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Hamdi M, Kapila A, Peters E, Ramaut L, Waked K, Giunta G, De Baerdemaeker R, Zeltzer A. Polyurethane Implants in Revision Breast Augmentation: A Prospective 5-Year Study. Aesthet Surg J 2024:sjae047. [PMID: 38408194 DOI: 10.1093/asj/sjae047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/07/2024] [Accepted: 02/14/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Revision surgery for aesthetic breast augmentation remains a challenging procedure. Polyurethane (PU) implants have been found to avoid capsular contracture recurrence as well as prevent implant displacement by bio-integrating into the pocket. OBJECTIVES Our study aims to assess the use of PU in breast revision surgery and provides an algorithm. METHODS Over a 5-year period, a prospective study was conducted involving consecutive patients undergoing implant revision. Patient demographics, previous breast procedures, and specific surgical details were documented. Post-operative outcomes were followed up. RESULTS Out of 92 patients (184 breasts), 78 (156 breasts) were included in the analysis. The average age was 47.4, with a BMI of 22.3, and a mean follow-up of 5 years. A majority (63%) represented secondary revision cases, while 37% were tertiary cases. Implant size averaged 296 cc, with 53% placed retropectoral and 47% prepectoral. Significantly more implants in secondary cases were changed from pre- to retropectoral (p = 0.005), and in tertiary changed from retro- to prepectoral (p = 0.002). Complete capsulectomy was performed in 61.5% and partial in 25.6%. Additional lipofilling was performed in 32%, and concurrent mastopexy in 40%. Revision surgery in our series had a 1.9% acute complication rate, 4.5% longer term re-operation rate for corrections, 0.6% implant exchange rate, and no recurrent capsular contracture. CONCLUSIONS This is the first study to provide data on outcomes of revision breast augmentation surgery with the use of PU implants. It shows that polyurethane implants offer consistent stability and have low rates of recurrent capsular contracture in revision surgery.
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Affiliation(s)
- Moustapha Hamdi
- From the Department of Plastic and Reconstructive Surgery, Brussels University Hospital - Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Ayush Kapila
- From the Department of Plastic and Reconstructive Surgery, Brussels University Hospital - Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Ellen Peters
- From the Department of Plastic and Reconstructive Surgery, Brussels University Hospital - Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Lisa Ramaut
- From the Department of Plastic and Reconstructive Surgery, Brussels University Hospital - Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Karl Waked
- From the Department of Plastic and Reconstructive Surgery, Brussels University Hospital - Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Gabriele Giunta
- From the Department of Plastic and Reconstructive Surgery, Brussels University Hospital - Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Randy De Baerdemaeker
- From the Department of Plastic and Reconstructive Surgery, Brussels University Hospital - Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Assaf Zeltzer
- From the Department of Plastic and Reconstructive Surgery, Brussels University Hospital - Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Giunta G, Kapila A, Brussaard C, Nistor A, De Baerdemaeker R, Zeltzer A, Hamdi M. Redefining the vascular anatomy of the medial gastrocnemius muscle: A computed tomography angiography study. J Plast Reconstr Aesthet Surg 2023; 83:165-171. [PMID: 37276735 DOI: 10.1016/j.bjps.2023.04.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 04/11/2023] [Accepted: 04/19/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND The medial gastrocnemius (GN) muscle flap is a historical reconstructive option in lower limb reconstruction. The flap is proximally based on the medial sural artery, and it is assumed not possible to harvest a distally based flap because of the absence of other minor pedicles. The aim of this study is to investigate the presence and the anatomy of a distal secondary pedicle given off by the posterior tibial artery (PTA). METHODS A retrospective CTA study was performed of 120 limbs between April 2018 and June 2020. 3D reconstruction was performed to delineate the anatomy of the distal secondary pedicle, if present. The distance of the pedicle, if found, from the intermalleolar line to the patella was noted. The number of pedicles, if multiple, was documented, as well as branches to the soleus muscle and the skin. RESULTS A distal pedicle to the gastrocnemius muscle was found in 64% of limbs. The average location from the intermalleolar line is 168 mm. The branching pattern from the PTA showed an isolated vessel going to the distal medial gastrocnemius (32.8%), two branches to the medial gastrocnemius and skin (39.3%), two branches to the medial gastrocnemius and soleus (24.6%), and three branches to the medial gastrocnemius, soleus, and the skin (3.3%). CONCLUSIONS This study confirms the presence of the secondary axial distal pedicle of the GN muscle. Furthermore, this study confirms that there is a likely association between the distal medial gastrocnemius pedicle and the PTA skin perforators.
