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Showing papers by "Jewish Hospital published in 2006"


Journal ArticleDOI
TL;DR: It is demonstrated that the sirolimus-eluting and the bare SMART stent are effective, safe, and free from restenosis in a majority of patients for up to 24 months.
Abstract: Purpose:To review clinical outcomes of patients with chronic limb ischemia and TASC type C lesions treated with sirolimus-eluting versus bare SMART nitinol self-expanding stents.Methods:Data were o...

456 citations


Journal ArticleDOI
TL;DR: In most patients with a significant cross correlation between sleep and/or bedrest and mood, the mood change occurred on the day following the change in sleep and or bedrest, most commonly with a time latency of one day.
Abstract: Background: Early recognition of the prodromal symptoms of bipolar disorder, combined with a patient action plan, may help to prevent relapses. Sleep disturbances are frequent warning signs of both mania and depression. This study used cross correlation analysis to characterize the relationship between mood, sleep and bedrest in longitudinal data. Methods: Self-reported mood, sleep and bedrest (mean 169 ± 59 days of data per patient) from 59 outpatients with bipolar disorder receiving standard treatment were analyzed. The cross correlation function was used to determine the latency between the changes in sleep and/or bedrest and mood for time shifts of between –7 and 7 days. Results: For sleep and/or bedrest, a significant inverse correlation was found with the change in mood, most commonly with a time latency of one day. Sleep plus bedrest had the strongest relationship with a change in mood, with a significant correlation in 24 of 59 patients (41%) for the night before or night of a mood change. The patients with a significant cross-correlation between mood and sleep plus bedrest reported about two thirds of all large sleep changes of >3 h and three fourths of all large mood changes (>20 on 100-unit scale). Patients with a significant cross correlation were more likely to take benzodiazepines. Conclusion: In most patients with a significant cross correlation between sleep and/or bedrest and mood, the mood change occurred on the day following the change in sleep and/or bedrest. Sleep changes from a previous pattern, especially those of more than 3 h, may indicate that a large mood change is imminent.

176 citations


Journal ArticleDOI
TL;DR: Preliminary data on the values and beliefs about obesity and weight reduction were obtained from women of different ethnic/racial backgrounds and have implications for nursing's role in the design of culturally relevant weight-loss programs.
Abstract: Designing culturally relevant weight-reduction programs requires understanding of ethnic variations and illness beliefs Preliminary data on the values and beliefs about obesity and weight reduction were obtained from women of different ethnic/racial backgrounds Purposive sampling was used to recruit African American (AA) and Caucasian (C) women with a body mass index (BMI)>or= 30 from the general internal medicine clinics of a large tertiary care facility Four focus groups (2 with AA women and 2 with C women) consisting of a total of 20 subjects were conducted in a 2-month period AA women cited culture specific barriers to weight loss more so than did C women AA women and C women also differed on how health care professionals could help them with weight loss These findings have implications for nursing's role in the design of culturally relevant weight-loss programs

96 citations


Journal ArticleDOI
TL;DR: In the conscious rat, the cardioprotection afforded by postconditioning is limited to mild to moderate myocardial injury, and unlike early preconditioning, post conditioning protects only against coronary occlusions <45 min.
Abstract: Objectives: Brief episodes of ischemia and reperfusion after a lethal ischemic insult confer cardioprotection, a phenomenon termed “ischemic postconditioning.” However, all studies reported to date...

75 citations


Journal ArticleDOI
TL;DR: The data suggest that pneumoperitoneum after PEG placement is common and, in the absence of clinical symptoms, is of no clinical significance and does not warrant any further intervention.

72 citations


Journal ArticleDOI
TL;DR: In these 61 hypercholesterolemic patients unable to tolerate other statins and, subsequently in some cases, unable to meet LDL-C goals while receiving nonstatin LIT monotherapy, preliminary observations suggest that rosuvastatin at doses of 5 and 10 mg/d+diet was well tolerated, effective, and had a good safety profile.

