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Search Results for all work with filters:

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Work 1-10 of 63

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Article

Real-Time Magnetic Resonance-Guided Stereotactic Laser Amygdalohippocampotomy for Mesial Temporal Lobe Epilepsy

by Jon T. Willie; Nealen G. Laxpati; Daniel L Drane; Ashok Gowda; Christina Appin; Chunhai Hao; Daniel J Brat; Sandra Helmers; Amit Saindane; Sherif G Nour; Robert Gross

2014

Subjects
  • Biology, Neuroscience
  • Health Sciences, Medicine and Surgery
  • Engineering, Biomedical
  • File Download
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Abstract:Close

BACKGROUND: Open surgery effectively treats mesial temporal lobe epilepsy, but carries the risk of neurocognitive deficits, which may be reduced with minimally invasive alternatives. OBJECTIVE: To describe technical and clinical outcomes of stereotactic laser amygdalohippocampotomy with real-time magnetic resonance thermal imaging guidance. METHODS: With patients under general anesthesia and using standard stereotactic methods, 13 adult patients with intractable mesial temporal lobe epilepsy (with and without mesial temporal sclerosis [MTS]) prospectively underwent insertion of a saline-cooled fiberoptic laser applicator in amygdalohippocampal structures from an occipital trajectory. Computer-controlled laser ablation was performed during continuous magnetic resonance thermal imaging followed by confirmatory contrast-enhanced anatomic imaging and volumetric reconstruction. Clinical outcomes were determined from seizure diaries. RESULTS: A mean 60% volume of the amygdalohippocampal complex was ablated in 13 patients (9 with MTS) undergoing 15 procedures. Median hospitalization was 1 day. With follow-up ranging from 5 to 26 months (median, 14 months), 77% (10/13) of patients achieved meaningful seizure reduction, of whom 54% (7/13) were free of disabling seizures. Of patients with preoperative MTS, 67% (6/9) achieved seizure freedom. All recurrences were observed before 6 months. Variances in ablation volume and length did not account for individual clinical outcomes. Although no complications of laser therapy itself were observed, 1 significant complication, a visual field defect, resulted from deviated insertion of a stereotactic aligning rod, which was corrected before ablation. CONCLUSION: Real-time magnetic resonance-guided stereotactic laser amygdalohippocampotomy is a technically novel, safe, and effective alternative to open surgery. Further evaluation with larger cohorts over time is warranted.

Article

Pseudoaneurysm of the Second Dorsal Metatarsal Artery: Case Report and Literature Review

by Christopher Kinter; Christopher W. Hodgkins

2019

Subjects
  • Health Sciences, Medicine and Surgery
  • File Download
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Pseudoaneurysms are a rare complication of foot and ankle surgeries that can potentially lead to serious sequelae, especially when there is delay in the diagnosis. Due to the rarity of this occurrence, guidelines for management are limited for orthopedic surgeons. Once diagnosed, the surgeon has to decide quickly on many options for how to best manage the patient. In this case report, we present the occurrence of a dorsal second metatarsal artery pseudoaneurysm that occurred after removal of hardware. We also discuss the most current literature on the subject to help guide other surgeons in the diagnosis and management of this condition.

Article

Transplant-Free Survival and Interventions at 6 Years in the SVR Trial

by Jane W. Newburger; Lynn A. Sleeper; J. William Gaynor; Danielle Hollenbeck-Pringle; Peter C. Frommelt; Jennifer S. Li; William Mahle; Ismee A. Williams; Andrew M. Atz; Kristin M. Burns; Shan Chen; James Cnota; Carolyn Dunbar-Masterson; Nancy S. Ghanayem; Caren S. Goldberg; Jeffrey P. Jacobs; Alan B. Lewis; Seema Mital; Christian Pizarro; Aaron Eckhauser; Paul Stark; Richard G. Ohye

2018

Subjects
  • Health Sciences, Medicine and Surgery
  • File Download
  • View Abstract

