bluuebunny/crossref_metadata_2025_split huggingface dataset:
Randomized Placebo-Controlled Phase II Trial of Perifosine Plus Capecitabine As Second- or Third-Line Therapy in Patients With Metastatic Colorectal Cancer
Authors: Bendell Johanna C. , Nemunaitis John , Vukelja Sasha J. , Hagenstad Christopher , Campos Luis T. , Hermann Robert C. , Sportelli Peter , Gardner Lesa , Richards Donald A. 
Published: October 2011

Purpose In a multicenter, double-blind phase II trial, we compared the efficacy and safety of perifosine plus capecitabine (P-CAP) with placebo plus capecitabine (CAP) in patients with metastatic colorectal cancer (mCRC) who had progressed after as many as two prior therapies. Patients and Methods Patients (n = 38) not previously treated with capecitabine received P-CAP (perifosine 50 mg orally once daily, days 1 to 21 and CAP 825 mg/m2 orally twice daily, days 1 to 14) or CAP (825 mg/m2 orally twice daily, days 1 to 14) in 21-day cycles until disease progression. The primary end point was time to progression (TTP). Secondary end points included overall survival (OS), overall response rate (ORR), safety, and tolerability. Results Twenty patients were randomly assigned to P-CAP and 18 to CAP. Median TTP (27.5 v 10.1 weeks; P < .001) and median OS (17.7 v 7.6 months; P = .0052) were improved in patients receiving P-CAP versus CAP. ORR was 20% v 7% in the P-CAP and CAP groups, respectively, and one patient in the P-CAP group had a complete response. A subset analysis of fluorouracil-refractory patients showed a median TTP of 17.6 v 9.0 weeks (P < .001) and median OS of 15.1 v 6.5 months (P = .0061). Toxicities, including diarrhea, nausea, fatigue, and hand-foot syndrome, were manageable. Conclusion P-CAP showed promising clinical activity compared with CAP in previously treated patients with mCRC. A phase III trial is underway comparing P-CAP with CAP in patients with refractory mCRC.
Mortality by Stage for Right- Versus Left-Sided Colon Cancer: Analysis of Surveillance, Epidemiology, and End Results–Medicare Data
Authors: Weiss Jennifer M. , Pfau Patrick R. , O'Connor Erin S. , King Jonathan , LoConte Noelle , Kennedy Gregory , Smith Maureen A. 
Published: October 2011

Purpose Recent studies have reported increased mortality for right-sided colon cancers but had limited adjustment for patient characteristics and conflicting results by stage. We examined the relationship between colon cancer location (right- v left-side) and 5-year mortality by stage. Patients and Methods We identified Medicare beneficiaries from 1992 to 2005 with American Joint Commission on Cancer stages I to III primary adenocarcinoma of the colon who underwent surgery for curative intent through Surveillance, Epidemiology, and End Results (SEER) –Medicare data. Adjusted hazard ratios (HRs) and 95% CIs for predictors of all-cause 5-year mortality were obtained by using Cox proportional hazards regression. Results Of 53,801 patients, 67% had right-sided colon cancer. Patients with right-sided cancer were more likely to be older, to be women, to be diagnosed with a more advanced stage, and to have more poorly differentiated tumors. Adjusted Cox regression showed no significant difference in mortality between right- and left-sided cancers for all stages combined (HR, 1.01; 95% CI, 0.98 to 1.04; P = .598) or for stage I cancers (HR, 0.95; 95% CI, 0.88 to 1.03; P = .211). Stage II right-sided cancers had lower mortality than left-sided cancers (HR, 0.92; 95% CI, 0.87 to 0.97; P = .001), and stage III right-sided cancers had higher mortality (HR, 1.12; 95% CI, 1.06 to 1.18; P < .001). Conclusion When analysis was adjusted for multiple patient, disease, comorbidity, and treatment variables, no overall difference in 5-year mortality was seen between right- and left-sided colon cancers. However, within stage II disease, right-sided cancers had lower mortality; within stage III, right-sided cancers had higher mortality.
Human Papillomavirus and Rising Oropharyngeal Cancer Incidence in the United States
Authors: Chaturvedi Anil K. , Engels Eric A. , Pfeiffer Ruth M. , Hernandez Brenda Y. , Xiao Weihong , Kim Esther , Jiang Bo , Goodman Marc T. , Sibug-Saber Maria , Cozen Wendy , Liu Lihua , Lynch Charles F. , Wentzensen Nicolas , Jordan Richard C. , Altekruse Sean , Anderson William F. , Rosenberg Philip S. , Gillison Maura L. 
Published: October 2011

