Peoria, IL, United States
Peoria, IL, United States

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Dake M.D.,Stanford University | Ansel G.M.,MidWest Cardiology Research Foundation | Jaff M.R.,Massachusetts General Hospital | Ohki T.,Jikei University School of Medicine | And 10 more authors.
Circulation: Cardiovascular Interventions | Year: 2011

Background-Sustained benefits of drug-eluting stents in femoropopliteal arteries have not been demonstrated. This prospective, multinational, randomized study was designed to compare the 12-month safety and effectiveness of a polymer-free, paclitaxel-coated nitinol drug-eluting stent (DES) with percutaneous transluminal angioplasty (PTA) and provisional bare metal stent (BMS) placement in patients with femoropopliteal peripheral artery disease. Methods and Results-Patients were randomly assigned to primary DES implantation (n=236) or PTA (n=238). Demographics and lesion characteristics were similar between groups (eg, average lesion length, approximately 65±40 mm). One hundred twenty patients had acute PTA failure and underwent secondary random assignment to provisional DES (n=61) or BMS (n=59). Primary end points were the 12-month rates of event-free survival and patency in the primary DES and PTA groups. Compared with the PTA group, the primary DES group exhibited superior 12-month event-free survival (90.4% versus 82.6%; P=0.004) and primary patency (83.1% versus 32.8%; P<0.001), satisfying the primary hypotheses. In the secondary evaluations, (1) the primary DES group exhibited superior clinical benefit compared with the PTA group (88.3% versus 75.8%; P<0.001), (2) the provisional DES group exhibited superior primary patency (89.9% versus 73.0%; P=0.01) and superior clinical benefit (90.5% and 72.3%, P=0.009) compared with the provisional BMS group, and (3) the stent fracture rate (both DES and BMS) was 0.9% (4/457). Conclusions-Femoropopliteal peripheral artery disease treatment with the paclitaxel-eluting stent was associated with superior 12-month outcomes compared with PTA and provisional BMS placement. Clinical Trial Registration-URL: Unique identifier: NCT00120406. © 2011 American Heart Association, Inc.

Farrell J.J.,University of Illinois at Urbana - Champaign | Larson J.A.,St Francis Medical Center | Akeson J.W.,University of Illinois at Urbana - Champaign | Lowery K.S.,Ibis Biosciences | And 5 more authors.
Journal of Clinical Microbiology | Year: 2014

We describe the first reported case of Ureaplasma parvum prosthetic joint infection (PJI) detected by PCR. Ureaplasma species do not possess a cell wall and are usually associated with colonization and infection of mucosal surfaces (not prosthetic material). U. parvum is a relatively new species name for certain serovars of Ureaplasma urealyticum, and PCR is useful for species determination. Our patient presented with late infection of his right total knee arthroplasty. Intraoperative fluid and tissue cultures and pre- and postoperative synovial fluid cultures were all negative. To discern the pathogen, we employed PCR coupled with electrospray ionization mass spectrometry (PCR/ESI-MS). Our patient's failure to respond to empirical antimicrobial treatment and our previous experience with PCR/ESI-MS in culture-negative cases of infection prompted us to use this approach over other diagnostic modalities. PCR/ESI-MS detected U. parvum in all samples. U. parvum-specific PCR testing was performed on all synovial fluid samples to confirm the U. parvum detection. Copyright © 2014, American Society for Microbiology. All Rights Reserved.

Jegatheesan P.,Santa Clara Valley Medical Center | Song D.,Santa Clara Valley Medical Center | Angell C.,Santa Clara Valley Medical Center | Angell C.,OConnor Hospital | And 2 more authors.
Pediatrics | Year: 2013

