16 results on '"Vakharia S"'
Search Results
2. Epidural Abscess.
- Author
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Wang, J. S., Fellows, D. G., Vakharia, S., Rosenbaum, A. E., and Thomas, P. S.
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- 1997
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3. An Unusual Presentation of an Amniotic Fluid Embolism: Fetal Bradycardia As the First Sign.
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Wang V, Dhoon TQ, Steller J, Carusillo D, Rahimian R, Vakharia S, and Rinehart J
- Abstract
Amniotic fluid embolism (AFE) is a potentially fatal maternal condition demanding awareness from obstetricians and anesthesiologists regarding its different manifestations. The typical presentation involves maternal respiratory distress, cardiovascular collapse, neurological changes, and coagulopathy followed by fetal distress. This unusual case study emphasizes that fetal compromise may precede maternal decompensation as the initial sign of AFE. Fetal distress is a known symptom of AFE and is typically seen due to cardiorespiratory issues that lead to reduced uteroplacental perfusion, resulting in fetal hypoxia. In the case presented, fetal bradycardia occurred before any visible maternal symptoms, suggesting that fetal distress could be induced by factors independent of the mother's cardiopulmonary status. A 34-year-old healthy G4P2012 at 41 weeks and 2 days gestation who was initially laboring on the floor was emergently taken to the operating room for a cesarean delivery due to fetal bradycardia. Around the time the fetus was delivered, the patient displayed seizure activity, followed by a complete loss of consciousness and cardiac arrest. The patient was intubated and underwent cardiopulmonary resuscitation and defibrillation, subsequently converting to a wide complex tachycardia. In the operating room, there was evidence of heavy vaginal bleeding, uterine atony, and a fulminant form of disseminated intravascular coagulopathy (DIC), which required aggressive management over the next four hours. After achieving hemodynamic stability, the patient was transferred to the surgical intensive care unit (SICU), extubated on day 3, and discharged home on day 8., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Wang et al.)
- Published
- 2024
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4. Perceptions of prospective pharmaceutical stimulant substitution treatments among people who use illicit stimulants in Vancouver, Canada.
- Author
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Fleming T, Ivsins A, Barker A, Mansoor M, Mayer S, Vakharia S, and McNeil R
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- Humans, Analgesics, Opioid, Prospective Studies, Canada epidemiology, Opioid-Related Disorders drug therapy, Central Nervous System Stimulants, Illicit Drugs, Drug Overdose
- Abstract
Background: Stimulant-involved overdose deaths are increasing, driven by polysubstance use and adulteration of the illicit drug supply. While emerging evidence for prescription stimulant substitution is promising, there are no approved treatment options for stimulant use disorder that address the realities of an unpredictable drug supply. This study explores treatment experiences of people who use illicit stimulants (PWUS) to identify gaps and perceptions of prospective pharmaceutical stimulant substitution treatments (SST)., Methods: In-depth qualitative interviews were conducted with 86 PWUS in Vancouver, Canada. Thematic analysis focused on experiences of available treatment options for stimulant use and perceptions of prospective SST., Results: Participants identified how primarily behavioral treatment approaches do not meet the unique needs of PWUS, in contrast with the range of medical treatments available for opioid use disorder. Participants anticipated health and social benefits if they were able to access SST, including avoiding the toxic illicit stimulant supply, reduced engagement in criminalized activities, and greater economic security. Perceptions of prospective SST were informed by knowledge of existing opioid treatments. This led some participants to be unsupportive of SST, citing concerns around agency and highly regulated operational contexts that do not align with the lived realities of stimulant use., Conclusion: Findings demonstrate the need for SST pilot programs in real-world settings and underscore the health and social advantages SST may offer; although drawing on existing opioid treatment models to implement SST pilots may limit success. Thus, any novel treatments for stimulant use must centre the lived realities of PWUS., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)
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- 2024
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5. Characterizing stimulant overdose: A qualitative study on perceptions and experiences of "overamping".