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Affiliation(s)
- Gabriele Giunta
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital (UZ) Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium.
| | - Ayush Kapila
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital (UZ) Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Carola Brussaard
- Department of Radiology, University Hospital (UZ) Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Alexandru Nistor
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital (UZ) Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Randy De Baerdemaeker
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital (UZ) Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Assaf Zeltzer
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital (UZ) Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Moustapha Hamdi
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital (UZ) Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium
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Geeroms M, Guimarães Dourado JA, El Abbadi S, De Cock D, Kapila A. A Professional Personality Is Pivotal in Plastic Surgery Residency. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03638-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Geeroms M, Pai A, Ceuterick B, Kapila A. Is the Systematic Sponge Count an Impediment to Patient Care During Plastic Surgical Procedures? Plast Aesthet Nurs (Phila) 2022; 42:103-110. [PMID: 36450091 DOI: 10.1097/psn.0000000000000433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Nurses and surgeons collaborate to conduct safe surgery. We follow time-consuming and labor-intensive protocols, such as the systematic counting and verifying of surgical sponges. However, the counting process may be distracting from other patient-centered tasks. To understand the perception of plastic surgery professionals about the intraoperative sponge count, we designed an online questionnaire. One hundred plastic surgeons and residents from 32 different countries completed the survey. The results showed that most often (70%) the scrub person determines when sponges will be counted, and 34.3% of the time, a sponge count is incorrect at the first count and then corrected. The main reason for an incorrect sponge count appears to be a change in personnel (53%). Radiological imaging is required during an average of 8.7% of surgeries to rule out a retained sponge in the patient. Notably, missing sponges are most frequently found elsewhere in the operating room. Younger surgeons prefer to pause during the surgical procedure until the sponge count is completed and noted to be correct. This approach appears to be associated with fewer counting errors, a shorter counting time, and a significant reduction in distraction of the whole surgical team. Performing a cavity sweep before beginning wound closure and using large surgical sponges are also suggested as alternatives to counting sponges. A sponge count can become an impediment to patient care because it has limited reliability and causes distraction among the team. A surgical pause can be implemented until the sponge count is completed or until any discrepancy is resolved.
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Affiliation(s)
- Maxim Geeroms
- Maxim Geeroms, MD, PhD, is a plastic, reconstructive, and aesthetic surgeon in private practice, Brussels, Belgium
- Ashwin Pai, MD, FRCS (Plast), is a plastic, reconstructive, and aesthetic surgeon, Wexham Park Hospital, Slough, United Kingdom
- Brecht Ceuterick, RN, is a perioperative nurse, Universitair Ziekenhuis, Brussels, Belgium
- Ayush Kapila, MD, MRCS, is a plastic surgery resident at the University of Brussels (VUB), Brussels, Belgium
| | - Ashwin Pai
- Maxim Geeroms, MD, PhD, is a plastic, reconstructive, and aesthetic surgeon in private practice, Brussels, Belgium
- Ashwin Pai, MD, FRCS (Plast), is a plastic, reconstructive, and aesthetic surgeon, Wexham Park Hospital, Slough, United Kingdom
- Brecht Ceuterick, RN, is a perioperative nurse, Universitair Ziekenhuis, Brussels, Belgium
- Ayush Kapila, MD, MRCS, is a plastic surgery resident at the University of Brussels (VUB), Brussels, Belgium
| | - Brecht Ceuterick
- Maxim Geeroms, MD, PhD, is a plastic, reconstructive, and aesthetic surgeon in private practice, Brussels, Belgium
- Ashwin Pai, MD, FRCS (Plast), is a plastic, reconstructive, and aesthetic surgeon, Wexham Park Hospital, Slough, United Kingdom
- Brecht Ceuterick, RN, is a perioperative nurse, Universitair Ziekenhuis, Brussels, Belgium
- Ayush Kapila, MD, MRCS, is a plastic surgery resident at the University of Brussels (VUB), Brussels, Belgium
| | - Ayush Kapila
- Maxim Geeroms, MD, PhD, is a plastic, reconstructive, and aesthetic surgeon in private practice, Brussels, Belgium
- Ashwin Pai, MD, FRCS (Plast), is a plastic, reconstructive, and aesthetic surgeon, Wexham Park Hospital, Slough, United Kingdom
- Brecht Ceuterick, RN, is a perioperative nurse, Universitair Ziekenhuis, Brussels, Belgium
- Ayush Kapila, MD, MRCS, is a plastic surgery resident at the University of Brussels (VUB), Brussels, Belgium
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Elkhatib R, Giunta G, Hanssens V, Kapila A, De Baerdemaeker R, Zeltzer A, Hamdi M. Case Report of Two Patients With COVID-19 and Sacral Pressure Injuries Associated with Pyoderma Gangrenosum. Adv Skin Wound Care 2021; 34:438-443. [PMID: 33871408 DOI: 10.1097/01.asw.0000744356.54317.c2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
ABSTRACT During the COVID-19 pandemic, an increasing number of patients have been admitted to the ICU with severe respiratory complications requiring prolonged supine positioning. Recently, many case reports have been published regarding dermatologic manifestations associated with COVID-19. However, there is little information about the clinical features of these manifestations. Pyoderma gangrenosum (PG) is an ulcerative noninfectious inflammatory disease of the skin. In at least 50% of the cases, the etiology is unknown. Nevertheless, PG is associated with many systemic diseases. In this article, the authors report two critically ill patients with COVID-19 who developed sacral ulcers during their recovery in the ICU. These ulcers had an atypical course and were exacerbated by surgical debridements. Accordingly, providers suspected PG, which was confirmed by the clinical evolution of the ulcers and biopsies taken from the wounds. To the best of the authors' knowledge, no previous articles have reported sacral pressure injuries associated with PG in patients with COVID-19. Providers should suspect PG in patients with COVID-19 who develop nonhealing pressure injuries.
