43 results on '"Christopher A. Tam"'
Search Results
2. The Entrapped Pulmonary Artery Catheter
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Laura S, Gonzalez, Colleen, Coghlan, Raed A, Alsatli, Ola, Alsatli, Christopher W, Tam, Shreyajit R, Kumar, Richard, Thalappillil, and Mark A, Chaney
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Catheters ,Anesthesiology and Pain Medicine ,Catheterization, Swan-Ganz ,Humans ,Equipment Failure ,Pulmonary Artery ,Cardiology and Cardiovascular Medicine - Published
- 2022
3. Haemodynamic Monitoring Needs for Goal-Directed Fluid Therapy in Lung Resection
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Olga Rozental, Richard Thalappillil, Rob White, and Christopher W. Tam
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,Haemodynamic monitoring ,Hemodynamic Monitoring ,Length of Stay ,Surgery ,Postoperative Complications ,Fluid therapy ,medicine ,Fluid Therapy ,Humans ,Lung resection ,Cardiology and Cardiovascular Medicine ,business ,Goals ,Lung - Published
- 2022
4. Loss of Independent Living in Patients Undergoing Transcatheter or Surgical Aortic Valve Replacement: A Retrospective Cohort Study
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Michael Blank, Mark J. Robitaille, Luca J. Wachtendorf, Felix C. Linhardt, Elena Ahrens, Jordan B. Strom, Omid Azimaraghi, Maximilian S. Schaefer, Louis M. Chu, Jee-Young Moon, Nicola Tarantino, Singh R. Nair, Richard Thalappilil, Christopher W. Tam, Jonathan Leff, Luigi Di Biase, and Matthias Eikermann
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Anesthesiology and Pain Medicine - Published
- 2023
5. ‘Case of the Month’ from University of Michigan, Ann Arbor, MI, USA: emphysematous pyelonephritis following ureteroscopy in a solitary kidney
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Christopher A. Tam, James J. Shields, Khurshid R. Ghani, Kathleen A Linder, and Lena M. Napolitano
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Emphysema ,Male ,Michigan ,medicine.medical_specialty ,2019-20 coronavirus outbreak ,Ureteral Calculi ,Pyelonephritis ,Coronavirus disease 2019 (COVID-19) ,medicine.diagnostic_test ,business.industry ,Urology ,General surgery ,Solitary kidney ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Hydronephrosis ,Middle Aged ,Hospitals, University ,Emphysematous pyelonephritis ,Sepsis ,Ureteroscopy ,medicine ,Humans ,business - Published
- 2021
6. Social determinants of health affect unplanned readmissions following acute myocardial infarction
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Marguerite M. Hoyler, Diana Khatib, Mark D Abramovitz, Rob White, Christopher W. Tam, Xiaoyue Ma, Richard Thalappillil, and Jon D. Samuels
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medicine.medical_specialty ,Social Determinants of Health ,Myocardial Infarction ,New York ,030204 cardiovascular system & hematology ,Affect (psychology) ,Patient Readmission ,Odds ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,medicine ,Humans ,030212 general & internal medicine ,Social determinants of health ,Myocardial infarction ,Socioeconomic status ,Retrospective Studies ,Retrospective review ,Maryland ,business.industry ,Health Policy ,medicine.disease ,United States ,Insurance status ,Emergency medicine ,Florida ,business ,Medicaid - Abstract
Background: Low socioeconomic status predicts inferior clinical outcomes in many patient populations. The effects of patient insurance status and hospital safety-net status on readmission rates following acute myocardial infarction are unclear. Materials & methods: A retrospective review of State Inpatient Databases for New York, California, Florida and Maryland, 2007–2014. Results: A total of 1,055,162 patients were included. Medicaid status was associated with 37.7 and 44.0% increases in risk-adjusted readmission odds at 30 and 90 days (p Conclusion: Insurance status and hospital safety-net burden affect readmission odds following acute myocardial infarction.
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- 2021
7. Tricuspid Stenosis in Pregnancy
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Tracy Grossman, Christopher W. Tam, Harsimran Singh, Geoffrey Bergman, Arash Salemi, Irbaz Hameed, Dmitriy N. Feldman, Robert M. Minutello, Luke K. Kim, Jonathan Villena-Vargas, Shanna S. Hill, Inna Landres, Oluwayemisi Adejumo, and Shing-Chiu Wong
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0301 basic medicine ,bioprosthetic valve ,medicine.medical_specialty ,valve-in-valve ,medicine.medical_treatment ,CO, cardiac output ,Tricuspid valve replacement ,Tricuspid stenosis ,Case Report ,030105 genetics & heredity ,03 medical and health sciences ,0302 clinical medicine ,Valve replacement ,Clinical Case ,valvular heart disease in pregnancy ,medicine ,Diseases of the circulatory (Cardiovascular) system ,Pregnancy ,CO - Cardiac output ,business.industry ,Operative mortality ,medicine.disease ,Valve in valve ,Surgery ,RV, right ventricle ,Stenosis ,LV, left ventricle ,ViV, transcatheter valve-in-valve ,RC666-701 ,tricuspid stenosis ,TV, tricuspid valve ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery - Abstract
Redo tricuspid valve replacement has high surgical operative mortality. Transcatheter valve-in-valve provides a viable option for valve replacement. We discuss the decision-making process involved in performing transcatheter tricuspid valve-in-valve replacement in a 23-week pregnant woman with multiple comorbidities and symptomatic severe bioprosthetic stenosis. (Level of Difficulty: Intermediate.), Graphical abstract
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- 2020
8. Use of Pulmonary Artery Pulsatility Index in Cardiac Surgery
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Mohamed Rahouma, Kane O. Pryor, Peter J. Neuburger, Mario Gaudino, Linda Shore-Lesserson, Gabriel R. Arguelles, Christopher W. Tam, Jacqueline Emerson, Elizabeth Mauer, and Lisa Q. Rong
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medicine.medical_specialty ,Ventricular Dysfunction, Right ,medicine.medical_treatment ,Population ,Diastole ,Hemodynamics ,Pulmonary Artery ,030204 cardiovascular system & hematology ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,law ,Internal medicine ,medicine.artery ,Cardiopulmonary bypass ,medicine ,Humans ,Cardiac Surgical Procedures ,education ,education.field_of_study ,Cardiopulmonary Bypass ,business.industry ,Pulmonary artery catheter ,Area under the curve ,Cardiac surgery ,surgical procedures, operative ,Anesthesiology and Pain Medicine ,Echocardiography ,Pulmonary artery ,Ventricular Function, Right ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
This study evaluated whether the pulmonary artery pulsatility index (PAPi) collected before and after cardiopulmonary bypass (CPB) is predictive and diagnostic of new onset right ventricular (RV) failure in the elective cardiac surgical population.This was a prospective observational study of patients who underwent cardiac surgery between 2017 and 2019.Weill Cornell Medicine, a single large academic medical center.The study comprised 119 patients undergoing elective cardiac surgery.Cardiopulmonary bypass, transesophageal echocardiography, pulmonary artery catheter, and elective cardiac surgery.Echocardiographic and hemodynamic data were collected at 2 time points: pre-CPB and post-chest closure/post-CPB. Patients with and without post-CPB RV dysfunction fractional area of change (35%) were compared, and receiver operating characteristic curves were constructed. One hundred and nineteen patients undergoing elective surgery-coronary artery bypass grafting (23%), aortic valve replacement (21%), aortic surgery (19%), and combined surgery (37%)-were evaluated. Post-CPB RV dysfunction was associated with lower pre-CPB PAPi values (2.0 ± 1.0 v 2.5 ± 1.2; p = 0.001 and p = 0.03) and higher pre-CPB central venous pressure (8.3 ± 3.6 and 6.9 ± 2.7; p = 0.003 and p = 0.02, respectively). Pre-CPB PAPi (0.98 [95% confidence interval {CI} 0.96-0.99]), end systolic area (0.99 [95% CI 0.98-0.99]), and end diastolic area (1.01 [95% CI 1.001-1.02]) were independently associated with RV dysfunction in multivariable modeling, with a lower PAPi and end systolic area and higher end diastolic area demonstrating a greater risk of RV dysfunction post-CPB (post-CPB area under the curve for PAPi 0.80 [95% CI 0.71-0.88; sensitivity = 0.68, specificity = 0.93, optimal cutoff = 1.9]).PAPi measured pre-CPB is a potential predictor and marker of post-CPB RV dysfunction and may have diagnostic utility in cardiac surgery. Additional, large-scale studies are needed to confirm this finding.
