Ho R.T.,Thomas Jefferson University |
Frisch D.R.,Thomas Jefferson University |
Pavri B.B.,Thomas Jefferson University |
Levi S.A.,Our Lady of Lourdes Hospital |
Greenspon A.J.,Thomas Jefferson University
Circulation: Arrhythmia and Electrophysiology | Year: 2013
Background-Diagnosing atypical atrioventricular node-dependent long RP supraventricular tachycardias (SVTs) can be challenging. Methods and Results-Nineteen patients with 20 SVTs (atypical atrioventricular nodal reentrant tachycardia without [n=11]/with [n=3] a bystander nodofascicular [NF] accessory pathway, orthodromic reciprocating tachycardia [ORT] using a decremental atrioventricular [permanent form of junctional reciprocating tachycardia; n=4] or NF [NF reentrant tachycardia; n=2]) accessory pathway underwent electrophysiological study. Postpacing interval (PPI)-tachycardia cycle length (TCL), corrected PPI, ΔVA (ventriculoatrial), ΔHA (His-atrial), ΔAH (atrio-His) values, and responses to His-refractory ventricular premature depolarizations were studied. Compared with atrioventricular nodal reentrant tachycardia, ORT patients were younger (42±13 years versus 54±19 years; P=0.036) and were women (5/6 [83%] versus 3/14 [21%]; P=0.036); TCLs were similar (435 ms versus 429 ms; 95% confidence interval, -47.5 to 35.5). PPI-TCL was shorter for ORT (118 ms versus 176 ms; 95% confidence interval, 26.3-89.7) but only 50% had PPI-TCL <115 ms, whereas 5 of 6 (83%) had PPI-TCL <125 ms (sensitivity, 83%; specificity, 100%). Corrected PPI <110 ms, ΔVA <85 ms, and ΔHA <0 ms had equivalent sensitivity (67%) and 100% specificity for ORT. Compared with permanent form of junctional reciprocating tachycardia, NF reentrant tachycardia/atrioventricular nodal reentrant tachycardia had longer ΔAH (29 ms versus 10 ms; 95% confidence interval, 3.03-35.0) or AH(SVT)
Al-Alawi M.,Our Lady of Lourdes Hospital |
Hassan T.,Materials Misericordiae Hospital |
Chotirmall S.H.,St James's Hospital
American Journal of Medicine | Year: 2014
Global estimates on aging predict an increased burden of asthma in the older population. Consequently, its recognition, diagnosis, and management in clinical practice require optimization. This review aims to provide an update for clinicians, highlighting advances in the understanding of the aging process and immunosenescence together with their applicability to asthma from a diagnostic and therapeutic perspective. Aging impacts airway responses and immune function, and influences efficacy of emerging phenotype-specific therapies when applied to the elderly patient. Differentiating eosinophilic and neutrophilic disease accounts for atopic illness and distinguishes long-standing from late-onset asthma. Therapeutic challenges in drug delivery, treatment adherence, and side-effect profiles persist in the older patient, while novel recording devices developed to aid detection of an adequate inhalation evaluate treatment effectiveness and compliance more accurately than previously attainable. Anticytokine therapies improve control of brittle asthma, while bronchial thermoplasty is an option in refractory cases. Multidimensional intervention strategies prove best in the management of asthma in the older adult, which remains a condition that is not rare but rarely diagnosed in this patient population.
Naqvi G.A.,Our Lady of Lourdes Hospital |
Cunningham P.,Our Lady of Lourdes Hospital |
Lynch B.,Our Lady of Lourdes Hospital |
Galvin R.,Royal College of Surgeons in Ireland |
Awan N.,Our Lady of Lourdes Hospital
American Journal of Sports Medicine | Year: 2012
Background: Ankle syndesmotic injuries are complex and require anatomic reduction and fixation to restore the normal biomechanics of the ankle joint and prevent long-term complications. Purpose: The aim of this study is to compare the accuracy and maintenance of syndesmotic reduction using TightRope versus syndesmotic screw fixation. Study Design: Cohort study; Level of evidence, 2. Methods: This cohort study included consecutive patients treated for ankle syndesmotic diastases between July 2007 and June 2009. Single slice axial computed tomography (CT) scans of both the ankles together were performed at the level of syndesmosis, 1 cm above the tibial plafond. A greater than 2-mm widening of syndesmosis compared with the untreated contralateral ankle was considered significant malreduction. Clinical outcomes were measured using the American Orthopaedics Foot and Ankle Society (AOFAS) and Foot and Ankle Disability Index (FADI) scores. Results: Forty-six of 55 eligible patients participated in the study; 23 patients were in the TightRope group and 23 in the syndesmotic screw group. The average age was 42 years in the TightRope and 40 years in the syndesmotic screw group, and the mean follow-up time was 2.5 years (range, 1.5-3.5 years). The average width of normal syndesmosis was 4.03±0.89 mm. In the Tight- Rope group, the mean width of syndesmosis was 4.37 mm (SD, ±1.12 mm) (P = .30, t test) compared with 5.16 mm (SD, ±1.92 mm) in the syndesmotic screw group (P = .01, t test). Five of 23 ankles (21.7%) in the syndesmotic screw group had syndesmotic malreduction, whereas none of the TightRope group showed malreduction on CT scans (P = .04, Fisher exact test). Average time to full weightbearing was 8 weeks in the TightRope group and 9.1 weeks in the syndesmotic screw group. There was no significant difference between the TightRope and syndesmotic screw groups in mean postoperative AOFAS score (89.56 and 86.52, respectively) or FADI score (82.42 and 81.22, respectively). Regression analysis confirmed malreduction of syndesmosis as the only independent variable that affected the clinical outcome (regression coefficient, 12.39; t = 2.43; P = .02). Conclusion: The results of this study indicate that fixation with TightRope provides a more accurate method of syndesmotic stabilization compared with screw fixation. Syndesmotic malreduction is the most important independent predictor of clinical outcomes; therefore, care should be taken to reduce the syndesmosis accurately. © 2012 The Author(s).