72 citations


Journal ArticleDOI
TL;DR: It is hypothesized that Glucophage promotes successful live births in women with PCOS by lowering PAI-1 activity before conception and maintaining further reductions of PAI,1 activity during the first trimester of pregnancy, and that increments or no change in PAI -1 activity despite Glucophile appears to be associated with first-trimester miscarriage.
Abstract: We assessed whether hypofibrinolytic plasminogen activator inhibitor 1 (PAI-1 activity) showed an independent association with first-trimester miscarriage in the 430 women with polycystic ovary syndrome (PCOS) who had previous pregnancies (from a cohort of 967 women with PCOS). Prospectively, we hypothesized that Glucophage (Bristol-Myers Squibb, Princeton, NJ) promotes successful live births in women with PCOS by lowering PAI-1 activity before conception and maintaining further reductions of PAI-1 activity during the first trimester of pregnancy. We also assessed whether PAI-1 activity levels were independently related to PAI-1 genotype and to modifiable risk factors body mass index (BMI), insulin, and triglyceride. By stepwise logistic regression, with the dependent variable being previous pregnancy outcomes at 3 levels (live birth pregnancies only [n = 208]; both ≥1 live birth and ≥1 first-trimester miscarriage [n = 111]; or first-trimester miscarriages only [n = 71]) and explanatory variables PAI-1 genotype, PAI-1 activity, insulin, homeostasis model assessment of insulin resistance, BMI, and triglyceride, PAI-1 activity was positively associated with first-trimester miscarriage (P = .004). For each 5 IU/mL increment in PAI-1 activity, the risk being in an adverse first-trimester miscarriage category increased (odds ratio, 1.12; 95% confidence interval, 1.04-1.20). Prospectively, from pretreatment to the last preconception visit on Glucophage, in 30 women who subsequently had live births, PAI-1 activity fell 44%, but rose 19% in 23 women with first-trimester miscarriage (P = .03). In the 30 women with live birth pregnancies, median PAI-1 activity fell continuously from pretreatment through the first trimester (from 16.8 to 6.7 IU/mL), whereas PAI-1 activity was either unchanged or rose in women with first-trimester miscarriage. Of the 921 women with PCOS who had 4G5G data, 718 (78%) had 4G4G-4G5G genotypes vs 87 (69%) of 126 normal female controls (χ2 = 4.95, P = .026). The 4G allele frequency was 53% in women with PCOS vs 46% in controls (χ2 = 4.3, P = .04). Of the 866 women with PCOS who had PAI-1 activity data, by stepwise regression, positive independent determinants of PAI-1 activity included BMI (partial R2 = 10.6%, P

66 citations


Journal ArticleDOI
TL;DR: Lithium is the foremost and most well-documented augmentation strategy in refractory depression and is considered a first-line treatment strategy for patients with a major depressive episode who do not adequately respond to standard antidepressant treatment.
Abstract: Lithium augmentation refers to the addition of lithium to an antidepressant in the acute treatment phase of patients with depressive episodes who have failed to respond satisfactorily to treatment with antidepressant monotherapy. This article reviews the clinical evidence and hypotheses on the mode of action of lithium augmentation. For this purpose, studies were identified by searching Medline and by scanning the references of published reviews and standard textbooks. With regard to efficacy, 28 prospective studies (with a total of 838 depressed patients) were identified. The majority of randomized controlled trials has demonstrated substantial efficacy of lithium augmentation. A recent meta-analysis including only double-blind, placebo-controlled trials (N = 9) provided firm evidence that lithium augmentation has a statistically significant effect on response rate compared to placebo, and showed that lithium augmentation should be administered for at least 2 weeks to allow assessment of the patient's response. A recent double-blind, placebo-controlled trial revealed that responders to lithium augmentation should be maintained on the lithium-antidepressant combination for a minimum of 12 months. From animal studies there is robust evidence that lithium augmentation increases serotonin (5-HT) neurotransmission, possibly through a synergistic action of lithium and the antidepressant on brain 5-HT pathways. Neuroendocrine studies in humans on the effects of lithium augmentation on the HPA system showed an unexpected and marked increase in the ACTH and cortisol response in the combined dexamethasone/CRH test. These results are in contrast to the established decline of HPA system activity during treatment with antidepressants. In conclusion, lithium is the foremost and most well-documented augmentation strategy in refractory depression. In international treatment guidelines and algorithms, lithium augmentation is considered a first-line treatment strategy for patients with a major depressive episode who do not adequately respond to standard antidepressant treatment.