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- 2020
9. Respiratory Mechanics and Gas Exchange in COVID-19–associated Respiratory Failure
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Kapil Rajwani, Justin J Choi, Lisa K. Torres, David A. Berlin, Parag Goyal, Katherine Hoffman, Natalia S. Ivascu, Edward J. Schenck, Fernando J. Martinez, and Christopher W. Tam
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Pulmonary and Respiratory Medicine ,Male ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Pneumonia, Viral ,Respiratory physiology ,Betacoronavirus ,Pandemic ,Medicine ,Humans ,Letters ,Pandemics ,Aged ,biology ,business.industry ,Pulmonary Gas Exchange ,SARS-CoV-2 ,COVID-19 ,Middle Aged ,biology.organism_classification ,medicine.disease ,Virology ,Respiration, Artificial ,Pneumonia ,Respiratory failure ,Respiratory Mechanics ,Female ,business ,Coronavirus Infections ,Respiratory Insufficiency - Published
- 2020
10. New Persistent Opioid Use After Outpatient Ureteroscopy for Upper Tract Stone Treatment
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David Leavitt, Christopher A. Tam, Tae Kim, Phyllis Yan, John M. Hollingsworth, Casey A. Dauw, Khurshid R. Ghani, Vidhya Gunaseelan, and Jeremy Raisky
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Adult ,Male ,medicine.medical_specialty ,Urologists ,Urology ,media_common.quotation_subject ,030232 urology & nephrology ,Insurance Claim Review ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Ureteroscopy ,medicine ,Humans ,Practice Patterns, Physicians' ,Medical prescription ,Demography ,media_common ,Pain, Postoperative ,medicine.diagnostic_test ,business.industry ,Addiction ,Incidence (epidemiology) ,Opioid overdose ,Odds ratio ,Middle Aged ,Opioid-Related Disorders ,medicine.disease ,United States ,Analgesics, Opioid ,Ambulatory Surgical Procedures ,Socioeconomic Factors ,Upper tract ,Opioid ,030220 oncology & carcinogenesis ,Female ,Urinary Calculi ,business ,medicine.drug - Abstract
Objective To measure the incidence of persistent opioid use following ureteroscopy (URS). Over 100 Americans die every day from opioid overdose. Recent studies suggest that many opioid addictions surface after surgery. Methods Using claims data, we identified adults who underwent outpatient URS for treatment of upper tract stones between January 2008 and December 2016 and filled an opioid prescription attributable to URS. We then measured the rate of new persistent opioid use—defined as continued use of opioids 91-180 days after URS among those who were previously opioid-naive. Finally, we fit multivariable models to assess whether new persistent opioid use was associated with the amount of opioid prescribed at the time of URS. Results In total, 27,740 patients underwent outpatient URS, 51.2% of whom were opioid-naive. Nearly 1 in 16 (6.2%) opioid-naive patients developed new persistent opioid use after URS. Six months following surgery, beneficiaries with new persistent opioid use continued to fill prescriptions with daily doses of 4.2 oral morphine equivalents. Adjusting for measured sociodemographic and clinical differences, patients in the highest tercile of opioids prescribed at the time of URS had 69% higher odds of new persistent opioid use compared to those in the lowest tercile (odds ratio, 1.69; 95% CI, 1.41-2.03). Conclusion Nearly 1 in 16 opioid-naive patients develop new persistent opioid use after URS. New persistent opioid use is associated with the amount of opioid prescribed at the time of URS. Given these findings, urologists should re-evaluate their post-URS opioid prescribing patterns.
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- 2019
11. On the spectral shape and a second component of broadband shock-cell noise
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Christopher K.W. Tam
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Acoustics and Ultrasonics ,Mechanics of Materials ,Mechanical Engineering ,Condensed Matter Physics - Published
- 2022
12. Hemodynamic Monitoring Options in COVID-19
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Olga Rozental, Shreyajit R. Kumar, Rob White, Richard Thalappillil, and Christopher W. Tam
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Respiratory Distress Syndrome ,medicine.medical_specialty ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Multiple Organ Failure ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Hemodynamic Monitoring ,MEDLINE ,COVID-19 ,Article ,Anesthesiology and Pain Medicine ,medicine ,Humans ,Respiratory Insufficiency ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business - Published
- 2020
13. Left Ventricular Assist Device Implantation and Management
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Christopher W. Tam
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medicine.medical_specialty ,business.industry ,Internal medicine ,Ventricular assist device ,medicine.medical_treatment ,medicine ,Cardiology ,equipment and supplies ,business - Abstract
This chapter studies left ventricular assist device (LVAD) implantation. A thorough preoperative evaluation of a patient undergoing LVAD implantation is of utmost importance because of the confluence of associated medical problems patients can have secondary to heart failure. Knowledge of the indications and contraindications for LVAD implantation is needed to provide proper consultation. Indications for LVAD implantation include bridge to transplantation, destination therapy, bridge to decision, and bridge to recovery. Contraindications to LVAD implantation include neurological changes following implantation, pulmonary dysfunction, renal dysfunction, and hepatic dysfunction. Intraoperative management of LVAD implantation involves monitoring, anesthetic induction/maintenance, and device management. Echocardiography is an invaluable tool in the perioperative monitoring and diagnostic assessment of LVAD implantation. The chapter then looks at early complications such as hypovolemia, vasoplegia, and right ventricular failure.