Heelan K.,Our Lady of Lourdes Hospital |
Heelan K.,Sunnybrook Health science Center |
Watson R.,Our Ladys Childrens Hospital |
Collins S.M.,Our Lady of Lourdes Hospital
Pediatric Dermatology | Year: 2013
Neonatal lupus erythematosus (NLE) is a rare acquired autoimmune disease caused by transplacental transfer of maternal immunoglobulin G antibodies to the fetus. NLE has well-recognized cutaneous features and may also manifest in other organs. The majority of cases are associated with Ro/SSA and La/SSB antibodies. Neonatal lupus due to antiribonucleoprotein (RNP) antibodies has rarely been reported. On rare occasions RNP has been found in association with other antibodies. We report a case of NLE occurring solely due to RNP antibodies presenting as varicelliform lesions at birth. We recorded the features in our case and 14 additional cases identified in the literature. It is important to recognize that maternal transfer of RNP antibodies may produce the classic cutaneous features of neonatal lupus. The limited case reports of this condition suggest that manifestations are limited to the skin; specifically, there are no reports of cardiac involvement. The long-term outcome remains unknown. RNP-positive, Ro/La-negative NLE seems to represent a different clinical subset of NLE. The recognition of RNP antibody NLE as a benign condition limited to the skin is helpful in planning antenatal care for subsequent pregnancies. © 2013 Wiley Periodicals, Inc.
Khan S.A.,Our Lady of Lourdes Hospital |
Khokhar H.A.,Our Lady of Lourdes Hospital |
Nasr A.R.H.,Our Lady of Lourdes Hospital |
Carton E.,Our Lady of Lourdes Hospital |
El-Masry S.,Our Lady of Lourdes Hospital
Surgical Endoscopy and Other Interventional Techniques | Year: 2013
Purpose: Use of thoracic epidural analgesia (TEA) with local anesthetic and adjuncts, such as opioids, are cornerstones of ERAS (Enhanced Recovery After Surgery) and are considered to play a key role in recovery after colorectal surgery. However, its effect on bowel function may lead to prolong hospital stay and is still a matter of debate. The purpose of this systemic review was to assess whether epidural analgesia could have a detrimental effect on bowel function in laparoscopic colorectal surgery with a subsequent effect on hospital stay duration, leading to failure of ERAS in colorectal surgery. Methods: A systematic review of randomized, controlled trials for the effect of epidural analgesia on laparoscopic colorectal surgery was performed. The effect on postoperative recovery was evaluated in terms of return of bowel function as the primary outcome, whereas length of stay (LOS), pain score on visual analogue scale, operative time, and incidence of postoperative complications and side-effects of analgesia were recorded as secondary outcomes. Results: Six trials published between 1999 and 2011 were included in the final analysis. TEA significantly improves return of bowel function assessed by time to first bowel motion [WMD -0.62 (-1.11, -0.12) with Z = 2.43; P = 0.02, 95 % confidence interval (CI)], and pain scores [WMD -1.23 (-2.4, -0.07)] with Z = 2.07; P = 0.04, 95 % CI]. TEA did not influence duration of hospital stay [WMD -0.47 (-1.55, 0.61)] with Z = 0.85 (P = 0.39, 95 % CI). No significant increase in operative time or side effects was associated with TEA. Conclusions: Despite of some beneficial effect of epidural analgesia on return of bowel function and pain in laparoscopic surgery, it does not affect LOS, which is multifactorial. © 2013 Springer Science+Business Media New York.
McCarthy J.,Massachusetts General Hospital |
Mc Millan S.,Our Lady of Lourdes Hospital
Orthopedic Clinics of North America | Year: 2013
Hip arthroscopy is a rapidly progressing field that has advanced in function and survivorship over the past decade. As increasing literature is published on outcomes of hip arthroscopy, a retrospective review has allowed for the identification of factors that affect survivorship. Within this review, the authors present the factors identified to date that affect survivorship after hip arthroscopy while raising questions about the future direction of the field. © 2013 Elsevier Inc.
