Redline R.W.,University Hospitals Case Medical Center
American Journal of Obstetrics and Gynecology | Year: 2015
Placental pathology can be useful in a variety of ways including immediate diagnosis of important conditions affecting the mother or infant, identifying conditions that are likely to recur in subsequent pregnancies, separating clinical syndromes into distinct pathological phenotypes for further investigation, and uncovering the underlying cause of unexpected adverse outcomes. Classification of placental lesions has evolved from being a purely descriptive exercise through a stage in which the major pathophysiological processes such as disorders of maternal implantation and the amniotic fluid infection syndrome were first described to a recently proposed comprehensive classification system that includes all of the major maternal and fetal vascular and infectious and idiopathic/immune inflammatory processes (Amsterdam Placental Workshop Group). Implementation of this unified system with reproducible grading and staging should help establish evidence-based recommendations for placental submission and facilitate progress in studying the pathogenesis, diagnosis, and treatment of obstetric disorders with an underlying placental etiology. © 2015 Elsevier Inc.
Szabo A.L.,University Hospitals Case Medical Center
Anesthesia and Analgesia | Year: 2013
Although numerous studies have addressed the relationship between intrapartum neuraxial analgesia, particularly epidural fentanyl, and breastfeeding, substantial study design limitations have precluded the current literature from furnishing strong, clinically significant conclusions. Lack of randomized controlled trials, nonstandardization of breastfeeding evaluations across studies, and failure to control for confounding variables all pose significant problems. Further research is needed to elucidate the specific relationship between neuraxial opioids and breastfeeding and, if there are significant associations, whether these drugs act directly on neonatal brain tissue to attenuate exhibition of breastfeeding behaviors. In this review, I will detail the deficiencies of the current literature and make recommendations for future research. Copyright © 2013 International Anesthesia Research Society.
Hricik D.E.,University Hospitals Case Medical Center
Clinical Journal of the American Society of Nephrology | Year: 2011
The metabolic syndrome is a constellation of clinical abnormalities related to insulin resistance and inflammation. The syndrome is now recognized as a risk factor for diabetes and cardiovascular disease in the general population. Recent studies suggest that the metabolic syndrome is common after kidney transplantation, also possibly being predictive of allograft loss and poor allograft function. The development or worsening of obesity plays a central role in the development of metabolic syndrome after kidney transplantation. Immunosuppression also plays an important role in the pathogenesis of the individual components of the metabolic syndrome. In fact, the overriding influence of immunosuppressive medications makes it unclear whether the metabolic syndrome has the same value in predicting outcomes as is true in the general population. However, recent studies suggest that the presence of metabolic syndrome before transplantation predicts the subsequent development of new-onset diabetes after transplantation, independent of other widely known risk factors. Aggressive management of the metabolic syndrome is warranted both before and after transplantation. © 2011 by the American Society of Nephrology.
Wish J.B.,University Hospitals Case Medical Center
Kidney International | Year: 2011
The goal of a bundled payment policy for dialysis is to decrease overall expenditures and shift financial risk from the payer to the provider. The primary target for cost reduction is invariably erythropoiesis-stimulating agents (ESAs), because of their large costs and potential for dose sparing. Japan succeeded in reducing ESA doses and maintaining stable hemoglobin levels through modest increases in intravenous iron administration. Dialysis providers in the United States have this and other strategies available. © 2011 International Society of Nephrology.
Rogers L.R.,University Hospitals Case Medical Center
Epilepsia | Year: 2013
I present an overview of therapy for the most common rain tumors encountered in clinical practice f adult patients. Current therapy paradigms and volving therapies are reviewed. The introduction f non-enzyme-inducing antiepileptic drugs (NEIADs) as simplified the approach to combined edical treatment of epilepsy and brain tumors, but the major interactions between enzymeinducing ntiepileptic drugs (EIAEDs) are ncluded, to serve as guidance in selecting these edications if they are required. © 2013 International League Against Epilepsy.