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- 2020
14. Robotic Mitral Valve Surgery and Unilateral Pulmonary Edema
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Cindy Cheung and Christopher W. Tam
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medicine.medical_specialty ,business.industry ,medicine ,business ,Pulmonary edema ,medicine.disease ,Mitral valve surgery ,Surgery - Abstract
This chapter describes robotic or minimally invasive mitral valve surgery, which was pioneered in 1998 to be the less invasive approach to sternotomy-based mitral valve operations. Patients undergoing robotic valve surgery carry a similar risk of complications that may occur with traditional median sternotomy surgery, but minimally invasive valve surgery has its own inherent complications associated with cardiac access, perfusion, and ventilation methods used in robotic surgeries. Unilateral pulmonary edema (UPE) is an uncommon but potentially life-threatening complication of robotic mitral valve surgery. The incidence of unilateral lung injury, which commonly manifests as UPE, has been reported to be quite variable. The variation in incidence could be related to the difference in patient populations, diagnostic criteria, as well as management. Moreover, the pathophysiology of UPE associated with robotic mitral valve repair remains unclear. The current literature suggests that UPE can be prevented by shorter cardiopulmonary bypass times, avoiding barotrauma, limiting blood product transfusion, and minimizing lung isolation times. Lung preventive ventilation, such as low-level positive pressure and frequent alveolar recruitment, while on cardiopulmonary bypass may be beneficial. Meanwhile, treatment for UPE is dependent on the severity of symptoms.
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- 2020
15. Developing and Implementing a Cloud-Based Software Solution for Tracking Ureteral Stents: A Pilot Study
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William W. Roberts, John M. Hollingsworth, Christopher A. Tam, Mark W. Newman, Khurshid R. Ghani, Sapan N. Ambani, and Casey A. Dauw
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medicine.medical_specialty ,business.industry ,Urology ,medicine.medical_treatment ,food and beverages ,Stent ,Cloud computing ,Pilot Projects ,Ureteral stents ,Cloud Computing ,equipment and supplies ,Stent placement ,surgical procedures, operative ,Software ,Medicine ,Humans ,Stents ,cardiovascular diseases ,Radiology ,Ureter ,business ,Ureteral Obstruction - Abstract
Introduction: As many as 12.5% of patients who undergo ureteral stent placement fail to have their stent removed in a timely manner. Because retained stents can be a source of substantial morbidity...
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- 2020
16. Managing acute biventricular dysfunction during the resource-limited COVID-19 Pandemic in a major city
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Christopher W. Tam, Olga Rozental, and Richard Thalappillil
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Tachycardia ,ARDS ,medicine.medical_specialty ,business.industry ,Session: Closing Session - COVID-19 Outbreak – November 6, 2020 S23:04 ,Vital signs ,Emergency department ,medicine.disease ,Blood pressure ,Anesthesiology and Pain Medicine ,Emergency medicine ,Pandemic ,Breathing ,medicine ,Supraventricular tachycardia ,medicine.symptom ,business ,Cardiology and Cardiovascular Medicine - Abstract
Introduction The novel coronavirus 2019 (COVID-19) and ensuing pandemic placed significant pressure on the care of critically ill patients. We present a case of a patient presenting with acute onset left ventricular systolic failure with acute right ventricular dysfunction and unremitting supraventricular tachycardia. Methods A 69 year-old male presented with severe shortness of breath and fever to the emergency department in March of 2020 to a major city hospital in the midst of the resource-limited height of the COVID-19 pandemic. After a thorough history, physical exam, laboratory evaluation, and preliminary point-of-care ultrasonographic examination he was found to be have COVID-19 and mild acute respiratory distress syndrome (ARDS). He was managed initially with non-invasive ventilation, but on hospital day #6, was found to be profoundly hypoxic, confused, and tachycardic. On further evaluation, his vital signs demonstrated a fever of 38.2 C, tachycardia at 140 bpm, blood pressure 125/70 and SpO2 92% on 100% FiO2. Bedside transthoracic echocardiography demonstrated globally severely reduced left ventricular systolic function and a dilated right ventricle with severely reduced systolic function. An electrocardiogram demonstrated monomorphic supraventricular tachycardia. Results We describe the patient's prolonged hospital course extending forty-five days with nearly half requiring critical care. The patient eventually improved and was discharged from the hospital. Discussion We discuss the implications of resource-limited pandemic conditions in the care of critically ill patients. We incorporate the international experience of developed countries in facing a once-in-a-lifetime global medical emergency. In addition, we comment on the proposed ethical considerations when allocating patients to a significantly high level-of-care and the implications of this decision for other patients requiring care.
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- 2020
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17. VV-ECMO usage in ARDS due to COVID-19: Clinical, practical and ethical considerations
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Shreyajit R. Kumar, Marguerite M. Hoyler, Richard Thalappillil, Rob White, and Christopher W. Tam
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2019-20 coronavirus outbreak ,medicine.medical_specialty ,Anesthesiology and Pain Medicine ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Anesthesia ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,RESPIRATORY DISTRESS SYNDROME ADULT ,Medicine ,business ,Intensive care medicine ,Coronavirus Infections ,Article - Published
- 2020
18. POCUS to guide fluid-therapy in COVID-19
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Christopher W. Tam, Rob White, and Richard Thalappillil
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medicine.medical_specialty ,2019-20 coronavirus outbreak ,Lung ultrasound ,Coronavirus disease 2019 (COVID-19) ,POCUS ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Point-of-care ultrasound ,MEDLINE ,coronavirus ,COVID-19 ,Article ,Focused echocardiography ,Critical care ,Anesthesiology and Pain Medicine ,Fluid therapy ,Medicine ,ARDS ,business ,Intensive care medicine ,Cardiology and Cardiovascular Medicine ,Acute Respiratory Distress Syndrome - Published
- 2020
19. Noteworthy Literature From 2019 for Cardiothoracic Critical Care
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Natalia S. Ivascu, Christopher W. Tam, Liang Shen, Mandisa-Maia Jones, and Marguerite M. Hoyler
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medicine.medical_specialty ,Critical Care ,Primary Graft Dysfunction ,030204 cardiovascular system & hematology ,Extracorporeal ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Extracorporeal Membrane Oxygenation ,Enhanced recovery ,law ,medicine ,Humans ,Cardiac Surgical Procedures ,Intensive care medicine ,Acetaminophen ,business.industry ,Delirium ,Intensive care unit ,Cardiac Anesthesia ,Cardiac surgery ,Anesthesiology and Pain Medicine ,030228 respiratory system ,Heart Transplantation ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Enhanced Recovery After Surgery - Abstract
This annual article summarizes key findings from notable studies published in 2019 relevant to the practice of cardiothoracic critical care medicine. This year’s article encompasses updates to the literature on enhanced recovery after cardiac surgery, extracorporeal membranous oxygenation, delirium, and primary graft dysfunction after heart transplant.
