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Weeraddana P, Sandhu MK, Anand S, Othman H, Makar M, Matta B. Pulmonary Angiosarcoma With Synchronous Invasive Aspergillosis Presenting as Diffuse Alveolar Hemorrhage and Acute Kidney Injury: A Case Report of a Previously Unreported Combination Posing a Diagnostic Challenge. Cureus 2023; 15:e38507. [PMID: 37284386 PMCID: PMC10240848 DOI: 10.7759/cureus.38507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 06/08/2023] Open
Abstract
Angiosarcoma is a rare soft tissue sarcoma originating from endothelial cells. It can occur anywhere when there is a blood vessel or lymphatic channel, making highly perfused cutaneous sites their usual location, though they can also develop within visceral structures. Pulmonary angiosarcoma is usually caused by metastasis from other primary sites. The clinical course of pulmonary angiosarcoma is very aggressive, and the prognosis is poor. We present a case of a 55-year-old man who presented to the hospital with progressive exertional dyspnea and right-sided pleuritic chest pain for the past few days. He was found to have recurrent anemia and acute kidney injury. His hospital course was complicated by the development of hypoxia and hemoptysis. Computed tomography of the chest without contrast revealed bilateral nodular, ground-glass opacities compatible with diffuse alveolar hemorrhage. Further investigation with a lung biopsy revealed epithelioid angiosarcoma with extensive microvascular tumor emboli and invasive pulmonary aspergillosis (Aspergillus fumigatus) with patchy necrotizing pneumonia. He later developed acute hypoxic respiratory failure and worsening kidney failure, so he was transferred to the intensive care unit. Upon discussing with the family, the patient was put on comfort measures, and he passed away the following day. We present a rare presentation of concurrence of pulmonary angiosarcoma and invasive aspergillosis. Upon searching the literature, our case is one of the first to report such concurrence. Because of its rarity, the non-specific clinical presentation makes the diagnosis challenging.
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Affiliation(s)
| | | | | | | | - Mina Makar
- Internal Medicine, Danbury Hospital, Danbury, USA
| | - Bhavna Matta
- Internal Medicine, Danbury Hospital, Danbury, USA
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Zou G, Khanna M, Zahid S, Dengle S, Matta B, Zaheer H, Farrell M, Stein R. Ventricular fibrillation arrest due to Brugada syndrome in a coronavirus disease 2019 patient with negative procainamide challenge: a case report. Eur Heart J Case Rep 2021; 5:ytab454. [PMID: 34909573 PMCID: PMC8664766 DOI: 10.1093/ehjcr/ytab454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/05/2021] [Accepted: 10/25/2021] [Indexed: 11/12/2022]
Abstract
Background Pharmacologic challenge test is often used to diagnose Brugada syndrome (BrS) when spontaneous electrocardiograms (ECG) do not show type I Brugada pattern but reported sensitivity varies. The role of the exercise stress test in diagnosing Brugada syndrome is not well-established. Case summary A patient had a type I Brugada pattern ECG during the recovery phase of exercise stress test but had a negative procainamide challenge test. He had a loop recorder implanted and later survived a ventricular fibrillation (VF) arrest provoked by coronavirus disease 2019 (COVID-19). Electrocardiogram on arrival showed type 1 Brugada pattern. He was discharged after implantable cardioverter-defibrillator implantation. He later underwent genetic testing and was found to be heterozygous for c.844C>G (p.Arg282Gly) mutation in the SCN5A gene. Discussion Type 1 Brugada pattern ECG may be unmasked by ST-segment augmentation during recovery from exercise. Exercise stress test may play a role in the diagnosis of Brugada syndrome when suspicion for Brugada syndrome remains after a negative procainamide challenge test or if the patient has exercise-related symptoms. COVID-19 can unmask BrS and trigger a VF cardiac arrest.