Mohd M.S.N.,Beaumont Hospital |
Mohd M.S.N.,Our Lady of Lourdes Hospital |
Crown J.,St Vincents University Hospital |
Hennessy B.T.,Beaumont Hospital |
Hennessy B.T.,Our Lady of Lourdes Hospital
Annals of Oncology | Year: 2012
Background: Approximately 15%-23% of breast cancers overexpress human epidermal growth factor receptor 2 (HER2), which leads to the activation of signaling pathways that stimulate cell proliferation and survival. HER2-targeted therapy has substantially improved outcomes in patients with HER2-positive breast cancer. However, both de novo and acquired resistance are observed. Design: A literature search was performed to identify proposed mechanisms of resistance to HER2-targeted therapy and identified novel targets in clinical development for treating HER2-resistant disease. Results: Proposed HER2-resistance mechanisms include impediments to HER2-inhibitor binding, signaling through alternative pathways, upregulation of signaling pathways downstream of HER2, and failure to elicit an appropriate immune response. Although continuing HER2 inhibition beyond progression may provide an additional clinical benefit, the availability of novel therapies targeting different mechanisms of action could improve outcomes. The developmental strategy with the most available data is targeting the phosphatidylinositol 3-kinase/protein kinase B/mammalian target of rapamycin (mTOR) pathway. The oral mTOR inhibitor everolimus has shown promising activity in combination with chemotherapy and trastuzumab in trastuzumab-refractory, advanced breast cancer. Conclusions: Non-HER2-targeted therapy is a promising means of overcoming resistance to HER2-targeted treatment. Ongoing clinical studies will provide additional information on the efficacy and safety of novel targeted therapies in HER2-resistant advanced breast cancer.. © The Author 2012. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.
Raza H.,Our Lady of Lourdes Hospital |
Mahapatra A.,Our Lady of Lourdes Hospital
Advances in Orthopedics | Year: 2015
Almost all orthopaedic surgeons come across acute compartment syndrome (ACS) in their clinical practice. Diagnosis of ACS mostly relies on clinical findings. If the diagnosis is missed and left untreated, it can lead to serious consequences which can endanger limb and life of the patient and also risk the clinician to face lawsuits. This review article highlights the characteristic features of ACS which will help an orthopaedic surgeon to understand the pathophysiology, natural history, high risk patients, diagnosis, and surgical management of the condition. © 2015 Hasnain Raza and Anant Mahapatra.
Naqvi G.A.,Our Lady of Lourdes Hospital |
Shafqat A.,Our Lady of Lourdes Hospital |
Awan N.,Our Lady of Lourdes Hospital
Injury | Year: 2012
Background: Ankle syndesmotic injuries are complex and require anatomic reduction and fixation. Tightrope fixation is a relatively new technique and we present the largest series of syndesmosis fixation using Arthrex Tightrope™ (Naples, FL, USA). Materials and methods: Forty-nine patients with ankle diastasis, treated with Arthrex tightrope™, were reviewed retrospectively, using American Orthopaedic Foot and Ankle Society (AOFAS) and Foot and Ankle Disability Index (FADI) scores and radiographic parameters for syndesmosis integrity. The operative technique was slightly modified by the senior author in 31 cases to avoid soft-tissue complications requiring removal of the implant. The aim of this study was to assess the rate of hardware removal after tightrope fixation and the effect of the author's modification to avoid soft-tissue complications. Results: The mean age of patients was 37.7 years. Eighteen were performed with standard technique whilst 31 with the modified technique. The mean radiological follow-up was 6 months. Final data were collected using a confidential questionnaire and FADI score at an average of 24 (12-38) months postoperatively. The average time to full weight bearing was 7.7 weeks and to return to normal activities was 11.2 weeks. Postoperative radiographic measurements demonstrated satisfactory reduction of syndesmosis. The Mean AOFAS score was 85.57(95% confidence interval (CI) 77.96-93.18) and the mean FADI score was 81.20 (95% CI 73.86-88.53). There were three cases of hardware removal in the standard technique group as compared to none in the group with the modified technique. Conclusion: Arthrex Tightrope™ provides an effective method of syndesmosis stabilisation, which obviates the need for routine removal of implant and facilitates dynamic stabilisation. The results of this study are satisfactory and comparable to previously reported studies. We emphasise that surgeons must be aware of the potential risk of soft-tissue complications and recommend our modified technique. Further long-term prospective studies should be carried out to resolve this issue. © 2011 Elsevier Ltd. All rights reserved.
Idrees A.,Our Lady of Lourdes Hospital
Journal of the Pakistan Medical Association | Year: 2012
The case of a 39 year old woman who had diastasis of pubic symphysis following childbirth and later developed severe chronic neuropathic pain and disability is presented. She received extensive surgical and medical treatment for 6 years with no improvement of symptoms. The VNRS (Visual Numerical Rating Scale) pain score was 7/10 or more most of the time. This was quite disabling in terms of her quality of life. A spinal cord stimulator was inserted after failure of other modalities of pain management which resulted in dramatic improvement in the quality of life measured with SF-36 questionnaire. Her pain score became 0/10 VNRS and she was free from opioids and psychotropic medications within 3 months post insertion. Spinal cord stimulator can be considered for the management of pain due to diastasis of pubic symphysis, not amenable to other therapies.