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- 2020
20. Preoperative Opioid Use Disorder Is Associated With Poorer Outcomes After Coronary Bypass and Valve Surgery: A Multistate Analysis, 2007-2014
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Alina Boltunova, Christopher W. Tam, Xiaoyue Ma, Richard Thalappillil, Rob White, Caryl Bailey, and Roniel Weinberg
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medicine.medical_specialty ,Adolescent ,business.industry ,Opioid use disorder ,Odds ratio ,medicine.disease ,Opioid-Related Disorders ,Confidence interval ,Surgery ,Cardiac surgery ,Anesthesiology and Pain Medicine ,Postoperative Complications ,Risk Factors ,Relative risk ,medicine ,Humans ,Outcomes research ,Risk factor ,Cardiac Surgical Procedures ,Coronary Artery Bypass ,Cardiology and Cardiovascular Medicine ,Healthcare Cost and Utilization Project ,business ,Retrospective Studies - Abstract
Objective To determine the effect of preoperative opioid use disorder (OUD) on postoperative outcomes in patients undergoing coronary artery bypass grafting (CABG) and heart valve surgery. Design Retrospective, observational study using data from the State Inpatient Database and the Healthcare Cost and Utilization Project. Setting Inpatient data from Florida, California, New York, Maryland, and Kentucky between 2007 and 2014. Participants A total of 377,771 CABG patients and 194,469 valve surgery patients age ≥18 years. Interventions None. Measurements and Main Results The prevalence of OUD was 2,136 (0.57%) in the CABG group and 2,020 (1.04%) in the valve surgery group. There was no significant difference in mortality between the OUD and non-OUD groups in both surgical cohorts (both p > 0.05). On adjusted analyses, preoperative OUD was significantly associated with increased adjusted odds ratios (aORs) of 30-day hospital readmission (CABG aOR 1.47 [95% confidence interval {CI} 1.30-1.66]; valve surgery aOR 1.41 [95% CI 1.27-1.56]) and 90-day hospital readmission (CABG aOR 1.47 [95% CI 1.31-1.64]; valve surgery aOR 1.33 [95% CI 1.23-1.43]). Preoperative OUD was significantly associated with increased adjusted risk ratios (aRRs) of hospital length of stay (CABG aRR 1.13 [95% CI 1.10-1.16]; valve surgery aRR 1.63 [95% CI 1.54-1.72]) and total hospitalization charges (CABG aRR 1.05 [95% CI 1.03-1.07]; valve surgery aRR 1.28 [95% CI 1.24-1.32]). Conclusion Preoperative OUD is significantly associated with poorer outcomes after cardiac surgery, including increased 30- and 90-day readmissions, hospital length of stay, and total hospitalization charges. Opioid use should be considered a modifiable risk factor in cardiac surgery, and interventions should be attempted preoperatively.
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- 2020
21. Insurance Status and Socioeconomic Factors Affect Early Mortality After Cardiac Valve Surgery
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T. Robert Feng, Christopher W. Tam, Xiaoyue Ma, Lisa Q. Rong, Marguerite M. Hoyler, Dimitrios V. Avgerinos, and Rob White
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Adult ,medicine.medical_specialty ,Adolescent ,Medicare ,Insurance Coverage ,Aortic valve repair ,Risk Factors ,medicine ,Humans ,Hospital Mortality ,Healthcare Cost and Utilization Project ,Socioeconomic status ,Aged ,Retrospective Studies ,business.industry ,Mortality rate ,Retrospective cohort study ,Heart Valves ,Underinsured ,United States ,Cardiac surgery ,Surgery ,Anesthesiology and Pain Medicine ,Socioeconomic Factors ,Household income ,Cardiology and Cardiovascular Medicine ,business - Abstract
To characterize the effects markers of socioeconomic status (SES), including race and ethnicity, health insurance status, and median household income by zip code on in-patient mortality after cardiac valve surgery.Retrospective cohort study of adult valve surgery patients included in the State Inpatient Databases and Healthcare Cost and Utilization Project. The primary outcome was mortality during the index admission. Bivariate analyses and multivariate regression models were used to assess the independent effects of race and ethnicity, payer status, and median income by patient zip code on in-hospital mortality.Multistate database of hospitalizations from 2007 to 2014 from New York, Florida, Kentucky, California, and Maryland.In total, 181,305 patients ≥18 years old underwent mitral or aortic valve repair or replacement and met the inclusion criteria.None.Mortality rates were higher among black (5.59%) than white patients (4.28%, p0.001) and among Medicaid (4.66%), Medicare (5.22%), and uninsured (4.58%) patients compared with private insurance (2.45%, p0.001). After controlling for age, sex, presenting comorbidities, urgent or emergent operative status, and hospital case volume, mortality odds remained significantly elevated for black (odds ratio [OR] 1.127, confidence interval [CI] 1.038-1.223), uninsured (OR 1.213, CI 1.020-1.444), Medicaid (OR 1.270, 95% CI 1.116-1.449) and Medicare (OR 1.316, 95% CI 1.216-1.415) patients.Markers of low SES, including race/ethnicity, insurance status, and household income, are associated with increased risk of in-hospital mortality following cardiac valve surgery. Further research is warranted to understand and help decrease mortality risk in underinsured, less-wealthy and non-white patients undergoing cardiac valve surgery.
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- 2020
22. To Swan or Not to Swan: Indications, Alternatives, and Future Directions
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Olga Rozental, Rob White, Richard Thalappillil, and Christopher W. Tam
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medicine.medical_specialty ,Cardiac output ,medicine.medical_treatment ,Thermodilution ,Hemodynamics ,Afterload ,medicine.artery ,Internal medicine ,Anseriformes ,medicine ,Animals ,Humans ,Cardiac Output ,Pulmonary wedge pressure ,business.industry ,Pulmonary artery catheter ,Reproducibility of Results ,Preload ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Catheterization, Swan-Ganz ,Pulmonary artery ,Vascular resistance ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
The pulmonary artery catheter (PAC) has revolutionized bedside assessment of preload, afterload, and contractility using measured pulmonary capillary wedge pressure, calculated systemic vascular resistance, and estimated cardiac output. It is placed percutaneously by a flow-directed balloon-tipped technique through the venous system and the right heart to the pulmonary artery. Interest in the hemodynamic variables obtained from PACs paved the way for the development of numerous less-invasive hemodynamic monitors over the past 3 decades. These devices estimate cardiac output using concepts such as pulse contour and pressure analysis, transpulmonary thermodilution, carbon dioxide rebreathing, impedance plethysmography, Doppler ultrasonography, and echocardiography. Herein, the authors review the conception, technologic advancements, and modern use of PACs, as well as the criticisms regarding the clinical utility, reliability, and safety of PACs. The authors comment on the current understanding of the benefits and limitations of alternative hemodynamic monitors, which is important for providers caring for critically ill patients. The authors also briefly discuss the use of hemodynamic monitoring in goal-directed fluid therapy algorithms in Enhanced Recovery After Surgery programs.
