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Dive into the research topics where Elizabeth A. Stewart is active.

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Featured researches published by Elizabeth A. Stewart.


Journal of Clinical Oncology | 1998

DNA mismatch repair and O6-alkylguanine-DNA alkyltransferase analysis and response to Temodal in newly diagnosed malignant glioma

Henry S. Friedman; Roger E. McLendon; Tracy Kerby; M Dugan; Sandra H. Bigner; Aj Henry; David M. Ashley; J Krischer; Shelley Lovell; Karima Rasheed; F Marchev; Aj Seman; Ilkcan Cokgor; Jeremy N. Rich; Elizabeth A. Stewart; Colvin Om; James M. Provenzale; Darell D. Bigner; Michael M. Haglund; Allan H. Friedman; Paul Modrich

PURPOSE We evaluated the response to Temodal (Schering-Plough Research Institute, Kenilworth, NJ) of patients with newly diagnosed malignant glioma, as well as the predictive value of quantifying tumor DNA mismatch repair activity and O6-alkylguanine-DNA alkyltransferase (AGT). PATIENTS AND METHODS Thirty-three patients with newly diagnosed glioblastoma multiforme (GBM) and five patients with newly diagnosed anaplastic astrocytoma (AA) were treated with Temodal at a starting dose of 200 mg/m2 daily for 5 consecutive days with repeat dosing every 28 days after the first daily dose. Immunochemistry for the detection of the human DNA mismatch repair proteins MSH2 and MLH1 and the DNA repair protein AGT was performed with monoclonal antibodies and characterized with respect to percent positive staining. RESULTS Of the 33 patients with GBM, complete responses (CRs) occurred in three patients, partial responses (PRs) occurred in 14 patients, stable disease (SD) was seen in four patients, and 12 patients developed progressive disease (PD). Toxicity included infrequent grades 3 and 4 myelosuppression, constipation, nausea, and headache. Thirty tumors showed greater than 60% cells that stained for MSH2 and MLH1, with three CRs, 12 PRs, three SDs, and 12 PDs. Eight tumors showed 60% or less cells that stained with antibodies to MSH2 and/or MLH1, with 3 PRs, 3 SDs, and 2 PDs. Eleven tumors showed 20% or greater cells that stained with an antibody to AGT, with 1 PR, 2 SDs, and 8 PDs. Twenty-five tumors showed less than 20% cells that stained for AGT, with 3 CRs, 12 PRs, 4 SDs, and 6 PDs. CONCLUSION These results suggest that Temodal has activity against newly diagnosed GBM and AA and warrants continued evaluation of this agent. Furthermore, pretherapy analysis of tumor DNA mismatch repair and, particularly, AGT protein expression may identify patients in whom tumors are resistant to Temodal.


Obstetrics & Gynecology | 2007

Sustained Relief of Leiomyoma Symptoms by Using Focused Ultrasound Surgery

Elizabeth A. Stewart; Bobbie S. Gostout; Jaron Rabinovici; Hyun Soo Kim; Lesley Regan; Clare M. Tempany

OBJECTIVE: To assess several measures of the long-term outcome of magnetic resonance–guided focused ultrasound surgery for symptomatic uterine leiomyomata. METHODS: Data on 359 women completing 24-month follow-up in all clinical trials of magnetic resonance–guided focused ultrasound surgery for uterine leiomyomata were analyzed. Quality of life outcomes, measured by the symptom severity score of the Uterine Fibroid Symptoms Quality Of Life Questionnaire were assessed for 24 months after treatment. Clinical endpoints, including uterine shrinkage, the need for additional leiomyoma treatment, and the time to additional leiomyoma treatment, were all assessed. The nonperfused volume ratio after treatment, calculated from the gadolinium-enhanced magnetic resonance imaging after treatment and the best measure of tissue necrosis after treatment, was used to assess outcome based on completeness of leiomyoma ablation. RESULTS: Women undergoing magnetic resonance–guided focused ultrasound surgery for symptomatic uterine leiomyomata have durable symptom relief, as measured by the symptom severity score at 24 months, with significantly greater improvement with more complete ablation (P<.001). Survival analysis demonstrates a significant reduction in the percentage of women undergoing additional leiomyoma treatment (P=.001) in women in the high nonperfused volume group. The mean shrinkage and mean residual nonperfused volume ratio are both significantly above zero at 6 months in the high nonperfused volume group (P<.001). The incidence of adverse events is low. However, for women with minimal treatment, the risk of additional procedures is high. CONCLUSION: Magnetic resonance–guided focused ultrasound surgery is an effective treatment for uterine leiomyomata and results in sustained symptomatic relief. LEVEL OF EVIDENCE: III


