1
|
Aminlari A, Stone J, McKee R, Subramony R, Nadolski A, Tolia V, Hayden SR. Diagnosing Achilles Tendon Rupture with Ultrasound in Patients Treated Surgically: A Systematic Review and Meta-Analysis. J Emerg Med 2021; 61:558-567. [PMID: 34801318 DOI: 10.1016/j.jemermed.2021.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/08/2021] [Accepted: 09/11/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Achilles tendon rupture is a common injury with increasing incidence due to the rising popularity of high-velocity sports, continued physical activity of the aging American population, and use of fluoroquinolones and steroid injections. The diagnosis can often be missed or delayed, with up to 20% misdiagnosed, most commonly as an ankle sprain. OBJECTIVE The aim of our study was to systematically evaluate the reported sensitivity, specificity, and likelihood ratios of ultrasound for detecting Achilles tendon rupture in patients who were treated surgically. METHODS In January 2020, we performed a literature search of MEDLINE and EMBASE databases to identify eligible articles according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria were original studies with at least five patients, which reported data on the sonographic diagnosis of Achilles tendon rupture (complete or partial) compared to surgery as the reference standard. RESULTS A total of 15 studies with 808 patients were included in the primary analysis. The sensitivity of ultrasound for detecting complete Achilles tendon ruptures was 94.8% (95% confidence interval [CI] 91.3-97.2%), specificity was 98.7% (95% CI 97.0-99.6%), positive likelihood ratio was 74.0 (95% CI 31.0-176.8), and negative likelihood ratio was 0.05 (95% CI 0.03-0.09), in patients who underwent surgical treatment. CONCLUSIONS The results from our study suggested that a negative ultrasound result may have the potential to rule out a complete, as well as a partial, Achilles tendon rupture.
Collapse
Affiliation(s)
- Amir Aminlari
- Department of Emergency Medicine, University of California San Diego, La Jolla, California
| | - Jennifer Stone
- Department of Emergency Medicine, University of California San Diego, La Jolla, California
| | - Ryan McKee
- University of California San Diego School of Medicine, La Jolla, California
| | - Rachna Subramony
- Department of Emergency Medicine, University of California San Diego, La Jolla, California
| | - Adam Nadolski
- Department of Emergency Medicine, University of California San Diego, La Jolla, California
| | - Vaishal Tolia
- Department of Emergency Medicine, University of California San Diego, La Jolla, California.
| | - Stephen R Hayden
- Department of Emergency Medicine, University of California San Diego, La Jolla, California
| |
Collapse
|
2
|
Nene RV, Subramony R, Macias M, Campbell C, Aminlari A. Real-time Point-of-care Ultrasound for the Diagnosis and Treatment of Testicular Torsion. POCUS J 2021; 6:70-72. [PMID: 36895665 PMCID: PMC9979951 DOI: 10.24908/pocus.v6i2.15186] [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] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Testicular torsion is a surgical emergency that needs prompt diagnosis and treatment. Point-of-Care ultrasound (POCUS) can not only establish the diagnosis but also guide the Emergency Physician in evaluating the response to manual detorsion. Case Report: We describe the case of a 13-year-old male who presented with acute scrotal pain. We demonstrate how bedside ultrasound was used to make the diagnosis of testicular torsion, guide the technique for manual detorsion, and confirm adequate return of blood flow. Our case illustrates the ease with which POCUS can be used in real time to diagnose and treat organ-threatening pathology, but more importantly, it shows how real-time POCUS was used to detorse a testicle that was refractory to the standard detorsion technique. Conclusion: The acute scrotum is a time-sensitive presentation and if testicular torsion is present, the diagnosis should be made as soon as possible. Many Emergency Departments do not have 24-hour coverage of ultrasound technicians, which would delay the diagnosis and treatment. Moreover, when manual detorsion is attempted, it often does not work because the testicle may need more than the standard 180 degree medial to lateral rotation. POCUS provides real-time analysis of return of blood flow and can thus guide further rotation, or opposite direction rotation, as needed.