- Author
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Mansoor M, McNeil R, Fleming T, Barker A, Vakharia S, Sue K, and Ivsins A
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- Analgesics, Opioid, Harm Reduction, Humans, Qualitative Research, Central Nervous System Stimulants adverse effects, Drug Overdose drug therapy, Drug Overdose epidemiology, Opiate Overdose
- Abstract
Background: The dominant focus of North America's current overdose crisis has been opioids, resulting in considerable research and harm reduction efforts to address opioid-related overdose risks. Less attention has been paid to people who use stimulants (PWUS) despite recent increases in stimulant use and stimulant-involved overdoses (i.e., "overamping"). Stimulant users' definitions, risk factors and experiences of, and responses to, overamping are poorly understood, thereby putting PWUS at heightened risk of adverse health outcomes. This study explores how PWUS understand, experience, and respond to overamping., Methods: In-depth qualitative interviews were conducted with 61 PWUS in Vancouver, Canada's Downtown Eastside neighbourhood. Thematic analysis of interviews focused on contextualizing stimulant overdoses, including how PWUS understand, define, experience, and respond to overamping., Results: Participants associated overamping experiences with commonly identified signs and symptoms, such as rapid onset, elevated heart rate, incontinence, and audiovisua hallucinations, but also reported more serious indicators of overamping, such as unconsciousness, cardiac arrests and seizures. Our findings demonstrate that, among PWUS, there was no unified understanding of overamping such as with opioid overdose and individual experiences had substantial variation in severity and presentation. This impacted the ability to adequately respond to stimulant overdoses, which were primarily self-managed through methods including stabilizing breathing, polysubstance use, and cold showers., Conclusion: Given the growing role of stimulants in North America's overdose crisis, there is an urgent need to improve the identification of stimulant overdoses in real world settings. Our findings identify a gap in current understandings of stimulant overdose, and demonstrate the need for public health and harm reduction interventions to better address overamp risk among PWUS, including harm reduction campaigns to disseminate information regarding identifying signs of, and proper responses to, overamping., Competing Interests: Declarations of Interest The authors declare that they have no conflict of interest., (Copyright © 2022 Elsevier B.V. All rights reserved.)
- Published
- 2022
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6. A case of Strongyloides Stercoralis induced duodenitis and pancreatitis.
- Author
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Khan U, Tchomobe G, Vakharia S, Suryadevara M, and Nagarakanti S
- Abstract
Strongyloidiasis is endemic in tropical and sub-tropical regions however cases of strongyloidiasis have been reported in temperate climates. Corticosteroid use, immunosuppression, infection with human T-lymphotropic virus type 1 (HTLV1), and chronic alcohol use are the most common and well-established risk factors for strongyloidiasis. Due to Strongyloides stercoralis characteristic features of hyperinfection and dissemination, it can potentially cause a lethal infection in an immunocompromised individual. Strongyloidiasis is predominantly asymptomatic, however some unusual manifestations of strongyloidiasis include duodenal obstruction, ileus, reactive arthritis, ascites, hepatic lesions, and pancreatitis. Here we present a case of a 47-year-old-St. Lucian female who was found to have duodenitis and pancreatitis secondary to Strongyloides stercoralis in the setting of underlying HTLV-1 infection and chronic alcohol use., Competing Interests: No conflict of interests., (© 2022 The Authors. Published by Elsevier Ltd.)
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- 2022
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7. Stimulant safe supply: a potential opportunity to respond to the overdose epidemic.
- Author
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Fleming T, Barker A, Ivsins A, Vakharia S, and McNeil R
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- Humans, Amphetamine-Related Disorders mortality, Analgesics, Opioid poisoning, Drug Contamination prevention & control, Drug Overdose prevention & control, Fentanyl poisoning, Harm Reduction
- Abstract
Background: Occurring against the backdrop of an overdose crisis, stimulant use and stimulant-involved deaths in North America are increasing at an alarming rate. Many of these deaths are being attributed to fentanyl and related analogs, which have been increasingly found within street-level stimulant supplies. Within this, people experiencing socio-economic marginalization are at the greatest risk of overdose and other harms from adulterated stimulants. Current treatments for stimulant use disorder have limited effectiveness, and even less applicability to the lived realities of marginalized stimulant users. Emerging technologies, such as drug checking, are being implemented to support safer stimulant use, but the accessibility and utility of these technologies to stimulant users are framed by experiences of vulnerability that render them largely ineffective., Stimulant Safe Supply: Solutions that provide a legal and safe supply of non-adulterated stimulants of known quality, and within a health care framework, are needed to directly address the risk of an increasingly adulterated stimulant supply. Similar innovative opioid-focused interventions are being piloted with medications that have a similar pharmacological effect as their illicit counterparts. While there are currently no approved pharmacotherapies for stimulant use, research has demonstrated a number of stimulant medications that are promising substitutes for cocaine and methamphetamine use. Much like with opioid-focused pharmacotherapies, having a consistent and safe supply of stimulants can lead to improved health outcomes and will drastically reduce overdose risk. However, for a stimulant safe supply intervention to be a success, it must provide the high and performance-enhancing effects that people seek from the illicit market, which requires doses and user agency that trials to date have not provided., Conclusion: Efforts are needed to investigate the feasibility of pharmacological stimulant-based interventions that address safe supply needs. The promise of similar opioid-focused approaches in addressing both overdose-related risks and experiences related to vulnerability underscores the need to advance safe supply approaches targeted towards people who use stimulants. Given the current overdose crisis and rising stimulant use across North America, the implementation and evaluation of such novel stimulant-focused interventions should be a public health priority.
