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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.


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


Dries D.J.,Regions Hospital | Dries D.J.,University of Minnesota
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Year: 2010

Introduction: There is renewed interest in blood product use for resuscitation stimulated by recent military experience and growing recognition of the limitations of large-volume crystalloid resuscitation.Methods: An editorial review of recent reports published by investigators from the United States and Europe is presented. There is little prospective data in this area.Results: Despite increasing sophistication of trauma care systems, hemorrhage remains the major cause of early death after injury. In patients receiving massive transfusion, defined as 10 or more units of packed red blood cells in the first 24 hours after injury, administration of plasma and platelets in a ratio equivalent to packed red blood cells is becoming more common. There is a clear possibility of time dependent enrollment bias. The early use of multiple types of blood products is stimulated by the recognition of coagulopathy after reinjury which may occur as many as 25% of patients. These patients typically have large-volume tissue injury and are acidotic. Despite early enthusiasm, the value of administration of recombinant factor VIIa is now in question. Another dilemma is monitoring of appropriate component administration to control coagulopathy.Conclusion: In patients requiring large volumes of blood products or displaying coagulopathy after injury, it appears that early and aggressive administration of blood component therapy may actually reduce the aggregate amount of blood required. If recombinant factor VIIa is given, it should be utilized in the fully resuscitated patient. Thrombelastography is seeing increased application for real-time assessment of coagulation changes after injury and directed replacement of components of the clotting mechanism. © 2010 Dries; licensee BioMed Central Ltd.


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.


Stellpflug S.J.,Regions Hospital | Kealey S.E.,Regions Hospital | Hegarty C.B.,Regions Hospital | Janis G.C.,MedTox Laboratories
Journal of Medical Toxicology | Year: 2014

Introduction: 2C designer drugs have been in use since the 1970s, but new drugs continue to develop from substitutions to the base phenethylamine structure. This creates new clinical profiles and difficulty with laboratory confirmation. 2-(4-Iodo-2,5-dimethoxyphenyl)-N-[(2-methoxyphenyl)methyl]ethanamine (25I-NBOMe) is a relatively new 2C drug that is more potent than structural 2C analogs; exposure reports are rare. Testing for 2C drugs is developing; specific testing for new analogs such as 25I-NBOMe is a challenge. These drugs do not reliably trigger a positive result on rapid drug immunoassays. Additionally, most facilities with confirmatory testing capabilities will not identify 25I-NBOMe; methods for detecting 25I-NBOMe in biological samples have not been clearly described nor have optimal metabolic targets for detecting 25I-NBOMe ingestion. Case Report: An 18-year-old female presented following use of 25I-NBOMe. She had an isolated brief seizure, tachycardia, hypertension, agitation, and confusion. She improved with intravenously administered fluids and benzodiazepines and was discharged 7 h postingestion. Urine was analyzed using quantitative LC-MS/MS methodology for 25I-NBOMe, 2-(4-chloro-2,5-dimethoxyphenyl)-N-[(2-methoxyphenyl)-methyl]ethanamine (25C-NBOMe), and 2-(2,5-dimethoxyphenyl)-N-(2-methoxybenzyl)ethanamine (25H-NBOMe). 25I-NBOMe was found at a concentration of 7.5 ng/mL, and 25H-NBOMe was detected as well. Additional testing was pursued to characterize the metabolism of 25I-NBOMe; the sample was reanalyzed with UPLC-time-of-flight mass spectrometry to identify excreted metabolites. The sample was additionally analyzed for the presence of 2,5-dimethoxy-4-iodophenethylamine (2C-I), 4-bromo-2,5-dimethoxyphenethylamine (2C-B), and 1-(2,5-dimethoxy-4-ethylphenyl)-2-aminoethane (2C-E). Discussion: This is a report of a patient presenting following exposure to 25I-NBOMe, a dangerous member of the evolving 2C drug class. The exposure was confirmed in a unique manner that could prove helpful in guiding further patient analysis and laboratory studies. © 2013 American College of Medical Toxicology.


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.

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