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Hirshey Dirksen S.J.,Malignant Hyperthermia Association of the United States | Larach M.G.,North American Malignant Hyperthermia Registry of MHAUS | Rosenberg H.,St Barnabas Medical Center | Brandom B.W.,University of Pittsburgh | And 4 more authors.
Anesthesia and Analgesia | Year: 2011

Malignant hyperthermia (MH) is a complex pharmacogenetic disorder of muscle metabolism. To more closely examine the complexities of MH and other related muscle disorders, the Malignant Hyperthermia Association of the United States (MHAUS) recently sponsored a scientific conference at which an interdisciplinary group of experts gathered to share new information and ideas. In this Special Article, we highlight key concepts and theories presented at the conference along with exciting new trends and challenges in MH research and patient care. Copyright © 2011 International Anesthesia Research Society.

Orzechowski K.M.,Thomas Jefferson University | Miller R.C.,St Barnabas Medical Center
Clinical Obstetrics and Gynecology | Year: 2012

This article reviews the diagnosis and management of the most common respiratory conditions complicating pregnancy-asthma and influenza. We also review strategies for smoking cessation in pregnancy as, in addition to exacerbating all other pulmonary conditions, smoking is the most modifiable risk factor for poor pregnancy outcome. Moreover, the obstetrician frequently encounters each of these conditions in the ambulatory setting. A thorough knowledge of the normal pregnancy-induced physiological respiratory changes combined with a comprehensive understanding of how to manage these conditions, will provide the obstetrician with the armamentarium needed to optimize health outcomes for mothers and their fetuses. © 2012, Lippincott Williams &Wilkins.

Kulshrestha S.,University of Michigan | Barrantes F.,Presbyterian Kidney Transplant Center | Samaniego M.,University of Michigan | Luan F.L.,St Barnabas Medical Center
Clinical Transplantation | Year: 2014

Chronic opioid usage (COU) is common among patients with end-stage renal disease (ESRD) qualified for kidney transplantation and associated with inferior post-transplant outcomes. The magnitude of COU after kidney transplantation and its impact on transplant outcomes remain unknown. We performed a single-center retrospective study aimed to describe the prevalence of COU during the first year, to identify the predictors of COU and to determine the impact of COU on post-transplant outcomes including the rates of hospitalization and acute rejection during the first year, as well as long-term patient and graft survival. Among 1045 kidney transplant patients, 119 (11.4%) had required continued outpatient prescription of opioid analgesics during the first year after kidney transplantation, mostly for non-surgery-related pain (85%). A positive history of COU prior to transplantation was the strongest predictor of COU in the first year post-transplantation (adjusted odds ratio [AOR] 4.31, p<0.001). Patients with COU had more often hospital admission during the first year (AOR 2.48, p = 0.001, for 1 or 2 admissions, and AOR 6.03, p <0.001 for ≥3 admissions), but similar rate of acute rejection (19.3% vs. 15.7%, p=0.31). During long-term follow-up, however, the patient and/or death-censored kidney survival was not different. COU early post-kidney transplantation, when clinically indicated and properly supervised, does not appear to affect the risk of death and death-censored graft failure. © 2014 John Wiley & Sons A/S.

Weir M.R.,University of Maryland Baltimore County | Mulgaonkar S.,St Barnabas Medical Center | Chan L.,University of Colorado at Denver | Shidban H.,National Institute of Transplantation | And 4 more authors.
Kidney International | Year: 2011

As part of the Spare-the-Nephron trial, we evaluated the combination mycophenolate mofetil (MMF) and sirolimus (SRL) as a calcineurin inhibitor (CNI)-free regimen for the preservation of renal function in renal allograft recipients. This 2-year, open-label, multicenter trial randomized 299 patients of which 151 were maintained on MMF and a CNI, 148 on MMF plus SRL (n120, tacrolimus; n31, cyclosporine). Baseline characteristics including measured (iothalamate) glomerular filtration rate (GFR) were similar between groups. After 1 year, the mean percentage change from baseline in the primary end point of measured GFR was significantly higher in the MMF/SRL group compared with the MMF/CNI group. After 2 years, the change was indistinguishable. Calculated creatinine clearance and GFR were significantly greater with MMF/SRL at 2 years within which biopsy-proven acute rejection (BPAR) occurred in 14 MMF/SRL-treated patients (3 graft losses) and in 17 receiving the MMF/CNI (6 graft losses). Significantly, no patients receiving MMF/SRL but five treated with MMF/CNI died. Thus, compared with MMF/CNI treatment, a 2-year regimen of MMF/SRL resulted in similar measures of renal function but with fewer deaths and a trend to less BPAR and graft loss. © 2011 International Society of Nephrology.

Wu G.,St Barnabas Medical Center
BMJ case reports | Year: 2013

Tacrolimus is an immunosuppressant frequently used following solid organ transplantation, including renal transplantation. Peripheral neuropathy is an uncommon neurological side effect of tacrolimus and has rarely been reported in renal transplantation. We report a patient who received a living-related donor kidney transplant and presented with altered mental status and new-onset bilateral foot drop. Laboratory tests including cerebrospinal fluid tests excluded infection, and MRI of the brain showed chronic microvascular ischaemic changes. Electromyography and nerve conduction study confirmed bilateral common peroneal nerve demyelination. He was also found to have inadvertently overdosed on tacrolimus at home. After switching from tacrolimus to cyclosporine, the patient's symptoms improved within 5 months. His renal function was maintained with an immunosuppressant regimen of cyclosporine, prednisone and mycophenolic acid. The prompt recognition of tacrolimus as a potential neurotoxic drug in a patient with renal transplant and substituting tacrolimus with a different immunosuppressant may prevent permanent neurological damage.

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