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Affiliation(s)
- Rania Elkhatib
- In the Department of Plastic and Reconstructive Surgery, University Hospital Brussels, Belgium, Rania Elkhatib, MD, is Attending Physician; Gabriele Giunta, MD, FEBOPRAS, is Consultant; Valerie Hanssens, MSc, is Nurse Specialist; Ayush Kapila, MD, MRCS, is Resident; Randy De Baerdemaeker, MD, FEBOPRAS, is Consultant; Assaf Zeltzer, MD, PhD, is Consultant; and Moustapha Hamdi, MD, PhD, is Head of Department. Acknowledgment: Drs Elkhatib and Giunta contributed equally to this work. The authors have disclosed no financial relationships related to this article. Submitted September 2, 2020; accepted in revised form October 28, 2020; published online ahead of print April 16, 2021
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Birdi H, Kapila A, Tharmaratnam M, Davies N, Patel K, Ejtehadi F, Srinivasaiah N. Two week wait referrals of suspected colorectal cancer in young adults before and after UK NICE [NG12] guideline publication. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Davies N, Kapila A, Hatem F, Refson J. De Garengeot's Hernia: A surgical challenge- Case report and literature review. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kapila A, Chaplin P, Herd A, Knife N, Patel A. Can reflexology help in managing physical and psychological symptoms in breast cancer patients? Eur J Surg Oncol 2018. [DOI: 10.1016/j.ejso.2018.02.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Sankhyan P, Treece J, Cuervo-Pardo N, Kapila A, Gonzalez-Estrada A. P111 Cough hypersensitivity syndrome diagnosed after 30 years: a commonly unrecognized entity. Ann Allergy Asthma Immunol 2017. [DOI: 10.1016/j.anai.2017.08.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Affiliation(s)
- A Kapila
- East Tennessee State University, Johnson City, Tennessee, USA
| | - A Kalra
- East Tennessee State University, Johnson City, Tennessee, USA
| | - L Chhabra
- University of Connecticut, Hartford, Connecticut, USA
| | - R Murthy
- Gastroenterology, James H Quillen VA Medical Center, Johnson City, Tennessee, USA
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Nayak JK, Kedare SB, Banerjee R, Bandyopadhyay S, Desai NB, Paul S, Kapila A. A1 MW National Solar Thermal Research Cum Demonstration Facility at Gwalpahari, Haryana, India. CURR SCI INDIA 2015. [DOI: 10.18520/cs/v109/i8/1445-1457] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Nayak JK, Kedare SB, Banerjee R, Bandyopadhyay S, Desai NB, Paul S, Kapila A. A1 MW National Solar Thermal Research Cum Demonstration Facility at Gwalpahari, Haryana, India. CURR SCI INDIA 2015. [DOI: 10.18520/v109/i8/1445-1457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
This review highlights the current views on and differences and similarities between nocturnal enuresis (NE) in children and nocturia in adults, which might be a guidance to elucidate the missing links in our knowledge. In both conditions, a genetic factor is suspected. Reduced bladder capacity and nocturnal polyuria are the main underlying lower urinary tract-related conditions. There is a link with sleep disorders, although it is not clear whether this is a cause or consequence. Physical and mental health are comprised in both conditions, however, in different ways. In NE, constipation and attention deficit disorder are the most important comorbidities and the effect on mental health and quality of life is mainly through the negative impact on self-esteem. In nocturia, cardiovascular disease and fall injuries are important comorbidities, mainly affecting the older nocturia population; personal distress and depression are consequences of the related poor sleep quality. For both conditions, treatment is often inadequate and a more individualized approach seems to be necessary. The main difference between NE and nocturia seems to be the difference in arousal to bladder stimuli, suggesting that sleep characteristics might be a key factor in these conditions.