65 citations


Journal ArticleDOI
TL;DR: Complications of NOM of pediatric blunt hepatic injury are rare, but may include biloma, hepatic artery pseudoaneurysm, and necrotic gallbladder and the clinician must maintain a high index of suspicion for the development of complications.
Abstract: Background:Nonoperative management (NOM) of blunt hepatic injury is the standard of care in the hemodynamically stable pediatric patient, but it is not without pitfalls. The purpose of this study is to assess the incidence and types of complications associated with NOM in terms of diagnosis, managem

60 citations


Journal ArticleDOI
TL;DR: Using forcing functions (removal of betadine in kits, creation of an accessory pack and a checklist for line insertion) improved reliability and adherence to evidence-based practices increased from 30% to nearly 95%.

59 citations


Journal ArticleDOI
TL;DR: In this paper, the hypothesis that metformin during lactation versus formula feeding would have no adverse effects on infants’ growth, motor-social development, or intercurrent illness was tested.

Proceedings ArticleDOI
20 Aug 2006
TL;DR: Two new adaptive probability models of the visual appearance of small 2D and large 3D pulmonary nodules are jointly used to control the evolution of the de-formable model, and experiments with real LDCT chest images confirm the high accuracy of the proposed approach.
Abstract: To accurately separate each pulmonary nodule from its background in a low dose computer tomography (LDCT) chest image, two new adaptive probability models of the visual appearance of small 2D and large 3D pulmonary nodules are jointly used to control the evolution of the de-formable model. The appearance prior is modeled with a translation and rotation invariant Markov-Gibbs random field of voxel intensities with pairwise interaction. The model is analytically identified from a set of training nodule images with normalized intensity ranges. Both the nodules and their background in each current multi-modal chest image are also modeled with a linear combination of discrete Gaussians that closely approximate the empirical marginal probability distribution of voxel intensities. Experiments with real LDCT chest images confirm the high accuracy of the proposed approach

Book ChapterDOI
01 Oct 2006
TL;DR: Two new adaptive probability models of visual appearance of small 2D and large 3D pulmonary nodules are used to control evolution of deformable boundaries to more accurately separate each pulmonary nodule from its background in a low dose computer tomography (LDCT) chest image.
Abstract: To more accurately separate each pulmonary nodule from its background in a low dose computer tomography (LDCT) chest image, two new adaptive probability models of visual appearance of small 2D and large 3D pulmonary nodules are used to control evolution of deformable boundaries. The appearance prior is modeled with a translation and rotation invariant Markov-Gibbs random field of voxel intensities with pairwise interaction analytically identified from a set of training nodules. Appearance of the nodules and their background in a current multi-modal chest image is also represented with a marginal probability distribution of voxel intensities. The nodule appearance model is isolated from the mixed distribution using its close approximation with a linear combination of discrete Gaussians. Experiments with real LDCT chest images confirm high accuracy of the proposed approach.