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Affiliation(s)
- Guangchen Zou
- Department of Internal Medicine, Danbury Hospital, 24 Hospital Avenue, Danbury, CT 06810, USA
- Department of Medicine, University of Vermont, Burlington, VT, USA
| | - Mukul Khanna
- Department of Cardiology, Danbury Hospital, Danbury, CT, USA
| | - Saliha Zahid
- Department of Internal Medicine, Danbury Hospital, 24 Hospital Avenue, Danbury, CT 06810, USA
- Department of Medicine, University of Vermont, Burlington, VT, USA
| | - Samir Dengle
- Department of Cardiology, Danbury Hospital, Danbury, CT, USA
| | - Bhavna Matta
- Department of Internal Medicine, Danbury Hospital, 24 Hospital Avenue, Danbury, CT 06810, USA
- Department of Medicine, University of Vermont, Burlington, VT, USA
| | - Haris Zaheer
- Department of Internal Medicine, Danbury Hospital, 24 Hospital Avenue, Danbury, CT 06810, USA
- Department of Medicine, University of Vermont, Burlington, VT, USA
| | | | - Russell Stein
- Department of Cardiology, Danbury Hospital, Danbury, CT, USA
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Robba C, Cardim D, Donnelly J, Bertuccio A, Bacigaluppi S, Bragazzi N, Cabella B, Liu X, Matta B, Lattuada M, Czosnyka M. Effects of pneumoperitoneum and Trendelenburg position on intracranial pressure assessed using different non-invasive methods. Br J Anaesth 2018; 117:783-791. [PMID: 27956677 DOI: 10.1093/bja/aew356] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The laparoscopic approach is becoming increasingly frequent for many different surgical procedures. However, the combination of pneumoperitoneum and Trendelenburg positioning associated with this approach may increase the patient's risk for elevated intracranial pressure (ICP). Given that the gold standard for the measurement of ICP is invasive, little is known about the effect of these common procedures on ICP. METHODS We prospectively studied 40 patients without any history of cerebral disease who were undergoing laparoscopic procedures. Three different methods were used for non-invasive estimation of ICP: ultrasonography of the optic nerve sheath diameter (ONSD); transcranial Doppler-based (TCD) pulsatility index (ICPPI); and a method based on the diastolic component of the TCD cerebral blood flow velocity (ICPFVd). The ONSD and TCD were measured immediately after induction of general anaesthesia, after pneumoperitoneum insufflation, after Trendelenburg positioning, and again at the end of the procedure. RESULTS The ONSD, ICPFVd, and ICPPI increased significantly after the combination of pneumoperitoneum insufflation and Trendelenburg positioning. The ICPFVd showed an area under the curve of 0.80 [95% confidence interval (CI) 0.70-0.90] to distinguish the stage associated with the application of pneumoperitoneum and Trendelenburg position; ONSD and ICPPI showed an area under the curve of 0.75 (95% CI 0.65-0.86) and 0.70 (95% CI 0.58-0.81), respectively. CONCLUSIONS The concomitance of pneumoperitoneum and the Trendelenburg position can increase ICP as estimated with non-invasive methods. In high-risk patients undergoing laparoscopic procedures, non-invasive ICP monitoring through a combination of ONSD ultrasonography and TCD-derived ICPFVd could be a valid option to assess the risk of increased ICP.
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Affiliation(s)
- C Robba
- Neurosciences Critical Care Unit, Box 1, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK .,Department of Anaesthesiology, Mura delle Cappuccine 16, 16100 Galliera Hospital, Genoa, Italy
| | - D Cardim
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Hills Road, Cambridge CB2 0QQ, UK
| | - J Donnelly
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Hills Road, Cambridge CB2 0QQ, UK
| | - A Bertuccio
- Division of Neurosurgery, Department of Clinical Neurosciences, St George's Hospital, University of London, London, UK
| | - S Bacigaluppi
- Department of Neurosurgery, Galliera Hospital, Mura delle Cappuccine 16, 16100 University of Genoa, Genoa, Italy
| | - N Bragazzi
- School of Public Health, Department of Health Sciences (DISSAL), Via Antonio Pastore 1, University of Genoa, Genoa 16132, Italy
| | - B Cabella
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Hills Road, Cambridge CB2 0QQ, UK
| | - X Liu
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Hills Road, Cambridge CB2 0QQ, UK
| | - B Matta
- Neurosciences Critical Care Unit, Box 1, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - M Lattuada
- Department of Anaesthesiology, Mura delle Cappuccine 16, 16100 Galliera Hospital, Genoa, Italy
| | - M Czosnyka
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Hills Road, Cambridge CB2 0QQ, UK