Stein S.L.,University Hospitals Case Medical Center
Gastroenterology Clinics of North America | Year: 2013
Chronic pelvic pain is pain lasting longer than 6months and is estimated to occur in 15% of women. Causes of pelvic pain include disorders of gynecologic, urologic, gastroenterologic, and musculoskeletal systems. The multidisciplinary nature of chronic pelvic pain may complicate diagnosis and treatment. Treatments vary by cause but may include medicinal, neuroablative, and surgical treatments. © 2013 Elsevier Inc.
Eubanks J.D.,University Hospitals Case Medical Center
Journal of the American Academy of Orthopaedic Surgeons | Year: 2010
Total joint arthroplasty and deformity surgery of the spine can require complex reconstructive procedures accompanied by the potential for major blood loss. In an attempt to minimize the perioperative blood loss associated with these procedures, recent focus has concentrated on the efficacy of pharmacologic agents. Antifibrinolytics such as e-aminocaproic acid, tranexamic acid, and aprotinin have been shown to reduce perioperative blood loss, autologous blood donation, transfusions, and associated costs in cardiac as well as major orthopaedic surgery. These agents reduce perioperative blood loss by inhibition of clot breakdown. Prospective, randomized studies have shown that the use of these agents can be effective in reducing the perioperative blood loss and transfusion requirements in total joint arthroplasty, pediatric scoliosis surgery, and adult reconstructive surgery of the spine. Aprotinin, however, is currently under suspension from use pending further evaluation of a trial. Although concerns exist about increased thrombotic events with the use of these agents, large meta-analyses suggest that antifibrinolytics can be safely and efficaciously employed to decrease perioperative blood loss and transfusion requirements. Copyright 2010 by the American.
Rogers L.R.,University Hospitals Case Medical Center
Seminars in Neurology | Year: 2010
Stroke in the cancer patient is often caused by disorders of coagulation that are induced by the cancer, by cancer metastatic to the central nervous system, or by coagulation disorders or vascular injury due to cancer therapy. Nonbacterial thrombotic endocarditis in association with diffuse thrombosis of cerebral vessels is often the cause of cerebral infarction. Venous occlusion is most common in leukemic patients, but can also result from growth of solid tumor in the adjacent skull or dura. Chemotherapy administration is associated with a small risk of cerebral arterial or venous thrombosis. Radiation that is administered to the neck can result in delayed carotid atherosclerosis. Tumor embolization to the brain is a rare cause of stroke. Fungal septic cerebral emboli occur most commonly in leukemic patients who have undergone bone marrow transplantation. Hemorrhages occur in the brain parenchyma or the subdural and subarachnoid spaces and are most commonly caused by acute disseminated intravascular coagulation or metastatic tumor. Hemolysis from chemotherapy administration is a rare cause of brain hemorrhage. Careful clinical assessment, neuroimaging studies, measurement of coagulation function, and echocardiography are the most useful modalities to identify the cause of stroke. Copyright © 2010 by Thieme Medical Publishers, Inc.
University Hospitals Case Medical Center | Date: 2015-04-22
A spinal retractor system is provided to protect important structures of a patient while the surgeon performs surgery on spinal elements of the patient. The system includes a retractor blade including a retractor tab, a side body, and an upper platform having a tool connector tab for mating with a matching blade holder tool for securely holding the retractor blade. The retractor blade also has a screw holder attached to the side body of the retractor blade for receiving a bone screw provided in a channel of the screw holder A screwdriver is used to drive the bone screw into a vertebra of a patient, such as during an anterior spinal surgical procedure.
University Hospitals Case Medical Center | Date: 2014-03-14
Systems, methods, and devices for providing subcutaneous hydration are disclosed. A system for providing subcutaneous hydration may include an infusion bag including a hydration fluid, a tubing removably connected to the infusion bag, a squeezable bulb at least partially encompassing the tubing for at least one of flushing and priming the tubing, and a deployment device including an integrated needle which is operative provide subcutaneous hydration through the needle. A deployment device for subcutaneous hydration includes a base may include a needle aperture, a spring-loaded barrel attached the base and including a needle, and a firing mechanism within the barrel for deploying the needle from the barrel and further operative to project the needle through the aperture only when a tent of skin has been raised within the aperture for injection. A method for providing subcutaneous hydration may include steps necessary to operate the systems and devices for subcutaneous hydration.