Purpose Recent increases in incidence and survival of oropharyngeal cancers in the United States have been attributed to human papillomavirus (HPV) infection, but empirical evidence is lacking. Patients and Methods HPV status was determined for all 271 oropharyngeal cancers (1984-2004) collected by the three population-based cancer registries in the Surveillance, Epidemiology, and End Results (SEER) Residual Tissue Repositories Program by using polymerase chain reaction and genotyping (Inno-LiPA), HPV16 viral load, and HPV16 mRNA expression. Trends in HPV prevalence across four calendar periods were estimated by using logistic regression. Observed HPV prevalence was reweighted to all oropharyngeal cancers within the cancer registries to account for nonrandom selection and to calculate incidence trends. Survival of HPV-positive and HPV-negative patients was compared by using Kaplan-Meier and multivariable Cox regression analyses. Results HPV prevalence in oropharyngeal cancers significantly increased over calendar time regardless of HPV detection assay (P trend < .05). For example, HPV prevalence by Inno-LiPA increased from 16.3% during 1984 to 1989 to 71.7% during 2000 to 2004. Median survival was significantly longer for HPV-positive than for HPV-negative patients (131 v 20 months; log-rank P < .001; adjusted hazard ratio, 0.31; 95% CI, 0.21 to 0.46). Survival significantly increased across calendar periods for HPV-positive (P = .003) but not for HPV-negative patients (P = .18). Population-level incidence of HPV-positive oropharyngeal cancers increased by 225% (95% CI, 208% to 242%) from 1988 to 2004 (from 0.8 per 100,000 to 2.6 per 100,000), and incidence for HPV-negative cancers declined by 50% (95% CI, 47% to 53%; from 2.0 per 100,000 to 1.0 per 100,000). If recent incidence trends continue, the annual number of HPV-positive oropharyngeal cancers is expected to surpass the annual number of cervical cancers by the year 2020. Conclusion Increases in the population-level incidence and survival of oropharyngeal cancers in the United States since 1984 are caused by HPV infection.
Evaluation of Epidural Analgesic Paste Components in Lumbar Decompressive Surgery
Authors: Diaz Roberto Jose , Myles S. Terry , Hurlbert R. John 
Published: October 2011

Abstract

BACKGROUND:
Adjuncts for pain management in lumbar decompressive surgery are needed to reduce narcotic consumption and promote early mobility.

OBJECTIVE:
To evaluate the efficacy and active components of a previously described epidural analgesic paste in controlling postoperative pain and facilitating early discharge from hospital after lumbar decompressive surgery.

METHODS:
A randomized double-blind controlled trial was conducted. Two-hundred and one patients were randomized to 1 of 4 analgesic epidural pastes at the time of lumbar spinal surgery: combination paste (morphine + methylprednisolone), steroid paste (methylprednisolone alone), morphine paste (morphine alone), or placebo. The primary outcome measures used were analgesic consumption and the McGill Pain Questionnaire (MPQ). Secondary outcome measures were: modified American Spinal Cord Injury Association (ASIA) score, Short Form 36 General Health Survey (SF-36), Aberdeen Pain Index (ABPI), time to ambulation and time to discharge from hospital.