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Hoedebecke K, Borhany T, Shah S, Rahman Z, De Silva H, Nepal B, Matta B. The spice route's perspective on family medicine via the social media project “#1WordforFamilyMedicine”. J Family Med Prim Care 2017; 6:180-181. [PMID: 29302512 PMCID: PMC5749051 DOI: 10.4103/jfmpc.jfmpc_3_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Patel K, Tillmann HL, Matta B, Sheridan MJ, Gardner SD, Shackel NA, McHutchison JG, Goodman ZD. Longitudinal assessment of hepatitis C fibrosis progression by collagen and smooth muscle actin morphometry in comparison to serum markers. Aliment Pharmacol Ther 2016; 43:356-63. [PMID: 26560052 DOI: 10.1111/apt.13471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 05/21/2015] [Accepted: 10/21/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND Assessment of fibrosis progression in chronic liver disease relies upon non-invasive tools and changes in semi-quantitative histopathology scores that may not be reliable. AIM To assess the diagnostic performance of the FibroSURE (FS) index and collagen/alpha smooth muscle actin (α-SMA) morphometry in relation to longitudinal changes in fibrosis on paired biopsies. METHODS The study cohort included 201 chronic hepatitis C (CHC) nonresponders enrolled in a prior phase II anti-fibrotic study. Serum FS and paired biopsies, with both collagen and α-SMA morphometry, were evaluated at baseline and week 52. RESULTS Study patients were mostly male (67%) and Caucasian (77%), with Ishak stages 2 (n = 79), 3 (n = 88) and 4 (n = 30), excluded (n = 4 stage 1 or 5). Mean biopsy length was 22.9 mm. For baseline Ishak 2/3 vs. 4, there were no significant differences in AUROCs for collagen (0.71), SMA (0.66) or FS (0.70). At week 52, 62% of patients had no change in Ishak stage, but collagen/α-SMA increased by 34-51% (P < 0.0001), and FS decreased by 5% (P = 0.008). Among the 33% of patients with +/-1 Ishak stage change, FS changes were not significant, but α-SMA increased 29-72%, and collagen increased by 12-38% (P = 0.01 for +1 only). CONCLUSIONS Longitudinal changes in collagen and α-SMA morphometry are apparent prior to change in histological stage or FibroSURE in CHC nonresponders with intermediate fibrosis. This likely reflects quantitative morphological differences that are not detected by routine histological staging or serum markers such as FibroSURE.
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Affiliation(s)
- K Patel
- Duke Clinical Research Institute, Durham, NC, USA.,Duke University Medical Center, Durham, NC, USA.,Liver Cell Biology, Centenary Institute, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - H L Tillmann
- Duke Clinical Research Institute, Durham, NC, USA.,Duke University Medical Center, Durham, NC, USA
| | - B Matta
- Duke University Medical Center, Durham, NC, USA
| | - M J Sheridan
- Inova Research Center, Inova Fairfax Medical Campus, Falls Church, VA, USA
| | - S D Gardner
- Infectious Diseases Therapeutic Area Unit, GlaxoSmithKline, Research Triangle Park, NC, USA
| | - N A Shackel
- Liver Cell Biology, Centenary Institute, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | | | - Z D Goodman
- Hepatic Pathology Consultation and Research, Inova Fairfax Hospital, Falls Church, VA, USA
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Robba C, Bacigaluppi S, Cardim D, Donnelly J, Sekhon MS, Aries MJ, Mancardi G, Booth A, Bragazzi NL, Czosnyka M, Matta B. Intraoperative non invasive intracranial pressure monitoring during pneumoperitoneum: a case report and a review of the published cases and case report series. J Clin Monit Comput 2015; 30:527-38. [PMID: 26342642 DOI: 10.1007/s10877-015-9765-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 09/01/2015] [Indexed: 11/30/2022]
Abstract
Non-invasive measurement of ICP (nICP) can be warranted in patients at risk for developing increased ICP during pneumoperitoneum (PP). Our aim was to assess available data on the application of nICP monitoring during these procedures and to present a patient assessed with an innovative combination of noninvasive tools. Literature review of nICP assessment during PP did not find any studies comparing different methods intraprocedurally and only few studies of any nICP monitoring were available: transcranial Doppler (TCD) studies used the pulsatility index (PI) as an estimator of ICP and failed to detect a significant ICP increase during PP, whereas two out of three optic nerve sheath diameter (ONSD) studies detected a statistically significant ICP increase. In the case study, we describe a 52 year old man with a high grade thalamic glioma who underwent urgent laparoscopic cholecystectomy. Considering the high intraoperative risk of developing intracranial hypertension, he was monitored through parallel ONSD ultrasound measurement and TCD derived formulae (flow velocity diastolic formula, FVdnICP, and PI). ONSD and FVdnICP methods indicated a significant ICP increase during PP, whereas PI was not significantly increased. Our experience, combined with the literature review, seems to suggest that PI might not detect ICP changes in this context, however we indicate a possible interest of nICP monitoring during PP by means of ONSD and of TCD derived FVdNICP, especially for patients at risk for increased ICP.