Fertility and Sterility | 2010

Pregnancy outcome after magnetic resonance-guided focused ultrasound surgery (MRgFUS) for conservative treatment of uterine fibroids

Jaron Rabinovici; Matthias David; Hidenobu Fukunishi; Yutaka Morita; Bobbie S. Gostout; Elizabeth A. Stewart

OBJECTIVE To report all pregnancies to date after magnetic resonance-guided focused ultrasound surgery (MRgFUS) for the conservative treatment of clinically significant uterine fibroids. DESIGN Prospective registry of all known pregnancies occurring after MRgFUS maintained by the device manufacturer and reported to the Food and Drug Administration. SETTING World experience of pregnancies after treatment with reports from 13 sites in seven countries. PATIENT(S) Fifty-one reproductive-age women with uterine leiomyomas. INTERVENTION(S) Women underwent MRgFUS treatment for symptomatic uterine leiomyomas before this report. MAIN OUTCOME MEASURE(S) Pregnancy outcomes and complications. RESULT(S) Fifty-four pregnancies in 51 women have occurred after MRgFUS treatment of uterine leiomyomas. The mean time to conception was 8 months after treatment. Live births occurred in 41% of pregnancies, with a 28% spontaneous abortion rate, an 11% rate of elective pregnancy termination, and 11 (20%) ongoing pregnancies beyond 20 gestational weeks. The mean birth weight was 3.3 kg, and the vaginal delivery rate was 64%. CONCLUSION(S) Preliminary pregnancy experience after MRgFUS is encouraging, with a high rate of delivered and ongoing pregnancies.


Epidemiology | 2005

Influence of body size and body fat distribution on risk of uterine leiomyomata in U.S. black women.

Lauren A. Wise; Julie R. Palmer; Donna Spiegelman; Bernard L. Harlow; Elizabeth A. Stewart; Lucile L. Adams-Campbell; Lynn Rosenberg

Background: Uterine leiomyomata are a major source of morbidity in black women. We prospectively investigated the risk of self-reported uterine leiomyomata in relation to body mass index (BMI), weight change, height, waist and hip circumferences, and waist-to-hip ratio in a large cohort of U.S black women. Methods: Data were derived from the Black Womens Health Study, a U.S. prospective cohort study of black women who complete biannual mailed health questionnaires. From 1997 through 2001, we followed 21,506 premenopausal women with intact uteri and no prior diagnosis of uterine leiomyomata. Cox regression models were used to estimate incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Results: After 70,345 person-years of follow up, 2146 new cases of uterine leiomyomata confirmed by ultrasound (n = 1885) or hysterectomy (n = 261) were self-reported. Compared with the thinnest women (BMI <20.0 kg/m2), the multivariate IRRs for women with BMIs of 20.0–22.4, 22.5–24.9, 25.0–27.4, 27.5–29.9, 30.0–32.4, and 32.5+ kg/m2 were 1.34 (95% CI = 1.02–1.75), 1.39 (1.07–1.81), 1.45 (1.12–1.89), 1.47 (1.11–1.93), 1.36 (1.02–1.80), and 1.21 (0.93–1.58), respectively. IRRs were larger among parous women. Weight gain since age 18 was positively associated with risk, but only among parous women. No other anthropometric measures were associated with risk. Conclusions: BMI and weight gain exhibited a complex relation with risk of uterine leiomyomata in the Black Womens Health Study. The BMI association was inverse J-shaped and findings were stronger in parous women. Weight gain was positively associated with risk among parous women only.