RESULTS:
Administration of combination and steroid paste, but not morphine paste, resulted in a statistically significant reduction in mean pain rating index (PRI) and present pain intensity (PPI) components of the MPQ in the first 3 days after surgery. Likewise, postoperative in-patient narcotic analgesic consumption was reduced in the combination paste and steroid paste group, but not in the morphine paste group. No difference in time to ambulation or discharge, SF-36 scores, ABPI scores, or neurologic recovery was observed.

CONCLUSION:
An analgesic paste containing methylprednisolone acetate is effective at reducing postoperative pain after lumbar decompressive surgery. Mixing effective doses of morphine sulfate in the paste abrogates the expected analgesic effects of epidural morphine.
Merci Retrievers as Access Adjuncts for Reperfusion Catheters
Authors: Hui Ferdinand K. , Hussain Muhammad S. , Spiotta Alejandro , Bhalla Tarun , Toth Gabor , Moskowitz Shaye I. , Elgabaly Mohamed , Sivapatham Thinesh , Rasmussen Peter A. 
Published: October 2011

Abstract

BACKGROUND:
Expeditious, stable access in acute ischemic stroke is foundational for mechanical revascularization. Proximal vascular tortuosity and unfavorable anatomy may impede the access necessary for revascularization, particularly when large-caliber catheters are used. We describe an approach using the Merci retriever to gain stable catheter access for aspiration.

OBJECTIVE:
To assess the technical feasibility of using the Merci retriever system as an access adjunct in acute ischemic stroke and tortuous ophthalmic segment anatomy.

METHODS:
The acute ischemic stroke database was queried, and 3 patients presenting with acute ischemic stroke and tortuous proximal anatomy who were treated with mechanical thrombectomy and the Merci retriever as an access adjunct were identified. Patient charts and procedure reports were reviewed.

RESULTS:
In each of the patients, the ophthalmic segment of the internal carotid artery proved difficult to navigate. An appropriately sized Merci retriever was deployed in the M1 segment. Gentle tension on the retriever was applied, altering the angle at which the aspiration catheter navigated the ophthalmic segment, affording rapid access past the ophthalmic artery origin and into the target vessel. The 18 L microcatheter and retriever were withdrawn, followed by aspiration and clot maceration with the Penumbra aspiration system.

CONCLUSION:
Tortuous proximal anatomy may impede access to an occluded vessel. Use of tension on a deployed Merci retriever straightens the course of the wire, changing the angle that the aspiration catheter makes with the vessel. In the setting of unfavorable anatomy, this technique may be used to advance an aspiration catheter to the target lesion.
Implications of Spinopelvic Alignment for the Spine Surgeon
Authors: Mehta Vivek A. , Amin Anubhav , Omeis Ibrahim , Gokaslan Ziya L. , Gottfried Oren N. 
Published: October 2011

Abstract
The relation of the pelvis to the spine has previously been overlooked as a contributor to sagittal balance. However, it is now recognized that spinopelvic alignment is important to maintain an energy-efficient posture in normal and disease states. The pelvis is characterized by an important anatomic landmark, the pelvic incidence (PI). The PI does not change after adolescence, and it directly influences pelvic alignment, including the parameters of pelvic tilt (PT) and sacral slope (SS) (PI = PT 1 SS), overall sagittal spinal balance, and lumbar lordosis. In the setting of an elevated PI, the spineadapts with increased lumbar lordosis. To prevent or limit sagittal imbalance, the spine may also compensate with increased PT or pelvic retroversion to attempt to maintain anupright posture. Abnormal spinopelvic parameters contribute to multiple spinal conditions including isthmic spondylolysis, degenerative spondylolisthesis, deformity, and impact outcome after spinal fusion. Sagittal balance, pelvic incidence, and all spinopelvic parameters are easily and reliably measured on standing, full-spine (lateral) radiographs, and it is essential to accurately assess and measure these sagittal values to understand their potential role in the disease process, and to promote spinopelvic balance at surgery. In this article, we provide a comprehensive review of the literature regarding the implications of abnormal spinopelvic parameters and discuss surgical strategies for correction of sagittal balance. Additionally, the authors rate and critique the quality of the literature cited in a systematic review approach to give the reader an estimate of the veracity of the conclusions reached from these reports.
Comparison of the Diagnostic Utility of Electromyography, Ultrasonography, Computed Tomography, and Magnetic Resonance Imaging in Idiopathic Carpal Tunnel Syndrome Determined by Clinical Findings
Authors: Deniz Fatih Ersay , Öksüz Erol , Sarikaya Bas‚ar , Kurt Semiha , Erkorkmaz Ünal , Ulusoy Hasan , Arslan Șule 
Published: October 2011