- Published
- 2019
23. Anesthesia and the 'post-COVID syndrome': Perioperative considerations for patients with prior SARS-CoV-2 infection
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Marguerite M. Hoyler, Richard Thalappillil, Christopher W. Tam, and Rob White
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Patient discharge ,2019-20 coronavirus outbreak ,Anesthesiology and Pain Medicine ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Anesthesia ,Correspondence ,MEDLINE ,Medicine ,Perioperative ,business ,Cohort study - Published
- 2021
24. Mechanical valve prosthesis in pregnant patients
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Olga Rozental, Richard Thalappillil, and Christopher W. Tam
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medicine.medical_specialty ,Pregnancy ,business.industry ,medicine.drug_class ,medicine.medical_treatment ,Warfarin ,Low molecular weight heparin ,Thrombolysis ,medicine.disease ,Thrombosis ,Surgery ,Cardiac surgery ,Miscarriage ,Anesthesiology and Pain Medicine ,Valve replacement ,medicine ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
Introduction Pregnancy-induced hypercoagulable states present an anticoagulation management challenge in patients with mechanical prosthetic valves (PHV). In pregnant patients a thrombosed mechanical PHV presents a high risk of morbidity and mortality for both mother and fetus. We present a complex case of a pregnant patient with a thrombosed PHV. Methods N/A Results N/A Discussion A 32 y.o. female at 17 weeks gestation with rheumatic heart disease, s/p mechanical mitral (MVR) and aortic (AVR) valve replacement in 2002, was transferred for management of her thrombosed mitral PHV. The patient had been switched from warfarin to therapeutic low molecular weight heparin (LMWH) pre-partum. She first noticed increased shortness of breath at 10-11 weeks gestation and serial TTE revealed progressively increasing MV pressure gradients due to an immobile mitral PHV disk. Based on concerns that continued pregnancy would complicate maternal outcome and fetal age, a multi-specialty suggestion was made and pregnancy was terminated at our institution. The patient underwent a reoperation aimed at replacing the thrombosed mitral PHV. Intraoperatively, TEE showed that the mitral PHV disks had unrestricted motion and gradients decreased (from 9 mmHg to 3 mmHg). Subsequently, the patient underwent a thrombectomy of the mechanical mitral PHV. The anticoagulation management of pregnant women with mechanical PHV is challenging. The hypercoagulable state in pregnancy should be balanced by anticoagulation with its associated risks of teratogenicity and bleeding. The treatment options include thrombolysis, thrombectomy and valve replacement. The 2014 ACC/AHA guidelines provide guidance, based on class B or Class C evidence. The decision to switch the patient from warfarin to LMWH is controversial due to current ACC/AHA guidelines to continue warfarin up to 5 mg during pregnancy. Pregnancy termination is questionable due to multiple case reports showing the ability to continue pregnancy with thrombolysis, as long as the patient does not develop CHF. At the end, this patient's thrombosis resolved with heparin, and surgical thrombectomy and pregnancy termination could have been avoided. On the other hand, surgical thrombectomy, exposure to CPB and stress of cardiac surgery leads to ∼50% risk of miscarriage.
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- 2020
25. Chylopericardial Tamponade After Posterior Mediastinal Mass Resection
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Shreyajit R. Kumar and Christopher W. Tam
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medicine.medical_specialty ,business.industry ,Mediastinum ,MEDLINE ,Mediastinal mass ,Mediastinal Neoplasms ,Pericardial Effusion ,Cardiac Tamponade ,Resection ,Anesthesiology and Pain Medicine ,Text mining ,medicine ,Humans ,Radiology ,Tamponade ,Cardiology and Cardiovascular Medicine ,business - Published
- 2020
26. Enhanced Recovery After Surgery Protocols May Help Reduce Racial and Socioeconomic Disparities in Cardiac Surgery
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Marguerite M. Hoyler, Rob White, and Christopher W. Tam
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Aortic valve ,medicine.medical_specialty ,business.industry ,MEDLINE ,Length of Stay ,Cardiac surgery ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Socioeconomic Factors ,Aortic Valve ,Emergency medicine ,medicine ,Humans ,Prospective Studies ,Cardiac Surgical Procedures ,Enhanced Recovery After Surgery ,Cardiology and Cardiovascular Medicine ,business ,Prospective cohort study ,Socioeconomic status ,Enhanced recovery after surgery - Published
- 2020
27. Contributors
- Author
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Geoffrey W. Abbott, Martin S. Angst, Sherif I. Assaad, Ani Bagdasarjana, Travis Bailey, Renee Bassaly, Jonathan Bilmen, Edward A. Bittner, Daniel Bolliger, Michelle Braunfeld, Shane E. Brogan, Kyle Burke, Michael Cahalan, June M. Chan, Ben Chortkoff, George J. Crystal, Jennifer A. DeCou, Rebecca Desso, John C. Drummond, Thomas J. Ebert, Talmage D. Egan, Matthias Eikermann, Charles W. Emala, Katherine T. Forkin, Tong J. Gan, Paul S. García, Peter Gerner, Jacqueline A. Hannam, Paul M. Heerdt, Hugh C. Hemmings, Karl F. Herold, Soeren Hoehne, Harriet W. Hopf, Philip M. Hopkins, Elizabeth Horncastle, Andrew E. Hudson, Julie L. Huffmyer, Natalia S. Ivascu, Robert H. Jenkinson, Ken B. Johnson, Joel O. Johnson, Abhinav Kant, Mark T. Keegan, Patrick Kolbay, Kai Kuck, Shreyajit R. Kumar, James P. Lee, Brian P. Lemkuil, Roberto Levi, Jerrold H. Levy, Cynthia A. Lien, Philipp Lirk, Andrew B. Lumb, Srinand Mandyam, Robert G. Martindale, J.A. Jeevendra Martyn, Joseph S. Meltzer, Edward C. Nemergut, Christine T. Nguyen-Buckley, Jennifer Nguyen-Lee, Shinju Obara, Daniel W. Odell, Takahiro Ogura, Shannon M. Page, Hahnnah Park, Piyush M. Patel, Misha Perouansky, Nicholas Pierson, Alex Proekt, Kane O. Pryor, Daniel Pulsipher, Aeyal Raz, Paul M. Riegelhaupt, Peter Rodhe, Derek K. Rogalsky, Mark D. Rollins, David Royston, Elizabeth Ryals, John W. Sear, Peter S. Sebel, Timothy G. Short, Jill E. Sindt, John Skaggs, Roman M. Sniecinski, Randolph H. Steadman, David Stenehjem, Sarah E. Stilwill, Kingsley P. Storer, Bradley Stringer, Suzuko Suzuki, Christer Svensen, Jeffrey D. Swenson, Christopher W. Tam, Kenichi A. Tanaka, Elizabeth Thackeray, Ian Welsby, Matthew K. Whalin, Eric S. Zabirowicz, Khaled J. Zaza, and Josh Zimmerman
- Published
- 2019
28. Cardiopulmonary Resuscitation
- Author
-
Christopher W. Tam, Shreyajit R. Kumar, and Natalia S. Ivascu
- Published
- 2019
29. Measuring and Predicting Patient Dissatisfaction after Anterior Urethroplasty Using Patient Reported Outcomes Measures
- Author
-
Sean P. Elliott, Christopher McClung, Christopher A. Tam, Jeremy B. Myers, Laura A. Bertrand, Gareth Warren, Bradley A. Erickson, Bryan B. Voelzke, Benjamin N. Breyer, and Alex J. Vanni
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,Urethral stricture ,business.industry ,Urology ,Urethroplasty ,medicine.medical_treatment ,030232 urology & nephrology ,Cystoscopy ,medicine.disease ,Article ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Erectile dysfunction ,Patient satisfaction ,Urethra ,medicine.anatomical_structure ,Lower urinary tract symptoms ,030220 oncology & carcinogenesis ,medicine ,International Prostate Symptom Score ,business - Abstract
Purpose: Subjective measures of success after urethroplasty have become increasingly valuable in postoperative monitoring. We examined patient reported satisfaction following anterior urethroplasty using objective measures as a proxy for success.Materials and Methods: Men 18 years old or older with urethral strictures undergoing urethroplasty were prospectively enrolled in a longitudinal, multi-institutional urethroplasty outcomes database. Preoperative and postoperative assessment included questionnaires to assess lower urinary tract symptoms, pain, satisfaction and sexual health. Analyses controlling for stricture recurrence (defined as the inability to traverse the reconstructed urethra with a flexible cystoscope) were performed to determine independent predictors of dissatisfaction.Results: At a mean followup of 14 months we found a high 89.4% rate of overall postoperative satisfaction in 433 patients and a high 82.8% rate in those who would have chosen the operation again. Men with cystoscopic recurr...