Collapse
Affiliation(s)
- Rahul V Nene
- Department of Emergency Medicine, University of California San Diego, CA
| | - Rachna Subramony
- Department of Emergency Medicine, University of California San Diego, CA
| | - Michael Macias
- Department of Emergency Medicine, University of California San Diego, CA
| | - Colleen Campbell
- Department of Emergency Medicine, University of California San Diego, CA
| | - Amir Aminlari
- Department of Emergency Medicine, University of California San Diego, CA
| |
Collapse
|
3
|
Aminlari A, Grover I, Hayden S, Bisanz B, Nelson C, Campbell C. Parasitic Soft Tissue Infection Diagnosed by Point-of-Care Ultrasound. J Emerg Med 2020; 59:940-942. [PMID: 33036826 DOI: 10.1016/j.jemermed.2020.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/12/2020] [Accepted: 09/02/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Amir Aminlari
- Emergency Ultrasound Fellowship, Department of Emergency Medicine, University of California, San Diego Medical Center, San Diego, California
| | - Ian Grover
- Hyperbaric Medicine and Wound Care, University of California, San Diego Medical Center, San Diego, California; Clinical Emergency Medicine, University of California, San Diego Medical Center, San Diego, California
| | - Stephen Hayden
- Clinical Emergency Medicine, University of California, San Diego Medical Center, San Diego, California
| | - Bryan Bisanz
- Emergency Medicine, University of California, San Diego Medical Center, San Diego, California
| | - Cole Nelson
- Emergency Medicine, University of California, San Diego Medical Center, San Diego, California
| | - Colleen Campbell
- Clinical Emergency Medicine, University of California, San Diego Medical Center, San Diego, California; Emergency Ultrasound, University of California, San Diego Medical Center, San Diego, California
| |
Collapse
|
4
|
Abstract
BACKGROUND Kikuchi disease, also known as Kikuchi-Fujimoto disease, is a rare, benign cause of cervical lymphadenitis. It is characterized by painful cervical lymphadenopathy with fevers, leukopenia, and an elevated erythrocyte sedimentation rate. It is diagnosed by obtaining a biopsy specimen from a lymph node that shows characteristic histopathologic findings. CASE REPORT We highlight a 42-year-old Japanese man who presented with persistent fevers and cervical lymphadenopathy who was misdiagnosed at multiple urgent care facilities and emergency departments. He was eventually diagnosed with Kikuchi disease after a biopsy specimen was obtained from a lymph node 1 month after his symptoms began. He was treated with hydroxychloroquine and prednisone with resolution of his symptoms. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although Kikuchi disease has been previously described in various specialty medical journals, the published literature on Kikuchi disease in emergency medicine is relatively scarce. Given that cervical lymphadenopathy is a common presentation to emergency departments, it is important for emergency physicians to be cognizant of Kikuchi disease in the differential diagnosis of cervical lymphadenopathy to prevent misdiagnoses and unnecessary treatments.
Collapse
Affiliation(s)
- Alexandra M Frankel
- Department of Emergency Medicine, University of California San Diego, La Jolla, California
| | - Sam Frenkel
- Department of Emergency Medicine, University of California San Diego, La Jolla, California
| | - Amir Aminlari
- Department of Emergency Medicine, University of California San Diego, La Jolla, California
| | - Theodore Chan
- Department of Emergency Medicine, University of California San Diego, La Jolla, California
| |
Collapse
|
5
|
Bassell T, Aminlari A, Hayden S, Del Rosso J, Ly BT. Phenytoin Toxicity After Transjugular Intrahepatic Portosystemic Shunt (TIPS). J Emerg Med 2020; 60:54-57.e1. [PMID: 33160822 DOI: 10.1016/j.jemermed.2020.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/09/2020] [Revised: 07/21/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Transjugular intrahepatic portosystemic shunt (TIPS) alters portal blood flow and may impact drug metabolism and bioavailability. However, little evidence has been published to provide guidance on medication alterations after TIPS procedures. CASE REPORT We report a patient who developed phenytoin toxicity requiring a prolonged readmission after a TIPS procedure. It is likely that the TIPS procedure altered phenytoin metabolism and led to toxicity in this patient. Phenytoin is an antiepileptic drug that is primarily eliminated by hepatic metabolism. It is possible that phenytoin toxicity may occur after TIPS, and that decreased dose requirements may be a durable effect of the procedure. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: TIPS is now the most common portal hypertension decompressive procedure performed by interventional radiologists and has become the primary portosystemic shunt (surgical or percutaneous) performed in the United States. Patients with a history of TIPS procedures commonly present to tertiary- and quaternary-care emergency departments with complex clinical presentations. Greater familiarity with the potential effects of TIPS on drug metabolism may help emergency physicians prevent adverse drug effects and optimize clinical outcomes.