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BACKGROUND: In the SVR trial (Single Ventricle Reconstruction), 1-year transplant-free survival was better for the Norwood procedure with right ventricle-to-pulmonary artery shunt (RVPAS) compared with a modified Blalock‒Taussig shunt in patients with hypoplastic left heart and related syndromes. At 6 years, we compared transplant-free survival and other outcomes between the groups. METHODS: Medical history was collected annually using medical record review, telephone interviews, and the death index. The cohort included 549 patients randomized and treated in the SVR trial. RESULTS: Transplant-free survival for the RVPAS versus modified Blalock‒Taussig shunt groups did not differ at 6 years (64% versus 59%, P=0.25) or with all available follow-up of 7.1±1.6 years (log-rank P=0.13). The RVPAS versus modified Blalock‒Taussig shunt treatment effect had nonproportional hazards (P=0.009); the hazard ratio (HR) for death or transplant favored the RVPAS before stage II surgery (HR, 0.66; 95% confidence interval, 0.48-0.92). The effect of shunt type on death or transplant was not statistically significant between stage II to Fontan surgery (HR, 1.36; 95% confidence interval, 0.86-2.17; P=0.17) or after the Fontan procedure (HR, 0.76; 95% confidence interval, 0.33-1.74; P=0.52). By 6 years, patients with RVPAS had a higher incidence of catheter interventions (0.38 versus 0.23/patient-year, P<0.001), primarily because of more interventions between the stage II and Fontan procedures (HR, 1.72; 95% confidence interval, 1.00-3.03). Complications did not differ by shunt type; by 6 years, 1 in 5 patients had had a thrombotic event, and 1 in 6 had had seizures. CONCLUSIONS: By 6 years, the hazards of death or transplant and catheter interventions were not different between the RVPAS versus modified Blalock‒Taussig shunt groups. Children assigned to the RVPAS group had 5% higher transplant-free survival, but the difference did not reach statistical significance, and they required more catheter interventions. Both treatment groups have accrued important complications.

Article

Magnetic resonance imaging-guided surgical design: can we optimise the Fontan operation?

by Christopher M. Haggerty; Ajit Yoganathan; Mark A. Fogel

2013

Subjects
  • Health Sciences, Medicine and Surgery
  • Engineering, Biomedical
  • Health Sciences, Radiology
  • File Download
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The Fontan procedure, although an imperfect solution for children born with a single functional ventricle, is the only reconstruction at present short of transplantation. The haemodynamics associated with the total cavopulmonary connection, the modern approach to Fontan, are severely altered from the normal biventricular circulation and may contribute to the long-term complications that are frequently noted. Through recent technological advances, spear-headed by advances in medical imaging, it is now possible to virtually model these surgical procedures and evaluate the patient-specific haemodynamics as part of the pre-operative planning process. This is a novel paradigm with the potential to revolutionise the approach to Fontan surgery, help to optimise the haemodynamic results, and improve patient outcomes. This review provides a brief overview of these methods, presents preliminary results of their clinical usage, and offers insights into its potential future directions.

Article

The influence of context on recognition memory in monkeys: Effects of hippocampal, parahippocampal and perirhinal lesions

by Jocelyne Bachevalier; Sarah Nemanic; Maria Alvarado

2015

Subjects
  • Psychology, Experimental
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This study further investigated the specific contributions of the medial temporal lobe structures to contextual recognition memory. Monkeys (. Macaca mulatta) with either neurotoxic lesions of the hippocampus, aspiration lesions of the perirhinal cortex and parahippocampal areas TH/TF, or sham operations were tested on five conditions of a visual-paired comparison (VPC) task in which 3-dimensional objects were presented over multicolored backgrounds. In two conditions (Conditions 1 and 2: Context-changes), the sample object was presented on a new background during the retention tests, whereas in the three others (Conditions 3-5: No-context-changes) the sample object was presented over its familiar background. Novelty preference scores of control animals were weaker, but still significantly different from chance, in the Context-changes conditions than on the No-context-changes conditions. Animals in the three experimental groups showed strong preference for novelty on the No-context-change conditions, but weaker novelty preference on the Context-change conditions than controls. Thus, animals in all three lesion types had greater difficulty recognizing an object when its background was different from that used during encoding. The data are consistent with the view that the hippocampal formation, areas TH/TF, and perirhinal cortex contribute interactively to contextual memory processes.

