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Acquired Ch.ari Malformation: Safety of Neuraxial Anesth.sia?

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Open Journal of Anesth.siology 2013年第1期3卷 11-13页

作者： Twinkal P. Dalal Taruna Penmetch. Maria Torres Ramsis Gh.ly john h. stroger jr. hospital of cook county Chicago USA

Ch.ari malformation is a congenital anomaly th.t primarily involves th. downward displacement of th. cerebellar tonsils th.ough.th. foramen magnum and elongation of forth.ventricle and lower brainstem. Patients with.Ch.ari I (congenital or acquired) malformation are asymptomatic or may presents with.neurologic signs and symptoms. It is always a question of safety of neuraxial anesth.sia in th.se patients. Th.re is potential risk of dural puncture th.t can initiate th. neurologic symptoms or worsen th. existing symptoms due to CSF leakage or tonsillar h.rniation. Oth.r side, performance of neuraxial anesth.sia can cause acquired Ch.ari I type malformation due to CSF leak and intracranial h.potension. We reviewed th. case reports and articles regarding safety of neuraxial anesth.sia in th. setting of Congenital or Acquired Ch.ari malformation.

关键词： Ch.ari Malformation Neuraxial Anesth.sia

Outcomes in patients with.COVID-19 and new onset h.art blocks: Insigh. from th. National Inpatient Sample database

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World Journal of Cardiology 2023年第9期15卷 448-461页

作者： Sami J Sh.ura Tah. Teaima Muh.mmad Kh.war Sana Ayesh. Abbasi Ramtej Atluri Mah.r Yilmaz h.san h.mmo Laith.Ali Ch.navuth.Kanitsoraph.n Dae Yong Park Tareq Alyousef Department of Internal Medicine John H.Stroger Jr.Hospital of Cook CountyChicagoIL 60612United States Department of Cardiology John H.Stroger Jr Hospital of Cook CountyChicagoIL 60612United States

BACKGROUND Coronavirus disease 2019(COVID-19)caused by th. severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)h.s resulted in a worldwide h.alth.crisis since it first *** studies demonstrated th. virus’s predilection to cardiomyocytes;h.wever,th. effects th.t COVID-19 h.s on th. cardiac conduc-tion system still need to be fully *** To analyze th. impact th.t COVID-19 h.s on th. odds of major cardiovascular complications in patients with.new onset h.art blocks or bundle branch.blocks(BBB).METh.DS Th. 2020 National Inpatient Sample(NIS)database was used to identify patients admitted for COVID-19 pneumonia with.and with.ut h.gh.degree atrioven-tricular blocks(h.AVB)and righ. or left BBB utilizing ICD-10 *** patients with.pre-existing pacemakers,suggestive of a prior diagnosis of h.AVB or BBB,were excluded from th. *** primary outcome was inpatient *** outcomes included total hospital ch.rges(Th.),th. length.of hospital stay(LOS),and oth.r major cardiac outcomes detailed in th. Results *** and multivariate regression analyses were used to adjust for confounders with.Stata version *** A total of 1058815 COVID-19 hospitalizations were identified with.n th. 2020 NIS database,of wh.ch.3210(0.4%)and 17365(1.6%)patients were newly diagnosed with.h.AVB and BBB,*** observed a significantly h.gh.r odds of in-hospital mortality,cardiac arrest,cardiogenic sh.ck,sepsis,arryth.ias,and acute kidney injury in th. COVID-19 and h.AVB *** was no statistically significant difference in th. odds of cerebral infarction or pulmonary *** with.COVID-19 pneumonia and newly diagnosed BBB h.d a h.gh.r odds of arryth.ias,acute kidney injury,sepsis,need for mech.nical ventilation,and cardiogenic sh.ck th.n th.se with.ut ***,unlike h.AVB,COVID-19 pneumonia and BBB h.d no significant impact on mortality compared to patients with.ut *** In conclusion,th.re is a sign

关键词： In-patient outcomes Severe acute respiratory syndrome coronavirus 2 Coronavirus disease 2019,h.gh.degree atrioventricular blocks Bundle branch.blocks Retrospective observational study

Differential Diagnosis of Post-Procedural Skin Lesions: A Case Report

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Pain Studies and Treatment 2016年第1期4卷 1-4页

作者： Taruna Wagh.ay-Penmetch. Sam Li Roh.t Puranik Maria L. Torres john h. stroger jr. hospital of cook county Chicago IL USA

Skin reactions caused by interventional pain procedures are well documented in literature, ranging from fistula formation to urticarial allergic reactions and infections. Burn lesions may also occur, h.wever far less common;and as pain ph.sician we must be cognizant of th.s possible complication and its etiologies. Th.s is difficult in an outpatient setting wh.re a patient cannot be regularly monitored, th.ir adh.rence to prescribed th.rapies is unclear, and reporting is often done via ph.ne, ancillary staff, and outside facility records. Th.se compounding factors require clinicians to consider a broad differential and be comfortable with.instituting myriad th.rapies or appropriately involve outside consultation for th.rough.patient care.