AbstractBackground:Carpal tunnel syndrome (CTS) is the most common nerve entrapment syndrome. It is sometimes difficult to diagnose, and a late diagnosis may result in permanent nerve damage. Electromyography (EMG), ultrasonography (US), magnetic resonance imaging (MRI), and computed tomography (CT) may be performed for the diagnosis. The diagnostic accuracy of these tests is well documented, but most of these studies accept EMG as the gold standard.Objective:To evaluate the diagnostic accuracy of EMG, MRI, CT, and US for the diagnosis of carpal tunnel syndrome with the use of clinical findings as the gold standard.Methods:Patients suspected to have CTS on presentation to the outpatient clinic were evaluated. The tests were performed after a detailed physical examination. Both wrists of the 69 patients in the study were investigated.Results:The diagnostic accuracies of all the tests were found to be sufficient. Although EMG seemed to have the highest sensitivity and specificity, there was no statistically significant difference between the tests.Conclusion:EMG or US could be used as the first-step test in most cases. If they are both available, EMG should be the first choice. They may be performed together when diagnosis is challenging. CT may especially be preferred for bone-related pathological conditions, whereas MRI may be preferred for soft tissue-related pathological conditions. Even though imaging studies have been proven to be powerful diagnostic tools for CTS, no conclusive information currently exists to support replacing EMG with imaging studies.
Comparative Evaluation of Percutaneous Retrogasserian Glycerol Rhizolysis and Radiofrequency Thermocoagulation Techniques in the Management of Trigeminal Neuralgia
Authors: Udupi Bidkar Prasanna , Chouhan Rajendra S. , Dash Hari H. , Bithal Parmod K. , Prabhakar Hemanshu 
Published: October 2011

Abstract

BACKGROUND:
Among the percutaneous procedures for the treatment of trigeminal neuralgia, percutaneous anhydrous glycerol rhizolysis (PRGR) and radiofrequency (RF) ablation of trigeminal neuralgia have stood the test of time.

OBJECTIVE:
A prospective study was conducted to compare PRGR and RF ablation techniques in patients with trigeminal neuralgia in terms of (1) efficacy of pain relief, (2) duration of pain relief and (3) side effects.

METHODS:
All patients presenting to our pain clinic for the first time for the treatment of trigeminal neuralgia were enrolled to receive either PRGR or RF ablation; the treatment was chosen by the patient. Demographic data, magnetic resonance imaging scan, relevant medical disease, amount of anhydrous glycerol, lesion temperature, and total duration of RF were noted. The presence or absence of cerebrospinal fluid egress, immediate pain relief, duration of pain-free period, need for repeat injection or additional peripheral nerve block, and recurrence of pain were also noted. The degree of pain relief was recorded every 3 months. Any complications during the procedure and side effects were also recorded.

RESULTS:
Seventy-nine patients underwent either PRGR (n = 40) or RF thermocoagulation (n = 39). A total of 23 patients (58.9%) in the PRGR group and 33 patients (84.6%) in the RF group experienced excellent pain relief. The mean duration of excellent pain relief in the PRGR and RF groups was comparable. By the end of the study period, 39.1% patients in the PRGR group and 51.5% patients in the RF group experienced recurrence of pain.