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Affiliation(s)
- C Robba
- Neurosciences Critical Care Unit, Cambridge University Hospitals NHS Foundation Trust, Box 1, Hills Road, Cambridge, CB2 0QQ, UK.
| | - S Bacigaluppi
- Brain Physics Lab, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - D Cardim
- Department of Neurosurgery, Galliera Hospital, University of Genoa, Genoa, Italy
| | - J Donnelly
- Department of Neurosurgery, Galliera Hospital, University of Genoa, Genoa, Italy
| | - M S Sekhon
- Department of Medicine, Division of Critical Care Medicine, Vancouver General Hospital, Vancouver, Canada
| | - M J Aries
- Department of Critical Care, University of Groningen, Groningen, The Netherlands
| | - G Mancardi
- Section of Neurology, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - A Booth
- Neurosciences Critical Care Unit, Cambridge University Hospitals NHS Foundation Trust, Box 1, Hills Road, Cambridge, CB2 0QQ, UK
| | - N L Bragazzi
- Department of Health Sciences (DISSAL), School of Public Health, University of Genoa, Genoa, Italy
| | - M Czosnyka
- Department of Neurosurgery, Galliera Hospital, University of Genoa, Genoa, Italy
| | - B Matta
- Neurosciences Critical Care Unit, Cambridge University Hospitals NHS Foundation Trust, Box 1, Hills Road, Cambridge, CB2 0QQ, UK
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Delarbre D, Matta B, Poisnel E, Guzian MC, Graffin B, Roudier J, Carli P, Balandraud N. AB0233 Diagnosis and Evolution of Anti-Citrullinated Peptide Antibody (ACPA)-Negative Rheumatoid Arthritis (RA) Patients: A Retrospective Study of 48 Patients. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Savini H, Coulibaly B, Thomas G, Matta B, Brescianini A, Cournac JM, Jean R, Harle JR, Durand JM, Chiche L. Gougerot-Sjögren, sarcoïdose ou les deux ? Intérêt du phénotypage lymphocytaire sur la biopsie des glandes salivaires. Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.03.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Brescianini A, Thomas G, Jourde N, Matta B, Cournac JM, Savini H, Jean R, Durand JM, Harle JR, Chiche L. Dacryoadénite inaugurale d’une poussée de la maladie de Wegener : une complication méconnue. Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.03.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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10
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Kirkpatrick PJ, Kirollos RW, Higgins N, Matta B. Lessons to be learnt from the international subarachnoid haemorrhage trial (ISAT). Br J Neurosurg 2010. [DOI: 10.3109/02688690309177961] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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11
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Enoch D, Summers C, Brown N, Moore L, Gillham M, Burnstein R, Thaxter R, Enoch L, Matta B, Sule O. Investigation and management of an outbreak of multidrug-carbapenem-resistant Acinetobacter baumannii in Cambridge, UK. J Hosp Infect 2008; 70:109-18. [DOI: 10.1016/j.jhin.2008.05.015] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2008] [Accepted: 05/13/2008] [Indexed: 01/03/2023]
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Lau K, Matta B, Menon DK, Absalom AR. Attitudes of anaesthetists to awareness and depth of anaesthesia monitoring in the UK. Eur J Anaesthesiol 2006; 23:921-30. [PMID: 16723052 DOI: 10.1017/s0265021506000743] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2006] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND OBJECTIVE Awareness with postoperative recall of intraoperative events is a rare but serious complication of general anaesthesia. This survey investigated the attitude of anaesthetists in the UK to awareness and depth of anaesthesia monitoring. METHODS Questionnaires were sent to 4927 consultant anaesthetists in 285 hospitals in the UK in September 2004. The responses were recorded in an electronic database, summarized and compared with the results of studies performed in Australia and the USA. RESULTS The response rate was 44%. When judged against published awareness rates, anaesthetists underestimated the incidence of awareness in their own practice (median 1: 5000). One-third of respondents have dealt with patients who have experienced intraoperative recall. The majority of anaesthetists perceived awareness as a minor problem on an 11-point scale (modal score 2, median score 3, IQR 2-5). Eighty-six percent of anaesthetists considered clinical signs unreliable but 91% felt that measurement of end-tidal anaesthetic agent concentration reduces the likelihood of awareness. The majority of anaesthetists would use a monitor at least some of the time if one was available to them. Overall, the attitudes of anaesthetists in the UK, USA and Australia are remarkably similar. CONCLUSIONS Anaesthetists tend not to view awareness as a serious problem. Although most accept that clinical signs are unreliable indicators of awareness, few believe that monitors of anaesthetic depth should be used for routine cases.
