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  1. Article ; Online: Postoperative Diaphragmatic Liver Herniation Diagnosed by Point-of-Care Ultrasound.

    Prayal-Brown, Audrey / Eissa, Mohamed S / Tryphonopoulos, Peter / Talab, Hesham F / McFaul, Colleen M

    A&A practice

    2021  Volume 15, Issue 1, Page(s) e01366

    Abstract: Point-of-care ultrasound (PoCUS) is a sensitive and specific tool in early identification of malignant pathologies in unstable patients leading to improved outcomes. Postoperative diaphragmatic rupture is rare, can be life-threatening, and is difficult ... ...

    Abstract Point-of-care ultrasound (PoCUS) is a sensitive and specific tool in early identification of malignant pathologies in unstable patients leading to improved outcomes. Postoperative diaphragmatic rupture is rare, can be life-threatening, and is difficult to diagnose. This report describes a 62-year-old women undergoing thoracoscopic right hemidiaphragm plication with acute postoperative hemodynamic instability. Bedside PoCUS identified hepatic herniation into the thorax causing cardiac compression and lateral displacement, which lead to expedited imaging and surgical reexploration.
    MeSH term(s) Diaphragm/diagnostic imaging ; Diaphragm/surgery ; Female ; Humans ; Liver ; Middle Aged ; Point-of-Care Systems ; Point-of-Care Testing ; Ultrasonography
    Language English
    Publishing date 2021-01-06
    Publishing country United States
    Document type Journal Article
    ISSN 2575-3126
    ISSN (online) 2575-3126
    DOI 10.1213/XAA.0000000000001366
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: COVID-19 and One-Lung Ventilation.

    Tryphonopoulos, Peter / McFaul, Colleen / Gagne, Sylvain / Moffett, Stephane / Byford, Larry / Thompson, Calvin

    Anesthesia and analgesia

    2020  Volume 131, Issue 2, Page(s) e90–e91

    MeSH term(s) Aerosols/adverse effects ; Betacoronavirus ; COVID-19 ; Coronavirus Infections/prevention & control ; Coronavirus Infections/surgery ; Coronavirus Infections/transmission ; Humans ; Occupational Exposure/prevention & control ; One-Lung Ventilation/methods ; One-Lung Ventilation/standards ; Pandemics/prevention & control ; Pneumonia, Viral/prevention & control ; Pneumonia, Viral/surgery ; Pneumonia, Viral/transmission ; SARS-CoV-2
    Chemical Substances Aerosols
    Keywords covid19
    Language English
    Publishing date 2020-04-28
    Publishing country United States
    Document type Letter
    ZDB-ID 80032-6
    ISSN 1526-7598 ; 0003-2999
    ISSN (online) 1526-7598
    ISSN 0003-2999
    DOI 10.1213/ANE.0000000000004915
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.MO 149: Show issues

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  4. Article ; Online: COVID-19 and One-Lung Ventilation

    Tryphonopoulos, Peter / McFaul, Colleen / Gagne, Sylvain / Moffett, Stephane / Byford, Larry / Thompson, Calvin

    Anesthesia & Analgesia

    2020  Volume 131, Issue 2, Page(s) e90–e91

    Keywords Anesthesiology and Pain Medicine ; covid19
    Language English
    Publisher Ovid Technologies (Wolters Kluwer Health)
    Publishing country us
    Document type Article ; Online
    ZDB-ID 80032-6
    ISSN 1526-7598 ; 0003-2999
    ISSN (online) 1526-7598
    ISSN 0003-2999
    DOI 10.1213/ane.0000000000004915
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Article: Outcomes of General Anesthesia and Conscious Sedation in Endovascular Treatment for Stroke.