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Pandit JJ, Abbott T, Pandit M, Kapila A, Abraham R. A reply. Anaesthesia 2012. [DOI: 10.1111/anae.12023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Pandit JJ, Abbott T, Pandit M, Kapila A, Abraham R. Is ‘starting on time’ useful (or useless) as a surrogate measure for ‘surgical theatre efficiency’?*. Anaesthesia 2012; 67:823-32. [DOI: 10.1111/j.1365-2044.2012.07160.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bhorade S, Kapila A, Valentine V, Baz M. 348 Inter-Observer Variability on Diagnosing Bronchiolitis Obliterans Syndrome. J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Pandit JJ, Popat MT, Cook TM, Wilkes AR, Groom P, Cooke H, Kapila A, O’Sullivan E. A reply. Anaesthesia 2012. [DOI: 10.1111/j.1365-2044.2012.07113_2.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pandit JJ, Kapila A, O’Sullivan E. Specialty-appointed professors of anaesthesia: a solution to the problem of marginalisation of our specialty in national reports and enquiries. Anaesthesia 2012; 67:73-74. [DOI: 10.1111/j.1365-2044.2011.07013.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pandit JJ, Popat MT, Cook TM, Wilkes AR, Groom P, Cooke H, Kapila A, O’Sullivan E. The Difficult Airway Society ‘ADEPT’ Guidance on selecting airway devices: the basis of a strategy for equipment evaluation. Anaesthesia 2011; 66:726-37. [DOI: 10.1111/j.1365-2044.2011.06787.x] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Brostoff JM, Potter EK, Kapila A. Junior doctors are not good at recognizing and treating sepsis: a validated suggestion for improvement. Clin Med (Lond) 2010; 10:525-6. [PMID: 21117400 PMCID: PMC4952433 DOI: 10.7861/clinmedicine.10-5-525] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kumar A, Kapila A. P03-319 - The truth about polypharmacy in elderly inpatient population. Eur Psychiatry 2010. [DOI: 10.1016/s0924-9338(10)70925-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Odell M, Rechner IJ, Kapila A, Even T, Oliver D, Davies CWH, Milsom L, Forster A, Rudman K. The effect of a critical care outreach service and an early warning scoring system on respiratory rate recording on the general wards. Resuscitation 2007; 74:470-5. [PMID: 17420083 DOI: 10.1016/j.resuscitation.2007.01.035] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2006] [Revised: 01/26/2007] [Accepted: 01/29/2007] [Indexed: 11/23/2022]
Abstract
AIM To determine whether the implementation of a Reading-Modified Early Warning Scoring (R-MEWS) system, is associated with an increased recording of respiratory rate (RR) in hospital inpatients, and whether the presence of a critical care outreach (CCO) service has a further impact on the recording of patient's vital signs. METHOD Five annual point prevalence surveys of all adult, non-obstetric acute inpatients (n=2638) in two Hospitals (A and B) were carried out between 2001 and 2005. The R-MEWS system was implemented incrementally in both hospitals to include all study group patients, but a CCO service was only available in Hospital A. Data were collected on numbers of patients, routinely documented physiological observations and R-MEW score. RESULTS Respiratory rate (RR) recording increased from 6.0% in the first survey to 77.9% in the last, which correlated with the incremental implementation of the R-MEWS system. Hospital A that had the CCO service showed a greater increase in RR recording than Hospital B with no CCO service. CONCLUSION The introduction of an early warning scoring (EWS) was associated with improved respiratory rate recording, which may have been further enhanced by the presence of a CCO service.
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Affiliation(s)
- M Odell
- Critical Care Outreach, Department of Intensive Care, Royal Berkshire NHS Foundation Trust, Reading, UK.
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McGaughey J, Alderdice F, Fowler R, Kapila A, Mayhew A, Moutray M. Outreach and Early Warning Systems (EWS) for the prevention of intensive care admission and death of critically ill adult patients on general hospital wards. Cochrane Database Syst Rev 2007:CD005529. [PMID: 17636805 DOI: 10.1002/14651858.cd005529.pub2] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Despite the fact that outreach and early warning systems (EWS) are an integral part of a hospital wide systems approach to improve the early identification and management of deteriorating patients on general hospital wards, the widespread implementation of these interventions in practice is not based on robust research evidence. OBJECTIVES The primary objective was to determine the impact of critical care outreach services on hospital mortality rates. Secondary objectives included determining the effect of outreach services on intensive care unit (ICU) admission patterns, length of hospital stay and adverse events. SEARCH STRATEGY The review authors searched the following electronic databases: EPOC Specialised Register, The Cochrane Central Register of Controlled Trials (CENTRAL) and other Cochrane databases (all on The Cochrane Library 2006, Issue 3), MEDLINE (1996-June week 3 2006), EMBASE (1974-week 26 2006), CINAHL (1982-July week 5 2006), First Search (1992-2005) and CAB Health (1990-July 2006); also reference lists of relevant articles, conference abstracts, and made contact with experts and critical care organisations for further information. SELECTION CRITERIA Randomised controlled trials (RCTs), controlled clinical trials (CCTs), controlled before and after studies (CBAs) and interrupted time series designs (ITS) which measured hospital mortality, unanticipated ICU admissions, ICU readmissions, length of hospital stay and adverse events following implementation of outreach and EWS in a general hospital ward to identify deteriorating adult patients versus general hospital ward setting without outreach and EWS were included in the review. DATA COLLECTION AND ANALYSIS Three review authors independently extracted data and two review authors assessed the methodological quality of the included studies. Meta-analysis was not possible due to heterogeneity. Summary statistics and descriptive summaries of primary and secondary outcomes are presented for each study. MAIN RESULTS Two cluster-randomised control trials were included: one randomised at hospital level (23 hospitals in Australia) and one at ward level (16 wards in the UK). The primary outcome in the Australian trial (a composite score comprising incidence of unexpected cardiac arrests, unexpected deaths and unplanned ICU admissions) showed no statistical significant difference between control and medical emergency team (MET) hospitals (adjusted P value 0.640; adjusted odds ratio (OR) 0.98; 95% confidence interval (CI) 0.83 to 1.16). The UK-based trial found that outreach reduced in-hospital mortality (adjusted OR 0.52; 95% CI 0.32 to 0.85) compared with the control group. AUTHORS' CONCLUSIONS The evidence from this review highlights the diversity and poor methodological quality of most studies investigating outreach. The results of the two included studies showed either no evidence of the effectiveness of outreach or a reduction in overall mortality in patients receiving outreach. The lack of evidence on outreach requires further multi-site RCT's to determine potential effectiveness.