- Published
- 2016
30. Critical Analysis of the Use of Uroflowmetry for Urethral Stricture Disease Surveillance
- Author
-
Benjamin N. Breyer, Alex J. Vanni, Sean P. Elliott, Christopher McClung, Bradley A. Erickson, Christopher A. Tam, Jeremy B. Myers, and Bryan B. Voelzke
- Subjects
Adult ,Male ,medicine.medical_specialty ,Urethral stricture ,Urology ,Urinary system ,Urethroplasty ,medicine.medical_treatment ,Penile Induration ,030232 urology & nephrology ,Sensitivity and Specificity ,Article ,Prosthesis Implantation ,03 medical and health sciences ,0302 clinical medicine ,Older patients ,Recurrence ,medicine ,Humans ,Pain Management ,In patient ,Prospective Studies ,Prospective cohort study ,Physical Therapy Modalities ,Urethral Stricture ,medicine.diagnostic_test ,business.industry ,Cystoscopy ,medicine.disease ,Surgery ,Urodynamics ,Population Surveillance ,030220 oncology & carcinogenesis ,International Prostate Symptom Score ,Rheology ,business ,Penis - Abstract
Uroflowmetry (UF) is a simple, noninvasive method to evaluate voiding function in patients experiencing lower urinary tract symptoms.1,2 It is often combined with other metrics, including the International Prostate Symptom Score, in the initial diagnosis and follow-up of benign prostatic hyperplasia (BPH), and other causes of obstruction.3 In patients with urethral stricture disease (USD) who have undergone urethroplasty, UF is one of the most frequently used tests to monitor for stricture recurrence.4 However, UF’s use as a stand-alone tool to screen for recurrence following urethroplasty has never been rigorously validated. It has been well established that the maximum flow rate (Qm) in patients with USD is significantly diminished relative to age-matched normal controls.5,6 This knowledge has been extrapolated to the post-urethroplasty setting, where commonly used cutpoints of a postoperative Qm of less than 10 mL/s or a postoperative Qm of less than 15 mL/s are used as indicators of urethral stricture recurrence.5–7 Similarly, when UF data are available both pre- and postoperatively, a change in Qm following surgery of less than 10 mL/s has also been suggested as a predictor of recurrence.8 The goal for each of these UF parameters is to minimize the invasiveness of postoperative screening while maximizing the ability to find recurrences. The purpose of this study is to rigorously evaluate the capability of individual UF parameters, such as Qm and average flow rate (Qa), as well as a novel hybrid measure (Qm-Qa) to monitor for urethral stricture recurrence. Use of Qm-Qa has not been described in prior literature and attempts to provide a simple method to quantify the shape of the voiding curve. The study tested two hypotheses: (1) when compared to the gold-standard cystoscopy, UF parameters will have high test (screening) sensitivity and specificity, and (2) the sensitivity and specificity of UF to screen for stricture recurrence will be diminished in older patients.
- Published
- 2016
31. PD15-03 PATTERNS OF UNPLANNED HEALTHCARE ENCOUNTERS AND OUTCOMES FOR PROXIMAL URETERAL STONES UNDERGOING URETEROSCOPY OR SHOCKWAVE LITHOTRIPSY IN A STATEWIDE QUALITY IMPROVEMENT COLLABORATIVE
- Author
-
Casey A. Dauw, Kavya Swarna, Hector Pimentel, Spencer C. Hiller, and Christopher A. Tam
- Subjects
medicine.medical_specialty ,Quality management ,medicine.diagnostic_test ,business.industry ,Urology ,General surgery ,Health care ,medicine ,Ureteroscopy ,business ,Shockwave lithotripsy - Abstract
INTRODUCTION AND OBJECTIVE:Ureteroscopy (URS) and shockwave lithotripsy (SWL) are standard treatments for patients presenting with proximal ureteral stones. Contemporary data comparing Emergency De...
- Published
- 2020
32. Noise of high-performance aircraft at afterburner
- Author
-
Christopher K.W. Tam and Sarah A. Parrish
- Subjects
Engineering ,Acoustics and Ultrasonics ,Cross-correlation ,Aircraft noise ,business.industry ,Mechanical Engineering ,Acoustics ,Nozzle ,Acoustic wave ,Condensed Matter Physics ,Mechanics of Materials ,Performance engineering ,Supersonic speed ,Aerospace engineering ,business - Abstract
The noise of a F18E aircraft is studied and analyzed. The main objective is to find out whether the noise has the same dominant noise components as those of a laboratory supersonic jet. The noise spectra at 3 power settings were studied. It is found that at low power, the dominant noise componets are very similar to those of a laboratory jet. But at hight power, there are significant differences.
