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  1. Article: Erroneous Central Venous Catheter Placement: Multidisciplinary Primary Surgical Repair of the Vertebral Artery.

    Opperman, Patrick J / Thompson, Jonathan R / Surdell, Daniel L

    Cureus

    2022  Volume 14, Issue 3, Page(s) e22933

    Abstract: Central venous catheters are a common practice in critical care medicine. These lines are of particular importance when a patient needs large volume resuscitation or medications that cannot be infused through a peripheral line. Even though central venous ...

    Abstract Central venous catheters are a common practice in critical care medicine. These lines are of particular importance when a patient needs large volume resuscitation or medications that cannot be infused through a peripheral line. Even though central venous catheters are frequently utilized, they are associated with potentially significant risks that one must be aware of when attempting placement. The anatomy and pertinent complications are key for any healthcare professional to be aware of during this procedure. As such, vascular injury has been described in the literature, but vertebral artery injury and common repair techniques are less common. Primary repair of the second vertebral artery segment is infrequently detailed in the literature and this report describes pertinent case details and plan of action for identification and repair of iatrogenic vertebral artery injury following catheter placement.
    Language English
    Publishing date 2022-03-07
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.22933
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Intravascular ultrasound to aid in the diagnosis and revision of an intra-aortic pedicle screw: illustrative case.

    Ehlers, Landon D / Opperman, Patrick J / Mordeson, Jack E / Thompson, Jonathan R / Surdell, Daniel L

    Journal of neurosurgery. Case lessons

    2023  Volume 6, Issue 7

    Abstract: Background: Pedicle screw impingement on vessel walls has the potential for complications due to pulsatile effects and wall erosion. Artifacts from spinal instrumentation create difficulty in accurately evaluating this interface. The authors present the ...

    Abstract Background: Pedicle screw impingement on vessel walls has the potential for complications due to pulsatile effects and wall erosion. Artifacts from spinal instrumentation create difficulty in accurately evaluating this interface. The authors present the first case of intravascular ultrasound (IVUS) used to characterize a pedicle screw breach into the aortic lumen.
    Observations: A 21-year-old female with surgically corrected scoliosis underwent computed tomography angiography (CTA) 3 years postoperatively, which revealed a pedicle screw within the thoracic aorta lumen. Metal artifact distorted the CTA images, which prompted the decision to use intraoperative IVUS. The IVUS confirmed the noninvasive imaging findings and guided final decisions regarding aortic endograft size and location during spine hardware revision.
    Lessons: For asymptomatic patients presenting with pedicle screws malpositioned in or near the aorta, treatment decisions revolve around the extent of vessel wall penetration. Intraluminal depth can be obscured by artifact on computed tomography or magnetic resonance imaging or inadequately evaluated by a transesophageal echocardiogram. In our intraoperative experience, IVUS confirmed the depth of vessel lumen violation by a single pedicle screw and no wall penetration by two additional screws of concern. This was useful in deciding on thoracic endovascular aortic repair graft size and landing zone and facilitated safe spinal instrumentation removal and revision.
    Language English
    Publishing date 2023-08-14
    Publishing country United States
    Document type Journal Article
    ISSN 2694-1902
    ISSN (online) 2694-1902
    DOI 10.3171/CASE23272
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Decision-Making and Management in a Patient With Coexistent Colloid Cyst and Pituitary Macroadenoma: A Case Report.

    Koskay, Grant / Opperman, Patrick / Mezzacappa, Frank M / Surdell, Daniel

    Cureus

    2022  Volume 14, Issue 3, Page(s) e22884

    Abstract: The coexistence of separate and distinct primary intracranial tumors is rare. Specifically, there are no previous reports of a colloid cyst coexisting with a pituitary macroadenoma. We present the case of a 40-year-old male with a colloid cyst associated ...

    Abstract The coexistence of separate and distinct primary intracranial tumors is rare. Specifically, there are no previous reports of a colloid cyst coexisting with a pituitary macroadenoma. We present the case of a 40-year-old male with a colloid cyst associated with mild enlargement of the right lateral ventricle and a coexistent pituitary macroadenoma with compression of the optic apparatus. An endoscopic endonasal transsphenoidal surgery (EETS) for resection of the pituitary mass was performed first due to the patient's complaints of acute visual changes. He then underwent a right frontal craniotomy for resection of the colloid cyst one month later. The patient recovered without residual deficits in vision, and he did not require ventricular shunting after removal of the colloid cyst. We aimed to discuss our decision-making process and the management of these coexistent lesions.
    Language English
    Publishing date 2022-03-06
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.22884
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Stimulant Use for Analgesia: A Case Series.

    Opperman, Patrick J / Derr, John / Karre, VaKara M Meyer / Balasanova, Alëna A

    The primary care companion for CNS disorders

    2021  Volume 23, Issue 1

    MeSH term(s) Analgesia ; Central Nervous System Stimulants/adverse effects ; Humans ; Pain ; Pain Management
    Chemical Substances Central Nervous System Stimulants
    Language English
    Publishing date 2021-01-14
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2675414-9
    ISSN 2155-7780 ; 2155-7780
    ISSN (online) 2155-7780
    ISSN 2155-7780
    DOI 10.4088/PCC.20l02620
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Presacral mature cystic teratoma associated with Currarino syndrome in an adolescent with androgen insensitivity: illustrative case.