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Affiliation(s)
- J McGaughey
- Queen's University Belfast, School of Nursing and Midwifery, Belfast, UK.
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McGaughey J, Alderdice F, Fowler R, Kapila A, Moutray M. Outreach and Early Warning Systems (EWS) for the prevention of intensive care admission and death of critically ill adult patients on general hospital wards. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2005. [DOI: 10.1002/14651858.cd005529] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Verghese C, Rangasami J, Kapila A, Parke T. Airway control during percutaneous dilatational tracheostomy: pilot study with the intubating laryngeal mask airway. Br J Anaesth 1998; 81:608-9. [PMID: 9924242 DOI: 10.1093/bja/81.4.608] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Percutaneous dilatation tracheostomy has become a common procedure for bedside insertion of tracheostomy tubes in the intensive care unit. Management of the airway during the procedure using the laryngeal mask airway (LMA) and other methods has been described. The intubating laryngeal mask airway has several potential benefits for airway management during percutaneous dilatation tracheostomy compared with the LMA. These include the use of both the fibreoptic bronchoscope and tracheal tube if necessary. We report the results of a pilot study of 10 patients that illustrates these advantages.
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Affiliation(s)
- C Verghese
- Department of Anaesthesia and Intensive Care, Royal Berkshire Hospital NHS Trust, Reading
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Abstract
We conducted a clinical comparison of the laryngeal mask airway (LMA) and the new single use PVC LMA (LMA-Unique) in 100 fasted adult patients undergoing elective surgery. Patients were allocated to one of two groups: group 1 (n = 50) was managed by two consultants and group 2 by two trainee anaesthetists. Airway management was randomized prospectively within each group, and cuff pressure in both devices was maintained at a maximum of 50 mm Hg with upward size substitution if leaks persisted during intermittent positive pressure ventilation (IPPV). Insertion with the recommended technique was successful in all patients (85 first attempt). One patient (group 1) required four attempts for insertion of the LMA-Unique and in one patient (group 2) the LMA-Unique was replaced by a tracheal tube because of persistent leaks during IPPV. In 99 patients IPPV was uneventful. The adjusted mean volume of air for cuff inflation in the LMA-Unique was significantly less in group 1 (P = 0.0013). At fibreoptic laryngoscopic examination, the vocal cords or arytenoids, or both, could be seen in 92% of patients in group 1 and in 90% of patients in group 2. Immediate throat soreness was reported in four patients in group 1 and in seven in group 2. The results suggest that the LMA-Unique was similar in clinical performance to the LMA.
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Affiliation(s)
- C Verghese
- Department of Anaesthesia, Royal Berkshire Hospital, Reading
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Abstract
The standard laryngeal mask airway (LMA) functions both as a ventilatory device and as an aid to blind/fibrescopic-guided tracheal intubation. We describe the radiological and laboratory work used to bioengineer a new laryngeal mask prototype, the intubating laryngeal mask airway (ILMA). The aim was to create a new airway system with better intubation characteristics than the LMA. Other design goals were to eliminate the need for head-neck manipulation and insertion of fingers in the mouth during placement. Development was aided by analysis of magnetic resonance images of the human pharynx and laboratory testing with a variety of tracheal tubes. The principal features of this new system are an anatomically curved, rigid airway tube with an integral guiding handle, an epiglottic elevating bar replacing the mask bars, a guiding ramp built into the floor of the mask aperture and a modified silicone tracheal tube developed for use with the device.
