45 results on '"Michael C. Soult"'
Search Results
2. Iliac artery-enteric fistulas following failed pancreatic transplant
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Lorela B. Weise, MD, Paul R. Crisostomo, MD, Carlos F. Bechara, MD, and Michael C. Soult, MD
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Arterio-enteric fistula ,Iliac artery to small bowel fistula ,GI bleed in failed pancreatic transplant ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Arterial-enteric fistulas occur from a multitude of causes, especially following surgical manipulation of vasculature. The development of an iliac artery-enteric fistula (IEF) occurs rarely in patients with failed pancreatic transplants. IEFs warrant urgent intervention due to the high mortality from hemorrhagic and septic shock. The diagnosis can be delayed by a lack of suspicion, the low sensitivity of diagnostic tests, and the nonspecific signs of fistulas on computed tomography. The management of IEFs is adapted from guidelines for arterial-enteric fistulas of other causes, with little consensus on ideal vascular reconstruction and postoperative antimicrobial management. The outcomes are limited to the short-term results from case reports and case series. We report two cases of IEFs in patients with a history of simultaneous pancreatic kidney transplant. Our patients underwent successful resolution of gastrointestinal bleeding and sepsis, with definitive management of fistula resection and interposition iliac artery bypass. The index of suspicion for IEFs should be high, and they should be considered as a source of anemia or gastrointestinal bleeding of an unknown source in patients with failed pancreatic transplant. Definitive management should be pursued in patients who can tolerate fistula resection, allograft explant, and arterial reconstruction.
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- 2024
- Full Text
- View/download PDF
3. Dual true and false lumen stent graft technique for endovascular repair of isolated common iliac artery aneurysm in chronic type A10 dissection
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Jonathan H. Lin, MD, Tara Zielke, BS, Mary K. Zorn, MD, Lindsey M. Korepta, MD, Michael C. Soult, MD, and Carlos F. Bechara, MD, DFSVS
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Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
A 52-year-old man presented with a chronic type A10 aortic dissection with subsequent aneurysmal degeneration of the left common iliac artery measuring up to 4.6 cm. He had previously undergone hemiarch replacement, which was complicated by renal failure. Owing to the presence of the growing aneurysm, he was unable to be listed for renal transplantation. He declined open operative repair. A novel dual true and false lumen stent graft technique using thoracic endografts was performed to successfully exclude the aneurysm. Follow-up imaging demonstrated aneurysm sac regression, with the patient subsequently undergoing renal transplantation.
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- 2022
- Full Text
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4. International Multi-Institutional Experience with Presentation and Management of Aortic Arch Laterality in Aberrant Subclavian Artery and Kommerell’s Diverticulum
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Clare Moffatt, Jonathan Bath, Richard T. Rogers, Jill J. Colglazier, Drew J. Braet, Dawn M. Coleman, Salvatore T. Scali, Martin R. Back, Gregory A. Magee, Anastasia Plotkin, Philip Dueppers, Alexander Zimmermann, Rana O. Afifi, Sophia Khan, Devin Zarkowsky, Gregory Dyba, Michael C. Soult, Kevin Mani, Anders Wanhainen, Carlo Setacci, Massimo Lenti, Loay S. Kabbani, Mitchell R. Weaver, Daniele Bissacco, Santi Trimarchi, Jordan B. Stoecker, Grace J. Wang, Zoltan Szeberin, Eniko Pomozi, Hugh A. Gelabert, Shahed Tish, Andrew W. Hoel, Nicholas S. Cortolillo, Emily L. Spangler, Marc A. Passman, Giovanni De Caridi, Filippo Benedetto, Wei Zhou, Yousef Abuhakmeh, Daniel H. Newton, Christopher M. Liu, Giovanni Tinelli, Yamume Tshomba, Airi Katoh, Sammy S. Siada, Manar Khashram, Sinead Gormley MBBCH, John R. Mullins, Zachary C. Schmittling, Thomas S. Maldonado, Amani D. Politano, Pawel Rynio, Arkadiusz Kazimierczak, Alexander Gombert, Houman Jalaie, Paolo Spath, Enrico Gallitto, Martin Czerny, Tim Berger, Mark G. Davies, Francesco Stilo, Nunzio Montelione, Luca Mezzetto, Gian Franco Veraldi, Mario D'Oria, Sandro Lepidi, Peter Lawrence, and Karen Woo