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- 2020
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8. "A Time of Opportunity": Patient Safety and the Perioperative Surgical Home.
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Garson LM, Vakharia S, Edwards AF, and Maze M
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- Humans, Patient Safety, Patient-Centered Care, Perioperative Care, Anesthesiology
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- 2016
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9. Total Joint Replacement Perioperative Surgical Home Program: 2-Year Follow-Up.
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Cyriac J, Garson L, Schwarzkopf R, Ahn K, Rinehart J, Vakharia S, Cannesson M, and Kain Z
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- Aged, Blood Transfusion, California, Elective Surgical Procedures, Female, Follow-Up Studies, Humans, Length of Stay, Male, Middle Aged, Pain, Postoperative etiology, Patient Discharge, Patient Readmission, Program Evaluation, Prospective Studies, Risk Factors, Skilled Nursing Facilities, Time Factors, Treatment Outcome, Arthroplasty, Replacement, Hip adverse effects, Arthroplasty, Replacement, Hip instrumentation, Arthroplasty, Replacement, Knee adverse effects, Arthroplasty, Replacement, Knee instrumentation, Delivery of Health Care, Integrated organization & administration, Patient-Centered Care organization & administration, Process Assessment, Health Care
- Abstract
Background: Previously, our group successfully established one of the nation's first Perioperative Surgical Homes (PSHs) aimed at coordinating services to patients undergoing primary total hip arthroplasty (THA) and primary total knee arthroplasty (TKA). As we now focus on extending the PSH to other service lines within the hospital, the long-term sustainability of this practice model is an important factor to consider moving forward., Methods: We prospectively collected data from all patients who underwent elective primary TKA and THA at our institution between October 1, 2012, and September 30, 2014. Prospectively collected data included length of stay (LOS), 30-day readmission rate, postoperative pain scores, and complications., Results: During the 2-year period, there were 328 primary joint arthroplasty patients. Overall, the median LOS was significantly shorter in the second year of the PSH initiative (P = 0.03). Stratified by procedure, the median LOS for patients undergoing THA was significantly shorter in the second year (P = 0.02), whereas the median LOS for patients undergoing TKA did not differ between the 2 time periods. In the second year of the PSH initiative, significantly more patients were discharged home than to a skilled nursing facility compared with year 1 of the PSH initiative (P = 0.02). Readmission rates within 30 days after surgery to our institution were 0.9% (0.0-4.4) in the first year of the PSH initiative and 3.3% (confidence interval, 1.3%-7.2%) in the second year of the PSH initiative (P = not significant). Pain scores did not change significantly from year 1 to year 2 (P = not significant)., Conclusions: Data for the second year of implementation demonstrate similarly positive results in LOS, pain control, discharge destination, readmission, transfusion rates, and complications.
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- 2016
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10. Perioperative goal-directed therapy and postoperative outcomes in patients undergoing high-risk abdominal surgery: a historical-prospective, comparative effectiveness study.
