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  1. Article ; Online: Complex Endovascular Aortic Reconstruction: An Update.

    Chait, Jesse / Gilkey, George D / Mendes, Bernardo C / Ramakrishna, Harish

    Journal of cardiothoracic and vascular anesthesia

    2023  Volume 37, Issue 10, Page(s) 2125–2132

    MeSH term(s) Humans ; Blood Vessel Prosthesis ; Aortic Aneurysm, Abdominal/surgery ; Endovascular Procedures ; Blood Vessel Prosthesis Implantation ; Treatment Outcome ; Prosthesis Design ; Aortic Aneurysm, Thoracic/surgery ; Stents
    Language English
    Publishing date 2023-06-02
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1067317-9
    ISSN 1532-8422 ; 1053-0770
    ISSN (online) 1532-8422
    ISSN 1053-0770
    DOI 10.1053/j.jvca.2023.05.041
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Undiagnosed Systemic Mastocytosis Presenting as Postoperative Distributive Shock: A Case Report.

    Ripoll, Juan G / Ritter, Matthew J / Comfere, Thomas B / Smith, Mark M / Schaff, Hartzell V / Gilkey, George D / Warner, Matthew A

    A&A practice

    2019  Volume 13, Issue 10, Page(s) 392–395

    Abstract: Systemic mastocytosis (SM) is a rare clinical condition resulting from a clonal proliferation of abnormal mast cells. The clinical presentation may vary from mild cutaneous manifestations to aggressive systemic symptoms including intermittent episodes of ...

    Abstract Systemic mastocytosis (SM) is a rare clinical condition resulting from a clonal proliferation of abnormal mast cells. The clinical presentation may vary from mild cutaneous manifestations to aggressive systemic symptoms including intermittent episodes of anaphylaxis. We present a case of a 69-year-old male with abrupt and recurrent episodes of anaphylaxis with refractory distributive shock following cardiac surgery with cardiopulmonary bypass. Following a complex postoperative course, a bone marrow biopsy ultimately confirmed the diagnosis. Although rare, SM should be considered in the differential diagnosis of postoperative patients with unexplained and recurrent episodes of distributive shock.
    MeSH term(s) Aged ; Amino Acid Substitution ; Anaphylaxis/etiology ; Biopsy ; Cardiopulmonary Bypass/adverse effects ; Disease Management ; Humans ; Male ; Mastocytosis, Systemic/blood ; Mastocytosis, Systemic/diagnosis ; Mastocytosis, Systemic/genetics ; Myocardial Bridging/surgery ; Proto-Oncogene Proteins c-kit/genetics ; Shock, Hemorrhagic/etiology
    Chemical Substances KIT protein, human (EC 2.7.10.1) ; Proto-Oncogene Proteins c-kit (EC 2.7.10.1)
    Language English
    Publishing date 2019-09-30
    Publishing country United States
    Document type Case Reports ; Journal Article
    ISSN 2575-3126
    ISSN (online) 2575-3126
    DOI 10.1213/XAA.0000000000001093
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Cardiac calcified amorphous 'tumour': the CAT is on a broken line.

    Padang, Ratnasari / Kotkar, Kunal D / Gilkey, George D / Joyce, David L / Villarraga, Hector R

    European heart journal cardiovascular Imaging

    2016  Volume 17, Issue 9, Page(s) 1064

    MeSH term(s) Calcinosis/diagnostic imaging ; Catheterization, Central Venous/adverse effects ; Catheterization, Central Venous/instrumentation ; Catheters, Indwelling/adverse effects ; Diagnosis, Differential ; Echocardiography/methods ; Echocardiography, Three-Dimensional/methods ; Foreign Bodies/diagnostic imaging ; Foreign Bodies/surgery ; Heart Neoplasms/diagnostic imaging ; Humans ; Incidental Findings ; Male ; Middle Aged
    Language English
    Publishing date 2016-09
    Publishing country England
    Document type Case Reports ; Journal Article
    ZDB-ID 2638345-7
    ISSN 2047-2412 ; 2047-2404
    ISSN (online) 2047-2412
    ISSN 2047-2404
    DOI 10.1093/ehjci/jew112
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Cerebrospinal fluid drainage complications during first stage and completion fenestrated-branched endovascular aortic repair.

    Kärkkäinen, Jussi M / Cirillo-Penn, Nolan C / Sen, Indrani / Tenorio, Emanuel R / Mauermann, William J / Gilkey, George D / Kaufmann, Timothy J / Oderich, Gustavo S

    Journal of vascular surgery

    2019  Volume 71, Issue 4, Page(s) 1109–1118.e2

    Abstract: Objective: To determine the rates and risk factors of complications related to cerebrospinal fluid drainage (CSFD) during first stage and completion fenestrated-branched endovascular aortic repair (F-BEVAR) of pararenal and thoracoabdominal aortic ... ...