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Surgery ,General Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2023
5. Female gender increases risk of stroke and readmission after carotid endarterectomy and carotid artery stenting
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Carlos F. Bechara, Bernadette Aulivola, Steven Goicoechea, Martin Walsh, Pegge Halandras, Paul Crisostomo, and Michael C. Soult
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Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Population ,Carotid endarterectomy ,Patient Readmission ,Risk Assessment ,Asymptomatic ,Risk Factors ,Internal medicine ,medicine ,Humans ,Carotid Stenosis ,education ,Stroke ,Aged ,Retrospective Studies ,Endarterectomy, Carotid ,education.field_of_study ,Cerebral infarction ,business.industry ,Perioperative ,medicine.disease ,Carotid Arteries ,Treatment Outcome ,Cohort ,Current Procedural Terminology ,Female ,Stents ,Surgery ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Carotid endarterectomy (CEA) has historically demonstrated a higher rate of perioperative adverse events for female patients. However, recent evidence suggests similar outcomes for CEA between genders. In contrast, fewer studies have examined gender in carotid artery stenting (CAS). Using contemporary data from the American College of Surgeons National Surgical Quality Improvement Program database, we aim to determine if gender impacts differences in postoperative complications in patients who undergo CEA or CAS.The American College of Surgeons National Surgical Quality Improvement Program database was queried from 2005 to 2017 using Current Procedural Terminology and International Classification of Diseases codes for retrospective review. Patients with carotid intervention (CEA or CAS) were stratified into asymptomatic vs symptomatic cohorts to determine the effect of gender on 30-day postoperative outcomes. Symptomatic patients were defined as those with perioperative transient cerebral ischemic attack or stenosis of carotid artery with cerebral infarction. Descriptive statistics were calculated. Risk-adjusted odds of 30-day postoperative outcomes were calculated using multivariate regression analysis with fixed effects for age, race, and comorbidities.There were 106,568 patients with CEA or CAS (104,412 CEA and 2156 CAS). The average age was 70.9 years, and female patients accounted for 39.9% of the population. For asymptomatic patients that underwent CEA or CAS, female gender was associated with significantly higher rates of cerebrovascular accident (CVA)/stroke (13%; P = .005), readmission (10%; P = .004), bleeding complication (32%; P = .001), and urinary tract infection (54%; P = .001), as well as less infection (26%; P = .001). In the symptomatic cohort, female gender was associated with significantly higher rates of CVA/stroke (32%; P = .034), bleeding complication (203%; P = .001), and urinary tract infection (70%; P = .011), whereas female gender was associated with a lower rate of pneumonia (39%; P = .039). Subset analysis found that, compared with male patients, female patients 75 years old have an increased rate of CVA/stroke (21%; P = .001) and readmission (15%; P .001), whereas female patients ≥75 years old did not. In asymptomatic and symptomatic patients that underwent CEA, female gender was associated with significantly higher rates of CVA/stroke (13%; P = .006 and 31%; P = .044, respectively), but this finding was not present in patients undergoing CAS.In patients undergoing carotid intervention, female gender was associated with significantly increased rates of postoperative CVA/stroke in the asymptomatic and symptomatic cohorts as well as readmission in the asymptomatic cohort. Female gender was associated with higher rates of CVA/stroke following CEA, but not CAS. We recommend that randomized control trials ensure adequate representation of female patients to better understand gender-based disparities in carotid intervention.