Article

Risk Factors for Major Adverse Events Late after Fontan Palliation

by Robert W. Elder; Nancy M. McCabe; Emir Veledar; Brian Kogon; Maan Jokhadar; Fred Rodriguez III; Michael McConnell; Wendy Book

2015

Subjects
  • Health Sciences, General
  • Health Sciences, Medicine and Surgery
  • File Download
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Objective: Risk factors for major adverse events late after Fontan palliation are unknown. Prior studies have suggested ventricular function and morphology as important risk factors. The aim of this study is to (1) characterize the late major adverse event profile in adult Fontan patients and (2) identify additional risk factors that may contribute to adverse outcomes. Design and Setting: A retrospective review of all adult patients >15 years post-Fontan seen at a tertiary academic center was conducted. Clinical, laboratory, cardiac data, and abdominal imaging were collected via chart review. Major adverse events (death, cardiac transplantation, or listing) were identified, and timing of events was plotted using Kaplan-Meier methods. Univariate and multivariate logistic regression was used to determine independent predictors of late-term events. Results: A total of 123 adult Fontan patients were identified (mean time post-Fontan 22.4 years [±4.4]). Major adverse events occurred in 19/123 patients (15%). In this 15-year survivor cohort, transplant-free survival rates were 94.6%, 82.9%, and 59.8% at 20, 25, and 30 years postoperation, respectively. Modes of death were Fontan failure with preserved function (4), congestive heart failure with decreased function (2), sudden death (2), thromboembolic event (1), post-Fontan conversion (2), and posttransplant (2). No differences in adverse outcomes were found based on morphology of the systemic ventricle, Fontan type, or systolic ventricular function. On the other hand, features of portal hypertension (OR 19.0, CI 4.7-77.3, P < .0001), presence of a pacemaker (OR 13.4, CI 2.6-69.8, P=.002), and systemic oxygen desaturation (OR 0.86, CI 0.75-0.98, P=.02) were risk factors for major adverse events in the multivariate analysis. Conclusions: In adult Fontan patients surviving >15 years post-Fontan, portal hypertension, oxygen desaturation, and need for pacemaker were predictive of adverse events. Traditional measures may not predict late-term outcomes in adult survivors; further study of the liver's role in late outcomes is warranted.

Article

Factors Associated with Neurodevelopment for Children with Single Ventricle Lesions

by Caren S. Goldberg; Minmin Lu; Lynn A. Sleeper; William Mahle; J. William Gaynor; Ismee A. Williams; Kathleen A. Mussatto; Richard G. Ohye; Eric M. Graham; Deborah U. Frank; Jeffrey P. Jacobs; Catherine Krawczeski; Linda Lambert; Alan Lewis; Victoria L. Pemberton; Renee Sananes; Eric Sood; Stephanie Wechsler; David C. Bellinger; Jane W. Newburger

2014

Subjects
  • Health Sciences, Medicine and Surgery
  • Health Sciences, Human Development
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Objectiv:e To measure neurodevelopment at 3 years of age in children with single right-ventricle anomalies and to assess its relationship to Norwood shunt type, neurodevelopment at 14 months of age, and patient and medical factors. Study design: All subjects in the Single Ventricle Reconstruction Trial who were alive without cardiac transplant were eligible for inclusion. The Ages and Stages Questionnaire (ASQ, n = 203) and other measures of behavior and quality of life were completed at age 3 years. Medical history, including measures of growth, feeding, and complications, was assessed through annual review of the records and phone interviews. The Bayley Scales of Infant Development, Second Edition (BSID-II) scores from age 14 months were also evaluated as predictors. Results: Scores on each ASQ domain were significantly lower than normal (P <.001). ASQ domain scores at 3 years of age varied nonlinearly with 14-month BSID-II. More complications, abnormal growth, and evidence of feeding, vision, or hearing problems were independently associated with lower ASQ scores, although models explained <30% of variation. Type of shunt was not associated with any ASQ domain score or with behavior or quality-of-life measures. Conclusion: Children with single right-ventricle anomalies have impaired neurodevelopment at 3 years of age. Lower ASQ scores are associated with medical morbidity, and lower BSID-II scores but not with shunt type. Because only a modest percentage of variation in 3-year neurodevelopmental outcome could be predicted from early measures, however, all children with single right-ventricle anomalies should be followed longitudinally to improve recognition of delays.

