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Tampa, FL, United States

Matar F.,Tampa General Hospital | Mroue J.,Saint - Joseph University
Journal of Cardiovascular Translational Research | Year: 2012

Plaque rupture with superimposed thrombosis is the major mechanism of acute coronary syndromes. Although angiography underestimates the presence of thrombi, their detection is a poor prognostic indicator which is proportional to their size. Although emergent percutaneous coronary intervention (PCI) in the setting of ST elevation myocardial infarction (STEMI) and early PCI in the setting of unstable angina and non-STEMI were shown to be preferred strategies, the presence of angiographic thrombosis by virtue of causing micro and macro embolization can reduce the benefit of the intervention. Antiplatelet therapy especially using glycoprotein IIb/IIIa inhibitors reduces thrombus size, and improves myocardial perfusion and ventricular function. Routine manual aspiration prior to PCI in STEMI also improves myocardial flow and reduces distal embolization and improves survival. Distal embolic protection devices and mechanical thrombectomy do not have the same clinical benefits however, rheolytic thrombectomy may have a role in large vessels with a large thrombi. © Springer Science+Business Media, LLC 2011. Source


Trotter J.F.,Baylor University | Grafals M.,University of Washington | Alsina A.E.,Tampa General Hospital
Liver Transplantation | Year: 2013

Renal dysfunction is a critical issue for liver transplant candidates and recipients. Acute nephrotoxicity and chronic nephrotoxicity, however, are the compromises for the potent immunosuppression provided by calcineurin inhibitors (CNIs). To maintain the graft and patient survival afforded by CNIs while minimizing renal dysfunction in liver transplant patients, the reduction, delay, or elimination of CNIs in immunosuppression regimens is being implemented more frequently by clinicians. The void left by standard-dose CNIs is being filled by nonnephrotoxic immunosuppressants such as mycophenolates and mammalian target of rapamycin inhibitors. The results of studies of renal-sparing regimens in liver transplant recipients have been inconsistent, and this may be explained upon a closer examination of several study-related factors, including the study design and the duration of follow-up. © 2013 American Association for the Study of Liver Diseases. Source


Gargasz A.,Tampa General Hospital
AACN Advanced Critical Care | Year: 2012

Parenteral nutrition is one of the most important therapeutic modalities invented in the last several decades. Since its introduction in the 1960s, this modality has saved thousands of lives by providing nutrients parenterally to sustain growth in premature neonates with severe intestinal immaturity and other pediatric patients with intestinal failure, such as a gastrointestinal fistula or short bowel syndrome. Although parenteral nutrition can be a lifesaving treatment, it is not benign. Many complications can result from either short- or longterm usage. This review discusses the nutritional requirements, common complications, medication additives, and special considerations for pediatric patients requiring parenteral nutrition. © 2012, AACN. Source


Gundra U.M.,University of Texas at San Antonio | Mishra B.B.,University of Texas at San Antonio | Wong K.,Tampa General Hospital | Teale J.M.,University of Texas at San Antonio
Infection and Immunity | Year: 2011

In a murine model for neurocysticercosis (NCC), intracranial inoculation of the helminth parasite Mesocestoides corti induces multiple Toll-like receptors (TLRs), among which TLR2 is upregulated first and to a relatively high extent. Here, we report that TLR2-/- mice displayed significantly increased susceptibility to parasite infection accompanied by increased numbers of parasites in the brain parenchyma compared to infection in wild-type (WT) mice. This coincided with an increased display of microglial nodule formations and greater neuropathology than in the WT. Parasite-infected TLR2-/- brains exhibited a scarcity of lymphocytic cuffing and displayed reduced numbers of infiltrating leukocytes. Fluorescence-activated cell sorter (FACS) analyses revealed significantly lower numbers of CD11b+ myeloid cells, γδ T cells, αβ T cells, and B cells in the brains of parasite-infected TLR2-/- mice. This correlated with significantly reduced levels of inflammatory mediators, including tumor necrosis factor alpha (TNF-α), gamma interferon (IFN-γ), CCL2, CCL3, and interleukin-6 (IL-6) in the central nervous system (CNS) of TLR2-/- mice. As TLR2 has been implicated in immune regulation of helminth infections and as alternatively activated macrophages (AAMs) are thought to play a profound regulatory role in such infections, induction of AAMs in infected TLR2-/- mice was compared with that in WT mice. Parasite-infected WT brains showed larger numbers of macrophages/microglia (CD11b+ cells) expressing AAM-associated molecules such as YM1, Fizz1 (found in inflammatory zone-1 antigen), and arginase 1 than TLR2-/- brains, consistent with a protective role of AAMs during infection. Importantly, these results demonstrate that TLR2-associated responses modulate the disease severity of murine NCC. © 2011, American Society for Microbiology. Source


Davis C.R.,Tampa General Hospital
Cancer Control | Year: 2010

Background: Locoregional treatments of hepatocellular carcinoma (HCC) have evolved over the past 20 years. Interventional radiologists have developed an important role in the palliative and curative treatment of the disease. This review summarizes commonly used interventional radiological treatment protocols to assist practitioners in understanding the techniques used to treat HCC. Methods: Various searches were performed to evaluate recent publications regarding systemic treatments of HCC as well as transplant/surgery, chemoembolization, yttrium-90 radioembolization, percutaneous radiofrequency ablation (RFA), cryoablation, and percutaneous ethanol injection (PEI). Results: No standard for chemoembolization was found. Two studies evaluating survival with chemoembolization vs medical therapy found benefits with the former. PEI offers favorable outcomes in small HCC but has increased recurrence and decreased long-term survival compared with RFA. Local recurrence, response rates, and mortality from RFA rival surgical resection in HCC < 3 cm. Cryoablation appears to be effective, and yttrium-90 radioembolization is an additional tool. Conclusions: Chemoembolization improves survival and offers improved tumor response compared to systemic treatment. More studies are needed to standardize chemoembolization preparations and techniques. RFA provides better results than PEI but has not been compared with cryoablation. Radioembolization appears to be as effective as chemoembolization, but the preprocedure evaluation and costs may limit its use. Source

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