Collapse
Affiliation(s)
- Timothy Bassell
- Department of Pharmacy, University of California (UC) San Diego Health System, San Diego, California
| | - Amir Aminlari
- Department of Emergency Medicine, UC San Diego School of Medicine, San Diego, California; Division of Ultrasound, UC San Diego Health, San Diego, California
| | - Stephen Hayden
- Department of Emergency Medicine, UC San Diego School of Medicine, San Diego, California; Division of Hyperbaric Medicine, UC San Diego Health, San Diego, California
| | - Jake Del Rosso
- Department of Pharmacy, University of California (UC) San Diego Health System, San Diego, California
| | - Binh T Ly
- Department of Emergency Medicine, UC San Diego School of Medicine, San Diego, California; Division of Medical Toxicology, UC San Diego Health, San Diego, California
| |
Collapse
|
6
|
Aminlari A, Quenzer F, Hayden S, Stone J, Murchison C, Campbell C. A Case of Covid-19 Diagnosed at Home With Portable Ultrasound and Confirmed With Home Serology Test. J Emerg Med 2020; 60:399-401. [PMID: 33288350 PMCID: PMC7550171 DOI: 10.1016/j.jemermed.2020.10.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 12/23/2022]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has pushed us to find better ways to accurately diagnose what can be an elusory disease, preferably in a way that limits exposure to others. The potential for home diagnosis and monitoring could reduce infectious risk for other patients and health care providers, limit use of finite hospital resources, and enable better social distancing and isolation practices. Case Report We report a case of an otherwise healthy emergency physician diagnosed with COVID-19 at home using portable ultrasound, pulse oximetry, and antibody testing. Her clinical picture and typical lung findings of COVID-19 on ultrasound, combined with a normal echocardiogram and negative deep vein thrombosis study, helped inform her diagnosis. She then monitored her clinical course using pulse oximetry, was able to self-isolate for 4 weeks, and had an uneventful recovery. Her diagnosis was confirmed with a positive IgG antibody test after 3 weeks. Conclusions Novel times call for novel solutions and our case demonstrates one possible path for home diagnosis and monitoring of COVID-19. The tools used, namely ultrasound and pulse oximetry, should be familiar to most emergency physicians. Ultrasound in particular was helpful in eliminating other potential diagnoses, such as pulmonary embolus.
Collapse
Affiliation(s)
- Amir Aminlari
- Department of Emergency Medicine, University of California, San Diego School of Medicine, San Diego, California
| | - Faith Quenzer
- Department of Emergency Medicine, University of California, San Diego School of Medicine, San Diego, California
| | - Stephen Hayden
- Department of Emergency Medicine, University of California, San Diego School of Medicine, San Diego, California
| | - Jennifer Stone
- Department of Emergency Medicine, University of California, San Diego School of Medicine, San Diego, California
| | - Charles Murchison
- Department of Emergency Medicine, University of California, San Diego School of Medicine, San Diego, California
| | - Colleen Campbell
- Department of Emergency Medicine, University of California, San Diego School of Medicine, San Diego, California
| |
Collapse
|
7
|
Campbell C, Aminlari A, Bisanz B, Medak A. An Unusual Case of Dyspnea Diagnosed by Point-of-Care Ultrasound. J Emerg Med 2020; 59:129-131. [PMID: 32600885 DOI: 10.1016/j.jemermed.2020.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/17/2020] [Accepted: 05/07/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Colleen Campbell
- Emergency Ultrasound, Clinical Emergency Medicine, University of California, San Diego, Medical Center, Solana Beach, California
| | - Amir Aminlari