- Author
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Cannesson M, Ramsingh D, Rinehart J, Demirjian A, Vu T, Vakharia S, Imagawa D, Yu Z, Greenfield S, and Kain Z
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- Aged, California epidemiology, Comparative Effectiveness Research, Crystalloid Solutions, Erythrocyte Transfusion statistics & numerical data, Female, Humans, Length of Stay statistics & numerical data, Male, Middle Aged, Patient Readmission statistics & numerical data, Abdomen surgery, Fluid Therapy, Isotonic Solutions administration & dosage, Perioperative Care, Postoperative Complications epidemiology
- Abstract
Introduction: Perioperative goal-directed therapy (PGDT) may improve postoperative outcome in high-risk surgery patients but its adoption has been slow. In 2012, we initiated a performance improvement (PI) project focusing on the implementation of PGDT during high-risk abdominal surgeries. The objective of the present study was to evaluate the effectiveness of this intervention., Methods: This is a historical prospective quality improvement study. The goal of this initiative was to standardize the way fluid management and hemodynamic optimization are conducted during high-risk abdominal surgery in the Departments of Anesthesiology and Surgery at the University of California Irvine. For fluid management, the protocol consisted in standardized baseline crystalloid administration of 3 ml/kg/hour and any additional boluses based on PGDT. The impact of the intervention was assessed on the length of stay in the hospital (LOS) and post-operative complications (NSQIP database)., Results: In the 1 year pre- and post-implementation periods, 128 and 202 patients were included. The average volume of fluid administered during the case was 9.9 (7.1-13.0) ml/kg/hour in the pre-implementation period and 6.6 (4.7-9.5) ml/kg/hour in the post-implementation period (p < 0.01). LOS decreased from 10 (6-16) days to 7 (5-11) days (p = 0.0001). Based on the multiple linear regression analysis, the estimated coefficient for intervention was 0.203 (SE = 0.054, p = 0.0002) indicating that, with the other conditions being held the same, introducing intervention reduced LOS by 18% (95% confidence interval 9-27%). The incidence of NSQIP complications decreased from 39% to 25% (p = 0.04)., Conclusion: These results suggest that the implementation of a PI program focusing on the implementation of PGDT can transform fluid administration patterns and improve postoperative outcome in patients undergoing high-risk abdominal surgeries., Trial Registration: Clinicaltrials.gov NCT02057653. Registered 17 December 2013.
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- 2015
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11. Implementation of a total joint replacement-focused perioperative surgical home: a management case report.
- Author
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Garson L, Schwarzkopf R, Vakharia S, Alexander B, Stead S, Cannesson M, and Kain Z
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- Aged, Anesthesia, Arthroplasty, Replacement adverse effects, Arthroplasty, Replacement economics, Blood Transfusion statistics & numerical data, Case Management, Cost Control, Feasibility Studies, Female, Hospital Mortality, Humans, Intraoperative Care, Length of Stay, Male, Middle Aged, Patient Discharge, Patient Safety, Patient-Centered Care, Postoperative Care, Preoperative Care, Quality Improvement, Treatment Outcome, Arthroplasty, Replacement methods, Perioperative Care methods
- Abstract
Background: The perioperative setting in the United States is noted for variable and fragmented care that increases the chance for errors and adverse outcomes as well as the overall cost of perioperative care. Recently, the American Society of Anesthesiologists put forward the Perioperative Surgical Home (PSH) concept as a potential solution to this problem. Although the PSH concept has been described previously, "real-life" implementation of this new model has not been reported., Methods: Members of the Departments of Anesthesiology and Perioperative Care and Orthopedic Surgery, in addition to perioperative hospital services, developed and implemented a series of clinical care pathways defining and standardizing preoperative, intraoperative, postoperative, and postdischarge management for patients undergoing elective primary hip (n = 51) and knee (n = 95) arthroplasty. We report on the impact of the Total Joint Replacement PSH on length of hospital stay (LOS), incidence of perioperative blood transfusions, postoperative complications, 30-day readmission rates, emergency department visits, mortality, and patient satisfaction., Results: The incidence of major complication was 0.0 (0.0-7.0)% and of perioperative blood transfusion was 6.2 (2.9-11.4)%. In-hospital mortality was 0.0 (0.0-7.0)% and 30-day readmission was 0.7 (0.0-3.8)%. All Surgical Care Improvements Project measures were at 100.0 (93.0-100.0)%. The median LOS for total knee arthroplasty and total hip arthroplasty, respectively, was (median (95% confidence interval [interquartile range]) 3 (2-3) [2-3] and 3 (2-3) [2-3] days. Approximately half of the patients were discharged to a location other than their customary residence (70 to skilled nursing facility, 1 to rehabilitation, 39 to home with organization health services, and 36 to home)., Conclusions: We believe that our experience with the Total Joint Replacement PSH program provides solid evidence of the feasibility of this practice model to improve patient outcomes and achieve high patient satisfaction. In the future, the impact of LOS on cost will have to be better quantified. Specifically, future studies comparing PSH to traditional care will have to include consideration of postdischarge care, which are drivers of the perioperative costs.
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- 2014
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12. The perioperative surgical home as a future perioperative practice model.
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Kain ZN, Vakharia S, Garson L, Engwall S, Schwarzkopf R, Gupta R, and Cannesson M
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- Delivery of Health Care methods, Delivery of Health Care trends, Humans, Patient Care Team, Patient-Centered Care, Perioperative Care economics, Professional Practice, Quality Improvement, Treatment Outcome, Models, Organizational, Perioperative Care methods
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- 2014
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13. Technical communication: respiratory variation in pulse pressure and plethysmographic waveforms: intraoperative applicability in a North American academic center.