Radiology | 2008

Uterine Leiomyomas: MR Imaging–guided Focused Ultrasound Surgery—Imaging Predictors of Success

Zsuzsanna M. Lénárd; Nathan McDannold; Fiona M. Fennessy; Elizabeth A. Stewart; Ferenc A. Jolesz; Kullervo Hynynen; Clare M. Tempany

PURPOSE To retrospectively assess the magnetic resonance (MR) imaging predictors of success at reducing uterine leiomyoma volume and achieving patient symptom relief 12 months after MR imaging-guided focused ultrasound surgery. MATERIALS AND METHODS This single-center retrospective analysis of 71 symptomatic fibroids in 66 women was approved by the institutional review board and was HIPAA-compliant. Patients were treated with MR imaging-guided focused ultrasound surgery. The volume of treated fibroid and nonperfused volume (NPV) were calculated with software, while symptom outcome was assessed with a symptom severity score (SSS). Fibroids were classified as hyperintense or hypointense relative to skeletal muscle on pretreatment T2-weighted MR images. RESULTS Baseline volume of treated fibroids was 255.5 cm(3) +/- 201.7 (standard deviation), and baseline SSS was 61.5 +/- 14.9. Both pretreatment fibroid signal intensity (SI) and posttreatment NPV predicted 12-month volume reduction independently: Fibroids with an NPV of at least 20% or with low SI both showed significantly larger volume reduction (17.0% +/- 13.0 and 17.2% +/- 20.1, respectively) than fibroids with an NPV less than 20% or with high SI (10.7% +/- 18.2 and no significant change, respectively). Patients whose fibroids demonstrated an NPV of at least 20% also experienced a larger decrease in SSS than did patients with fibroids with an NPV less than 20% (50.1% +/- 19.8 vs 32.6% +/- 29.9). CONCLUSION Fibroids with low SI on pretreatment T2-weighted MR images were more likely to shrink than were ones with high SI. The larger the NPV immediately after treatment, the greater the volume reduction and symptom relief were. These findings may help both in selecting appropriate patients for MR-guided focused ultrasound surgery and in predicting patient outcome.


Obstetrics & Gynecology | 2005

Age-specific incidence rates for self-reported uterine leiomyomata in the Black Women's Health Study

Lauren A. Wise; Julie R. Palmer; Elizabeth A. Stewart; Lynn Rosenberg

OBJECTIVE: Uterine leiomyomata represent a major public health problem for black women in the United States, but limited data are available on age–incidence curves in this high-risk population. We estimated overall and age-specific incidence rates for self-reported uterine leiomyomata in a large cohort of African-American women in the United States. METHODS: Data were derived from the Black Womens Health Study, an ongoing prospective cohort study of 59,000 black women from across the United States who were aged 21–69 years at baseline (ie, 1995). From March 1997 through March 2001, we followed up 22,895 premenopausal women with no prior diagnosis of uterine leiomyoma. Poisson regression was used to estimate overall and age-specific incidence rates and 95% confidence intervals (CIs) for self-reported uterine leiomyoma. In a subset of 248 patients who were selected randomly from the total case group, the self-reported diagnosis was verified in 96% of cases who released their medical records. RESULTS: During 76,711 woman-years of follow-up, 2,637 incident cases of uterine leiomyomata reported as confirmed by pelvic examination (n = 358), ultrasonography (n = 2,006), or hysterectomy (n = 273) were observed. Incidence rates per 1,000 woman-years were 34.4 (95% CI 33.1–35.7) for all cases combined, 29.7 (95% CI 28.5–30.9) for cases confirmed by ultrasonography or hysterectomy, and 3.6 (95% CI 3.2–4.0) for cases confirmed by hysterectomy. The incidence rate peaked at ages 40–44 years for all cases combined (incidence rate 45.6, 95% CI 42.0–49.5) and for cases confirmed by ultrasonography or hysterectomy (incidence rate 39.8, 95% CI 36.5–43.4), and peaked at ages 45–49 years for cases confirmed by hysterectomy (incidence rate 8.3, 95% CI 6.4–10.7). CONCLUSION: Overall incidence rates for self-reported uterine leiomyomata were consistent with other U.S studies in black women and confirmed a high burden of disease in this population. Age-specific incidence rates showed a later peak incidence than that observed among U.S. black women in previous studies. LEVEL OF EVIDENCE: II-2


Journal of Vascular and Interventional Radiology | 2011

Magnetic resonance-guided focused ultrasound of uterine leiomyomas: review of a 12-month outcome of 130 clinical patients.

