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Buffalo, NY, United States

Patil M.H.,State University of New York at Buffalo | Siddiqi A.,State University of New York at Buffalo | Siddiqi A.,Buffalo General Medical Center | Jeffrey Mador M.,State University of New York at Buffalo
Respiratory Medicine Case Reports | Year: 2016

Plastic bronchitis is a rare disorder, characterized by formation of thick fibrinous bronchial casts which can obstruct the airway and present as a life threatening emergency (1). It is more common in the pediatric population after corrective or palliative surgery for congenital heart disease like fontan procedure but has rarely been reported in adults as well (1). Pregnancy is a relative contraindication for bronchoscopy. Bronchoscopy in the pregnant patient poses significant risks as manipulation of the airway can lead to impaired oxygenation and ventilation. In addition, the drugs used during this procedure to provide sedation can have a direct impact on the developing fetus (2). In spite of these risks bronchoscopy should not be withheld in an emergent situation as it can be a lifesaving measure. We report a case of successful bronchoscopy using Propofol as the sedating agent in a pregnant female with plastic bronchitis who presented with respiratory distress. © 2016 The Authors.


Woodruff A.E.,Buffalo General Medical Center
The Annals of pharmacotherapy | Year: 2013

To report the case of a 32-year-old woman with abdominal migraine and present a literature review to evaluate abdominal migraine in adults, with particular regard to effective treatment. A 32-year-old African American female presented with recurrent, severe abdominal pain. The patient had several previous admissions with similar symptoms and an extensive gastrointestinal workup in which findings were normal. Attacks of abdominal pain occurred despite treatment with analgesics and antiemetics. She had a family history of migraine headaches. A diagnosis of abdominal migraine was presumed and prophylactic therapy with topiramate 50 mg twice daily relieved the symptoms. Most published cases of adult abdominal migraine describe females who had a long history of abdominal pain refractory to conventional therapies. The majority of patients had a strong family history of migraine and reported similar episodic abdominal pain. Patients responded to prophylactic migraine therapies, including calcium channel blockers, β-blockers, topiramate, and antihistamines; a few responded to abortive sumatriptan therapy. Abdominal migraine should be considered a possible source of incurable abdominal pain in adults when accompanied by a complete gastrointestinal workup with normal results. We recommend a trial of topiramate as prophylactic therapy if abdominal migraine is the likely source of the pain.


Woodruff A.E.,State University of New York at Buffalo | Woodruff A.E.,Buffalo General Medical Center | Meaney C.J.,State University of New York at Buffalo | Hansen E.A.,University of Rochester | Prescott G.M.,State University of New York at Buffalo
Pharmacotherapy | Year: 2015

Acute interstitial nephritis (AIN) is a form of acute kidney injury (AKI) characterized by a rapid deterioration of renal function, inflammatory infiltration of interstitial tissues, and renal edema. Drug-induced AIN is the most common etiology of AIN, but AIN can also have infectious, autoimmune, or idiopathic causes. β-Lactam antibacterials, nonsteroidal antiinflammatory drugs, and proton pump inhibitors are recognized as leading causes of AIN; however, many other drugs have been identified as causes. We describe the case of a 59-year-old white male who developed AIN that required hemodialysis following azithromycin treatment. He presented to the hospital with complaints of nausea, vomiting, malaise, and fever over the past 3 days, along with no urine output in the preceding 24 hours. Two weeks earlier, he had completed a 5-day course of azithromycin 500 mg on day 1 followed by 250 mg/day on days 2-5 (total dose 1.5 g) for an upper respiratory tract infection. On admission, the patient's serum creatinine (Scr) concentration was 7.4 mg/dl (baseline = 1.3 mg/dl). He reported a similar episode of kidney failure 2 years earlier after taking azithromycin; however, at that time it was believed the AKI was likely due to benazepril use in the setting of acute infection, and a kidney biopsy was not performed. His Scr concentration peaked at 11.4 mg/dl, and three sessions of hemodialysis were required. A kidney biopsy was performed that revealed AIN. Low-dose prednisone 0.3 mg/kg (30 mg)/day, tapered over the next 3 months, was administered, and his renal function improved to near baseline prior to discharge; 6 months later, his Scr concentration was 1.4 mg/dl. Despite lower than recommended dosing, this patient responded well to prednisone and did not experience long-term sequelae from renal injury. Use of the Naranjo Adverse Drug Reaction Probability Scale indicated a definite relationship (score of 10) between azithromycin exposure and the manifestation of AIN. To our knowledge, this is the first report of azithromycin-induced acute interstitial nephritis with near-complete resolution of renal injury in an adult. This case report illustrates the importance of rapid recognition of drug-induced renal injuries and discontinuation of the offending agent. Select use of corticosteroids may improve both time to and extent of renal function recovery. © 2015 Pharmacotherapy Publications, Inc.


Woodruff A.E.,Buffalo General Medical Center | Woodruff A.E.,St. John Fisher College | Abeles J.,State University of New York at Buffalo | Seyse S.J.,Buffalo General Medical Center
Annals of Pharmacotherapy | Year: 2013

OBJECTIVE: To report the case of a 32-year-old woman with abdominal migraine and present a literature review to evaluate abdominal migraine in adults, with particular regard to effective treatment. CASE SUMMARY: A 32-year-old African American female presented with recurrent, severe abdominal pain. The patient had several previous admissions with similar symptoms and an extensive gastrointestinal workup in which findings were normal. Attacks of abdominal pain occurred despite treatment with analgesics and anti-emetics. She had a family history of migraine headaches. A diagnosis of abdominal migraine was presumed and prophylactic therapy with topiramate 50 mg twice daily relieved the symptoms. DISCUSSION: Most published cases of adult abdominal migraine describe females who had a long history of abdominal pain refractory to conventional therapies. The majority of patients had a strong family history of migraine and reported similar episodic abdominal pain. Patients responded to prophylactic migraine therapies, including calcium channel blockers, β-blockers, topiramate, and anti hista mines; a few responded to abortive sumatriptan therapy. CONCLUSIONS: Abdominal migraine should be considered a possible source of incurable abdominal pain in adults when accompanied by a complete gastrointestinal workup with normal results. We recommend a trial of topiramate as prophylactic therapy if abdominal migraine is the likely source of the pain. © 1967-2013 Harvey Whitney Books Co. All rights reserved.


Aliotta R.E.,State University of New York at Buffalo | Aliotta R.E.,Roswell Park Cancer Institute | Roger E.P.,State University of New York at Buffalo | Roger E.P.,Buffalo General Medical Center | And 5 more authors.
Journal of Craniovertebral Junction and Spine | Year: 2014

Anterior thoracic spinal instrumentation has traditionally been supported by a posterior thoracic construct spanning from at least two levels above to two levels below; however, instrumentation at a single-level above and below may be adequate to support such a construct. We report two cases of transthoracic corpectomy with short-segment posterior fixation with success in long-term stabilization. Two patients with thoracic vertebral malignancy resulting in spinal deformity and spinal cord compression underwent transthoracic corpectomy with placement of an expandable cage proceeded by posterior fixation one level above and one level below. Using the Cobb angle, the degree of kyphosis was measured at 3, 6, and 12 months postoperatively. Long-term spinal stabilization was achieved in both patients. There was no significant increase in kyphosis and no evidence of hardware failure in either patient during the follow-up period. Transthoracic corpectomy with supplementary posterior fixation one level above and below may be adequate to stabilize the spine.

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