitis in one patient with underlying small-bowel obstruction required surgical intervention. One wound infection was treated with antibiotics and local wound care. No catheters became dislodged or obstructed. Four patients treated during the early postoperative period had resolution of symptoms after tube placement and recovered uneventfully. Three of four patients presenting during the intermediate or late postoperative periods had temporary resolution of symptoms, but all eventually required surgical intervention. CONCLUSION: In the absence of complete small-bowel obstruction, percutaneous radiologic gastrostomy provides safe and effective decompression of the excluded gastric remnant after Roux-en-Y gastric bypass. Gastrostomy tube placement after the early postoperative period is temporizing, with surgical intervention eventually required.

Adult↗
PubMed2003

Dynamic quiz bank: a portable tool set for authoring and managing distributed, Web-based educational programs in radiology.

RATIONALE AND OBJECTIVES: The authors performed this study to evaluate a portable, platform-independent software program that enables users from remote sites to transform raw materials (eg, text, images, video) into Web-ready, interactive tutorials and examinations. MATERIALS AND METHODS: The software program evaluated consists of three modules: a network-based interface developed in the Java programming language, an Oracle 8i relational database with liaison software, and shell scripts developed in the Perl programming language to automate the authoring, maintenance, and updating of content in a dynamic quiz bank (DBQ). Four faculty members, one radiology resident, and two undergraduates majoring in computer science volunteered to create questions for the DQB and to evaluate ease of authoring. RESULTS: Faculty members with various levels of computer proficiency were able to establish a comprehensive DQB of more than 1,000 interactive questions. These radiologists reported the scripts reliable and easy to use. The DQB, offered in a pathology course for 2nd-year medical students, was used by 151 students and may have played a role in improving standardized test scores. Eighty-seven percent (n = 131) of the students believed that the DQB was extremely useful as an educational tool. CONCLUSION: The DQB software program facilitated access to, and authoring and maintenance of, Web-based educational materials developed in the departments of radiology and pathology.

Computer-Assisted Instruction↗
PubMedDate not supplied

Balloon-assisted occlusion of the internal iliac arteries in patients with placenta accreta/percreta.

BACKGROUND: Placenta accreta/percreta is a leading cause of third trimester hemorrhage and postpartum maternal death. The current treatment for third trimester hemorrhage due to placenta accreta/percreta is cesarean hysterectomy, which may be complicated by large volume blood loss. PURPOSE: To determine what role, if any, prophylactic temporary balloon occlusion and transcatheter embolization of the anterior division of the internal iliac arteries plays in the management of patients with placenta accreta/percreta. METHODS: The records of 28 consecutive patients with a diagnosis of placenta accreta/percreta were retrospectively reviewed. Patients were divided into two groups. Six patients underwent prophylactic temporary balloon occlusion, followed by cesarean section, transcatheter embolization of the anterior division of the internal iliac arteries and cesarean hysterectomy (n = 5) or uterine curettage (n = 1). Twenty-two patients underwent cesarean hysterectomy without endovascular intervention. The following parameters were compared in the two groups: patient age, gravidity, parity, gestational age at delivery, days in the intensive care unit after delivery, total hospital days, volume of transfused blood products, volume of fluid replacement intraoperatively, operating room time, estimated blood loss, and postoperative morbidity and mortality. RESULTS: Patients in the embolization group had more frequent episodes of third trimester bleeding requiring admission and bedrest prior to delivery (16.7 days vs. 2.9 days), resulting in significantly more hospitalization time in the embolization group (23 days vs. 8.8 days) and delivery at an earlier gestational age than in those in the surgical group (32.5 weeks). There was no statistical difference in mean estimated blood loss, volume of replaced blood products, fluid replacement needs, operating room time or postoperative recovery time. CONCLUSION: Our findings do not support the contention that in patients with placenta accreta/percreta, prophylactic temporary balloon occlusion and embolization prior to hysterectomy diminishes intraoperative blood loss.

Adult↗
PubMedDate not supplied

Volumetric analysis of liver metastases in computed tomography with the fuzzy C-means algorithm.

Tumor size is often determined from computed tomography (CT) images to assess disease progression. A study was conducted to demonstrate the advantages of the fuzzy C-means (FCM) algorithm for volumetric analysis of colorectal liver metastases in comparison with manual contouring. Intra-and interobserver variability was assessed for manual contouring and the FCM algorithm in a study involving contrast-enhanced helical CT images of 43 hypoattenuating liver lesions from 15 patients with a history of colorectal cancer. Measurement accuracy and interscan variability of the FCM and manual methods were assessed in a phantom study using paraffin pseudotumors. In the clinical imaging study, intra-and interobserver variability was reduced using the FCM algorithm as compared with manual contouring (P = 0.0070 and P = 0.0019, respectively). Accuracy of the measurement of the pseudotumor volume was improved using the FCM method as compared with the manual method (P = 0.047). Interscan variability of the pseudotumor volumes was measured using the FCM method as compared with the manual method (P = 0.04). The FCM algorithm volume was highly correlated with the manual contouring volume (r = 0.9997). Finally, the shorter time spent in calculating tumor volume using the FCM method versus the manual contouring method was marginally statistically significant (P = 0.080). These results suggest that the FCM algorithm has substantial advantages over manual contouring for volumetric measurement of colorectal liver metastases from CT.

Algorithms↗
PubMedDate not supplied

Visceral and renal artery aneurysms: a pictorial essay on endovascular therapy.

Visceral artery aneurysms (VAAs), which were once considered uncommon, are now being diagnosed with increasing frequency, a fact that reflects the routine use of computed tomography (CT), magnetic resonance imaging, and ultrasonography. Diagnostic radiology plays a major role in the detection and characterization of VAAs. Cross-sectional imaging can help exclude aneurysm rupture, which requires emergent treatment. CT angiography or catheter angiography can clearly depict the aneurysm and help identify other aortic, visceral, or peripheral aneurysms. Most important, radiologic examination can help determine the adequacy of the collateral blood supply to the vascular bed distal to the aneurysm, information that is essential prior to the initiation of endovascular treatment. Advances in endovascular therapy have allowed interventional radiologists to contribute to the management of VAAs. Coil embolization or covered stent placement can now be used to treat patients with aneurysms whose size or location would make a surgical approach problematic, as well as patients in whom surgery is considered to pose considerable risk.

Aneurysm↗