News Article | May 11, 2017
Hossein Aliabadi, MD, FAAP, Pediatric Urologist at Pediatric Urology Associates, and affiliated with the Children’s Hospitals & Clinics of Minnesota and Park Nicollet Methodist Hospital, has been named a 2017 Top Doctor in Minneapolis, Minnesota. Top Doctor Awards is dedicated to selecting and honoring those healthcare practitioners who have demonstrated clinical excellence while delivering the highest standards of patient care. Dr. Hossein Aliabadi is a very experienced urologist, having been in practice for more than 36 years. His medical career began in India in 1980, when he graduated from the All India Institute of Medical Sciences in New Delhi. After moving to the United States, he completed residencies at Regions Hospital in St. Paul and at the University of Minnesota Medical Center in Minneapolis. Dr. Aliabadi then completed a fellowship at the University of Toronto Hospital for Sick Children in Ontario, Canada. Dr. Aliabadi is certified by the American Board of Urology, has earned the coveted title of Fellow of the American Academy of Pediatrics, and is renowned across Minnesota and beyond as a specialist in pediatric urology. He is a noted expert in prenatally diagnosed fetal anomalies, and in genitourinary tract reconstruction, and has published a number of medical papers in these areas. Dr. Aliabadi is committed to keeping up to date with the latest technological advances in pediatric urology. He does this through his membership of professional organizations including the Society of Laparoendoscopic Surgeons and the American College of Surgeons. His expertise and dedication makes Dr. Hossein Aliabadi a very deserving winner of a 2017 Top Doctor Award. Top Doctor Awards specializes in recognizing and commemorating the achievements of today’s most influential and respected doctors in medicine. Our selection process considers education, research contributions, patient reviews, and other quality measures to identify top doctors.
Engebretsen K.M.,Regions Hospital |
Kaczmarek K.M.,University of Minnesota |
Morgan J.,University of Minnesota |
Holger J.S.,Regions Hospital
Clinical Toxicology | Year: 2011
Introduction. High-dose insulin therapy, along with glucose supplementation, has emerged as an effective treatment for severe beta-blocker and calcium channel-blocker poisoning. We review the experimental data and clinical experience that suggests high-dose insulin is superior to conventional therapies for these poisonings. Presentation and general management. Hypotension, bradycardia, decreased systemic vascular resistance (SVR), and cardiogenic shock are characteristic features of beta-blocker and calcium-channel blocker poisoning. Initial treatment is primarily supportive and includes saline fluid resuscitation which is essential to correct vasodilation and low cardiac filling pressures. Conventional therapies such as atropine, glucagon and calcium often fail to improve hemodynamic status in severely poisoned patients. Catecholamines can increase blood pressure and heart rate, but they also increase SVR which may result in decreases in cardiac output and perfusion of vascular beds. The increased myocardial oxygen demand that results from catecholamines and vasopressors may be deleterious in the setting of hypotension and decreased coronary perfusion. Methods. The Medline, Embase, Toxnet, and Google Scholar databases were searched for the years 1975-2010 using the terms: high-dose insulin, hyperinsulinemia-euglycemia, beta-blocker, calcium-channel blocker, toxicology, poisoning, antidote, toxin-induced cardiovascular shock, and overdose. In addition, a manual search of the Abstracts of the North American Congress of Clinical Toxicology and the Congress of the European Association of Poisons Centres and Clinical Toxicologists published in Clinical Toxicology for the years 1996-2010 was undertaken. These searches identified 485 articles of which 72 were considered relevant. Mechanisms of high-dose insulin benefit. There are three main mechanisms of benefit: increased inotropy, increased intracellular glucose transport, and vascular dilatation. Efficacy of high-dose insulin. Animal models have shown high-dose insulin to be superior to calcium salts, glucagon, epinephrine, and vasopressin in terms of survival. Currently, there are no published controlled clinical trials in humans, but a review of case reports and case series supports the use of high-dose insulin as an initial therapy. High-dose insulin treatment protocols. When first introduced, insulin doses were cautiously initiated at 0.5 U/kg bolus followed by a 0.5-1 U/kg/h continuous infusion due to concern for hypoglycemia and electrolyte imbalances. With increasing clinical experience and the publication of animal studies, high-dose insulin dosing recommendations have been increased to 1 U/kg insulin bolus followed by a 1-10 U/kg/h continuous infusion. Although the optimal regimen is still to be determined, bolus doses up to 10 U/kg and continuous infusions as high as 22 U/kg/h have been administered with good outcomes and minimal adverse events. Adverse effects of high-dose insulin. The major anticipated adverse events associated with high-dose insulin are hypoglycemia and hypokalemia. Glucose concentrations must be monitored regularly and supplementation of glucose will likely be required throughout therapy and for up to 24 h after discontinuation of high-dose insulin. The change in serum potassium concentrations reflects a shifting of potassium from the extracellular to intracellular space rather than a decrease in total body stores. Conclusions. While more clinical data are needed, animal studies and human case reports demonstrate that high-dose insulin (1-10 U/kg/hour) is a superior treatment in terms of safety and survival in both beta-blocker and calcium-channel blocker poisoning. High-dose insulin should be considered initial therapy in these poisonings. © 2011 Informa Healthcare USA, Inc.