- Published
- 2015
33. Transfemoral Transcatheter Aortic Valve Replacement in a Patient With Heparin-Induced Thrombocytopenia: Intraoperative Anticoagulation Management With Bivalirudin (Angiomax)
- Author
-
Roger S. Moon, Christopher W. Tam, and Bharathi H. Scott
- Subjects
Male ,medicine.medical_specialty ,medicine.drug_class ,medicine.medical_treatment ,Transcatheter Aortic Valve Replacement ,Valve replacement ,Aortic valve replacement ,Heparin-induced thrombocytopenia ,Internal medicine ,medicine ,Humans ,Bivalirudin ,Aged ,Intraoperative Care ,Heparin ,business.industry ,Anticoagulant ,Anticoagulants ,Disease Management ,Perioperative ,Hirudins ,medicine.disease ,Thrombocytopenia ,Peptide Fragments ,Recombinant Proteins ,Surgery ,Femoral Artery ,Stenosis ,Anesthesiology and Pain Medicine ,Cardiothoracic surgery ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
ORTIC VALVE REPLACEMENT secondary to calcified aortic stenosis is the most common valvular replacement surgery in the United States, constituting nearly 50,000 cases per year. 1 Historically, aortic valve replacement required open heart surgery, which had a 4% to 18% risk of mortality, until 2002 when transcatheter aortic valve replacement (TAVR) was first described. 2 TAVR is an alternative for patients who are at high risk for perioperative complications for an open valve replacement. Maintaining adequate anticoagulation during a TAVR procedure is an integral component, with unfractionated heparin (UFH) being the anticoagulant of choice. Alternative agents for patients with contraindications to heparin undergoing TAVR have not been well-described in the literature. The authors present a case report of a patient with heparin-induced thrombocytopenia (HIT) type II who successfully underwent TAVR with bivalirudin anticoagulation. To the best of their knowledge, this is the first case report of utilizing an alternative anticoagulant, bivalirudin, during a TAVR procedure. CASE PRESENTATION
- Published
- 2015
34. The Relationship Between Diabetes, Diabetes Severity, Diabetes Biomarkers, and the Presence of Lower Urinary Tract Symptoms: Findings From the National Health and Nutrition Examination Survey
- Author
-
Brian T. Helfand, Christopher A. Tam, and Bradley A. Erickson
- Subjects
Adult ,Blood Glucose ,Male ,Pathology ,medicine.medical_specialty ,National Health and Nutrition Examination Survey ,Urology ,Health Behavior ,030232 urology & nephrology ,Disease ,Severity of Illness Index ,Article ,Diabetes Complications ,03 medical and health sciences ,0302 clinical medicine ,Lower Urinary Tract Symptoms ,Lower urinary tract symptoms ,Diabetes mellitus ,Internal medicine ,Severity of illness ,Diabetes Mellitus ,Prevalence ,Medicine ,Nocturia ,Humans ,Urinary Tract ,Aged ,Gynecology ,Glycated Hemoglobin ,business.industry ,Odds ratio ,Middle Aged ,Prostate-Specific Antigen ,medicine.disease ,Nutrition Surveys ,United States ,Logistic Models ,030220 oncology & carcinogenesis ,Biomarker (medicine) ,medicine.symptom ,business ,Biomarkers - Abstract
To characterize the associations between diabetes mellitus (DM) and lower urinary tract symptoms (LUTS). This study focuses on the relationships between specific diabetic characteristics (eg, severity, biomarkers) and the prevalence of LUTS.The 2005-2008 cycles of the National Health and Nutrition Examination Survey were queried for men who completed both a DM and a kidney/prostate questionnaire. Men with LUTS were defined as those experiencing at least 1 out of 3 of the following: nocturia, hesitancy, or incomplete emptying. Men with DM were defined as having been diagnosed by a physician and being actively treated. Multivariate logistic regression with sample weighting was performed to assess effects of biomarker levels (HgbA1c, fasting glucose), medication use, and surrogates of disease progression on the presence of LUTS.Of the 2127 male participants, those with DM (n = 405) were more likely to experience at least 1 urinary symptom (adjusted odds ratio 1.63, P .0001). Men under the age of 70 with long-standing (5 years) DM were more likely to report LUTS than those with a shorter duration of the disease (5 years). Diabetes-specific biomarkers (HgbA1c, fasting glucose) were not predictors of LUTS in men with DM.DM was confirmed to be strongly associated with patient-reported LUTS in men. Younger men and those with longer-standing disease appear to be most susceptible. In actively treated patients with DM, DM biomarkers were not helpful in predicting individual LUTS. Instead, biomarkers that indirectly reflect DM disease progression were most useful.
- Published
- 2016
35. MP81-07 PATIENT-REPORTED ASSESSMENT OF ANATOMICAL, NEUROLOGICAL AND FUNCTIONAL CHANGES OF THE GENITALIA AFTER ANTERIOR URETHROPLASTY: INCIDENCE AND RECOVERY OF FUNCTION
- Author
-
Christopher McClung, Jeremy B. Myers, Christopher A. Tam, Alex J. Vanni, Bradley A. Erickson, Benjamin N. Breyer, Maria Voznesensky, Bryan B. Voelzke, and Sean Elliott
- Subjects
medicine.medical_specialty ,business.industry ,Urology ,Urethroplasty ,medicine.medical_treatment ,Incidence (epidemiology) ,medicine ,business ,Surgery - Published
- 2016
36. MP74-13 DIABETES SEVERITY, DIABETES BIOMARKERS AND LUTS: FINDINGS FROM NHANES
- Author
-
Christopher A. Tam and Bradley A. Erickson
- Subjects
medicine.medical_specialty ,business.industry ,Urology ,Internal medicine ,Diabetes mellitus ,medicine ,business ,medicine.disease - Published
- 2016
37. The International Prostate Symptom Score (IPSS) Is an Inadequate Tool to Screen for Urethral Stricture Recurrence After Anterior Urethroplasty
- Author
-
Bradley A. Erickson, Sean P. Elliott, Thomas G. Smith, Christopher A. Tam, Bryan B. Voelzke, Christopher McClung, Jeremy B. Myers, Benjamin N. Breyer, and Alex J. Vanni
- Subjects
Adult ,Male ,medicine.medical_specialty ,Urologic Surgical Procedures, Male ,Urethral stricture ,Urology ,Urethroplasty ,medicine.medical_treatment ,030232 urology & nephrology ,urologic and male genital diseases ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Urethra ,Recurrence ,medicine ,Humans ,Urethral Stricture ,medicine.diagnostic_test ,Receiver operating characteristic ,business.industry ,Cystoscopy ,Middle Aged ,medicine.disease ,Weak stream ,Surgery ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,International Prostate Symptom Score ,Symptom Assessment ,business - Abstract
Objective To validate the use of the International Prostate Symptom Score (IPSS) as a stand-alone tool to detect urethral stricture recurrence following urethroplasty. Materials and Methods This study included 393 men who had undergone anterior urethroplasty and were enrolled in a multi-institutional outcomes study. Data analyzed included pre- and post-operative answers to the IPSS in addition to findings from a same- day cystoscopy. IPSS from men found to have cystoscopic recurrence were then compared to scores from those with successful repairs, and receiver operating characteristic curves were plotted to illustrate the predictive ability of these questions to screen for cystoscopic recurrence. Results Mean postoperative scores were lower (fewer symptoms) in successful repairs; IPSS improved from preoperative values regardless of recurrence. Successful repairs had significantly better degree of improvement in question #5 (assessing weak stream) compared to recurrences. Receiver operating characteristic curves demonstrated the highest area under the curve for the IPSS quality of life question (0.66) that alone outperformed the complete IPSS questionnaire (0.56). Conclusion The IPSS had inadequate sensitivity and specificity to be used as a stand-alone screening tool for stricture recurrence in this large cohort of men, highlighting the need to continue development of a disease-specific, validated patient-reported outcome measure.