OBJECTIVE: To establish simultaneous pre- and postductal oxygen saturation nomograms in asymptomatic newborns when screening for critical congenital heart disease (CCHD) at ∼24 hours after birth. METHODS: Asymptomatic term and late preterm newborns admitted to the newborn nursery were screened with simultaneous pre- and postductal oxygen saturation measurements at ∼24 hours after birth. The screening program was implemented in a stepwise fashion in 3 different affiliated institutions. Data were collected prospectively from July 2009 to March 2012 in all 3 centers. RESULTS: We screened 13 714 healthy newborns at a median age of 25 hours. The mean preductal saturation was 98.29% (95% confidence interval [CI]: 98.27-98.31), median 98%, and mean postductal saturation was 98.57% (95% CI: 98.55-98.60), median 99%. The mean difference between the pre- and postductal saturation was -0.29% (95% CI: -0.31 to -0.27) with P < .00005. Its clinical relevance to CCHD screening remains to be determined. The postductal saturation was equal to preductal saturation in 38% and greater than preductal saturation in 40% of the screens. CONCLUSIONS: We have established simultaneous pre- and postductal oxygen saturation nomograms at ∼24 hours after birth based on >13 000 asymptomatic newborns. Such nomograms are important to optimize screening thresholds and methodology for detecting CCHD.

Cleri D.J.,St Francis Medical Center | Cleri D.J.,Seton Hall University | Ricketti A.J.,St Francis Medical Center | Ricketti A.J.,Seton Hall University | Vernaleo J.R.,Wyckoff Heights Medical Center
Infectious Disease Clinics of North America | Year: 2010

This article reviews the virology, history, pathology, epidemiology, clinical presentations, complications, radiology, laboratory testing, diagnosis, treatment, and prevention of severe respiratory distress syndrome, with reference to documented outbreaks of the disease. © 2010 Elsevier Inc. All rights reserved.

Bailey L.D.,St Francis Medical Center
Advances in Neonatal Care | Year: 2013

Nurse-to-nurse, or horizontal, hostility creates a multitude of problems. There are a number of specific and direct problems, including impact on the culture of nursing, stress, healthcare economics, and patient outcomes, that are illustrated in the literature. Horizontal hostility is a pervasive and destructive force that must be addressed in every venue in which nursing is involved. This study discusses the problem of horizontal hostility and the impact it has on nursing and healthcare. Nursing theory is applied to practice and provides concepts and frameworks that are utilized to underscore the critical nature of the problem and provide a map for solutions. Copyright © 2013 by The National Association of Neonatal Nurses.

Pressman G.S.,Albert Einstein Medical Center | Agarwal A.,Albert Einstein Medical Center | Braitman L.E.,Albert Einstein Medical Center | Muddassir S.M.,St Francis Medical Center
American Journal of Cardiology | Year: 2010

Mitral annular calcium (MAC) is a common finding at echocardiography, although it is an unusual cause of severe mitral stenosis. Although MAC is known to be associated with atherosclerosis and chronic kidney disease, little is known about its natural history as affects mitral valve function. This report describes a cohort of 37 outpatients with severe MAC (>5 mm) of whom 32 were followed longitudinally with echocardiography (mean follow-up 2.6 ± 1.6 years). Progression of the mitral valve gradient occurred in 16 of 32 (50%). There was wide variation in rate of progression with a few subjects demonstrating a rapid increase in gradient, up to 9 mm Hg/year. Progression of mitral valve gradient correlated with baseline gradient at rest and with severity of overall cardiac calcification as measured by a semiquantitative echocardiographic score. Age at index echocardiogram was inversely related to mitral valve gradient after baseline, suggesting that calcification may proceed at a greater rate in younger patients. In conclusion, although severe mitral stenosis is uncommon in patients with MAC, those with a pre-existing gradient at rest and severe overall cardiac calcification appear to be at greater risk for development of this disease state. © 2010 Elsevier Inc. All rights reserved.

Kansal R.,Cedars Sinai Medical Center | Quintanilla-Martinez L.,University of Tübingen | Datta V.,Cedars Sinai Medical Center | Lopategui J.,Cedars Sinai Medical Center | And 2 more authors.
Genes Chromosomes and Cancer | Year: 2013