关键词： Facet Arth.opath. Skin Lesions Transcutaneous Electrical Stimulation Capsaicin

Rates, predictors, and causes of readmission after transcath.ter aortic valve replacement in patients with.ch.onic kidney disease

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World Journal of Cardiology 2024年第7期16卷 402-411页

作者： Tah. Teaima Gianfranco Bittar Carlini Roh.n A Gajjar Imran Aziz Sami J Sh.ura Abdul-Rah.m Sh.lbayeh.Naim Battikh.Tareq Alyousef Division of Cardiology Department of MedicineJohn H.StrogerJr.Hospital of Cook CountyChicagoIL 60612United States

BACKGROUND Transcath.ter aortic valve replacement(TAVR)is a revolutionary procedure for severe aortic *** coexistence of ch.onic kidney disease(CKD)and TAVR introduces a ch.llenge th.t significantly impacts patient *** To define readmission rates,predictors,and causes after TAVR procedure in CKD stage 1-4 *** We used th. national readmission database 2018 and 2020 to look into readmission rates,causes and predictors after TAVR procedure in patients with.CKD stage *** Out of 24758 wh. underwent TAVR and h.d CKD,7892(32.4%)patients were readmitted with.n 90 days,and h.d h.gh.r adjusted odds of being females(adjusted odds ratio:1.17,95%CI:1.02-1.31,P=0.02)with.longer length.of hospital stay>6 days,and more comorbidities including but not limited to diabetes mellitus,anemia,and congestive h.art failure(Ch.).CONCLUSION Most common causes of readmission included Ch.(18.0%),sepsis,and complete atrioventricular *** readmission predictors with.very close followup is warranted to prevent such.h.gh.rate of readmission.

关键词： Ch.onic kidney disease Transcath.ter aortic valve replacement Readmission Predictors Rates

Does Ch.mo-Radiation Th.rapy Influence Outcomes in Unresectable Locally Advanced State IV Rectal Cancer?

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Surgical Science 2012年第10期3卷 469-472页

作者： Joaquin J. Estrada Vivek Ch.udh.y Jose R. Cintron Leela M. Prasad h.rand Abcarian Division of Colon and Rectal Surgery John H. Stroger Jr. Hospital of Cook County Chicago USA

Introduction: Th. median survival for patients with.stage IV rectal cancer is approximately 20 month.. Th.rapy sh.uld focus not only on improving survival but also on quality of life. Th. aim of our study was to determine if ch.moradiation (C-RT) would improve palliation for metastatic unresectable locally advanced disease compared to patients receiving palliative ch.moth.rapy alone (C) for stage IV cancer. Meth.ds: Retrospective review of a prospectively maintained database at a single institution was carried out under IRB approval. From January 2004 to December 2008, 43 patients presenting with.unresectable stage IV rectal cancer were identified with.a median follow-up of 12 month.. Patients with.evidence of locally advanced disease or bulky disease received infusional 5-FU ± bevacizumab and 3D conformed mega voltage ph.ton th.rapy (5400 cGy). Patients with.ut evidence of bulky disease received eith.r FOLFOX or FOLFIRI ± bevacizumab. Data on demograph.cs, investigations, treatment, complications, metastasis, number of blood transfusions, days of hospitalization, and surgical intervention were analyzed using SPSS statistical software. p h.re were 25 and 18 patients in th. C and C-RT groups respectively. Th.re was no difference in mean age, sex or overall survival. Th.ee patient (12%) in th. C group developed h.droneph.osis compared to 8 patients (44%) in th. C-RT group (p h. C group compared to 9 patient (50%) in th. C-RT group (p = 0.07). In th. C arm, 80% of patients required multiple hospitalizations for symptoms consistent with.progression of disease compared to 61% of patients in th. C-RT arm (p h.moradiation in patients with.locally advanced unresectable stage IV cancer h.s not been extensively investigated. At our institution, patients treated with.C-RT for bulky stage IV rectal cancer required fewe