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- 2022
6. Effect of Stent-Graft Active Fixation and Oversizing on Aortic Neck Dilation After Endovascular Aneurysm Exclusion For Infrarenal Aortic Aneurysm
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Bernadette Aulivola, Nader Tehrani, Lillian Malach, Michael C. Soult, Amy Wozniak, Shilpa Kolachina, Carlos F. Bechara, and Karolina Krawczyk
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Male ,medicine.medical_specialty ,Time Factors ,Endoleak ,medicine.medical_treatment ,Prosthesis Design ,Endovascular aneurysm repair ,Blood Vessel Prosthesis Implantation ,Aortic aneurysm ,Aneurysm ,Risk Factors ,medicine.artery ,medicine ,Humans ,Renal artery ,Aged ,Retrospective Studies ,Fixation (histology) ,Aged, 80 and over ,business.industry ,Endovascular Procedures ,Stent ,General Medicine ,Middle Aged ,medicine.disease ,Blood Vessel Prosthesis ,Surgery ,Treatment Outcome ,Dilation (morphology) ,Female ,Stents ,Cardiology and Cardiovascular Medicine ,business ,Aortic Aneurysm, Abdominal ,Active fixation - Abstract
Aortic neck dilation post endovascular aneurysm repair (EVAR) has been implicated in the long-term development of endoleak and the subsequent re-intervention. Optimal endograft sizing is a vital aspect to successful repair. This study looked at percentage of graft oversizing as well as type of fixation on aortic neck dilation.We retrospectively evaluated all EVARs completed at Loyola's University from 2006 to 2015 after IRB approval. Patients without follow-up scans within a year were excluded. We collected demographics, comorbidities, graft type, size, aortic neck diameter, maximum sac size diameters from the pre-operative and follow-up scans. We reviewed and collected data on 432 patients but analyzed 154. We measured the largest aortic diameter on axial images 1 cm above and 1 cm below the lowest renal artery. Change in supra and infrarenal aortic measurements were evaluated by calculating the mm difference from each scan compared to the pre-operative scan. Linear mixed effects models were used to estimate patients' mean differences over time.We compared three groups of neck fixation grafts. Those with active suprarenal fixation had a significant change in suprarenal aortic diameter at four-year follow-up (1.86 mm, CI:0.65-3.06), compared to those with active infrarenal (0.22 mm, CI: -0.67 to -1.11) or passive suprarenal fixation (1.52 mm, CI: -0.11 to -3.15) (Fig. 1). Those with active suprarenal fixation were the only ones to have significant increase in suprarenal aortic diameter (P = 0.0026). Degree of oversizing was also divided into three groups. Oversizing by10% had less impact on the suprarenal aorta than15% oversizing at 4 years (0.41 mm, CI: -0.31 to -1.14 vs. 3.26 mm, CI: 1.63-4.88, P0.001) (Fig. 2). Oversizing had a more pronounced effect on the infrarenal aorta: 3.01 mm, CI: 2.18-3.83; 5.95 mm, CI: 3.26-8.64; and 5.05 mm, CI: 3.41-6.69 for10%, 10-15%, and15% oversizing at four years, respectively.Stent-grafts with active fixation below the renal arteries as well as oversizing by10% seem to have the least effect on aortic neck dilation over time. These factors should be considered when performing EVARs, as aortic neck dilation could lead to endoleak and need for further intervention. Further research defining the optimal stent-graft type, self-expanding versus balloon expandable, type of fixation and degree of oversizing.