Hunt J.M.,Clinical and Public Health Microbiology |
Hunt J.M.,Regions Hospital
Clinics in Laboratory Medicine | Year: 2010
Shiga toxin-producing Escherichia coli (STEC) are important enteric pathogens worldwide, causing diarrhea with or without blood visibly present and hemolytic uremic syndrome. STEC are unique among diarrheogenic E coli in producing Shiga toxin type 1 and type 2, the virulence factors responsible for bloody diarrhea and hemolytic uremic syndrome. Cattle and other ruminants are the natural reservoir of STEC as their normal intestinal flora. Humans become infected by consumption of foods contaminated with cattle feces. Early diagnosis of STEC infection is important because of the contraindication for treating STEC using antimicrobial agents, and the intense supportive care needed if renal failure occurs. © 2010 Elsevier Inc.
News Article | December 9, 2016
The International Association of HealthCare Professionals is pleased to welcome Charlene E. McEvoy, MD, MPH, Pulmonologist and Sleep Medicine Specialist, to their prestigious organization with her upcoming publication in The Leading Physicians of the World. Dr. McEvoy is a highly trained and qualified pulmonologist and sleep medicine specialist with a vast expertise in all facets of her work. Dr. McEvoy has been in practice for over 18 years and is currently serving patients at her private practice Dr. Charlene E. McEvoy, MD in St. Paul, Minnesota and is also affiliated with Regions Hospital, and Hudson Hospital & Clinic. Dr. McEvoy attended the University of Minnesota School of Medicine where she received her Medical Degree in 1986. In addition, Dr. McEvoy completed her Master in Public Health Degree with a focus on epidemiology at the University of Minnesota. She then completed her Internal Medicine residency at the University of Minnesota, her Internal Medicine residency at Regions Hospital, and her Pulmonary Medicine fellowship at the University of Minnesota. Dr. McEvoy is board certified in Internal Medicine and Pulmonary Disease by the American Board of Internal Medicine, and in Sleep Medicine by the American Board of Sleep Medicine. To keep up to date with the latest advances in her field, Dr. McEvoy maintains a professional membership with the American Thoracic Society, the American College of Chest Physicians, the American Academy of Sleep Medicine, and is also the recipient of many awards and honors. She attributes her great success to caring, her hard work, treating her patients as family, and sticking to her values. When she is not assisting patients, Dr. McEvoy likes to relax by working out. Learn more about Dr. McEvoy here: https://www.regionshospital.com/rh/provider-search/practitionerdetail/8643/show.html and read her upcoming publication in the Leading Physicians of the World. FindaTopDoc.com is a hub for all things medicine, featuring detailed descriptions of medical professionals across all areas of expertise, and information on thousands of healthcare topics. Each month, millions of patients use FindaTopDoc to find a doctor nearby and instantly book an appointment online or create a review. FindaTopDoc.com features each doctor’s full professional biography highlighting their achievements, experience, patient reviews, and areas of expertise. A leading provider of valuable health information that helps empower patient and doctor alike, FindaTopDoc enables readers to live a happier and healthier life. For more information about FindaTopDoc, visit:http://www.findatopdoc.com
Boffeli T.J.,Regions Hospital HealthPartners Institute for Medical Education |
Reinking R.R.,Regions Hospital
Journal of Foot and Ankle Surgery | Year: 2012
A variety of fixation methods are used in fusion of the subtalar joint (STJ) including 1 screw and 2 screw constructs. The rate of union is generally high for STJ fusion, regardless of the fixation method, provided the joint surfaces have been properly prepared and compressed and the patient avoids premature stress on the fusion site. Certain populations are known to have an increased risk of nonunion or delayed union including diabetics, smokers, and those undergoing revision of failed fusion. In this high-risk patient population, we propose that our novel 2-screw construct might have advantages over traditional fixation constructs without identified disadvantages. The technique is simple enough to be used in all primary and revision STJ fusion