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Affiliation(s)
- K Lau
- University Division of Anaesthesia, Addenbrooke's Hospital, Cambridge, UK
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Balestreri M, Czosnyka M, Steiner LA, Hiler M, Schmidt EA, Matta B, Menon D, Hutchinson P, Pickard JD. Association between outcome, cerebral pressure reactivity and slow ICP waves following head injury. Intracranial Pressure and Brain Monitoring XII 2005; 95:25-8. [PMID: 16463814 DOI: 10.1007/3-211-32318-x_6] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
OBJECTIVE To investigate the relationships between slow vasogenic waves ('B waves') of intracranial pressure (ICP), pressure-reactivity and outcome after traumatic brain injury. MATERIAL AND METHOD 193 head-injured patients (age 34 +/- 16.7 years; median GCS 6) were monitored from 1997 to 2002. ICP, arterial blood pressure (ABP) were continuously monitored. Pressure-reactivity index (PRx) and magnitude of ICP slow waves were evaluated using the bed-side computers. RESULTS Distribution of PRx in different outcome groups indicated that pressure-reactivity was significantly worse in patients with fatal outcome. A magnitude of spontaneous slow waves of ICP was gradually decreasing in poorer outcome grades. Mortality indicated threshold rise from 20% to 70% when averaged PRx increased above 0.3 (p < 0.01). There was no threshold for mortality observed along distribution of magnitude of ICP slow waves. Mortality gradually increased when the magnitude of slow waves decreased (R = -0.26; p < 0.0001). CONCLUSION Inadequate pressure-reactivity and low magnitude of slow vasogenic waves of ICP are associated with fatal outcome after head injury. Based on brain monitoring data, differentiation between favourable outcome and severe disability is more problematic than differentiation between survivors and non-survivors.
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Affiliation(s)
- M Balestreri
- Academic Neurosurgical Unit, Addenbrooke's Hospital, Cambridge, UK
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Bernard F, Outtrim J, Menon D, Matta B. Crit Care 2005; 9:P402. [DOI: 10.1186/cc3465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Balestreri M, Czosnyka M, Steiner LA, Schmidt E, Smielewski P, Matta B, Pickard JD. Intracranial hypertension: what additional information can be derived from ICP waveform after head injury? Acta Neurochir (Wien) 2004; 146:131-41. [PMID: 14963745 DOI: 10.1007/s00701-003-0187-y] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Although intracranial hypertension is one of the important prognostic factors after head injury, increased intracranial pressure (ICP) may also be observed in patients with favourable outcome. We have studied whether the value of ICP monitoring can be augmented by indices describing cerebrovascular pressure-reactivity and pressure-volume compensatory reserve derived from ICP and arterial blood pressure (ABP) waveforms. METHOD 96 patients with intracranial hypertension were studied retrospectively: 57 with fatal outcome and 39 with favourable outcome. ABP and ICP waveforms were recorded. Indices of cerebrovascular reactivity (PRx) and cerebrospinal compensatory reserve (RAP) were calculated as moving correlation coefficients between slow waves of ABP and ICP, and between slow waves of ICP pulse amplitude and mean ICP, respectively. The magnitude of 'slow waves' was derived using ICP low-pass spectral filtration. RESULTS The most significant difference was found in the magnitude of slow waves that was persistently higher in patients with a favourable outcome (p<0.00004). In patients who died ICP was significantly higher (p<0.0001) and cerebrovascular pressure-reactivity (described by PRx) was compromised (p<0.024). In the same patients, pressure-volume compensatory reserve showed a gradual deterioration over time with a sudden drop of RAP when ICP started to rise, suggesting an overlapping disruption of the vasomotor response. CONCLUSION Indices derived from ICP waveform analysis can be helpful for the interpretation of progressive intracranial hypertension in patients after brain trauma.