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- 2022
7. Contemporary outcomes after treatment of aberrant subclavian artery and Kommerell's diverticulum
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Jonathan Bath, Mario D'Oria, Richard T. Rogers, Jill J. Colglazier, Drew J. Braet, Dawn M. Coleman, Salvatore T. Scali, Martin R. Back, Gregory A. Magee, Anastasia Plotkin, Philip Dueppers, Alexander Zimmermann, Rana O. Afifi, Sophia Khan, Devin Zarkowsky, Gregory Dyba, Michael C. Soult, Kevin Mani, Anders Wanhainen, Carlo Setacci, Massimo Lenti, Loay S. Kabbani, Mitchelle R. Weaver, Daniele Bissacco, Santi Trimarchi, Jordan B. Stoecker, Grace J. Wang, Zoltan Szeberin, Eniko Pomozi, Clare Moffatt, Hugh A. Gelabert, Shahed Tish, Andrew W. Hoel, Nicholas S. Cortolillo, Emily L. Spangler, Marc A. Passman, Giovanni De Caridi, Filippo Benedetto, Wei Zhou, Yousef Abuhakmeh, Daniel H. Newton, Christopher M. Liu, Giovanni Tinelli, Yamume Tshomba, Airi Katoh, Sammy S. Siada, Manar Khashram, Sinead Gormley, John R. Mullins, Zachary C. Schmittling, Thomas S. Maldonado, Amani D. Politano, Pawel Rynio, Arkadiusz Kazimierczak, Alexander Gombert, Houman Jalaie, Paolo Spath, Enrico Gallitto, Martin Czerny, Tim Berger, Mark G. Davies, Francesco Stilo, Nunzio Montelione, Luca Mezzetto, Gian Franco Veraldi, Sandro Lepidi, Peter Lawrence, and Karen Woo
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Aberrant subclavian artery ,Kommerell's diverticulum ,Surgery ,Cardiology and Cardiovascular Medicine ,Settore MED/22 - CHIRURGIA VASCOLARE - Published
- 2023
8. Community Hospital Experience With Bovine Tissue in Infected Vascular Fields
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Matthew Blecha, Michael C. Soult, and Patrick Sowa
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Adult ,Male ,Reoperation ,medicine.medical_specialty ,Prosthetic graft ,Prosthesis-Related Infections ,medicine.medical_treatment ,Transplantation, Heterologous ,Hospitals, Community ,Arteriotomy ,030204 cardiovascular system & hematology ,Blood Vessel Prosthesis Implantation ,03 medical and health sciences ,High morbidity ,0302 clinical medicine ,medicine ,Animals ,Humans ,030212 general & internal medicine ,Closure (psychology) ,Bovine tissue ,Device Removal ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,General Medicine ,Middle Aged ,Staphylococcal Infections ,Community hospital ,Blood Vessel Prosthesis ,Surgery ,Treatment Outcome ,Heterografts ,Cattle ,Female ,business ,Pericardium ,Follow-Up Studies - Abstract
Background Vascular prosthetic graft infections are rare but associated with high morbidity and mortality. Treatment involves removal of the infected graft requiring arteriotomy closure. Previously this was performed with autologous graft, but bovine tissue has increasingly been used. The objective of this paper is to review the community hospital experience with bovine tissue repair in an infected vascular field. Materials and Methods A retrospective review of all cases performed by a single surgeon in a community hospital for infected prosthetic grafts was completed. Sixteen cases were included where bovine tissue was used for repair. Presentation, location of graft, and causative organism were reviewed, and outcomes including reoperation and mortality were recorded. Results Of the 16 patients, 15 (94%) had positive cultures of the graft. Methicillin-Resistant Staph Aureus was the most commonly isolated organism (50%). There were 3 unplanned reoperations including a revision from below to above knee amputation, drainage of a hematoma, and a wound debridement within the first year. Over the 1 year follow up period, 3 patients died for a mortality of 19%. There were no reinfections during follow-up. Discussion Prosthetic graft infection is a rare but serious vascular surgery complication. The causative organism has shifted in the last few years to become increasingly drug resistant. Treatment requires excision, and bovine tissue has been demonstrated to provide a safe and durable method of repair.