    Koskay, Grant / Opperman, Patrick / Mezzacappa, Frank M / Menousek, Joseph / Fuller, Megan K / Fornoff, Linden / Surdell, Daniel

    Journal of neurosurgery. Case lessons

    2022  Volume 4, Issue 18

    Abstract: Background: Currarino syndrome is a rare disorder that classically presents with the triad of presacral mass, anorectal malformation, and spinal dysraphism. The presacral mass is typically benign, although malignant transformation is possible. Surgical ... ...

    Abstract Background: Currarino syndrome is a rare disorder that classically presents with the triad of presacral mass, anorectal malformation, and spinal dysraphism. The presacral mass is typically benign, although malignant transformation is possible. Surgical treatment of the mass and exploration and repair of associated dysraphism are indicated for diagnosis and symptom relief. There are no previous reports of Currarino syndrome in an androgen-insensitive patient.
    Observations: A 17-year-old female patient presented with lack of menarche. Physical examination and laboratory investigation identified complete androgen insensitivity. Imaging analysis revealed a presacral mass lesion, and the patient was taken to surgery for resection of the mass and spinal cord untethering. Intraoperative ultrasound revealed a fibrous stalk connecting the thecal sac to the presacral mass, which was disconnected without the need for intrathecal exploration. The presacral mass was then resected, and pathological analysis revealed a mature cystic teratoma. Postoperatively, the patient recovered without neurological or gastrointestinal sequelae.
    Lessons: Diagnosis of incomplete Currarino syndrome may be difficult but can be identified via work-up of other disorders, such as androgen insensitivity. Intraoperative ultrasound is useful for surgical decision making and may obviate the need for intrathecal exploration during repair of dysraphism in the setting of Currarino syndrome.
    Language English
    Publishing date 2022-10-31
    Publishing country United States
    Document type Journal Article
    ISSN 2694-1902
    ISSN (online) 2694-1902
    DOI 10.3171/CASE22351
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Malondialdehyde-Acetaldehyde Modified (MAA) Proteins Differentially Effect the Inflammatory Response in Macrophage, Endothelial Cells and Animal Models of Cardiovascular Disease.

    Duryee, Michael J / Clemens, Dahn L / Opperman, Patrick J / Thiele, Geoffrey M / Duryee, Logan M / Garvin, Robert P / Anderson, Daniel R

    International journal of molecular sciences

    2021  Volume 22, Issue 23

    Abstract: Chronic inflammation plays a critical role in the pathogenesis of atherosclerosis. Currently, the mechanism(s) by which inflammation contributes to this disease are not entirely understood. Inflammation is known to induce oxidative stress, which can lead ...

    Abstract Chronic inflammation plays a critical role in the pathogenesis of atherosclerosis. Currently, the mechanism(s) by which inflammation contributes to this disease are not entirely understood. Inflammation is known to induce oxidative stress, which can lead to lipid peroxidation. Lipid peroxidation can result in the production of reactive by-products that can oxidatively modify macromolecules including DNA, proteins, and lipoproteins. A major reactive by-product of lipid peroxidation is malondialdehyde (MDA). MDA can subsequently break down to form acetaldehyde (AA). These two aldehydes can covalently interact with the epsilon (ε)-amino group of lysines within proteins and lipoproteins leading to the formation of extremely stable, highly immunogenic malondialdehyde/acetaldehyde adducts (MAA-adducts). The aim of this study was to investigate the inflammatory response to MAA-modified human serum albumin (HSA-MAA) and low-density lipoprotein (LDL-MAA). We found that animals injected with LDL-MAA generate antibodies specific to MAA-adducts. The level of anti-MAA antibodies were further increased in an animal model of atherosclerosis fed a Western diet. An animal model that combined both high fat diet and immunization of MAA-modified protein resulted in a dramatic increase in antibodies to MAA-adducts and vascular fat accumulation compared with controls. In vitro exposure of endothelial cells and macrophages to MAA-modified proteins resulted in increased fat accumulation as well as increased expression of adhesion molecules and pro-inflammatory cytokines. The expression of cytokines varied between the different cell lines and was unique to the individual modified proteins. The results of these studies demonstrate that different MAA-modified proteins elicit unique responses in different cell types. Additionally, the presence of MAA-modified proteins appears to modulate cellular metabolism leading to increased accumulation of triglycerides and further progression of the inflammatory response.
    MeSH term(s) Acetaldehyde/metabolism ; Animals ; Atherosclerosis/etiology ; Atherosclerosis/immunology ; Atherosclerosis/metabolism ; Cardiovascular Diseases/etiology ; Cardiovascular Diseases/immunology ; Cardiovascular Diseases/metabolism ; Cell Adhesion Molecules/metabolism ; Cells, Cultured ; Cytokines/metabolism ; Disease Models, Animal ; Endothelial Cells/immunology ; Endothelial Cells/metabolism ; Female ; Humans ; Inflammation/etiology ; Inflammation/immunology ; Inflammation/metabolism ; Lipid Metabolism/immunology ; Lipoproteins, LDL/immunology ; Lipoproteins, LDL/metabolism ; Macrophages/immunology ; Macrophages/metabolism ; Male ; Malondialdehyde/metabolism ; Mice ; Mice, Inbred BALB C ; Protein Processing, Post-Translational ; Rats ; Rats, Sprague-Dawley ; Serum Albumin, Human/immunology ; Serum Albumin, Human/metabolism
    Chemical Substances Cell Adhesion Molecules ; Cytokines ; Lipoproteins, LDL ; Malondialdehyde (4Y8F71G49Q) ; Acetaldehyde (GO1N1ZPR3B) ; Serum Albumin, Human (ZIF514RVZR)
    Language English
    Publishing date 2021-11-30
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2019364-6
    ISSN 1422-0067 ; 1422-0067 ; 1661-6596
    ISSN (online) 1422-0067
    ISSN 1422-0067 ; 1661-6596
    DOI 10.3390/ijms222312948
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: IL-1β (Interleukin-1β) and TNF-α (Tumor Necrosis Factor-α) Impact Abdominal Aortic Aneurysm Formation by Differential Effects on Macrophage Polarization.