CONCLUSION:
Both PRGR and RF techniques can achieve acceptable pain relief with minimal side effects.
Risk Factors for Posttreatment Edema in Patients Treated With Stereotactic Radiosurgery for Meningiomas
Authors: Unger Keith R. , Lominska Christopher E. , Chanyasulkit June , Randolph-Jackson Pamela , White Robert L. , Aulisi Edward , Jacobson Jeffrey , Jean Walter , Gagnon Gregory J. 
Published: October 2011

Abstract

Background:
Peritumoral edema is a recognized complication following stereotactic radiosurgery (SRS).

Objective:
To evaluate the risk of posttreatment peritumoral edema following SRS for intracranial meningiomas and determine predictive factors.

Methods:
Between 2002 and 2008, 173 evaluable patients underwent CyberKnife or Gamma Knife SRS for meningiomas. Eighty-four patients (49%) had prior surgical resections, 13 patients had World Health Organization grade II (atypical) meningiomas, and 117 patients had a neurological deficit before SRS. Sixty-two tumors were in parasagittal, parafalcine, and convexity locations. The median tumor volume was 4.7 mL (range, 0.1–231.8 mL). The median prescribed dose and median prescribed biologically equivalent dose were 15 Gy (range, 9–40 Gy) and 67 Gy (range, 14–116 Gy), respectively. Ninety-seven patients were treated with single-fraction SRS, 74 received 2 to 5 fractions, and 2 received &gt;5 fractions.

Results:
The median follow-up was 21.0 months. Thirteen patients (8%) developed symptomatic peritumoral edema, with a median onset time of 4.5 months (range, 0.2– 9.5 months). The 3-, 6-, 12-, and 24-month actuarial symptomatic edema rates were 2.9%, 4.9%, 7.7%, and 8.5%, respectively. The crude tumor control rate was 94%. On univariate analysis, large tumor volume (P = .01) and single-fraction SRS (P = .04) were predictive for development of posttreatment edema.

Conclusion:
SRS meningioma treatment demonstrated a low incidence of toxicity; however, large tumor volumes and single-fraction SRS treatment had an increased risk for posttreatment edema. Risk factors for edema should be considered in meningiomas treatment.
Carotid Endarterectomy With Primary Closure: Analysis of Outcomes and Review of the Literature
Authors: Zenonos Georgios , Lin Ning , Kim Albert , Kim Jeong Eun , Governale Lance , Friedlander Robert Max 
Published: October 2011

Abstract

Background:
Despite abundant published support of patch angioplasty during carotid endarterectomy (CEA), primary closure is still widely used. The reasons underlying the persistence of primary closure are not quite evident in the literature.

Objective:
To present our experience with primary closure in CEA, and provide a rationale for its persistent wide use.

Methods:
Medical records of all patients undergoing CEA by the senior author (R.F.) were retrospectively reviewed. Follow-up was supplemented with a telephone interview and completion of a structured questionnaire. A review of the current literature was performed.

Results:
From 1998 to 2010, the senior author performed 111 CEAs. Average cross-clamp time was 33 ± 11 minutes. Postoperative complications included 1 non– ST-elevation myocardial infarction and 2 strokes. No deaths, cranial-nerve deficits, or acute reocclusions were observed. After a mean follow-up of 64.6 months (7170.6 case-months), there were 3 contralateral strokes and 7 deaths. There were no ipsilateral strokes or restenoses &gt;50%. Follow-up medication compliance was 94.6% for anti-platelet agents and 91.9% for statins. The outcomes of the current study were comparable to those of the available trials comparing patch angioplasty with primary closure. A careful evaluation of the literature revealed a number of reasons potentially explaining the persistent use of patch angioplasty.