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- 2020
9. There Is Limited Value in the One Month Post Endovascular Aortic Aneurysm Repair Surveillance Computed Tomography Scan
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Heron E. Rodriguez, Andrew W. Hoel, Neel A. Mansukhani, Mark K. Eskandari, Michael C. Soult, and Brian T. Cheng
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Male ,medicine.medical_specialty ,Time Factors ,Endoleak ,Computed Tomography Angiography ,030204 cardiovascular system & hematology ,Aortography ,030218 nuclear medicine & medical imaging ,Blood Vessel Prosthesis Implantation ,03 medical and health sciences ,Aortic aneurysm ,0302 clinical medicine ,Aneurysm ,Predictive Value of Tests ,medicine ,Humans ,cardiovascular diseases ,Aged ,Retrospective Studies ,Computed tomography angiography ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Endovascular Procedures ,Retrospective cohort study ,General Medicine ,Middle Aged ,medicine.disease ,Abdominal aortic aneurysm ,Early Diagnosis ,Treatment Outcome ,Predictive value of tests ,Angiography ,Female ,Surgery ,Illinois ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Aortic Aneurysm, Abdominal ,Abdominal surgery - Abstract
Background Endovascular aortic aneurysm repair (EVAR) is the preferred first-line treatment for abdominal aortic aneurysms. Current postprocedure surveillance recommendations by manufacturers are a 1-month computed tomography angiography (CTA) followed by a 12-month CTA in most circumstances. The objective of this study is to determine the utility of the 1-month CTA following elective EVAR and determine if initial surveillance at 6-month CTA is appropriate. Methods A single-center retrospective chart review of all elective EVARs at a tertiary medical center over a 12-year period was conducted. Patients were excluded if postoperative surveillance imaging was not available. Data analysis encompassed demographics, chart review, and imaging including angiogram and cross-sectional imaging to asses for endoleaks and other findings. Results There were 363 patients who underwent elective EVAR and had available postoperative imaging during the study period. Within the 1-month follow-up, a CTA group of 316 patients was detected with 98 (31%) endoleaks. Of these, 5 (1.5%) required intervention: 1 for infolding of an iliac limb and 4 for type I endoleak which was present on completion angiogram—3 in patients treated outside of instructions for use and 1 with a type Ib endoleak on intraoperative completion imaging. In the 158 patients with 1 and 3-month CTAs, there were 47 persistent endoleaks, 9 previously undetected endoleaks not seen in 1-month CTA, and 13 resolved endoleaks. Three patients (1.2%) underwent intervention for type II endoleak and aneurysm expansion. In 47 patients with only a 6-month CTA, there were 16 endoleaks not seen on completion angiography and 2 of which were treated with reintervention—1 for a type I endoleak and 1 for a type II endoleak. Conclusions There is limited utility to 1-month surveillance CTA in patients undergoing elective EVAR within the device instructions for use that has no evidence of type I endoleak on completion angiography. It is safe to start routine EVAR surveillance at 6 months in this patient population. This has implications when considering bundled and value-based payments in the longitudinal care of abdominal aortic aneurysm patients.
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- 2019
10. Detecting iliac vein thrombosis with current protocols of lower extremity venous duplex ultrasound
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Mark K. Eskandari, Patricia Astleford, Ashish K. Jain, Michael C. Soult, Heron E. Rodriguez, Kush R. Desai, and Scott A. Resnick
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medicine.medical_specialty ,Databases, Factual ,Computed Tomography Angiography ,Iliac Vein ,030204 cardiovascular system & hematology ,Deep venous thromboses ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,medicine ,Humans ,030212 general & internal medicine ,Retrospective Studies ,Venous Thrombosis ,Ultrasonography, Doppler, Duplex ,Iliac vein thrombosis ,business.industry ,Ultrasound ,Reproducibility of Results ,Phlebography ,medicine.disease ,Thrombosis ,Predictive value ,Venous thrombosis ,Iliac veins ,Duplex (building) ,Surgery ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Magnetic Resonance Angiography - Abstract
Background Deep venous thrombosis isolated to the iliac veins is uncommon. Venous duplex ultrasound (DU) is widely accepted as the screening modality of choice for lower extremity deep venous thromboses. This investigation evaluated the accuracy and efficacy of DU in diagnosis of iliac vein thrombosis. Methods We conducted a single-center retrospective review of patients who were diagnosed with iliac vein thrombosis between January 1, 2006, and December 31, 2015. Patients included in our analysis needed to have both DU and cross-sectional imaging performed within a month of each other. The efficacy of DU in diagnosis of iliac vein thrombosis was determined using cross-sectional imaging as a standard for diagnosis. Results In total, our query yielded 80 patients with a diagnosis of iliac vein thrombosis in the medical chart; 48 patients had both cross-sectional imaging and DU performed within 1 month of each other. There were 36 patients who had cross-sectional imaging positive for iliac vein thrombosis; only 10 (27.8%) of these patients were found to have iliac vein thrombosis by DU. Thus, 26 patients (72.2%) were not diagnosed accurately by DU. On the basis of our data, the sensitivity and positive predictive value of DU compared with cross-sectional imaging in diagnosis of iliac vein thrombosis were 27.8% and 76.9%, respectively. We did not identify any patient-specific factors that influenced the discrepancy between DU and cross-sectional imaging. Conclusions Our current protocol of lower extremity venous DU is not an effective tool in diagnosis of iliac vein thrombosis. All patients with clinically suspected iliac vein thrombosis should be evaluated with specific pelvic ultrasound protocols or cross-sectional imaging.