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Affiliation(s)
- M Balestreri
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, UK
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Balestreri M, Czosnyka M, Chatfield DA, Steiner LA, Schmidt EA, Smielewski P, Matta B, Pickard JD. Predictive value of Glasgow Coma Scale after brain trauma: change in trend over the past ten years. J Neurol Neurosurg Psychiatry 2004; 75:161-2. [PMID: 14707332 PMCID: PMC1757441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND Age and the Glasgow Coma Scale (GCS) score on admission are considered important predictors of outcome after traumatic brain injury. We investigated the predictive value of the GCS in a large group of patients whose computerised multimodal bedside monitoring data had been collected over the previous 10 years. METHODS Data from 358 subjects with head injury, collected between 1992 and 2001, were analysed retrospectively. Patients were grouped according to year of admission. Glasgow Outcome Scores (GOS) were determined at six months. Spearman's correlation coefficients between GCS and GOS scores were calculated for each year. RESULTS On average 34 (SD: 7) patients were monitored every year. We found a significant correlation between the GCS and GOS for the first five years (overall 1992-1996: r = 0.41; p<0.00001; n = 183) and consistent lack of correlations from 1997 onwards (overall 1997-2001: r = 0.091; p = 0.226; n = 175). In contrast, correlations between age and GOS were in both time periods significant and similar (r = -0.24 v r = -0.24; p<0.002). CONCLUSIONS The admission GCS lost its predictive value for outcome in this group of patients from 1997 onwards. The predictive value of the GCS should be carefully reconsidered when building prognostic models incorporating multimodality monitoring after head injury.
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Affiliation(s)
- M Balestreri
- Academic Neurosurgical Unit, Addenbrooke's Hospital, Cambridge, UK
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Kirkpatrick PJ, Kirollos RW, Higgins N, Matta B. Lessons to be learnt from the International Subarachnoid Haemorrhage Trial (ISAT). Br J Neurosurg 2003; 17:5-7. [PMID: 12779191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
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Matta B, Shankar R. Recent advances in neuroanaesthesia. Hosp Med 2001; 62:480-6. [PMID: 11530586 DOI: 10.12968/hosp.2001.62.8.1624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In order to provide optimum intracranial operating conditions for neurosurgery, anaesthetists must have a thorough understanding of brain physiology and how this is affected by pathology and anaesthetic drugs and techniques. This article discusses the current understanding of cerebral vascular physiology and how novel neuroanaesthetic drugs and techniques affect it.
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Affiliation(s)
- B Matta
- Department of Anaesthesia, Addenbrookes Hospital, Cambridge CB2 2QQ
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Pham XH, Reddy MK, Ehtesham NZ, Matta B, Tuteja N. A DNA helicase from Pisum sativum is homologous to translation initiation factor and stimulates topoisomerase I activity. Plant J 2000; 24:219-29. [PMID: 11069696 DOI: 10.1046/j.1365-313x.2000.00869.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
DNA helicases play an essential role in all aspects of nucleic acid metabolism, by providing a duplex-unwinding function. This is the first report of the isolation of a cDNA (1.6 kb) clone encoding functional DNA helicase from a plant (pea, Pisum sativum). The deduced amino-acid sequence has eight conserved helicase motifs of the DEAD-box protein family. It is a unique member of this family, containing DESD and SRT motifs instead of DEAD/H and SAT. The encoded 45.5 kDa protein has been overexpressed in bacteria and purified to homogeneity. The purified protein contains ATP-dependent DNA and RNA helicase, DNA-dependent ATPase, and ATP-binding activities. The protein sequence contains striking homology with eIF-4A, which has not so far been reported as DNA helicase. The antibodies against pea helicase inhibit in vitro translation. The gene is expressed as 1.6 kb mRNA in different organs of pea. The enzyme is localized in the nucleus and cytosol, and unwinds DNA in the 3' to 5' direction. The pea helicase interacts with pea topoisomerase I protein and stimulates its activity. These results suggest that pea DNA helicase could be an important multifunctional protein involved in protein synthesis, maintaining the basic activities of the cell, and in upregulation of topoisomerase I activity. The discovery of such a protein with intrinsic multiple activity should make an important contribution to our better understanding of DNA and RNA transactions in plants.