Journal ArticleDOI
TL;DR: In adolescents with PCOS, metformin-diet reduces weight, insulin, IR, cholesterol, and triglycerides, and facilitates resumption of regular menses.
Abstract: Background: In 35 adolescent females (17 ± 2 years) with polycystic ovary syndrome (PCOS), median body mass index (BMI) 30.8 kg/m 2 , we assessed effeicacy of metformin-diet for 1 year for reduction of weight, insulin, HOMA insulin resistance (IR), cholesterol, triglycerides, and resumption of regular menses. Methods: Calories (26% protein, 44% carbohydrate) were targeted to 1,500-1,800/day if BMI was <25 or to 1,200-1,500/day if BMI was ≥25, along with 2,550 mg metformin. Results: Median weight fell from 82.7 to 79.1 kg (p = 0.009), insulins 16.7 to 13.3 μU/ml (p <0.0001), HOMA IR 3.41 to 2.74 (p = 0.0004), total cholesterol 164 to 151 mg/dl (p = 0.002), and triglyceride 103 to 85 mg/dl (p = 0.006). The percentage of cycles with normal menses rose from a pre-treatment mean of 22% to 74%, p < 0.0001. Conclusions: In adolescents with PCOS, metformin-diet reduces weight, insulin, IR, cholesterol, and triglycerides, and facilitates resumption of regular menses.

Journal Article
TL;DR: Differences in cultural background and preferences about weight loss interventions have important policy implications for how the U.S. healthcare system provides care to an ever-increasing multicultural population with a national epidemic such as obesity.
Abstract: PURPOSE: To explore attitudes and perceptions of obesity, and identify preferences for weight-management interventions by African-American and Caucasian women who were followed in general internal medicine clinics. PROCEDURE: Surveys exploring these issues were mailed to African-American (n=240) and Caucasian (n=240) women with a BMI of > or =30. MAIN FINDINGS: Caucasian women felt past weight-loss efforts were helped by weight-loss programs significantly more than African-American women (P<0.001); African-American women were more likely to feel that their cultural background contributed to their weight gain than did Caucasian women (P=0.001). African-American women expressed a higher need for one-on-one counseling with their physician (P<0.001) as well as group meetings with the dietician, physician and other women (P=0.004) than did Caucasian women. African-American women also felt it was more important for weight-loss programs to have information on food common to their culture than did Caucasian women (P<0.001). CONCLUSIONS: Differences in cultural background and preferences about weight loss interventions have important policy implications for how the U.S. healthcare system provides care to an ever-increasing multicultural population with a national epidemic such as obesity.

Journal ArticleDOI
Charles J. Glueck1, Dawit Aregawi1, M. Agloria1, M. Winiarska1, L. Sieve1, Ping Wang1 
TL;DR: Metformin-diet in women with polycystic ovary syndrome effectively and safely reduces weight and LDL-C while raising HDL-C, and maintains these outcomes stable over 4 years.
Abstract: In 74 women with polycystic ovary syndrome, treated for 4 years with metformin (MET) and diet, we prospectively assessed whether, and to what degree, weight loss, reduction of insulin resistance, and amelioration of coronary heart disease risk factors could be sustained. We hypothesized that response to MET-diet would not differ by pretreatment body mass index (BMI) classes or =25 to or =30 to or =40 (extremely obese). [table: see text] Metformin-diet was successful in producing stable approximately 8% weight reduction for all 4 years (trend P or =40, > or =30 to or =25 to .1) in the 4 BMI categories. By stepwise regression, weight loss was a significant (P < or = .01) positive explanatory variable for reduction in HOMA-IR for all 4 follow-up years. Metformin-diet in women with polycystic ovary syndrome effectively and safely reduces weight and LDL-C while raising HDL-C, and maintains these outcomes stable over 4 years.