- Emergency Ultrasound, Clinical Emergency Medicine, University of California, San Diego, Medical Center, San Diego, California
| | - Bryan Bisanz
- Emergency Medicine, University of California, San Diego, Medical Center, San Diego, California
| | - Anthony Medak
- Emergency Ultrasound, Clinical Emergency Medicine, University of California, San Diego, Medical Center, San Diego, California
| |
Collapse
|
8
|
Aminlari A, Jazayeri Shooshtari M, Bakhshandeh AR. Association of cardiac rehabilitation with improvement in high sensitive C-reactive protein post-myocardial infarction. Iran Red Crescent Med J 2012; 14:49-50. [PMID: 22737555 PMCID: PMC3372024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Accepted: 08/09/2011] [Indexed: 11/10/2022]
Affiliation(s)
- A Aminlari
- Department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran,Correspondence: Ali Aminlari, MD, Department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran. Tel.: +98-711-2319040, E-mail:
| | - M Jazayeri Shooshtari
- Department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran
| | - A R Bakhshandeh
- Department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
9
|
Aminlari A, East M, Wei W, Quillen D. Topiramate induced acute angle closure glaucoma. Open Ophthalmol J 2008; 2:46-7. [PMID: 19478906 PMCID: PMC2687928 DOI: 10.2174/1874364100802010046] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Revised: 02/20/2008] [Accepted: 02/22/2008] [Indexed: 11/22/2022] Open
Abstract
Topiramate is an oral sulphamate medication primarily used for seizure, migraine and neuropathic pain. It has been associated with secondary angle closure, which can mimic acute angle closure glaucoma. Suspicion for medication induced angle closure glaucoma should be higher whenever angle closure presents bilaterally. We present two cases of bilateral angle closure glaucoma secondary to topiramate.
Collapse
Affiliation(s)
- A Aminlari
- Department of Ophthalmology, Pennsylvania State University Milton S. Hershey Medical Center, Hershey, USA.
| | | | | | | |
Collapse
|
10
|
Abstract
OBJECTIVE Septic complications and the emergence of drug-resistant microbes represent serious risks to patients. Recently, naturally occurring peptides have been discovered that possess potent and broad-spectrum antimicrobial activity. Protegrin-1 is particularly attractive for clinical use in human wounds because, unlike defensins, protegrin-1 retains broad antimicrobial and antifungal activity at physiologic salt concentration and in the presence of serum. The objective of this study was to examine the efficacy of protegrin-1 in killing multiple drug-resistant microbes isolated from human burn patients. DESIGN For thein vitroexperiment, bilayer radial diffusion was performed comparing standard antibiotics with protegrin-1 on multiple-drug-resistant microbial organisms isolated from infected burn wounds. In vivo, rats received a 20% total body surface area partial-thickness burn by immersion in 60 degrees C water for 20 secs followed by wound seeding with 106 colony forming units of Silvadene-resistant Pseudomonas aeruginosa. SETTING University of Michigan research laboratory. SUBJECTS Adult, male Sprague-Dawley rats. INTERVENTIONS Rats were randomized into three groups: those receiving synthetic protegrin-1, acetic acid (carrier), or gentamicin (positive control). Protegrin-1 was administered by topical application or intradermal injection. Wound tissues were harvested aseptically at different time points for quantitative bacterial counts. MEASUREMENTS AND MAIN RESULTS In vivo and in vitro experiments revealed rapid and significant decreases in bacterial counts for protegrin-1-treated groups compared with controls. CONCLUSIONS This study shows that protegrin-1 potentially may be used as an alternative or adjunct therapy to standard agents used to treat wound infections.