- Published
- 2016
38. Understanding the Relationship between Chronic Systemic Disease and Lichen Sclerosus Urethral Strictures
- Author
-
Christopher McClung, Sean P. Elliott, Jeremy B. Myers, Lee C. Zhao, Thomas G. Smith, Will O. Brant, Alex J. Vanni, Jill C. Buckley, Bryan B. Voelzke, Christopher A. Tam, Joshua A. Broghammer, Benjamin N. Breyer, Nejd F. Alsikafi, and Bradley A. Erickson
- Subjects
Adult ,Male ,medicine.medical_specialty ,Systemic disease ,Urologic Surgical Procedures, Male ,Urethral stricture ,Urology ,Urethroplasty ,medicine.medical_treatment ,030232 urology & nephrology ,Lichen sclerosus ,Article ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,stomatognathic system ,Risk Factors ,medicine ,Humans ,Retrospective Studies ,Urethral Stricture ,integumentary system ,business.industry ,Retrospective cohort study ,medicine.disease ,Dermatology ,Surgery ,stomatognathic diseases ,Lichen Sclerosus et Atrophicus ,030220 oncology & carcinogenesis ,Etiology ,International Prostate Symptom Score ,business - Abstract
Lichen sclerosus is a chronic, inflammatory skin condition of the genitalia of unknown origin that accounts for nearly 10% of urethral stricture disease. In this study we determine systemic comorbidities associated with lichen sclerosus in men.We analyzed data from 1,151 men who were enrolled in a multi-institutional prospective urethroplasty outcomes database. Individuals were grouped by stricture etiology, and baseline demographics, medical histories and patient reported outcome measures were retrospectively compared across groups.Of the 1,151 men in the database 81 (7.0%) were noted to have lichen sclerosus related urethral stricture disease. Average patient age was 46.06 ± 16.52 years, with those with lichen sclerosus being significantly older than those without lichen sclerosus (51.26 ± 13.84 vs 45.68 ± 16.64, p = 0.0011). Men with lichen sclerosus were more likely to have hypertension, hyperlipidemia and diabetes, and to use tobacco products. Controlling for age, men with lichen sclerosus related urethral stricture disease had a higher body mass index (aOR 1.089, 95% CI 1.050-1.130), and were more likely to have hypertension (aOR 2.028, 1.21-3.41) and be active tobacco users (aOR 2.0, 1.36-3.40). Mean preoperative patient reported outcome measures scores for urinary and sexual function were similar. Controlling for stricture length and location, the adjusted odds of surgical failure were higher for lichen sclerosus related urethral stricture disease (aOR 1.9, 95% CI 0.9-4.2).Lichen sclerosus related urethral stricture disease is associated with chronic systemic diseases. This association may implicate a systemic inflammatory and/or autoimmune pathophysiology. A 2-hit mechanism implicating local and systemic factors for lichen sclerosus related urethral stricture disease development and progression is hypothesized.
- Published
- 2015
39. Assessment of the Male Urethral Reconstruction Learning Curve
- Author
-
Jeremy B. Myers, Sean P. Elliott, Christopher A. Tam, Bryan B. Voelzke, Benjamin N. Breyer, Sarah F. Faris, Alex J. Vanni, and Bradley A. Erickson
- Subjects
Male ,medicine.medical_specialty ,Urologic Surgical Procedures, Male ,Urethral stricture ,Urology ,Urethroplasty ,medicine.medical_treatment ,030232 urology & nephrology ,Anastomosis ,Logistic regression ,03 medical and health sciences ,0302 clinical medicine ,Urethra ,medicine ,Humans ,Retrospective Studies ,Urethral Stricture ,business.industry ,Retrospective cohort study ,medicine.disease ,Surgery ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,business ,Learning Curve - Abstract
Objective To evaluate the urethroplasty learning curve. Published success rates of urethral reconstruction for urethral stricture disease are high even though these procedures can be technically demanding. It is likely that success rates improve with time although a learning curve for urethral reconstruction has never been established. Materials and Methods We retrospectively reviewed anterior urethroplasties from a prospectively maintained multi-institutional database. Success was analyzed at the 18-month mark in all patients and defined as freedom from secondary operation for stricture recurrence. A multivariate logistic regression was performed for outcomes vs time from fellowship and case number. Results A total of 613 consecutive cases from 6 surgeons were analyzed, with a functional success rate of 87.3%. The success rate for bulbar urethroplasties was higher than that for penile urethroplasties (88.2% vs 78.3%, P = .0116). The success rate of anastomotic repairs was higher than that for substitution repairs (95.0% vs 82.4%, P = .0001). There was a statistically significant trend toward improved outcomes with increasing number of cases (P = .0422), which was most pronounced with bulbar repairs. There was no statistical improvement in penile repairs over time. The case number to reach proficiency (>90% success) was approximately 100 cases for all types of reconstruction and 70 cases for bulbar urethroplasty. There were statistical differences in success rates among the participating surgeons (P = .0014). Complications decreased with time (P = .0053). Conclusion This study shows that success rates of anterior urethral reconstruction improve significantly with surgeon experience. Proficiency occurs after approximately 100 cases.
- Published
- 2015
40. MP15-09 CRITICAL ANALYSIS OF UROFLOWMETRY FOR URETHRAL STRICTURE DISEASE SURVEILLANCE
- Author
-
Christopher A. Tam, Bryan B. Voelzke, Sean P. Elliott, Alex J. Vanni, Jeremy B. Myers, and Bradley A. Erickson
- Subjects
Disease surveillance ,medicine.medical_specialty ,Urethral stricture ,business.industry ,Urology ,medicine ,medicine.disease ,business ,Surgery - Published
- 2015
41. PD14-06 VALIDATION OF A NON-INVASIVE URETHRAL MONITORING PROTOCOL AFTER URETHRAL RECONSTRUCTION
- Author
-
Bryan B. Voelzke, Jeremy B. Myers, Alex J. Vanni, Christopher A. Tam, Sean P. Elliott, and Bradley A. Erickson
- Subjects
Protocol (science) ,medicine.medical_specialty ,business.industry ,Urology ,Non invasive ,medicine ,Radiology ,business - Published
- 2015
42. MP15-17 ASSESSMENT OF THE LEARNING CURVE FOR MALE URETHRAL RECONSTRUCTION: DOES EXPERIENCE MATTER?
- Author
-
Christopher A. Tam, Jeremy B. Myers, Sean Elliott, Benjamin N. Breyer, Alex J. Vanni, Bryan B. Voelzke, Deep Bhatt, Sarah F. Faris, Thomas W. Gaither, Thomas W. Smith, and Bradley A. Erickson
- Subjects
medicine.medical_specialty ,Learning curve ,business.industry ,Urology ,General surgery ,medicine ,business ,Surgery - Published
- 2015
43. 'Shotgun therapy': the understanding and use of thyroid organotherapy in Britain, 1890-1925
- Author
-
Christopher K, Tam
- Subjects
Thyroid Hormones ,Thyroid Gland ,Humans ,Organotherapy ,History, 19th Century ,History, 20th Century ,United Kingdom - Published
- 2008
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