Journal ArticleDOI
TL;DR: A new method for examining neuropsychological test data in schizophrenia is reported, based on finite partially ordered sets (posets) as classification models, which may reveal more valid cognitive endophenotypes, while dramatically reducing the amount of testing required.
Abstract: Current methods for statistical analysis of neuropsychological test data in schizophrenia are inherently insufficient for revealing valid cognitive impairment profiles. While neuropsychological tests aim to selectively sample discrete cognitive domains, test performance often requires several cognitive operations or ‘‘attributes.’’ Conventional statistical approaches assign each neuropsychological score of interest to a single attribute or ‘‘domain’’ (e.g., attention, executive,etc.),andscoresarecalculatedforeach.Thiscan yield misleading information about underlying cognitive impairments. We report findings applying a new method for examining neuropsychological test data in schizophrenia, based on finite partially ordered sets (posets) as classification models. A total of 220 schizophrenia outpatients were administered the Positive and Negative Symptom Scale (PANSS) and a neuropsychological test battery. Selected tests were submitted to cognitive attribute analysis a priori by two neuropsychologists. Applying Bayesian classification methods (posets), each patient was classified with respect to proficiency on the underlying attributes, based upon his or her individual test performance pattern. Twelve cognitive ‘‘classes’’ are described in the sample. Resulting classification models provided detailed ‘‘diagnoses’’ into ‘‘attribute-based’’ profiles of cognitive strength/ weakness, mimicking expert clinician judgment. Classification was efficient, requiring few measures to achieve accurate classification. Attributes were associated with PANSS factors in the expected manner (only the negative and cognition factors were associated with the attributes), and a double dissociation was observed in which divergent thinking was selectively associated with negative symptoms, possibly reflecting a manifestation of Kraepelin’s hypothesis regarding the impact of volitional disturbances on thought. Using posets for extracting more precise cognitive information from neuropsychological data may reveal more valid cognitive endophenotypes, while dramatically reducing the amount of testing required.

Journal ArticleDOI
TL;DR: While the size of the test animal has decreased, the complexities of living protoplasm have not, and the problems posed by maintaining such microorganisms in cultures free from all other living forms are complicated by their need for an oceanic environment.
Abstract: The use of microorganisms to explore general problems of biochemistry and physiology has become an accepted approach. While bacteria, yeasts, and fungi primarily serve as test objects, the successful domestication of protozoa has made these primitive animals available for investigative purposes. Most of the protozoa now in use are f&h water varieties. Through the efforts of Prova801i1 and of Droop2 protista of marine origin are now available to the interested student. The problems posed by maintaining such microorganisms in cultures free from all other living forms are complicated by their need for an oceanic environment. The variations in crop yields, physiological activities, and morphological manifestations resulting from artificial cultivation must be recognized and separated from findings which are the consequence of experimental manipula t ion~.~ In other words, while the size of the test animal has decreased, the complexities of living protoplasm have not. The advantages offered by microbial forms of life to the investigator lie in their short generation times, the enormity of the populations which can be kept without mortgaging everything to feed them, and especially their lack of specializatioii a t the cellular level; that is, the individual cell performs all the functions of the entire organism. When to this last property is added the ability to extrude microscopic structures of high mineral content, one can appreciate why such strange bedfellows as microbiologists, orthopedic surgeons, and anatomists can fhd a common ground for a collaborative effort,. It is perhaps appropriate at this juncture to devote a few moments to

Journal ArticleDOI
TL;DR: Combination therapy with corticosteroids, disease-modifying antirheumatic drugs and nonsteroidal anti-inflammatory drugs, and replacement of the titanium cage with a polyetherketone cage identifies implant-related inflammatory arthritis.
Abstract: Background A 54-year-old woman presented with myalgia and arthralgia predominantly in the knees and small joints of the hands and feet with morning stiffness lasting for at least 2 h. The patient had received a wrought titanium 6-aluminium 4-vanadium alloy C cage implant 1.5 years previously, following a severe disc prolapse. No signs of rheumatic disease were evident before the C cage was implanted. Investigations Physical examination, radiography, skin and muscle biopsies, serology tests, white blood cell count, HLA genotyping, tumor necrosis factor release assay, skin patch test, lymphocyte transformation test. Diagnosis Implant-related inflammatory arthritis. Management Combination therapy with corticosteroids, disease-modifying antirheumatic drugs and nonsteroidal anti-inflammatory drugs, and replacement of the titanium cage with a polyetherketone cage.