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Affiliation(s)
- X H Pham
- Plant Molecular Biology Group, International Centre for Genetic Engineering and Biotechnology, PO Box 10504, Aruna Asaf Ali Marg, New Delhi 110 067, India
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Abstract
Following reports that tubal smooth muscle spasm may contribute to pelvic pain following laparoscopic sterilisation, we studied the effect of buscopan (an anticholinergic agent used to relieve smooth muscle spasm) on 45 patients undergoing general anaesthesia for day-case laparoscopic sterilisation. Patients were randomly allocated to receive either buscopan 20 mg or saline placebo after induction of anaesthesia. There were no significant differences in pain scores or postoperative analgesic requirements between the two groups. We conclude that intravenous buscopan confers no benefit in day-case laparoscopic sterilisation.
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Affiliation(s)
- C M Wilson
- Department of Anaesthesia, Addenbrookes Hospital, Cambridge, UK
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Abstract
OBJECTIVE To study the current intensive care management of patients with severe head injury (defined as a Glasgow Coma Scale score of < or = 8) in neurosurgical referral centers in the United Kingdom (UK) and ireland. DATA COLLECTION A questionnaire was sent to the directors of the 44 neurosurgical referral units identified from the UK Medical Directory. After 4 wks, a copy of the questionnaire was sent to all nonresponders, with a cover letter urging them to respond. The aim was to collect data regarding the characteristics of the intensive care units (ICU), sedation, monitoring modalities used, the treatment of intracranial hypertension, and general care of severely head-injured patients. DATA EXTRACTION Forty completed questionnaires were returned. Only 35 (88%) centers provided care for the severely head-injured as defined in the questionnaire. Patients were managed in specialized neurosurgical ICUs in 66% of centers and in general ICUs in the remainder of the centers. The ICUs were coordinated by an anesthesiologist in 66% of instances and by a neurosurgeon in 23%. The mean number of beds per units was 7.9 (range 4 to 16), with 1:1 nurse/bed ratio and 5.5 nurses per bed (total number of nursing staff per bed) (range 2.75 to 8). Annual caseload varied between units with the majority of units (49%) receiving between 25 and 50 patients with severe head injury, 23% receiving between 50 and 100 patients with severe head injury, and 29% receiving > 100 patients with severe head injury. There was considerable variability in both the nature of monitoring and therapy between centers. Although blood and central venous pressures were invasively monitored in > 50% of the patients in 94% and 77% of the centers, respectively, intracranial pressure was only monitored routinely in 57% of the centers. Jugular venous bulb oximetry, transcranial Doppler ultrasonography, electroencephalography, and near-infrared spectroscopy were rarely used. Nearly all centers used propofol and midazolam for sedation, with morphine, fentanyl, and alfentanil as the main analgesics. Muscle relaxation was commonly used, with 40% of the centers employing it in 100% of their patients. Atracurium and vecuronium were the most commonly used agents. Only 68% of the centers had a protocol for the treatment of intracranial hypertension. Although hyperventilation to a Paco2 of 26 to 30 torr (3.5 to 4.0 kPa) was the norm in the majority of centers (56%), two centers aimed for Paco2 values < 26 torr (< 3.5 kPa). A quarter of the units did not aim for a cerebral perfusion pressure of > 60 mm Hg. Mild hypothermia was rarely used and 14% of the centers continued to use corticosteroids for the treatment of intracranial hypertension as a result of head trauma. CONCLUSION We conclude that there are wide variations in the management of the severely head-injured patient in the UK and Ireland. Some of the therapies employed are not supported by available research findings. Rationalization (using rational management, i.e., based on good evidence) of the intensive care management of severe head injury with the development of widely accepted guidelines may result in an improvement in the quality of care of the head-injured patient.