关键词： Ch.mo-Radiation Cancer

Aorto-righ. atrial fistula: Late complication of tricuspid valve infective endocarditis

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World Journal of Cardiology 2014年第10期6卷 1122-1126页

作者： Pedro A Villablanca Sh.sh.at Sukh.l Oscar Maitas Afiach.ukwu Onuegbu Juan M Muoz-Pea Ajay Joseph.Carlos Requena Divyansh. Moh.naney Department of InternalMedicine John H. Stroger Jr. Hospital of Cook County ChicagoIL 60612 United States

Abnormal connections between th. ascending aortaand th. cardiac ch.mbers are rare, especially in th.context of righ.-sided infective endocarditis(IE). Trans-th.racic ech.cardiograph.(TTE) with.color-flow Dop-pler, transesoph.geal ech.cardiograph.(TEE), or both.ay be required for diagnosis. We present th. case ofa woman admitted with.righ.-sided h.art failure(h.)symptoms. Sh. h.d a previous h.story of tricuspid valveIE 30 years ago. TTE and TEE revealed an aorto-righ.atrium fistula located just under th. non-coronary cuspinto th. righ. atrium at th. level of th. previously af-fected tricuspid valve. Th. Patient refused surgery andwas disch.rged h.me on h. medications. Sh. h.s beenstable for th. last 3 years. Th. peculiarity of th.s caseis th. late symptomatic presentation of th. aorto-atrialfistula and th. unusual association to tricuspid valve IE.

关键词： Aorto-cardiac fistula Infective endocarditis Tricuspid valve

Resveratrol engages selective apoptotic signals in gastric adenocarcinoma cells

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World Journal of Gastroenterology 2006年第35期12卷 5628-5634页

作者： William L Riles Jason Erickson Sanjay Nayyar Mary Jo Atten Bash.r M Attar Oksana h.lian Department of Medicine Division of Gastroenterology John H. Stroger Hospital of Cook County Chicago IL 60612 United States

AIM： To investigate th. intracellular apoptotic signals engaged by resveratrol in th.ee gastric adenocarcinoma cancer cell lines, two of wh.ch.（AGS and SNU-1） express p53 and one （KATO-M） with.deleted p53. METh.DS： Nuclear fragmentation was used to quantitate apoptotic cells; caspase activity was determined by ph.tometric detection of cleaved substrates; formation of oxidized cytoch.ome C was used to measure cytoch.ome C activity, and Western blot analysis was used to determine protein expression, RESULTS： Gastric cancer cells, irrespective of th.ir p53 status, responded to resveratrol with.fragmentation of DNA and cleavage of nuclear lamins A and B and PARP. Resveratrol, h.wever, h.s no effect on mitoch.ndria-associated apoptotic proteins Bcl-2, Bcl- xl, Bax, Bid or Smac/Diablo, and did not promote sub-cellular redistribution of cytoch.ome C, indicating th.t resveratrol-induced apoptosis of gastric carcinoma cells does not require breakdown of mitoch.ndrial membrane integrity. Resveratrol up-regulated p53 protein in SNU-1 and AGS cells but th.re was a difference in response of intracellular apoptotic signals between th.se cell lines. SNU-1 cells responded to resveratrol treatment with.down-regulation of survivin, wh.reas in AGS and KATO- 111 cells resveratrol stimulated caspase 3 and cytoch.ome C oxidase activities. CONCLUSION： Th.se findings indicate th.t even with.n a specific cancer th. intracellular apoptotic signals engaged by resveratrol are cell type dependent and suggest th.t such.differences may be related to differentiation or lack of differentiation of th.se cells.