    Abstract Objective: To determine the rates and risk factors of complications related to cerebrospinal fluid drainage (CSFD) during first stage and completion fenestrated-branched endovascular aortic repair (F-BEVAR) of pararenal and thoracoabdominal aortic aneurysms.
    Methods: We reviewed the outcomes of 293 consecutive patients enrolled in a prospective, nonrandomized study to investigate outcomes of F-BEVAR between 2013 and 2018. Patients who received CSFD during first-stage thoracic endovascular aortic repair, index F-BEVAR, or completion of temporary aneurysm sac perfusion procedures were included in the analysis. CSFD complications were graded as severe or moderate if they were life threatening, escalated the level of care, or prolonged the hospital stay. Presence of substantial degenerative lumbar disease (DLD) was identified based on review of preoperative computed tomography. End points included technical difficulties during CSFD placement and CSFD-related complications.
    Results: A total of 187 patients (mean age, 73 ± 8 years; 70% male) treated for 20 pararenal and 167 thoracoabdominal aortic aneurysms received CSFD in 240 procedures, including 51 first-stage thoracic endovascular aortic repairs, 184 index F-BEVARs, and 5 completion temporary aneurysm sac perfusion procedures. Nineteen patients (10%) had 22 CSFD-related complications after 21 aortic procedures (9%). Complications were graded as severe to moderate in 17 patients (9%). There were 12 patients (6%) with intracranial hypotension, including three (2%) who had intracranial hemorrhage and nine (5%) with post dural puncture headache requiring blood patches in six. Another six patients (3%) developed spinal hematomas resulting in paraplegia in two (1%) and transient paraparesis in two (1%). One patient had CSF leakage from the puncture site (no intervention required). Four patients had bleeding during attempted drain placement, which required postponement of F-BEVAR. Technical difficulties were experienced in 57 drain insertions (24%), more often in patients with DLD than in those without DLD (35/113 [31%] vs 22/121 [18%]; P = .03). Fluoroscopic guidance was used in 44 drain placements (18%) with a lower rate of technical difficulties compared with the blind approach (9% vs 28%; P = .01). There was a statistically nonsignificant trend toward more complications in patients with technical challenges (14% vs 7%; P = .10). Of 13 study patients who developed spinal cord injuries during aortic procedures, 4 (31%) were attributed to CSFD.
    Conclusions: Although CSFD is widely used to prevent ischemic spinal cord injury during complex aortic repair, the risk of major CSFD-related complications is not negligible and should be carefully weighed against its potential benefits. One-third of spinal cord injuries were caused by CSF drain placement. The use of fluoroscopic guidance may decrease the risk of CSFD-related complications.
    MeSH term(s) Aged ; Aortic Aneurysm, Thoracic/surgery ; Cerebrospinal Fluid Leak/complications ; Endovascular Procedures/methods ; Female ; Humans ; Male ; Prospective Studies ; Risk Factors
    Language English
    Publishing date 2019-09-26
    Publishing country United States
    Document type Journal Article
    ZDB-ID 605700-7
    ISSN 1097-6809 ; 0741-5214
    ISSN (online) 1097-6809
    ISSN 0741-5214
    DOI 10.1016/j.jvs.2019.06.210
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Emergency Manual Implementation in a Large Academic Anesthesia Practice: Strategy and Improvement in Performance on Critical Steps.

    Gleich, Stephen J / Pearson, Amy C S / Lindeen, Kevin C / Hofer, Ryan E / Gilkey, George D / Borst, Luann F / Haile, Dawit T / Martin, David P

    Anesthesia and analgesia

    2018  Volume 128, Issue 2, Page(s) 335–341

    Abstract: Background: The use of cognitive aids, such as emergency manuals (EMs), improves team performance on critical steps during crisis events. In our large academic anesthesia practice, we sought to broadly implement an EM and subsequently evaluate team ... ...

    Abstract Background: The use of cognitive aids, such as emergency manuals (EMs), improves team performance on critical steps during crisis events. In our large academic anesthesia practice, we sought to broadly implement an EM and subsequently evaluate team member performance on critical steps.
    Methods: We observed the phases of implementing an EM at a large academic anesthesia practice from 2013 to 2016, including the formation of the EM implementation team, identification of preferred EM characteristics, consideration of institution-specific factors, selection of the preferred EM, recognition of logistical barriers, and staff education. Utilization of the EM was tested in a regular clinical environment with all available resources using a standardized verbal simulation of 3 crisis events both preimplementation and 6 months postimplementation. Individual members of the anesthesia team were asked to verbalize interventions for specific crisis events over 60 seconds.
    Results: We introduced a customized version of the Stanford Emergency Manual on January 26, 2015. Fifty-nine total participants (equal proportion of anesthesiology attending physicians, resident physicians, certified registered nurse anesthetists, and student registered nurse anesthetist staff) were surveyed in the preimplementation phase and 60 in the 6-month postimplementation phase. In the postimplementation phase, a minority (41.7%) utilized the EM for the verbal-simulated crisis events. Those who used the EM performed better than those who did not (median 21.0 critical steps out of a possible 30 total steps [70.0%], interquartile range 19-25 vs 18.0 critical steps verbalized [60.0%], interquartile range 16-20; P < .001). Among all subjects, the median number of critical steps verbalized was 16 (53.3%) preimplementation and 19.5 critical steps (65.0%) postimplementation.
    Conclusions: Implementation of an EM in a large academic anesthesia practice is not without challenges. While full integration of the EM was not achieved 6 months after implementation, verbalization of critical steps on 3 simulated crisis events improved when the EM was utilized.
    MeSH term(s) Academic Medical Centers/standards ; Academic Medical Centers/trends ; Anesthesia/standards ; Anesthesia/trends ; Clinical Competence/standards ; Emergency Medical Services/standards ; Emergency Medical Services/trends ; Humans ; Manuals as Topic/standards ; Workflow
    Language English
    Publishing date 2018-06-25
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80032-6
    ISSN 1526-7598 ; 0003-2999
    ISSN (online) 1526-7598
    ISSN 0003-2999
    DOI 10.1213/ANE.0000000000003578
    Database MEDical Literature Analysis and Retrieval System OnLINE

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