Collapse
Affiliation(s)
- L Steinstraesser
- Departments of Surgery, University of Michigan, Ann Arbor, MI, USA
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Abstract
Skin is an especially attractive target for genetic manipulation because it is readily accessible and easily monitored for both the presence and the expression of inserted genes. This study was designed to assess the feasibility of particle mediated gene transfer to burned skin and to compare the transfection efficiency, anatomic distribution, and duration of transgene expression achievable in normal versus burned skin. Two days following scald injury of varying depths in 60 degrees C water (10 s: superficial partial; 20 s: deep partial; 40 s: full thickness) reporter gene (beta-galactosidase) constructs were delivered using a gene gun at various helium pressures (200-600 psi) to normal and burned skin. A time course study was performed to examine the kinetics of transgene expression. Animals received a superficial partial thickness burn and were sacrificed 12 h, 1, 3, 5, 7, 14, or 21 days after gene transfer. India Ink injection and immunohistochemistry were used to assess the depth of the scald injury. Transfection efficiency was measured in skin homogenates 24 h after gene transfer by morphometric and chemoluminescent assays. We found that the extent of tissue damage was directly related to the duration of heat source exposure. Reporter gene activity was significantly higher in superficial partial thickness burns compared to normal controls and gradually declined with increasing tissue injury. No activity was seen in the full thickness burn group. Beta-galactosidase activity reached a maximum level 12 h after gene transfer in both normal and superficial partial thickness burned skin with no levels seen after 5 days post-transfection. These findings indicate that particle-mediated gene transfer in thermally injured skin is feasible and may provide a means of introducing biologic agents into injured tissue capable of enhancing bacterial clearance and improving wound healing.
Collapse
|
12
|
Klein RD, Su GL, Schmidt C, Aminlari A, Steinstraesser L, Alarcon WH, Zhang HY, Wang SC. Lipopolysaccharide-binding protein accelerates and augments Escherichia coli phagocytosis by alveolar macrophages. J Surg Res 2000; 94:159-66. [PMID: 11104656 DOI: 10.1006/jsre.2000.5975] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [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: 11/22/2022]
Abstract
BACKGROUND The first step in bacterial clearance by leukocytes is attachment and phagocytosis. Although lipopolysaccharide-binding protein (LBP) is best known for potentiating LPS-induced cytokine production through a CD14-dependent pathway, recent studies suggest that LBP plays a critical role in clearance of gram-negative bacteria and is essential for survival after bacterial challenge. We therefore sought to examine LBP's effect on Escherichia coli phagocytosis by alveolar macrophages (AMs) and to determine if this effect is mediated through CD14. MATERIALS AND METHODS Phosphatidylinositol-specific phospholipase C (PIPLC)-treated and untreated rat AMs were incubated in the presence of increasing doses of recombinant LBP or negative control protein (choramphenicol acetyltransferase) prior to E. coli-FITC (Ec-F) BioParticle challenge. Phagocytosed bacteria were assayed by fluorescence measurement. A time course study was also performed. RESULTS LBP potentiated phagocytosis of Ec-F BioParticles by AMs in a dose-dependent fashion. Kinetic studies showed that LBP augmented Ec-F phagocytosis by 76% at 30 min. Treatment of AMs with PIPLC to remove CD14 resulted in only a partial decrease in LBP-mediated enhancement of phagocytosis. CONCLUSION These results clearly demonstrate that LBP plays an important role in enhancing Ec-F binding and phagocytosis in a time- and dose-dependent manner. This observed increase may not require the presence of CD14 as significant potentiation of phagocytosis still occurred after PIPLC treatment. We postulate that the LBP-mediated increase in Ec-F phagocytosis can occur in the absence of CD14 through the presence of another receptor.
Collapse
Affiliation(s)
- R D Klein
- Department of Surgery, University of Michigan, Ann Arbor, Michigan 48109-0666, USA.
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Johnson LN, Sassani JW, Aminlari A. Supervision during automated perimetry. Ophthalmology 2000; 107:1439-40. [PMID: 10919883 DOI: 10.1016/s0161-6420(00)00208-6] [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: 11/23/2022] Open
|
14
|
Klein RD, Su GL, Aminlari A, Zhang H, Steinstraesser L, Alarcon WH, Wang SC. Skin lipopolysaccharide-binding protein and IL-1beta production after thermal injury. J Burn Care Rehabil 2000; 21:345-52. [PMID: 10935817 DOI: 10.1067/mbc.2000.107542] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In response to a burn injury, skin can have an inflammatory response characterized by the production of inflammatory cytokines, recruitment of immune cells, containment of invading organisms, and clearance of noxious substances from the wound. Lipopolysaccharide-binding protein (LBP) is a molecule that is capable of coordinating all 4 functions; we previously found evidence that suggested that LBP is produced within surgical wounds. Because of the central role of LBP in the response to bacterial infection, as well as in the high rate of infection after burn injuries, we sought to determine whether a thermal injury could affect wound LBP production and thereby affect host responses against bacterial infection. Rats were given either a burn or a sham burn and were killed 24, 48, and 72 hours after the injuries. Wound specimens were assayed for bacterial counts and for the presence of LBP, messenger (m)RNA, and interleukin (IL)-1beta mRNA. Wound LBP mRNA was significantly upregulated at 24 hours in the group with burn injuries (P < .05; burn vs sham burn); this was followed by decreases at 48 and 72 hours. Immunohistochemistry showed LBP protein in the epidermis of animals with burns. Bacterial counts increased in the group with burn injuries (P < .05; burn vs sham burn) and continued to rise for 72 hours. IL-1beta mRNA levels were elevated at all time points in the group with burn injuries (P < .05). These results suggest an inverse correlation between burn wound LBP expression and bacterial wound counts. This failure to maintain local LBP production after severe thermal injury despite localized inflammation shown by high IL-1beta levels may predispose local wounds to bacterial invasion.