关键词： Resveratrol Ch.moprevention Apoptosis p53 Survivin Cytoch.ome C oxidase

Autologous tissue patch.rich.in stem cells created in th. subcutaneous tissue

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World Journal of Stem Cells 2015年第8期7卷 1127-1136页

作者： Ignacio Garcia-Gomez Krish.amurth. P Gudeh.th.u Jose A L Arruda Ash.k K Singh Division of Neph.ology Hektoen Institute of Medicine john h.stroger Jr.Hospital of Cook County Division of Neph.ology Department of MedicineUniversity of Illinois Medical Center at Chicago and the Chicago VA Medical Center

AIM:To investigate wh.th.r we could create natural autologous tissue patch.s in th. subcutaneous space for organ repair. METh.DS: We implanted th. following th.ee types of inert foreign bodies in th. subcutaneous tissue of rats to produce autologous tissue patch.s of different geometries:(1) a large-sized polyvinyl tube(L = 25 mm,internal diameter = 7 mm) sealed at both.ends by h.at application for obtaining a large flat piece of tissue patch.for organ repair;(2) a fine polyvinyl tubing(L = 25 mm,internal diameter = 3 mm) for creating cylindrically sh.ped grafts for vascular or nerve repair; and(3) a slurry of polydextran particle gel for inducing a bladder-like tissue. Implantation of inert materials was carried out by making a small incision on one or eith.r side of th. th.racic-lumbar region of rats. Subcutaneous pockets were created by blunt dissection around th. incision into wh.ch.th. inert bodies were inserted(1 or 2 per rat). Th. incisions were closed with.silk sutures,and th. animals were allowed to recover. In case of th. polydextran gel slurry 5 m L of th. slurry was injected in th. subcutaneous space using an 18 gauge needle. After implanting th. foreign bodies a newly regenerated encapsulating tissue developed around th. foreign bodies. Th. tissues were h.rvested after 4-42 d of implantation and studied by gross examination,h.stology,and h.stoch.mistry for organization,vascularity,and presence of mesench.mal stem cells(MSCs)(CD271+CD34+ cells). RESULTS: Implanting a large cylindrically sh.ped polyvinyl tube resulted in a large flat sh.et of tissue th.t could be tailored to a specific size and sh.pe for use as a tissue patch.for repairing large organs. Implanting a smaller sized polyvinyl tube yielded a cylindrical tissue th.t could be useful for repairing nerves and blood vessels. Th.s type of patch.could be obtained in different length. by varying th. length.of th. implanted tube. Implanting a suspension of inert polydextran suspension gave rise to a b

关键词： Autologous tissue patch Foreign body Subcutaneous

Endoscopic retrograde ch.langiopancreatograph. under moderate sedation and factors predicting need for anesth.siologist directed sedation: A county hospital experience

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World Journal of Gastrointestinal Endoscopy 2013年第4期5卷 160-164页

作者： Saurabh.Ch.wla Ariel Katz Bash.r M Attar Benjamin Go Division of Gastroenterology Department of Medicine Cook County-John H Stroger Jr Hospital Department of Medicine Cook County-John H Stroger Jr Hospital Department of Medicine Rush Medical College

AIM: To evaluate variables associated with.failure of gastroenterologist directed moderate sedation (GDS) during endoscopic retrograde ch.langiopancreatograph. (ERCP) and derive a predictive model for use of anesth.siologist directed sedation (ADS) in selected patients. METh.DS: With.institutional review board approval, we retrospectively analyzed consecutive records of all patients wh. underwent ERCPs between July 1, 2009 to October 1, 2011 to identify patient related and procedure related factors wh.ch.could predict failure of GDS. For patient related factors, we abstracted and analyzeddata regarding th. age, gender, eth.icity, alcoh.l and illicit drug use h.bits. For procedure related factors, we abstracted data regarding initial or repeat procedures, indication for performing ERCP, th. interventions performed during ERCP, and th. grade d difficulty of cannulation as defined in th. American Society for Gastrointestinal Endoscopy guidelines. Our outcome of interest was procedural success. If th. procedure was not successful, th. reasons for failure of procedures were recorded along with.immediate post procedure complications. Multivariate analysis was th.n performed to define factors associated with.failure of GDS and a model constructed to predict requirement of ADS. RESULTS: Fourteen percent of patients undergoing GDS could not complete th. procedure due to intolerance and 2% due to cardiovascular complications. Substance abuse, male gender, black race and alcoh.l use were significant predictors of failure of GDS on univariate analysis and substance abuse and h.gh.r grade of procedure remained significant on multivariate analysis. Using our predictive model wh.re th. presence of substance abuse was given 1 point and planned grade of intervention was scored from 1-3, only 12% patients with.a score of 1 would require ADS due to failure of GDS, compared to 50% with.a score of 3 or h.gh.r. CONCLUSION: We conclude th.t ERCP under GDS is safe and effective for low gra

关键词： Ch.langiopancreatograph. Endoscopic retrograde/meth.ds Conscious sedation/utilization Deep sedation/utilization Adult Endoscopy