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Abstract
A new prototype of the laryngeal mask airway (LMA), the intubating laryngeal mask airway (ILMA), was used to facilitate tracheal intubation in 100 fasted patients presenting for elective surgery. Alignment of the ILMA with the larynx was assessed fibreoptically before intubation without the investigator performing the intubation being aware of the view score. Ease of intubation correlated with the view obtained and with the degree of manipulation of the ILMA needed to achieve tracheal intubation. Intubation was successful in 93 patients. Of the seven intubation failures, five occurred in the first 20 patients. Conventional connection to the breathing system and ventilation of the lungs of the patients were possible throughout the intubation procedure.
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Affiliation(s)
- A Kapila
- Royal Berkshire Hospital, Reading
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Brain AI, Verghese C, Addy EV, Kapila A, Brimacombe J. The intubating laryngeal mask. II: A preliminary clinical report of a new means of intubating the trachea. Br J Anaesth 1997; 79:704-9. [PMID: 9496199 DOI: 10.1093/bja/79.6.704] [Citation(s) in RCA: 249] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We have assessed the efficacy of a new laryngeal mask prototype, the intubating laryngeal mask airway (ILMA), as a ventilatory device and blind intubation guide. The ILMA consists of an anatomically curved, short, wide bore, stainless steel tube sheathed in silicone which is bonded to a laryngeal mask and a guiding handle. It has a single moveable aperture bar, a guiding ramp and can accommodate an 8 mm tracheal tube (TT). After induction of anaesthesia with propofol 2.5 mg kg-1 and fentanyl 2.5 micrograms kg-1, the device was inserted successfully at the first attempt in all 150 (100%) patients and adequate ventilation achieved in all, with minor adjustments required in four patients. Placement did not require movement of the head and neck or insertion of the fingers in the patient's mouth. Blind tracheal intubation using a straight silicone cuffed TT was attempted after administration of atracurium 0.5 mg kg-1. If resistance was felt during intubation, a sequence of adjusting manoeuvres was used based on the depth at which resistance occurred. Tracheal intubation was possible in 149 of 150 (99.3%) patients. In 75 (50%) patients no resistance was encountered and the trachea was intubated at the first attempt, 28 (19%) patients required one adjusting manoeuvre and 46 (31%) patients required 2-4 adjusting manoeuvres before intubation was successful. There were 13 patients with potential or known airway problems. The lungs of all of these patients were ventilated easily and the trachea intubated using the ILMA. In 10 of 13 (77%) of these patients, no resistance was encountered and the trachea was intubated at the first attempt; three of 13 (23%) patients required one adjusting manoeuvre. Tracheal intubation required significantly fewer adjusting manoeuvres in patients with a predicted or known difficult airway (P < 0.05). We conclude that the ILMA appeared on initial assessment to be an effective ventilatory device and intubation guide for routine and difficult airway patients not at risk of gastric aspiration.
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Abstract
BACKGROUND Remifentanil is a new micro-specific opioid receptor agonist currently under investigation. The interaction between opioids and volatile anesthetics is complex. Defining this interaction provides a basis for more rational dosing schemes when such combinations are used for anesthesia and allows the anesthetic potency of remifentanil relative to other opioids to be determined. METHODS Two centers enrolled a total of 220 patients. Patients were randomized to receive a target concentration of remifentanil via a computer-assisted continuous infusion device of either 0.0, 0.5, 1.0, 1.5, 2.0, 4.0, 8.0, 16.0, and 32.0 ng/ml initiated before the administration of isoflurane. Patients were also stratified by groups 18-30, 31-55, and 56-65 yr. After induction of anesthesia with isoflurane the initial patient in each dose group was assigned an age-adjusted isoflurane concentration. The isoflurane concentration for each subsequent patient was adjusted according to the up/down technique until a minimum of 12 patients were enrolled in each group. Arterial blood samples for remifentanil whole blood concentrations were obtained. The patient was observed for purposeful movement for up to 1 min after skin incision. The minimum alveolar concentration (MAC) of isoflurane (0 ng/ml remifentanil group) and MAC reduction of isoflurane by remifentanil were determined. RESULTS The MAC of isoflurane alone was 1.3%. Remifentanil caused an exponential reduction in the MAC of isoflurane with 1.37 ng/ml remifentanil a 77% reduction and 32 ng/ml a 91% reduction of isoflurane MAC. CONCLUSION The MAC reduction of isoflurane by remifentanil is similar to that produced by other opioids. Although remifentanil was given at extremely high concentrations in the absence of isoflurane, it did not provide adequate anesthesia. A 50% isoflurane MAC reduction is produced by 1.37 ng/ml remifentanil whole blood concentration compared to previously published plasma concentrations of fentanyl of 1.67 ng/ml or sufentanil of 0.14 ng/ml.