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Affiliation(s)
- B Matta
- Department of Anaesthesia and Neurosurgical Critical Care, Addenbrooke's Hospital, Cambridge, UK
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Affiliation(s)
- N Lillywhite
- Department of Anaesthesia, Ipswich Hospital, Suffolk, United Kingdom
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Strebel S, Lam AM, Matta B, Mayberg TS, Aaslid R, Newell DW. Dynamic and static cerebral autoregulation during isoflurane, desflurane, and propofol anesthesia. Anesthesiology 1995; 83:66-76. [PMID: 7605020 DOI: 10.1097/00000542-199507000-00008] [Citation(s) in RCA: 307] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Although inhalation anesthetic agents are thought to impair cerebral autoregulation more than intravenous agents, there are few controlled studies in humans. METHODS In the first group (n = 24), dynamic autoregulation was assessed from the response of middle cerebral artery blood flow velocity (Vmca) to a transient step decrease in mean arterial blood pressure (MABP). The transient hypotension was induced by rapid deflation of thigh cuffs after inflation for 3 min. In the second group (n = 18), static autoregulation was studied by observing Vmca in response to a phenylephrine-induced increase in MABP. All patients were studied during fentanyl (3 micrograms.kg-1.h-1)/nitrous oxide (70%) anesthesia, followed by, in a randomized manner, isoflurane, desflurane, or propofol in a low dose (0.5 MAC or 100 micrograms.kg-1.min-1) and a high dose (1.5 MAC or 200 micrograms.kg-1.min-1). The dynamic rate of regulation (dROR) was assessed from the rate of change in cerebrovascular resistance (MABP/Vmca) with the blood pressure decreases using computer modeling, whereas the static rate of regulation (sROR) was assessed from the change in Vmca with the change in MABP. RESULTS Low-dose isoflurane delayed (dROR decreased) but did not reduce the autoregulatory response (sROR intact). Low-dose desflurane decreased both dROR and sROR. During 1.5 MAC isoflurane or desflurane, autoregulation was ablated (both dROR and sROR impaired). Neither dROR nor sROR changed with low- or high-dose propofol. CONCLUSIONS At 1.5 MAC, isoflurane and desflurane impaired autoregulation whereas propofol (200 micrograms.kg-1.min-1) preserved it.
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Affiliation(s)
- S Strebel
- Departments of Anesthesiology and Neurological Surgery, University of Washington, Seattle, USA
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Matta B. Age-related haematological disturbances. Anaesthesia 1995; 50:477-8. [PMID: 7793574 DOI: 10.1111/j.1365-2044.1995.tb06026.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Abstract
We describe a case of intracranial hypertension in a previously healthy 25-year-old man who sustained a head injury in a motor vehicle accident, in whom a Valsalva maneuver resulted in parallel reductions in mean arterial blood pressure, cerebral blood flow velocity in the middle cerebral artery, and intracranial pressure. The effects of raising intrathoracic pressure in patients with intracranial hypertension are discussed.
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Affiliation(s)
- B Matta
- Department of Anesthesiology, Harborview Medical Center, University of Washington School of Medicine, Seattle 98104
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Matta B, Lam A. Isoflurane-induced hypotension and vital organ blood flow. Anesth Analg 1994; 79:396-7. [PMID: 7639395 DOI: 10.1213/00000539-199408000-00048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Matta B, Willatts S. A possible complication with a sheath introducer. Anaesthesia 1992; 47:534-5. [PMID: 1616100 DOI: 10.1111/j.1365-2044.1992.tb02291.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Hardin JM, Guillebaud JC, Lallement PY, Matta B, Andrejak M. [Rhabdomyolysis associated to fenoverin therapy and complicated by acute renal failure]. Therapie 1992; 47:165-6. [PMID: 1412146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Fakir M, Saison C, Wong T, Matta B, Hardin JM. Septicemia due to Yersinia enterocolitica in a hemodialyzed, iron-depleted patient receiving omeprazole and oral iron supplementation. Am J Kidney Dis 1992; 19:282-4. [PMID: 1553973 DOI: 10.1016/s0272-6386(13)80010-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Septicemia occurred in a long-term hemodialysis patient on oral iron supplementation who had been treated for esophageal ulcer by omeprazole, an ulcer-healing drug. Yersinia enterocolitica serotype 0:3 was recovered from blood cultures. A raised intraintestinal pH and an increased intraluminal iron load may have been contributing factors for the enhanced proliferation and generalized infection of Y enterocolitica.
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Affiliation(s)
- M Fakir
- Service d'Hémodialyse, Epuration extra-rénale-Médecine interne, Centre Hospitalier de Soissons, Reims, France
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Matta B, Franco AE, Le Zotte LA, Rudzik AD, Veldkamp W. Comparison of triazolam, flurazepam and placebo as hypnotic agents in pre-surgical patients. Curr Ther Res Clin Exp 1974; 16:958-63. [PMID: 4214670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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