    Just, Caroline / Rizek, Philippe / Tryphonopoulos, Peter / Pelz, David / Arango, Miguel

    The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques

    2016  Volume 43, Issue 5, Page(s) 655–658

    Abstract: Background Recent studies have strongly indicated the benefits of endovascular therapy for acute ischemic stroke, but what remains a continued debate is the role for general anaesthesia versus conscious sedation (CS) for such procedures. Retrospective ... ...

    Abstract Background Recent studies have strongly indicated the benefits of endovascular therapy for acute ischemic stroke, but what remains a continued debate is the role for general anaesthesia versus conscious sedation (CS) for such procedures. Retrospective studies have found poorer neurological outcomes in patients who underwent general anesthesia (GA); however, some have revealed worse baseline stroke severity in these patients. Methods This study is a retrospective cohort study aimed at comparing mortality and morbidity of GA versus CS in patients treated with endovascular intervention in acute ischemic stroke. Chi-square and t-test analyses were used. Results Patients in the GA (n=42) group were more likely to be deceased than those in the CS (n=67) group at hospital discharge, 3 months, and 6 months poststroke onset. Morbidity, as defined by modified Rankin Score, was significantly greater in the GA group at hospital discharge, and a similar trend was seen in morbidity at 3 months postdischarge. Conclusion General anesthesia for endovascular intervention in acute ischemic stroke was associated with increased mortality and poorer neurological incomes compared with conscious sedation. In our study, age, gender, history of hypertension, history of diabetes, and baseline National Institute of Health Stroke Scale were not significantly different between the groups. Although the need for a randomized, prospective study on this topic is clear, our study represents further corroboration of the safety and efficacy of conscious sedation in these procedures.
    MeSH term(s) Anesthesia, General/methods ; Brain Ischemia/complications ; Cohort Studies ; Conscious Sedation/methods ; Endovascular Procedures/methods ; Female ; Humans ; Male ; Middle Aged ; Severity of Illness Index ; Statistics, Nonparametric ; Stroke/etiology ; Stroke/mortality ; Stroke/surgery ; Time Factors ; Treatment Outcome
    Language English
    Publishing date 2016-09
    Publishing country England
    Document type Journal Article
    ZDB-ID 197622-9
    ISSN 0317-1671
    ISSN 0317-1671
    DOI 10.1017/cjn.2016.256
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 1203: Show issues Location:
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  6. Article ; Online: Is Serum Bicarbonate Level Associated With Negative Outcomes in Pediatric Patients?: A Retrospective Cohort Study.

    Poonai, Naveen / Mainprize, David / Travers, Carolyn / Vivas, Lilian Lee Yan / Tryphonopoulos, Peter / Sangha, Gurinder / Arbeau, Ryan / Seabrook, Jamie / Miller, Michael / Sarpal, Amrita / Lim, Rodrick

    Pediatric emergency care

    2017  Volume 33, Issue 11, Page(s) e108–e113

    Abstract: Objectives: Early identification of children at risk for adverse outcomes is important. Serum bicarbonate is easily collected and widely available. We described the relationship between bicarbonate and adverse outcomes in children presenting to the ... ...