    Batra, Rishi / Suh, Melissa K / Carson, Jeffrey S / Dale, Matthew A / Meisinger, Trevor M / Fitzgerald, Matthew / Opperman, Patrick J / Luo, Jiangtao / Pipinos, Iraklis I / Xiong, Wanfen / Baxter, B Timothy

    Arteriosclerosis, thrombosis, and vascular biology

    2017  Volume 38, Issue 2, Page(s) 457–463

    Abstract: Objective: Abdominal aortic aneurysms are inflammatory in nature and are associated with some risk factors that also lead to atherosclerotic occlusive disease, most notably smoking. The purpose of our study was to identify differential cytokine ... ...

    Abstract Objective: Abdominal aortic aneurysms are inflammatory in nature and are associated with some risk factors that also lead to atherosclerotic occlusive disease, most notably smoking. The purpose of our study was to identify differential cytokine expression in patients with abdominal aortic aneurysm and those with atherosclerotic occlusive disease. Based on this analysis, we further explored and compared the mechanism of action of IL (interleukin)-1β versus TNF-α (tumor necrosis factor-α) in abdominal aortic aneurysm formation.
    Approach and results: IL-1β was differentially expressed in human plasma with lower levels detected in patients with abdominal aortic aneurysm compared with matched atherosclerotic controls. We further explored its mechanism of action using a murine model and cell culture. Genetic deletion of IL-1β and IL-1R did not inhibit aneurysm formation or decrease MMP (matrix metalloproteinase) expression. The effects of IL-1β deletion on M1 macrophage polarization were compared with another proinflammatory cytokine, TNF-α. Bone marrow-derived macrophages from IL-1β
    Conclusions: Although IL-1β is a proinflammatory cytokine, its effects on aneurysm formation and macrophage polarization differ from TNF-α. The differential effects of IL-1β and TNF-α inhibition are related to M1/M2 macrophage polarization and this may account for the differences in clinical efficacy of IL-1β and TNF-α antibody therapies in management of inflammatory diseases.
    MeSH term(s) Aged ; Animals ; Aorta, Abdominal/metabolism ; Aorta, Abdominal/pathology ; Aortic Aneurysm, Abdominal/metabolism ; Aortic Aneurysm, Abdominal/pathology ; Case-Control Studies ; Dilatation, Pathologic ; Disease Models, Animal ; Female ; Humans ; Interleukin-1beta/blood ; Interleukin-1beta/deficiency ; Interleukin-1beta/genetics ; Interleukin-1beta/metabolism ; Macrophage Activation ; Macrophages/metabolism ; Macrophages/pathology ; Macrophages/transplantation ; Male ; Mice, 129 Strain ; Mice, Inbred C57BL ; Mice, Knockout ; Middle Aged ; Phenotype ; Receptors, Interleukin-1/genetics ; Receptors, Interleukin-1/metabolism ; Signal Transduction ; Tumor Necrosis Factor-alpha/deficiency ; Tumor Necrosis Factor-alpha/genetics ; Tumor Necrosis Factor-alpha/metabolism
    Chemical Substances IL1B protein, human ; IL1B protein, mouse ; Interleukin-1beta ; Receptors, Interleukin-1 ; Tumor Necrosis Factor-alpha
    Language English
    Publishing date 2017-12-07
    Publishing country United States
    Document type Comparative Study ; Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 1221433-4
    ISSN 1524-4636 ; 1079-5642
    ISSN (online) 1524-4636
    ISSN 1079-5642
    DOI 10.1161/ATVBAHA.117.310333
    Database MEDical Literature Analysis and Retrieval System OnLINE

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