Collapse
Affiliation(s)
- R D Klein
- Department of Surgery, University of Michigan, Ann Arbor, USA
| | | | | | | | | | | | | |
Collapse
|
15
|
Su GL, Klein RD, Aminlari A, Zhang HY, Steinstraesser L, Alarcon WH, Remick DG, Wang SC. Kupffer cell activation by lipopolysaccharide in rats: role for lipopolysaccharide binding protein and toll-like receptor 4. Hepatology 2000; 31:932-6. [PMID: 10733550 DOI: 10.1053/he.2000.5634] [Citation(s) in RCA: 214] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Lipopolysaccharide (LPS) binding protein (LBP) is a key serum factor that mediates LPS activation of mononuclear cells. In the presence of LBP, 1/1,000 the concentration of LPS is sufficient to activate peripheral blood monocytes. Previous studies with Kupffer cells have shown a variable effect of serum on LPS activation of these cells and led to the conclusion that, unlike extrahepatic mononuclear cells, Kupffer cells do not respond to LPS in an LBP-dependent fashion. Because there are multiple components in serum other than LBP that might affect LPS activation, these reports with serum are difficult to interpret. To investigate the specific role of LBP in LPS activation of Kupffer cells, we produced a functional recombinant rat LBP using a baculovirus expression system, which we used to selectively examine the role of LBP's on Kupffer-cell function. Isolated Kupffer cells exposed to increasing concentrations of LPS (0, 1, 10 ng/mL) showed a dose-dependent increase in TNF-alpha production, which was augmented and accelerated by the presence of LBP. The effects of LBP on Kupffer cell activation by LPS are dependent on a functional Toll-like receptor 4 (Tlr 4) because Kupffer cells from C3H/HeJ mice failed to respond to LPS in the presence of LBP. LBP plays an important role in mediating Kupffer cell activation by LPS, and these effects are dependent on the presence of functioning Tlr 4.
Collapse
Affiliation(s)
- G L Su
- Departments of Medicine, University of Michigan, Ann Arbor, MI, USA.
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Abstract
BACKGROUND The acute respiratory distress syndrome (ARDS) causes significant morbidity and mortality among trauma patients. Although multiple factors have been implicated, pulmonary injury in this population may be due to inflammatory mediators released in response to stimuli such as endotoxin (LPS). LBP plays an integral part in LPS-mediated release of inflammatory cytokines and increased local expression of LBP as the result of a primary injury may prime the lung to secondary LPS-mediated damage. MATERIALS AND METHODS To determine the magnitude of pulmonary LBP upregulation following LPS injury we challenged rats with either intravenous (IV) or intratracheal (IT) LPS. Animals from each group were euthanized at 1, 2, 4, and 8 h postchallenge. Lung LBP and CD14 mRNA levels were assayed by Northern blot. Serum and bronchoalveolar lavage (BAL) fluid were assayed for inflammatory cytokines (TNF-alpha, MCP-1, IL-1beta, IL-6, and IL-10) by ELISA. RESULTS LBP and CD14 mRNA levels were found to increase significantly in lung tissue after both IV and IT LPS with the IV LPS animals having a greater increase over 8 h. Serum TNF-alpha was significantly elevated in the IV LPS group whereas very low levels were detected in the BAL. Only BAL TNF-alpha was increased in the IT group at 8 h. CONCLUSION Local pulmonary LBP and CD14 mRNA are both upregulated after either systemic or local LPS exposure. Such upregulation may render thelung more susceptible to local immune overactivation and injury during subsequent exposures to LPS.