Langerhans cell histiocytosis (LCH) is a well-known but rare disease that may occur at any age with markedly variable clinical features: self-regressive, localized, multiorgan, aggressive, or fatal outcome. Congenital LCH is rare and often clinically benign. While LCH is characterized by a clonal proliferation of Langerhans cells, its etiology is unknown. Although BRAF V600E mutations were recently identified as a recurrent genetic alteration in LCH cases, the clinical significance of this mutation within the heterogeneous spectrum of LCH is also currently unknown. We studied a cutaneous, benign form of congenital LCH that occurred in a newborn male, without recurrence for 8 years. Histopathologically, the skin lesion excised after birth showed the typical cytologic and immunophenotypic features of LCH. Sequencing analysis of Exon 15 of the BRAF gene revealed the V600D mutation, with an allelic abundance of 25-30%, corresponding to the LCH cells being hemizygous for the mutant allele. BRAF V600E-specific polymerase chain reaction was negative. Our report is the first to identify the rare, variant BRAF V600D mutation in LCH, and provides support for constitutively activated BRAF oncogene-induced cell senescence as a mechanism of regression in congenital, benign LCH. Further, our clinicopathologic findings provide proof for the first time that the V600D mutation can also occur in the absence of ultraviolet light, and can occur in a clinically benign proliferation, similar to the V600E mutation. Additional clinicopathologic studies in larger numbers of LCH patients may be valuable to ascertain the pathophysiologic role of BRAF mutations in LCH. © 2012 Wiley Periodicals, Inc.

Barnette A.R.,St Francis Medical Center | Barnette A.R.,University of Washington | Horbar J.D.,University of Vermont | Soll R.F.,University of Vermont | And 7 more authors.
Pediatrics | Year: 2014

BACKGROUND AND OBJECTIVE: Computed tomography (CT) is still used for neuroimaging of infants with known or suspected neurologic disorders. Alternative neuroimaging options that do not expose the immature brain to radiation include MRI and cranial ultrasound. We aim to characterize and compare the use and findings of neuroimaging modalities, especially CT, in infants with neonatal encephalopathy. METHODS: The Vermont Oxford Network Neonatal Encephalopathy Registry enrolled 4171 infants (≥36 weeks' gestation or treated with therapeutic hypothermia) between 2006 and 2010 who were diagnosed with encephalopathy in the first 3 days of life. Demographic, perinatal, and medical conditions were recorded, along with treatments, comorbidities, and outcomes. The modality, timing, and results of neuroimaging were also collected. RESULTS: CT scans were performed on 933 of 4107 (22.7%) infants, and 100 of 921 (10.9%) of those received multiple CT scans. Compared with MRI, CT provided less detailed evaluation of cerebral injury in areas of prognostic significance, but was more sensitive than cranial ultrasound for hemorrhage and deep brain structural abnormalities. CONCLUSIONS: CT is commonly used for neuroimaging in newborn infants with neonatal encephalopathy despite concerns over potential harm from radiation exposure. The diagnostic performance of CT is inferior to MRI in identifying neonatal brain injury. Our data suggest that using cranial ultrasound for screening, followed by MRI would be more appropriate than CTat any stage to evaluate infants with neonatal encephalopathy. Copyright © 2014 by the American Academy of Pediatrics.

Perry R.E.,Trenton Health Team | Stephenson C.,St Francis Medical Center
Population Health Management | Year: 2013

As a health care collaborative among Trenton's hospitals, its only Federally Qualified Health Center, its Division of Health, and more than 40 community organizations serving on the Community Advisory Board, Trenton Health Team has leveraged unprecedented data sharing and direct engagement with community residents to identify the health needs and priorities for its geography. This process has resulted in a unified Community Health Needs Assessment and Community Health Improvement Plan for the city of Trenton, allowing collaborative allocation of resources to manage and improve population health in the city. (Population Health Management 2013;16:S-34-S-37) © Copyright 2013, Mary Ann Liebert, Inc.

Stone R.H.,St Francis Medical Center | Bricknell S.S.,St Francis Medical Center
Respiratory Care | Year: 2011

Partial or total obstruction of an endotracheal tube (ETT) by mucus can cause severe respiratory distress, hypoxemia, or death. Signs of an obstructed ETT include increased ventilation pressure, changes in the ventilator graphics, SpO2 decrease, and cardiovascular changes. We present 3 patients whose ETTs were partially obstructed by mucus. In each case the patient displayed adverse effects from the obstruction, but once the obstruction was removed they showed dramatic improvement. In each case we used a new device (Rescue Cath, Omneotech, Tavernier, Florida) designed to remove mucus from the ETT lumen. The 3 cases demonstrate that the device is effective and capable of relieving the adverse effects of ETT mucus obstruction. © 2011 Daedalus Enterprises.

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