Journal ArticleDOI
TL;DR: Mild hypercapnia, which normally markedly increases tissue oxygenation, did not do so during cardiopulmonary bypass with fixed pump output, which suggests that hyper capnia normally increases tissueoxyation by increasing cardiac output rather than direct dilation of peripheral vessels.
Abstract: Background Tissue oxygenation is the primary determinant of wound infection risk. Mild hypercapnia markedly improves cutaneous, subcutaneous (s.c.), and muscular tissue oxygenation in volunteers and patients. However, relative contributions of increased cardiac output and peripheral vasodilation to this response remains unknown. We thus tested the hypothesis that increased cardiac output is the dominant mechanism. Methods We recruited 10 ASA III patients, aged 40–65 yr, undergoing cardiopulmonary bypass for this crossover trial. After induction of anaesthesia, a Silastic tonometer was inserted s.c. in the upper arm. S.C. tissue oxygen tension was measured with both polarographic electrode and fluorescence-based systems. Oximeter probes were placed bilaterally on the forehead to monitor cerebral oxygenation. After initiation of cardiopulmonary bypass, in random order patients were exposed to two arterial CO2 partial pressures for 30 min each: 35 (normocapnia) or 50 mm Hg (hypercapnia). Bypass pump flow was kept constant throughout the measurement periods. Results Hypercapnia during bypass had essentially no effect on P a O 2 , mean arterial pressure, or tissue temperature. P a CO 2 and pH differed significantly. S.C. tissue oxygenation was virtually identical during the two P a CO 2 periods [139 (50–163) vs 145 (38–158), P=0.335] [median (range)]. In contrast, cerebral oxygen saturation (our positive control measurement) was significantly less during normocapnia [57 (28–67)%] than hypercapnia [64 (37–89)%, P=0.025]. Conclusions Mild hypercapnia, which normally markedly increases tissue oxygenation, did not do so during cardiopulmonary bypass with fixed pump output. This suggests that hypercapnia normally increases tissue oxygenation by increasing cardiac output rather than direct dilation of peripheral vessels.

Journal ArticleDOI
TL;DR: Patients with bipolar disorder who were taking antidepressants—overwhelmingly not tricyclics and with a concurrent mood stabilizer—did not experience an increase in the rate of switches to mania or rapid cycling compared to those not taking antidepressants.

Journal ArticleDOI
TL;DR: In smokers homo/heterozygous for stromelysin-1 5A/6A and eNOS T-786C mutations, it is speculated that the development and severity of BD are related to a gene-environment vasospastic interaction with reduced NO-mediated vasodilatation.
Abstract: Buerger’s disease (BD) etiologies are poorly understood. Beyond smoking cessation, medical-surgical treatments have limited success. We hypothesized that mutations associated with arterial vasospas...

Journal ArticleDOI
TL;DR: As many women with IIH have PCOS, and because weight loss is central to IIH treatment, diet-MET is a novel approach to treat IIH in women with concurrent PCOS or hyperinsulinemia without PCOS.

Book ChapterDOI
01 Oct 2006
TL;DR: A new visualization technique for virtual colonoscopy, called Virtual Fly-Over, which splits the entire colon anatomy into exactly two halves and assigns a virtual camera to each half to perform fly-over navigation, which has several advantages over both traditional fly-through and related methods.
Abstract: In this paper, we propose a new visualization technique for virtual colonoscopy (VC). The proposed method is called Virtual Fly-Over, which splits the entire colon anatomy into exactly two halves. Then, it assigns a virtual camera to each half to perform fly-over navigation, which has several advantages over both traditional fly-through and related methods. First, by controlling the elevation of the camera, there is no restriction on its field of view (FOV) angle (e.g., >90o) to maximize visualized surface areas, and hence no perspective distortion. Second, the camera viewing volume is perpendicular to each colon half, so potential polyps that are hidden behind haustral folds are easily found. Finally, because the orientation of the splitting surface is controllable, the navigation can be repeated at a different split orientation to overcome the problem of having a polyp that is divided between the two halves of the colon. Quantitative experimental results on 15 clinical datasets have shown that the average surface visibility coverage is 99.59±0.2%.