Collapse
Affiliation(s)
- R D Klein
- Department of Surgery, University of Michigan, Ann-Arbor, Michigan 48109, USA
| | | | | | | | | |
Collapse
|
17
|
Campanella PC, Aminlari A, DeMaio R. Traumatic cataract and Wieger's ligament. J Ophthalmic Nurs Technol 1997; 16:175-6. [PMID: 9335730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- P C Campanella
- Department of Ophthalmology, Penn State University College of Medicine, Hershey, USA
| | | | | |
Collapse
|
18
|
Campanella PC, Aminlari A, DeMaio R. Traumatic cataract and Wieger's ligament. Ophthalmic Surg Lasers 1997; 28:422-3. [PMID: 9150526] [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] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The objective of this study was to determine the relationship between posterior subcapsular contusion cataract and Wieger's ligament. Two clinical cases of traumatic cataract, occurring in young patients, were analyzed. In neither case was there evidence of penetrating or perforating injuries to the globe. During cataract extraction a smooth oval defect in the posterior capsule was observed; however, there was no evidence of intraoperative capsular damage. The outline of the defect was consistent with the border of Wieger's ligament. It appears that blunt trauma avulsed this region of lens capsule, resulting in these findings.
Collapse
Affiliation(s)
- P C Campanella
- Department of Ophthalmology, Penn State University College of Medicine, Hershey 17033, USA
| | | | | |
Collapse
|
19
|
Parnes RE, Dailey JR, Aminlari A. Hypotonus cyclodialysis cleft following anterior chamber intraocular lens removal. Ophthalmic Surg 1994; 25:386-387. [PMID: 8090419] [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] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Inadvertent cyclodialysis cleft formation is a rare complication of intraocular surgery. We report a patient in whom a hypotonus cyclodialysis cleft developed following the removal of an anterior chamber intraocular lens. The cleft closed and the hypotony resolved after 1 month of topical atropine therapy.
Collapse
Affiliation(s)
- R E Parnes
- Department of Ophthalmology, Penn State University College of Medicine, Hershey 17033
| | | | | |
Collapse
|
20
|
Aminlari A. Inadvertent cyclodialysis cleft. Ophthalmic Surg 1993; 24:331-5. [PMID: 8515950] [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] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We report four patients with functionally significant inadvertent cyclodialysis cleft. In three, the cleft followed uneventful extracapsular cataract extraction with posterior chamber intraocular lens implantation; in the fourth, blunt trauma with hyphema. Ocular hypotony resolved in three patients with medical therapy; the fourth required argon laser photocoagulation. Causes, clinical findings, and treatment of inadvertent cyclodialysis cleft are reviewed.
Collapse
Affiliation(s)
- A Aminlari
- Department of Ophthalmology, Pennsylvania Lions Vision and Research Center, Penn State University, College of Medicine, Hershey
| |
Collapse
|
21
|
|
22
|
Johnson LN, Aminlari A, Sassani JW. Effect of intermittent versus continuous patient monitoring on reliability indices during automated perimetry. Ophthalmology 1993; 100:76-84. [PMID: 8433832 DOI: 10.1016/s0161-6420(93)31689-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [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: 01/30/2023] Open
Abstract
PURPOSE This prospective, randomized study was undertaken to determine the effect of intermittent versus continuous patient monitoring on reliability indices (fixation losses, false-positive errors, and false-negative errors) during automated static perimetry. METHODS A practice Humphrey Program C30-2 visual field was administered to 169 subjects (mean age +/- standard deviation, 56 +/- 18 years) for 1.5 minutes, during which time trained technicians continuously monitored all subjects and assessed patient fixation as noted on the eye monitor. The computer-generated reliability indices during the 1.5 minute practice test were recorded. After completion of the practice test, the 169 eyes were randomized to either intermittent or continuous monitor for the permanent C30-2 test. During intermittent monitoring, the technician returned periodically to the examination room to assess the subject's performance. For continuous monitoring, the technician continually assessed the subject's performance while remaining in the examination room throughout the test duration. RESULTS The mean number of visits per visual field test during intermittent monitoring was 4.0, and mean test duration was 15.8 minutes. There was no difference in the mean deviation, pattern standard deviation, and short-term fluctuation (P = 0.85, 0.98, and 0.41, respectively) of the visual fields for intermittent and continuous monitoring, suggesting similar diffuse depression and localized defects in the visual fields for each group. The mean fixation losses (6.9%), false-positive errors (1.8%), and false-negative errors (5.8%) for the intermittently monitored group were not different from the mean fixation losses (7.8%), false-positive errors, (3.1%) and false-negative errors (5.0%) for the continuously monitored group (P = 0.40, 0.24, and 0.36, respectively). CONCLUSION Although recommended, continuous monitoring does not appear necessary for all patients undergoing automated perimetry. Error-free reliability indices combined with the technician's judgment of patient reliability during the first 1.5 minutes of C30-2 testing may be a guideline for choosing intermittent monitoring.