procedures, and this has become our practice. In the present study, 15 feet in 15 consecutive patients who underwent STJ fusion using a novel 2-screw fixation construct were retrospectively reviewed to assess the fusion outcome and complications. Specifically, we offer a novel 2-screw construct that offers the stability of the traditional parallel 2-screw construct while maintaining a maximum raw bone surface area at the posterior facet achieved by single-screw fixation. A retrospective review of radiographs taken 10 weeks postoperatively indentified a 100% fusion rate (15 of 15). All patients in our series achieved fusion, including several high-risk cases, and no significant complications were identified. © 2012 American College of Foot and Ankle Surgeons.
Harris C.R.,Regions Hospital |
Brown A.,Regions Hospital
Journal of Emergency Medicine | Year: 2013
Background: Synthetic cannabinoid receptor agonists are becoming increasingly popular with adolescents as an abused substance. Chronic use of these drugs can lead to addiction syndrome and withdrawal symptoms similar to cannabis abuse. Due to their potential health risk, several countries have banned these substances. Objectives: To report the clinical presentation and legislation status of synthetic cannabinoids in "Spice" products and alert the health care community about the identification and risk assessment problems of these compounds. Case Reports: We retrospectively reviewed cases presenting to our Emergency Department (ED) during a 3-month period with chief complaints of Spice drug use before arrival. Six cases presented to our ED after using Spice drugs. Two patients were admitted after reporting seizures. All but one presented with tachycardia. Two patients had hallucinations. The average length of ED observation was 2.8 h. No patient with seizures had recurrent episodes. Conclusion: Spice drugs can cause potentially serious health care conditions that necessitate ED evaluation. Most cases can be discharged from the ED after a period of observation. Legal issues surrounding these drugs are yet to be finalized in the United States. Copyright © 2013 Elsevier Inc. Printed in the USA. All rights reserved.
Endorf F.W.,Regions Hospital |
Dries D.J.,Regions Hospital
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Year: 2011
Fluid resuscitation following burn injury must support organ perfusion with the least amount of fluid necessary and the least physiological cost. Under resuscitation may lead to organ failure and death. With adoption of weight and injury size-based formulas for resuscitation, multiple organ dysfunction and inadequate resuscitation have become uncommon. Instead, administration of fluid volumes well in excess of historic guidelines has been reported. A number of strategies including greater use of colloids and vasoactive drugs are now under investigation to optimize preservation of end organ function while avoiding complications which can include respiratory failure and compartment syndromes. Adjuncts to resuscitation, such as antioxidants, are also being investigated along with parameters beyond urine output and vital signs to identify endpoints of therapy. Here we briefly review the state-of-the-art and provide a sample of protocols now under investigation in North American burn centers. © 2011 Endorf and Dries; licensee BioMed Central Ltd.
Kalliainen L.K.,Regions Hospital
Journal of Reconstructive Microsurgery | Year: 2010
Facial transplantation has recently been offered to patients with severely disfigured faces not amenable to functional reconstruction with autologous tissues. Arguments against this procedure include risks of immunosuppression, the concern that it will be done for cosmesis, the belief that acceptable reconstruction can be achieved with autologous tissues, the potential impact on the patient of graft failure, and the concern that the procedure may be adopted by unqualified centers. If we look to bioethics to help us dissect the question of whether or not facial transplantation should be performed, we see that the majority of the arguments have been proscriptive rather than prescriptive. There are valid arguments in favor of facial transplantation based on the prescriptive pillars of bioethics: autonomy, justice, and beneficence. This article attempts to reframe the dialogue in a prescriptive manner. Copyright © 2010 by Thieme Medical Publishers, Inc.