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Affiliation(s)
- E Lang
- Duke University Medical Center, Durham, North Carolina 27710, USA
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34
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Abstract
BACKGROUND The context-sensitive half-time, rather than the terminal elimination half-life, has been proposed as a more clinically relevant measure of decreasing drug concentration after a constant infusion of a given duration. The context-sensitive half-time is derived from computer modelling using known pharmacokinetic parameters. The modelled context-sensitive half-time for a 3-h infusion of alfentanil is 50-55 min and is 3 min for remifentanil. The terminal elimination half-life is 111 min for alfentanil and 12-30 min for remifentanil. It has not been tested whether the modelled context-sensitive half-time reflects the true time for a 50% decrease in drug concentration or drug effect. METHODS Thirty volunteers received a 3-h infusion of remifentanil or alfentanil at equieffective concentrations. Depression of minute ventilation to 7.5% ETCO2 was used as a measure of drug effect. Minute ventilation response was measured, and blood samples for drug concentration were taken during and after drug infusion. The recovery of minute ventilation (drug effect) and decrease in blood drug concentration was plotted, and the time for a 50% change was determined. RESULTS The measured pharmacokinetic context-sensitive half-time for remifentanil after a 3-h infusion was 3.2 +/- 0.9 min, and its pharmacodynamic offset was 5.4 +/- 1.8 min. Alfentanil's measured pharmacokinetic context-sensitive half-time was 47.3 +/- 12 min, and its pharmacodynamic offset was 54.0 +/- 48 min. The terminal elimination half-life modelled from the volunteers was 11.8 +/- 5.1 min for remifentanil and 76.5 +/- 12.6 min for alfentanil. CONCLUSIONS The measured context-sensitive half-times were in close agreement with the context-sensitive half-times previously modelled for these drugs. The results of this study confirm the value of the context-sensitive half-time in describing drug offset compared to the terminal elimination half-life.
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Affiliation(s)
- A Kapila
- Department of Anesthesia, Duke University Medical Center, Durham, North Carolina 27710, USA
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Uncles DR, Carapiet DA, Kapila A, Salt RH. Prototype Macintosh laryngoscopes and the 'Real McCoy'. Anaesthesia 1995; 50:175-6. [PMID: 7710034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Stables J, Rees E, Goodson S, Sheehan M, Kapila A, Disney G, Marshall F, Lee M. Co-expression of the adenosine A2A receptor and the stimulatory G-protein alpha subunit in a stable cell line using a novel poly-cistronic expression vector. Pharmacol Res 1995. [DOI: 10.1016/1043-6618(95)87064-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Brooks BS, Duvall ER, el Gammal T, Garcia JH, Gupta KL, Kapila A. Neuroimaging features of neurenteric cysts: analysis of nine cases and review of the literature. AJNR Am J Neuroradiol 1993; 14:735-46. [PMID: 8517367 PMCID: PMC8333386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE To gain a better understanding of neurenteric (NE) cysts via correlation of imaging findings and surgical and pathologic data. METHODS The medical records, imaging studies, surgical information, and pathologic material were retrospectively reviewed in nine patients with NE cysts, including seven proved and two very probable cases. RESULTS NE cysts occurred in the cerebellopontine angle in one case and extended from the cerebellopontine angle to the C2 level in a second. In the latter patient and the remaining seven with intraspinal lesions, the NE cyst was always located anterior to the spinal cord. The most common myelographic and CT myelographic appearance was that of a lobulated intradural extramedullary (IDEM) mass. Two patients had an intramedullary NE cyst with a somewhat unusual appearing exophytic IDEM-appearing expansion that can be a characteristic feature of these lesions. MR imaging demonstrated the NE cyst to be isointense to hyperintense relative to cerebrospinal fluid on long TR sequences and isointense or slightly hyperintense to cerebrospinal fluid on T1-weighted images. These signal characteristics correlate with the high-protein-content fluid within the cysts, usually described at surgery as milky or mucinous in character. CONCLUSION The diagnosis of NE cyst should be considered when imaging studies reveal the presence of a lobulated IDEM or an exophytic intramedullary cystic mass, especially in association with anterior spina bifida or other vertebral anomalies. MR can uniquely confirm the cystic nature of these masses and is the method of choice for their imaging investigation. Because cyst recurrence can occur, MR should also be used for long-term patient follow-up.
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Affiliation(s)
- B S Brooks
- Department of Radiology, University of Alabama, Birmingham 35233
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38
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Mulligan MJ, Vasu R, Grossi CE, Prasthofer EF, Griffin FM, Kapila A, Trupp JM, Barton JC. Neoplastic meningitis with eosinophilic pleocytosis in Hodgkin's disease: a case with cerebellar dysfunction and a review of the literature. Am J Med Sci 1988; 296:322-6. [PMID: 3057913 DOI: 10.1097/00000441-198811000-00005] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A 31-year-old man had Hodgkin's disease (stage IIA, nodular sclerosis) in apparent remission after radiotherapy. Nine months after the diagnosis of Hodgkin's disease, he developed neoplastic meningitis with eosinophilic pleocytosis and neurologic findings suggestive of peri-fourth ventricle infiltration. Morphologic and surface marker analysis of cerebrospinal fluid cells showed large numbers of T-lymphocytes and Reed-Sternberg variant cells positive for CD15, the Lex hapten expressed on myeloid cells and on a variety of malignant cells. Therapy with intrathecal methotrexate, oral dexamethasone, and cranial irradiation resulted in prompt resolution of his cerebrospinal fluid abnormalities and neurologic deficits. Ten months after the diagnosis of eosinophilic meningitis, systemic relapse of Hodgkin's disease occurred in right iliac and inguinal lymph nodes. The diagnosis, pathogenesis, and therapy of this unusual complication of Hodgkin's disease are reviewed.