Conclusion:
In conjunction with contemporary medical management, primary closure during CEA may yield results comparable or superior to patch angioplasty. Advantages of primary closure include shorter cross-clamp times and elimination of graft-specific complications.
Image-Guided Thoracoscopic Resection of Thoracic Dumbbell Nerve Sheath Tumors
Authors: Ghostine Samer , Vaynman Shoshanna , Schoeb James Scott , Cambron Helen , King Wesley A. , Samudrala Srinath , Johnson J. Patrick 
Published: October 2011

Abstract

BACKGROUND:
Surgical removal of dumbbell nerve sheath tumors (NSTs) remains challenging because these neoplasms occupy ≥ 2 spinal and extraspinal spaces. The presence of intraspinal extension, tumor dimension, and/or its location within the thoracic cavity have previously made the resection of these types of neoplasms difficult.

OBJECTIVE:
To describe the feasibility of performing minimally invasive thoracoscopic surgery, as facilitated by an image guidance system (IGS), to achieve gross total resection of select dumbbell NSTs located in the thoracic spine.

METHODS:
The 3 cases presented here contained small intraspinal or foraminal components. Preoperative symptoms included Horner syndrome and back and chest wall pain. We used IGS to help guide the complete thoracoscopic resection of select dumbbell NSTs, consisting of extradural, intraforaminal, and paravertebral tumor components, which previously would have been challenging with only a thoracoscopic approach.

RESULTS:
IGS provided continuous intraoperative anatomic orientation to achieve gross total resection in all 3 cases. All surgical and postsurgical outcomes were satisfactory; preoperative symptoms improved or resolved; and no adverse events were observed.

CONCLUSION:
Thoracic dumbbell NSTs that have small intraspinal or foraminal components could be resected thoracoscopically when facilitated by IGS. Image-guided thoracoscopic resection of such dumbbell tumors may not only improve the precision of resection, reduce recurrence, and avoid the need for spinal reconstruction but also obviate the need for more invasive or simultaneous posterior procedures. The IGS enhances the accuracy and safety of 2-dimensional thoracoscopic surgery and may reduce its learning curve.
Visual and quantitative assessment of lateral lumbar spinal canal stenosis with magnetic resonance imaging
Authors: Sipola Petri , Leinonen Ville , Niemeläinen Riikka , Aalto Timo , Vanninen Ritva , Manninen Hannu , Airaksinen Olavi , Battié Michele C 
Published: October 2011

Background Lateral lumbar spinal canal stenosis is a common etiology of lumbar radicular symptoms. Quantitative measurements have commonly demonstrated better repeatability than visual assessments. We are not aware of any studies examining the repeatability of quantitative assessment of the lateral canal. Purpose To evaluate the repeatability of visual assessments and newly developed quantitative measurements of lateral lumbar spinal canal stenosis using magnetic resonance imaging (MRI). Material and Methods Twenty-eight patients with lateral lumbar spinal canal stenosis or prior spinal surgery with recurrent symptoms were imaged with MRI. A radiologist, a neurosurgeon and a spine research trainee graded visually and quantitatively subarticular ( n = 188) and foraminal zones ( n = 260) of the lateral spinal canal. Quantitative measurements included the minimal subarticular width and the cross-sectional area of the foramen. Results The repeatability of visual assessment at the subarticular zone and foraminal zones between raters varied from 0.45-0.59 and 0.42-0.53, respectively. Similarly, the intraclass correlation coefficients for the quantitative measurements varied from 0.67-0.71 and 0.66-0.76, respectively. The intra-rater repeatability for the visual assessments of the subarticular and foraminal zones was 0.70 and 0.62, respectively, while the corresponding intraclass correlation coefficients for quantitative measurements were 0.83 and 0.81, respectively. Conclusion Inter-rater repeatability of visual assessments of lateral stenosis is moderate, whereas quantitative measurements of both subarticular width and the cross-sectional area of the foramen have substantial reproducibility and may be particularly useful for longitudinal studies and research purposes. The clinical value of these parameters requires further study.