Article

Comparative Definitions for Moderate-Severe Ischemia in Stress Nuclear, Echocardiography, and Magnetic Resonance Imaging

by Leslee Shaw; Daniel S. Berman; Michael H. Picard; Matthias G. Friedrich; Raymond Y. Kwong; Gregg W. Stone; Roxy Senior; James K. Min; Rory Hachamovitch; Marielle Scherrer-Crosbie; Jennifer H. Mieres; Thomas H. Marwick; Lawrence M. Phillips; Farooq A. Chaudhry; Patricia A. Pellikka; Piotr Slomka; Andrew E. Arai; Ami E. Iskandrian; Timothy M. Bateman; Gary V. Heller; Abhinav Goyal

2014

Subjects
  • Health Sciences, Medicine and Surgery
  • Health Sciences, Radiology
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The lack of standardized reporting of the magnitude of ischemia on noninvasive imaging contributes to variability in translating the severity of ischemia across stress imaging modalities. We identified the risk of coronary artery disease (CAD) death or myocardial infarction (MI) associated with ≥10% ischemic myocardium on stress nuclear imaging as the risk threshold for stress echocardiography and cardiac magnetic resonance. A narrative review revealed that ≥10% ischemic myocardium on stress nuclear imaging was associated with a median rate of CAD death or MI of 4.9%/year (interquartile range: 3.75% to 5.3%). For stress echocardiography, ≥3 newly dysfunctional segments portend a median rate of CAD death or MI of 4.5%/year (interquartile range: 3.8% to 5.9%). Although imprecisely delineated, moderate-severe ischemia on cardiac magnetic resonance may be indicated by ≥4 of 32 stress perfusion defects or ≥3 dobutamine-induced dysfunctional segments. Risk-based thresholds can define equivalent amounts of ischemia across the stress imaging modalities, which will help to translate a common understanding of patient risk on which to guide subsequent management decisions.

Article

Geometric Characterization of Patient-Specific Total Cavopulmonary Connections and its Relationship to Hemodynamics

by Elaine Tang; Maria Restrepo; Christopher M. Haggerty; Lucia Mirabella; James Bethel; Kevin K. Whitehead; Mark A. Fogel; Ajit Yoganathan

2014

Subjects
  • Engineering, Biomedical
  • Health Sciences, Medicine and Surgery
  • File Download
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Total cavopulmonary connection (TCPC) geometries have great variability. Geometric features, such as diameter, connection angle, and distance between vessels, are hypothesized to affect the energetics and flow dynamics within the connection. This study aimed to identify important geometric characteristics that can influence TCPC hemodynamics. Anatomies from 108 consecutive patients were reconstructed from cardiac magnetic resonance (CMR) images and analyzed for their geometric features. Vessel flow rates were computed from phase contrast CMR. Computational fluid dynamics simulations were carried out to quantify the indexed power loss and hepatic flow distribution. TCPC indexed power loss correlated inversely with minimum Fontan pathway (FP), left pulmonary artery, and right pulmonary artery diameters. Cardiac index correlated with minimum FP diameter and superior vena cava (SVC) minimum/maximum diameter ratio. Hepatic flow distribution correlated with caval offset, pulmonary flow distribution, and the angle between FP and SVC. These correlations can have important implications for future connection design and patient follow-up.

Article

Rationale and methodology of a collaborative learning project in congenital cardiac care

by Michael J. Wolf; Eva K. Lee; Susan C. Nicolson; Gail D. Pearson; Madolin K. Witte; Jeryl Huckaby; Michael Gaies; Lara S. Shekerdemian; William Mahle

2016

Subjects
  • Health Sciences, Medicine and Surgery
  • Health Sciences, General
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Background Collaborative learning is a technique through which individuals or teams learn together by capitalizing on one another's knowledge, skills, resources, experience, and ideas. Clinicians providing congenital cardiac care may benefit from collaborative learning given the complexity of the patient population and team approach to patient care. Rationale and development Industrial system engineers first performed broad-based time-motion and process analyses of congenital cardiac care programs at 5 Pediatric Heart Network core centers. Rotating multidisciplinary team site visits to each center were completed to facilitate deep learning and information exchange. Through monthly conference calls and an in-person meeting, we determined that duration of mechanical ventilation following infant cardiac surgery was one key variation that could impact a number of clinical outcomes. This was underscored by one participating center's practice of early extubation in the majority of its patients. A consensus clinical practice guideline using collaborative learning was developed and implemented by multidisciplinary teams from the same 5 centers. The 1-year prospective initiative was completed in May 2015, and data analysis is under way. Conclusion Collaborative learning that uses multidisciplinary team site visits and information sharing allows for rapid structured fact-finding and dissemination of expertise among institutions. System modeling and machine learning approaches objectively identify and prioritize focused areas for guideline development. The collaborative learning framework can potentially be applied to other components of congenital cardiac care and provide a complement to randomized clinical trials as a method to rapidly inform and improve the care of children with congenital heart disease.
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