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Affiliation(s)
- M J Mulligan
- Department of Medicine, University of Alabama, Birmingham 35294
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39
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Gupta KL, Kapila A, Nasca RJ, Duvall ER. Post-traumatic lumbar extra-arachnoid mass with radiculopathy responding to conservative therapy in a patient with bilateral laminar fractures. Spine (Phila Pa 1976) 1988; 13:945-8. [PMID: 3187722 DOI: 10.1097/00007632-198808000-00018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- K L Gupta
- Department of Radiology, University of Alabama, Birmingham
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40
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Merlin SI, Brissie RM, Kapila A, Hauser MT. Hyperpyrexia, seizures, and hypotension in a 31-year-old man. Ala J Med Sci 1988; 25:274-9. [PMID: 3177800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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41
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Affiliation(s)
- L W Epperson
- Department of Neurology, University of Alabama at Birmingham 35294
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Kapila A, Gupta KL, Garcia JH. CT and MR of lymphomatoid granulomatosis of the CNS: report of four cases and review of the literature. AJNR Am J Neuroradiol 1988; 9:1139-43. [PMID: 3143235 PMCID: PMC8331898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Lymphomatoid granulomatosis is an uncommon disease characterized by a perivascular pleomorphic cellular infiltration and necrosis. CNS involvement occurs in 20% of the cases. CT findings have been described in five of the previously reported cases of CNS lymphomatoid granulomatosis, and include unifocal, multifocal, and diffuse contrast-enhancing supratentorial lesions. We reviewed the CT scans of three patients and the MR image of a fourth patient with histologically confirmed CNS lymphomatoid granulomatosis. The lesions were in the posterior fossa in three of the four cases. Hemorrhage, which was present in three of the four cases, was detected by imaging studies in two and at autopsy in the third. Systemic involvement was present at autopsy in three cases and was clinically suspected in the fourth. A diagnosis of CNS lymphomatoid granulomatosis should be considered when hemorrhagic or posterior fossa lesions occur in patients with constitutional symptoms.
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Affiliation(s)
- A Kapila
- Department of Radiology, University of Alabama, Birmingham 35294
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43
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Affiliation(s)
- A Kapila
- Department of Radiology, University of Alabama, Birmingham
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44
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Kapila A, Whitaker JN. Cranial magnetic resonance imaging in multiple sclerosis. Ala J Med Sci 1987; 24:290-300. [PMID: 3310702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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45
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Abstract
The CT and magnetic resonance findings of neuropathic spinal arthropathy in a patient with long-standing complete post-traumatic paraplegia are reported. The arthropathy involved primarily the disk space between the 11th and 12th thoracic vertebrae. The CT changes included vertebral body sclerosis with foci of bone destruction, replacement of the disk space by a soft tissue mass containing bone fragments extending beyond the confines of the vertebral body margins, degenerative changes of the posterior joints, a partially calcified progressively enlarging paraspinal soft tissue mass, and calcification within the spinal canal.
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46
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Gupta KL, Kapila A, Duvall ER, Rubin E, Vitek JJ. Computed tomographic evaluation of deep cerebral vein thrombosis. Ala J Med Sci 1987; 24:41-5. [PMID: 3826542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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47
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Abstract
A combination of computed tomography and angiography permits accurate detailed evaluation of common lesions of the ambient cistern.
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48
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Abstract
A new technique has been designed to improve myelography examinations of the entire lumbar spinal canal in patients with severe spinal stenosis using a single needle puncture. When a high-grade obstruction to the caudal flow of contrast material is encountered, the patient is placed in a flexed sitting position for 1 minute. This technique was performed in eight patients with severe lumbar spinal stenosis. It successfully helped depict the lower lumbosacral canal below an apparently complete block in four patients and resulted in improved visualization of the lower sac in four patients with partial block.
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49
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Abstract
Embolism with brain infarction rarely complicates calcific aortic stenosis (CAS). We report a case with severe CAS where the patient experienced multiple embolic strokes immediately following retrograde heart catheterization. Calcific emboli in the cerebral arteries were demonstrated by computed tomography (CT).
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50
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Beerbower J, Chakeres DW, Larsen PD, Kapila A. Radiographic findings in Moebius and Moebius-like syndromes. AJNR Am J Neuroradiol 1986; 7:364-5. [PMID: 3082172 PMCID: PMC8332690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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