Journal ArticleDOI
TL;DR: Naltrexone implants prove prevention of relapse during the most vulnerable period after detoxification and lead to a significantly better psychological condition in patients, compared with Levomethadone withdrawal.

Journal ArticleDOI
Albert E. Sobel1
TL;DR: This paper will emphasize those portions of the investigations that have bearing on the caries problem and some of the relationships have been investigated extensively, while others require further study.
Abstract: For many years this laboratory has been concerned with the composition of mineralized tissues and the relationships that exist between the composition of the mineral fraction of the tissue, the composition of the body fluids, and the composition of the diet. This paper will emphasize those portions of the investigations that have bearing on the caries problem. As will be developed later, some of the relationships have been investigated extensively, while others require further study.

Journal ArticleDOI
TL;DR: Techniques that lead to the rapid and reliable recognition of those microorganisms most frequently isolated in the authors' particular geographical area are introduced, which leads to the immediate recognition of extraordinary microorganisms by their inability to conform with the precepts established for the routine organisms.
Abstract: The renaissance of diagnostic microbiology can be attributed to several causes, not the least of which are the usage of antibiotics, ecological shifts in the normal human microflora, and altered host experience. Today, microbiology laboratories of general hospitals are confronted with pressures from physicians for the rapid isolation of organisms from patients with, or suspected of having, infectious diseases and for guidance in their therapy. With these considerations are coupled the scientist’s endeavor for the correct identification of the isolated agent, the determination of a causal relationship between this isolate and the disease, and his concern with the potential consequences of the microorganism for the hospital population and the community at large. We have attempted to meet this challenge by instituting techniques that lead to the rapid and reliable recognition of those microorganisms most frequently isolated in our particular geographical area. Such a procedure leads to the immediate recognition of extraordinary microorganisms by their inability to conform with the precepts established for the routine organisms. This dichotomy enables personnel of the diagnostic laboratory to render presumptive identification of isolates from clinical material rapidly while the information still has consequence for the diagnosis and treatment of the patient.

Journal Article
TL;DR: The damage-control philosophy proposes early stabilization, resuscitation, and delayed definitive treatment for polytrauma patients with orthopedic injuries who are most at risk.
Abstract: Evaluation and management of patients who sustain blunt trauma with multiple injuries have changed significantly over the past 50 years. Initially, clinical research supported delayed definitive treatment of the orthopedic subset of injuries in these patients. With the advancement of splinting and fixation techniques, this view changed to one of "early total care." Current developments in classifying trauma patients at risk for deterioration (objective scoring scales) and understanding the posttraumatic immune response have allowed us to stratify patients' clinical severity and treat appropriately. The damage-control philosophy proposes early stabilization, resuscitation, and delayed definitive treatment for polytrauma patients with orthopedic injuries who are most at risk.

Journal ArticleDOI
TL;DR: This manuscript should summarize the hopes and limitations of different approaches such as brachytherapy, cutting balloons, stents and stent grafts, drug-eluting stents, and drug-coated balloons in treatment of the superficial femoral artery.
Abstract: Treatment of the superficial femoral artery (SFA) has been among the least effective of all endovascular procedures in terms of long-term patency. The relatively small vessel lumen, in conjunction with a high plaque burden, slow flow, and a high frequency of primary occlusions, contributes to a considerable rate of acute technical failures. Because of these technical limitations a much effort has been made during the past years. This manuscript should summarize the hopes and limitations of different approaches such as brachytherapy, cutting balloons, stents and stent grafts, drug-eluting stents, and drug-coated balloons.

Journal ArticleDOI
TL;DR: Flat elevated lesions selected by endoscopic criteria are, in fact, a heterogeneous population of lesions, demonstrating that FELs and FAs are not homologous terms.