Boffeli T.J.,Regions Hospital |
Tabatt J.A.,Regions Hospital
Journal of Foot and Ankle Surgery | Year: 2015
Charcot-Marie-Tooth disease is a neuromuscular disorder that commonly results in a predictable pattern of progressive bilateral lower extremity weakness, numbness, contracture, and deformity, including drop foot, loss of ankle eversion strength, dislocated hammertoes, and severe cavus foot deformity. Late stage reconstructive surgery will be often necessary if the deformity becomes unbraceable or when neuropathic ulcers have developed. Reconstructive surgery for Charcot-Marie-Tooth deformity is generally extensive and sometimes staged. Traditional reconstructive surgery involves a combination of procedures, including tendon lengthening or transfer, osteotomy, and arthrodesis. The described technique highlights our early surgical approach, which involves limited intervention before the deformity becomes rigid, severe, or disabling. We present 2 cases to contrast our early minimally invasive technique with traditional late stage reconstruction. Charcot-Marie-Tooth disease affects different muscles at various stages of disease progression. As 1 muscle becomes weak, the antagonist will overpower it and cause progressive deformity. The focus of the early minimally invasive approach is to decrease the forces that cause progressive deformity yet maintain function, where possible. Our goal has been to maintain a functional and braceable foot and ankle, with the hope of avoiding or limiting the extent of future major reconstructive surgery. The presented cases highlight the patient selection criteria, the ideal timing of early surgical intervention, the procedure selection criteria, and operative pearls. The early minimally invasive approach includes plantar fasciotomy, Achilles tendon lengthening, transfer of the peroneus longus to the fifth metatarsal, Hibbs and Jones tendon transfer, and hammertoe repair of digits 1 to 5. © 2015 American College of Foot and Ankle Surgeons.
Dries D.J.,Regions Hospital |
Endorf F.W.,Regions Hospital
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Year: 2013
Lung injury resulting from inhalation of smoke or chemical products of combustion continues to be associated with significant morbidity and mortality. Combined with cutaneous burns, inhalation injury increases fluid resuscitation requirements, incidence of pulmonary complications and overall mortality of thermal injury. While many products and techniques have been developed to manage cutaneous thermal trauma, relatively few diagnosis-specific therapeutic options have been identified for patients with inhalation injury. Several factors explain slower progress for improvement in management of patients with inhalation injury. Inhalation injury is a more complex clinical problem. Burned cutaneous tissue may be excised and replaced with skin grafts. Injured pulmonary tissue must be protected from secondary injury due to resuscitation, mechanical ventilation and infection while host repair mechanisms receive appropriate support. Many of the consequences of smoke inhalation result from an inflammatory response involving mediators whose number and role remain incompletely understood despite improved tools for processing of clinical material. Improvements in mortality from inhalation injury are mostly due to widespread improvements in critical care rather than focused interventions for smoke inhalation.Morbidity associated with inhalation injury is produced by heat exposure and inhaled toxins. Management of toxin exposure in smoke inhalation remains controversial, particularly as related to carbon monoxide and cyanide. Hyperbaric oxygen treatment has been evaluated in multiple trials to manage neurologic sequelae of carbon monoxide exposure. Unfortunately, data to date do not support application of hyperbaric oxygen in this population outside the context of clinical trials. Cyanide is another toxin produced by combustion of natural or synthetic materials. A number of antidote strategies have been evaluated to address tissue hypoxia associated with cyanide exposure. Data from European centers supports application of specific antidotes for cyanide toxicity. Consistent international support for this therapy is lacking. Even diagnostic criteria are not consistently applied though bronchoscopy is one diagnostic and therapeutic tool. Medical strategies under investigation for specific treatment of smoke inhalation include beta-agonists, pulmonary blood flow modifiers, anticoagulants and antiinflammatory strategies. Until the value of these and other approaches is confirmed, however, the clinical approach to inhalation injury is supportive. © 2013 Dries and Endorf; licensee BioMed Central Ltd.