Frost J.H.,Memorial Healthcare System |
Price E.E.,Nova Southeastern University
BMJ Case Reports | Year: 2015
Abdominal cocoon, or idiopathic sclerosing encapsulating peritonitis, is a rare condition characterised by the presence of a dense fibrocollagenous membrane partially or totally encapsulating the small bowel leading to recurrent intestinal obstructions. We present the case of a patient who has presented for the fourth time with a small bowel obstruction. Previous laparoscopy revealed a plaque-like reactive process encapsulating much of the small bowel and the liver. After initial adhesiolysis, the patient' s obstructions continued to reoccur. Further laparotomy was performed in order to excise the entirety of the cocoon membrane and free up loops of small bowel encapsulated by the process, hopefully preventing future obstructions. Copyright © 2015 BMJ Publishing Group. All rights reserved.
Kiechle F.L.,Memorial Healthcare System
Point of Care | Year: 2015
Molecular diagnostic tests consist of 3 processes: extraction/purification of nucleic acid, amplification of specific target region, and finally detection of amplified products. For Point of Care Testing applications, these 3 steps need to be miniaturized using microfluidics to reduce reagent volumes and associated costs. Extraction may be eliminated if Polymerase Chain Reaction enhancers are added and if mutated/modified DNA polymerase are used, which are resistant to polymerase inhibitors. Numerous proof of concept devices have been reported for molecular diagnostic assays, and some are Food and Drug Administration cleared. This review focuses on 3 specific applications: (1) multiplex Polymerase Chain Reaction identification of 4 Plasmodium species that causes malaria; (2) CYP2C19 variant detection that alters the prodrug clopidogrel's conversion to an active anticoagulant; and (3) next-generation sequencing using nanopores embedded in biological or nonbiological substrates to sequence DNA. These clinical applications provide the potential of added clinical value with faster turnaround time and increased sensitivity and specificity. This technology will rapidly provide a final diagnosis and a subsequent appropriate treatment decision. © Wolters Kluwer Health, Inc. All rights reserved.
Mitrani R.D.,University of Miami |
Sager S.J.,University of Miami |
Moscucci M.,University of Miami |
Cogan J.,Memorial Healthcare System |
Myerburg R.J.,University of Miami
International Journal of Cardiology | Year: 2014
Background Transient variations in physiological parameters may forewarn of life-threatening cardiac events, but are difficult to identify clinically. Implantable cardioverter defibrillators (ICD) designed to measure transthoracic impedance provide a surrogate marker for pulmonary congestion. Objective The aim of this study is to determine if the frequency of changes in transthoracic impedance (TTI) is associated with congestive heart failure (CHF) exacerbation and predicts mortality. Methods We followed 109 consecutive patients (pts) with ICDs (n = 58) or CRT-ICDs (n = 51) for a mean of 21.3 (+ 10.2) months. Using 80 ohm-days as a reference, we correlated the frequency of TTI changes above this index to CHF hospitalizations or death. Results There was at least one TTI threshold crossing in 79 (72%) pts over 23.3 months follow-up, with a mean of 1.8 ± 3.4 per year. There were 18 pts with CHF hospitalizations who had a mean of 4.3 TTI threshold crossings/year (S.D. = ± 7.3; median = 2.8), compared to 1.3 (S.D. = ± 1.5; median = 0.8) among pts without CHF hospitalizations (p = 0.0006). Among 20 patients who died during follow-up, there were 4.2 (S.D. = ± 7.0; median = 2.9) TTI threshold crossings/year, compared with 1.3 (S.D. = ± 1.3; median = 0.9) threshold crossings/year among survivors (p = 0.0004). Using Cox Proportional Hazard modeling, after adjusting for age, baseline EF, and number of shocks, TTI threshold crossing was an independent predictor of death (HR 1.72, 95% CI 1.26-2.36, p = 0.001). Conclusions Increased frequency of TTI threshold crossings may be a useful predictor of transient risk for identifying a subgroup of ICD recipients at greater individual risk for death or CHF hospitalizations. © 2014 Elsevier Ireland Ltd. All rights reserved.
Block M.I.,Memorial Healthcare System
Annals of Thoracic Surgery | Year: 2010
Background: Esophageal endoscopic ultrasound (EUS) and endobronchial ultrasound (EBUS) are gaining popularity for mediastinal staging of patients with lung cancer. Endoscopic ultrasound and then EBUS were introduced into a single-surgeon thoracic surgical practice. Records were reviewed to determine what effect this had on performance of mediastinoscopy for lung cancer staging, and on discovery of unsuspected N2 disease at the time of resection. Methods: Endoscopic ultrasound and EBUS were introduced 10 months apart. Records were reviewed for the 10 months before EUS (phase 1), the 10 months between EUS and EBUS (phase 2), 8 months after the introduction of EBUS (phase 3), and 11 months after that (phase 4). The number of staging procedures, patients undergoing resection after negative staging, and patients with N2 disease discovered at resection were determined. Results: Two hundred fifty-three patients met inclusion criteria. Eighty-two had resection without staging; staging was positive in 62, negative in 90 who went on to resection, and negative in 19 who had no further evaluation. There was a strong trend toward preferential use of EUS in phase 2 and EBUS in phases 3 and 4. Nine patients (10%) had N2 disease found at surgery: 0 of 16 in phase 1, 4 of 24 in phase 2, 3 of 24 in phase 3, and 2 of 25 in phase 4. Overall sensitivity and negative predictive value of EUS and EBUS were 84% and 87%, respectively. Conclusions: Introduction of EUS and EBUS reduced use of mediastinoscopy. Discovery of N2 disease at surgery was higher than expected initially, but with experience results proved comparable to those of mediastinoscopy. © 2010 The Society of Thoracic Surgeons.
Fredericks J.E.,Memorial Healthcare System
Journal of healthcare risk management : the journal of the American Society for Healthcare Risk Management | Year: 2010
Preventable adverse drug events have a direct impact on the well-being of patients. The creation and implementation of a patient-friendly daily medication schedule improved the way care is delivered at Memorial Healthcare System. The staff collaborated with patients and families and empowered them with the knowledge and tools needed to make their healthcare safer. Patient and family participation, a critical component of patient- and family-centered care, is a vital part of making healthcare safer. This tool enhances communication with patients and family members and enables patients to better understand the medications they receive while hospitalized. An additional welcomed byproduct is the prevention of potential medication errors.