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Maguire S, Rinehart J, Vakharia S, and Cannesson M
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- Academic Medical Centers methods, California, Humans, Monitoring, Intraoperative methods, Plethysmography methods, Positive-Pressure Respiration standards, Retrospective Studies, Academic Medical Centers standards, Blood Pressure physiology, Monitoring, Intraoperative standards, Respiratory Mechanics physiology
- Abstract
Dynamic variables are the best predictors of fluid responsiveness in patients under general anesthesia and mechanical ventilation; namely, respiratory variations in pulse pressure and in the plethysmographic waveform. However, these variables have potential limitations. Our aim was to evaluate their intraoperative applicability. We extracted clinical data from all anesthesia procedures performed at our institution in 2009 and identified the number of cases that presented predetermined conditions of application. Among the 12,308 procedures, 39% met the criteria for the noninvasive monitoring of variations in the plethysmographic waveform of which 23% had arterial lines and met the criteria for the invasive monitoring of variations in pulse pressure.
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- 2011
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14. The ParaSight-F test for detecting treatment failure.
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Vakharia S, Gopinathan N, and Kshirsagar NA
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- Antimalarials therapeutic use, Artemether, Chloroquine therapeutic use, Humans, Sesquiterpenes therapeutic use, Treatment Failure, Artemisinins, Malaria, Falciparum drug therapy, Parasitology methods, Reagent Kits, Diagnostic
- Published
- 1997
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15. Magnetic resonance imaging of cerebrospinal fluid leak and tamponade effect of blood patch in postdural puncture headache.
- Author
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Vakharia SB, Thomas PS, Rosenbaum AE, Wasenko JJ, and Fellows DG
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- Adult, Female, Humans, Magnetic Resonance Imaging, Male, Prospective Studies, Anesthesia, Epidural adverse effects, Anesthesia, Spinal adverse effects, Blood Patch, Epidural, Cerebrospinal Fluid physiology, Headache diagnosis, Myelography adverse effects
- Abstract
This prospective study examined the efficacy of magnetic resonance imaging (MRI) in visualizing cerebrospinal fluid (CSF) leak in patients with postdural puncture headache (PDPH) and determining the spread of the blood patch in the epidural space and the extent of tamponade on the thecal sac. After obtaining institutional review board approval, five patients with symptomatic PDPH after 3 days of failed conservative treatment were included in this study. MRI using proton density (PD) and T2-weighted imaging was performed on all patients and CSF flow studies were done on one patient. All patients received 20 mL of blood in the epidural space. They remained supine for 45 min, and repeat MRI studies were performed. Extent of the spread of blood in the epidural space was measured. A visual analog scale of 0-10 was used to evaluate the headache. All patients had severe postural headache with nausea/vomiting. Preblood patch MRI showed extrathecal CSF and hemosiderosis indicating the site of dural puncture in four patients. The postprocedure MRI demonstrated the blood patch as a large extradural collection with anterior displacement of the thecal sac, the mean spread being 4.6 intervertebral spaces. The tamponade effect of the blood patch was observed on PD, T2-weighted, and CSF flow images. All patients experienced immediate resolution of their symptoms. This study suggests that using MRI, the site of the CSF leak, the tamponade effect of the blood patch, and its spread in the epidural space can be documented.
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- 1997
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16. Epidural abscess--early magnetic resonance imaging detection and conservative therapy.
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Wang JS, Fellows DG, Vakharia S, Rosenbaum AE, and Thomas PS
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- Abscess drug therapy, Adult, Analgesia, Epidural adverse effects, Analgesia, Epidural instrumentation, Anti-Bacterial Agents administration & dosage, Anti-Bacterial Agents therapeutic use, Catheters, Indwelling adverse effects, Ceftriaxone administration & dosage, Ceftriaxone therapeutic use, Cephalosporins administration & dosage, Cephalosporins therapeutic use, Drug Therapy, Combination therapeutic use, Epidural Space, Female, Humans, Lumbar Vertebrae, Spinal Diseases diagnosis, Spinal Diseases drug therapy, Vancomycin administration & dosage, Vancomycin therapeutic use, Abscess diagnosis, Magnetic Resonance Imaging, Spinal Diseases microbiology
- Published
- 1996
- Full Text
- View/download PDF
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