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Stony Brook, NY, United States

Bodily K.D.,Mayo Medical School | Cloft H.J.,Mayo Medical School | Lanzino G.,Mayo Medical School | Fiorella D.J.,Stony Brook Medical Center | And 2 more authors.
American Journal of Neuroradiology | Year: 2011

BACKGROUND AND PURPOSE: The use of stents for treatment of morphologically unfavorable, acutely ruptured aneurysms is avoided by most operators because of concerns about the risk of using dual antiplatelet therapy in the setting of acute SAH. Our aim was to review the literature regarding stent-assisted coil embolization of acutely ruptured intracranial aneurysms to determine the safety and efficacy of this treatment option. MATERIALS AND METHODS: Articles including ≥5 patients with ruptured aneurysms who were treated acutely with stent-assisted coiling or uncovered stent placement alone were identified. Data on clinical presentation, technical success, surgical crossover, intracranial complications, and clinical outcome were evaluated. RESULTS: A total of 17 articles were identified reporting 339 patients who met inclusion criteria. Among 212 patients with available data, technical success was noted in 198 (93%) patients. Three hundred twenty-six (96%) of 339 patients received both heparin during the procedure and dualantiplatelet therapy during or immediately postprocedure. One hundred thirty (63%) of 207 aneurysms were completely occluded. Six (2%) of 339 patients required surgical crossover, usually for failure in stent placement or for intraprocedural aneurysm rupture. Clinically significant intracranial hemorrhagic complications occurred in 27 (8%) of 339 patients, including 9 (10%) of 90 patients known to have EVDs who had ventricular drain-related hemorrhages. Clinically significant thromboembolic events occurred in 16 (6%) of 288 patients. Sixty-seven percent of patients had favorable clinical outcomes, 14% had poor outcomes, and 19% died. CONCLUSIONS: Stent-assisted coiling in ruptured aneurysms can be performed with high degrees of technical success, but adverse events appear more common and clinical outcomes are likely worse than those achieved without stent assistance. Thromboembolic complications appear reasonably well-controlled. Reported EVD-related hemorrhagic complications were uncommon, though the total number of EVDs placed was unknown. Source

Malgor R.D.,Stony Brook Medical Center
Phlebology / Venous Forum of the Royal Society of Medicine | Year: 2013

Venous thromboembolism is one of the most common causes of morbidity and mortality in modern societies. The entirety of events involved in venous thrombus formation and resolution remains to be elucidated. Temporal relation between the initial cellular insult, thrombus formation and resolution is critical for instituting a prompt treatment. This paper analyses the current basic knowledge and the events involved in venous re-modelling after an episode of venous thrombosis. Source

Orr T.M.,Stony Brook Medical Center | Orr II D.L.,University of Nevada, Las Vegas
Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology | Year: 2011

Background Methemoglobinemia is a potentially lethal condition which may result from exposure to benzocaine. It must be treated promptly, because it may cause a significant decrease in oxygen delivery to tissues and organs. Case description A 39-year-old caucasian man presented to the emergency department (ED) with dental pain. After a review of systems and a dental exam, an oxygen saturation of 90% was noted. The patient reported no previous cardiac or pulmonary pathology, but did report using a large amount of over-the-counter Anbesol. A second oxygen saturation measurement had fallen to 87%. An arterial blood gas sample was taken, and the patient was found to have high levels of methemoglobin. He was transfered to the critical care ED and treated with 2 mg/kg intravenous methylene blue. Clinical implications Dentists must be aware of the possible lethal effects of benzocaine toxicity, including methemoglobinemia. It is important to recognize the signs and symptoms and act in a judicious manner. © 2011 Mosby, Inc. All rights reserved. Source

Bosmans F.,U.S. National Institutes of Health | Puopolo M.,Harvard University | Puopolo M.,Stony Brook Medical Center | Martin-Eauclaire M.-F.,Roche Holding AG | And 2 more authors.
Journal of General Physiology | Year: 2011

The voltage-activated sodium (Nav) channel Nav1.9 is expressed in dorsal root ganglion (DRG) neurons where it is believed to play an important role in nociception. Progress in revealing the functional properties and pharmacological sensitivities of this non-canonical Nav channel has been slow because attempts to express this channel in a heterologous expression system have been unsuccessful. Here, we use a protein engineering approach to dissect the contributions of the four Nav1.9 voltage sensors to channel function and pharmacology. We define individual S3b-S4 paddle motifs within each voltage sensor, and show that they can sense changes in membrane voltage and drive voltage sensor activation when transplanted into voltage-activated potassium channels. We also find that the paddle motifs in Nav1.9 are targeted by animal toxins, and that these toxins alter Nav1.9-mediated currents in DRG neurons. Our results demonstrate that slowly activating and inactivating Nav1.9 channels have functional and pharmacological properties in common with canonical Nav channels, but also show distinctive pharmacological sensitivities that can potentially be exploited for developing novel treatments for pain. Source

Yilmaz T.,Stony Brook Medical Center | Cordero-Coma M.,Hospital de Leon
Indian Journal of Ophthalmology | Year: 2013

A 28-year-old healthy male complaining of vision loss in his right eye was discovered to have localized bi-nasal macular edema in the presence of a pituitary adenoma. The presence of a junctional scotoma composed by a central scotoma in the right eye associated with superior temporal quadrantanopia in the fellow eye was seen. The pattern detected in the visual field suggested the presence of an expansive mass at the level of the optic chiasm. Optical coherence tomography findings also revealed subtle macular thickness beyond normal in the superior and nasal quadrants of both maculae. This report illustrates the importance of suspecting a pituitary adenoma in the light of uncharacteristic retinal alterations. Source

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