Krzysztof R. Gorny; David A. Woodrum; Douglas L. Brown; Tara L. Henrichsen; Amy L. Weaver; Kimberly K. Amrami; Nicholas J. Hangiandreou; Heidi A. Edmonson; Esther V.A. Bouwsma; Elizabeth A. Stewart; Bobbie S. Gostout; Dylan A. Ehman; Gina K. Hesley

PURPOSE To assess 12-month outcomes and safety of clinical magnetic resonance (MR)-guided focused ultrasound (US) treatments of uterine leiomyomas. MATERIALS AND METHODS Between March 2005 and December 2009, 150 women with symptomatic uterine leiomyomas were clinically treated with MR-guided focused US at a single institution; 130 patients completed treatment and agreed to have their data used for research purposes. Patients were followed through retrospective review of medical records and phone interviews conducted at 3-, 6-, and 12-month intervals after treatment to assess additional procedures and symptom relief. Outcome measures and treatment complications were analyzed for possible correlations with the appearance of the tumors on T2-weighted imaging. RESULTS The cumulative incidence of additional tumor-related treatments 12 months after MR-guided focused US was 7.4% by the Kaplan-Meier method. At 3-, 6-, and 12-month follow-up, 86% (90 of 105), 93% (92 of 99), and 88% (78 of 89) of patients reported relief of symptoms, respectively. No statistically significant correlation between tumor appearance on T2-weighted imaging and 12-month outcome was found. Treatment-related complications were observed in 17 patients (13.1%): 16 patients had minor complications and one had a major complication (deep vein thrombosis). All complications were resolved within the 12-month follow-up period. CONCLUSIONS MR-guided focused US is a noninvasive treatment option that can be used to effectively and safely treat uterine leiomyomas and delivers significant and lasting symptom relief for at least 12 months. The incidence of additional treatment during this time period is comparable with those in previous reports of uterine artery embolization.


The New England Journal of Medicine | 2015

Clinical practice. Uterine fibroids.

Elizabeth A. Stewart

A 47-year-old black woman has heavy menstrual bleeding and iron-deficiency anemia.She reports nocturia and urinary frequency. A colonoscopy is negative. Ultrasonography shows a modestly enlarged uterus with three uterine fibroids. She is not planning to become pregnant. How should this case be evaluated and managed?


Ultrasound in Obstetrics & Gynecology | 2009

Magnetic resonance‐guided focused ultrasound (MRgFUS) compared with abdominal hysterectomy for treatment of uterine leiomyomas

F. A. Taran; Clare M. Tempany; Lesley Regan; Yael Inbar; A. Revel; Elizabeth A. Stewart

To compare women undergoing magnetic resonance‐guided focused ultrasound (MRgFUS) to a group of contemporaneously recruited women undergoing total abdominal hysterectomy. Patient demographics, safety parameters, quality of life outcomes and disability measures are reported.


American Journal of Obstetrics and Gynecology | 2013

The impact of uterine leiomyomas: A national survey of affected women

Bijan J. Borah; Wanda K Nicholson; Linda D. Bradley; Elizabeth A. Stewart

OBJECTIVE We sought to characterize the impact of uterine leiomyomas (fibroids) in a racially diverse sample of women in the United States. STUDY DESIGN A total of 968 women (573 white, 268 African American, 127 other races) aged 29-59 years with self-reported symptomatic uterine leiomyomas participated in a national survey. We assessed diagnosis, information seeking, attitudes about fertility, impact on work, and treatment preferences. Frequencies and percentages were summarized. The χ(2) test was used to compare age groups. RESULTS Women waited an average of 3.6 years before seeking treatment for leiomyomas, and 41% saw ≥2 health care providers for diagnosis. Almost a third of employed respondents (28%) reported missing work due to leiomyoma symptoms, and 24% believed that their symptoms prevented them from reaching their career potential. Women expressed desire for treatments that do not involve invasive surgery (79%), preserve the uterus (51%), and preserve fertility (43% of women aged <40 years). CONCLUSION Uterine leiomyomas cause significant morbidity. When considering treatment, women are most concerned about surgical options, especially women aged <40 years who want to preserve fertility.

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Clare M. Tempany

Brigham and Women's Hospital

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Romana A. Nowak

University of Illinois at Urbana–Champaign

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