Collapse
Affiliation(s)
- L N Johnson
- Mason Eye Institute, University of Missouri-Columbia 65212
| | | | | |
Collapse
|
23
|
Abstract
A case of bilateral malignant glaucoma is described in a 50-year-old white woman 4 weeks after successful bilateral laser iridotomy for angle-closure glaucoma. The malignant glaucoma may have been precipitated by systemic hydrochlorothiazide therapy. The condition was worsened by pilocarpine; however, atropine and cyclopentolate opened the angle and deepened the anterior chamber, resulting in resolution of the malignant glaucoma. The clinician must be alert to the possibility of malignant glaucoma following laser iridotomy for angle-closure glaucoma.
Collapse
Affiliation(s)
- A Aminlari
- Department of Ophthalmology, Penn State University, College of Medicine, Hershey 17033
| | | |
Collapse
|
24
|
Hill RA, Aminlari A, Sassani JW, Michalski M. Use of a symblepharon ring for treatment of over-filtration and leaking blebs after glaucoma filtration surgery. Ophthalmic Surg 1990; 21:707-10. [PMID: 2250854] [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] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We report the use of a symblepharon ring in the treatment of seven cases of flat anterior chamber (six cases of total iridocorneal touch, and one of corneallens touch) secondary to overfiltration or to bleb leak. In all cases, the anterior chamber reformed within 24 hours after the symblepharon ring was used. Advantages of using the ring are: (a) it permits testing of visual acuity, tonometry, and intraocular examination without removing it; (b) it does not require suturing to the conjunctiva; (c) it does not disturb the corneal epithelium; (d) it may be available at institutions lacking other shells; and (e) it is cost-effective.
Collapse
Affiliation(s)
- R A Hill
- Department of Ophthalmology, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey 17033
| | | | | | | |
Collapse
|
25
|
Cameron HH, Hedges TR, Aminlari A. Correlation of ocular findings and plain skull roentgenogram in pituitary adenoma. Ann Ophthalmol 1982; 14:733-740. [PMID: 7125469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
A review of the conditions of 44 consecutive patients diagnosed as having pituitary tumor is presented. In none of those with abnormal visual acuity, visual field defect, or extraocular muscle palsy was the plain skull roentgenogram normal. In all but one patient who had an abnormality on ocular examination), there was erosion of the clinoids on the plain lateral skull roentgenogram and, in that one patient, erosion was found on the side of the visual loss by the use of tomography. Based on these observations, we have stressed primarily the early use of simple plain skull roentgenograms in the evaluation of the conditions of patients with unexplained visual loss or extraocular movement palsy. We have also presented a scheme for evaluation of the conditions and the follow-up of patients suspected of having pituitary tumors.
Collapse
|
26
|
|
27
|
|
28
|
|
29
|
Vucicevic Z, Aminlari A, Ralston J, Yaros M, Wen LY, Berry A, Frauenhoffer C. [Change of scleral rigidity during tonography (author's transl)]. Klin Monbl Augenheilkd 1973; 163:38-43. [PMID: 4750511] [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: 01/12/2023]
|
30
|
|