    Abstract Objectives: Early identification of children at risk for adverse outcomes is important. Serum bicarbonate is easily collected and widely available. We described the relationship between bicarbonate and adverse outcomes in children presenting to the emergency department (ED).
    Methods: We conducted a retrospective cohort study of children aged 0 to 17 years from January 1, 2007, to December 31, 2011, who had a serum bicarbonate measured in the ED. Primary outcome was the predictive ability of bicarbonate for the individual components of the composite outcome that included at least one of the following: intensive care unit admission, assisted ventilation, inotropic support, cardiopulmonary resuscitation, or death. Secondary outcome was the relationship between bicarbonate level of greater and less than 13 mEq/L and the composite outcome.
    Results: We reviewed 16,989 charts, of which 432 had an adverse outcome. Receiver operating characteristic curve analysis showed that a bicarbonate level of less than 18.5 mEq/L predicted inotropic support with an area under the curve of 0.69 (95% confidence interval [CI], 0.60-0.77; P < 0.001) and death with an area under the curve of 0.75 (CI, 0.66-0.85; P < 0.001). Significantly more patients with bicarbonate level of less than 13 mEq/L had at least 1 adverse outcome compared with those with bicarbonate level of greater than 13 mEq/L (4.4% vs 2.5%, P = 0.001), odds ratio 1.96 (95% CI, 1.3-2.97).
    Conclusions: Among children presenting to the ED, bicarbonate level of 18.5 mEq/L had fair specificity in predicting inotropic support and death. Negative outcomes are significantly associated with bicarbonate level of less than 13 mEq/L. Bicarbonate should routinely be measured in children at risk of clinical deterioration.
    Language English
    Publishing date 2017-11
    Publishing country United States
    Document type Journal Article
    ZDB-ID 632588-9
    ISSN 1535-1815 ; 0749-5161
    ISSN (online) 1535-1815
    ISSN 0749-5161
    DOI 10.1097/PEC.0000000000000937
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 2083: Show issues Location:
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  7. Article: Blood citrulline level is an exclusionary marker for significant acute rejection after intestinal transplantation.

    David, Andre I / Selvaggi, Gennaro / Ruiz, Phillip / Gaynor, Jeffrey J / Tryphonopoulos, Panagiotis / Kleiner, Gary I / Moon, Jang I / Nishida, Seigo / Pappas, Peter A / Conanan, Lobella / Weppler, Debbie / Esquenazi, Violet / Levi, David M / Kato, Tomoaki / Tzakis, Andreas G

    Transplantation

    2007  Volume 84, Issue 9, Page(s) 1077–1081

    Abstract: Background: Serum citrulline is a marker for acute cellular rejection (ACR) after intestinal transplantation; however, its clinical utility has not yet been established. The goal of this study was to determine clearcut serum levels beyond which the ... ...

    Abstract Background: Serum citrulline is a marker for acute cellular rejection (ACR) after intestinal transplantation; however, its clinical utility has not yet been established. The goal of this study was to determine clearcut serum levels beyond which the diagnosis of acute rejection could be supported or refuted, and predictors of citrulline levels posttransplant from which more accurate estimates of sensitivity and specificity could be obtained.
    Methods: Since March 2004, we obtained 2135 dried blood spot (DBS) citrulline samples from 57 intestinal transplant recipients at or beyond 3 months posttransplant. Stepwise linear regression was performed to determine the most significant multivariable predictors of the patient's DBS citrulline level.
    Results: Seven characteristics were associated with a significantly lower citrulline in multivariable analysis: presence of mild, moderate, or severe ACR; presence of bacteremia or respiratory infection; pediatric age; and time from transplant to DBS sample (P<0.00001 in each case). Using a <13 vs. > or =13 micromoles/L cutoff point, the sensitivity for detecting moderate or severe ACR and the negative predictive value were high (96.4% and >99% respectively). Specificity was 54% to 74% in children and 83% to 88% in adults.
    Conclusions: Citrulline levels <13 micromoles/L should alert the clinical team that a serious problem (rejection or infection) could be looming in a previously stable intestinal recipient. Levels > =13 micromoles/L practically rule out moderate or severe rejection.
    MeSH term(s) Acute Disease ; Biomarkers/blood ; Citrulline/blood ; Female ; Graft Rejection/blood ; Graft Rejection/diagnosis ; Humans ; Intestines/transplantation ; Male ; Retrospective Studies ; Sensitivity and Specificity
    Chemical Substances Biomarkers ; Citrulline (29VT07BGDA)
    Language English
    Publishing date 2007-11-15
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 208424-7
    ISSN 1534-6080 ; 0041-1337
    ISSN (online) 1534-6080
    ISSN 0041-1337
    DOI 10.1097/01.tp.0000287186.04342.82
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 488: Show issues Location:
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