- Published
- 2018
11. Contributors
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Babak Abai, James F. Abdo, Faryal G. Afridi, Olamide Alabi, Sarah Brown, Victoria Burton, Stephanie Carr, Venita Chandra, Vina Chhaya, Dawn M. Coleman, Michol A. Cooper, Alan Dardik, Sarah E. Deery, Ellen D. Dillavou, Laura M. Drudi, Audra Duncan, Jennifer L. Ellis, Yana Etkin, Amanda C. Filiberto, Julie Ann Freischlag, Vivian Gahtan, Mingjie Gao, Elizabeth L. George, Natalia O. Glebova, Philip Goodney, Jolanta Gorecka, Bernadette Goudreau, Linda M. Harris, Christine A. Heisler, Caitlin W. Hicks, Milan Ho, Vy Ho, Nicole Ilonzo, Sadia Ilyas, Brendan A. Jones, Enjae Jung, Manasa Kanneganti, Melina R. Kibbe, Misaki M. Kiguchi, Tanner I. Kim, Gregg S. Landis, Jason T. Lee, Jia Liu, Joann M. Lohr, Dimitra Lotakis, Natalia Rodriguez Luquerna, Pallavi Manvar-Singh, Christina L. Marcaccio, Katharine L. McGinigle, Pringl Miller, Samantha Minc, Erica L. Mitchell, Karina Newhall, Bao-Ngoc Nguyen, Sonya S. Noor, Cassius Iyad Ochoa Chaar, J. Westley Ohman, Kathleen J. Ozsvath, Georgina M. Pappas, Bruce A. Perler, Emily S. Reardon, Sudie-Ann Robinson, Meagan L. Rosenberg, Ethan S. Rosenfeld, Jessica R. Rouan, Danielle Salazar, Oonagh Scallan, Marc L. Schermerhorn, Palma M. Shaw, Jeffrey E. Silpe, Niten Singh, Brigitte Smith, Michael C. Soult, Elizabeth H. Stephens, Varuna Sundaram, Sarah M. Temkin, Robert W. Thompson, Britt H. Tonnessen, Margaret Tracci, Kaspar Trocha, Ashley K. Vavra, Gabriela Velazquez-Ramirez, Ageliki G. Vouyouka, Grace J. Wang, Tahlia L. Weis, Kimberly Zamor, and Pamela M. Zimmerman-Owen
- Published
- 2021
12. Outcomes of open treatment of infrainguinal peripheral artery disease in women
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Vivian Gahtan and Michael C. Soult
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medicine.medical_specialty ,business.industry ,Arterial disease ,Limb salvage ,Mortality rate ,Disease ,Surgery ,medicine.anatomical_structure ,Female patient ,Open treatment ,Medicine ,Presentation (obstetrics) ,business ,Artery - Abstract
As the prevalence of peripheral artery disease continues to increase, the open treatment of infrainguinal peripheral artery disease remains an essential option. There are many important factors to consider when evaluating female patients for bypass, including artery diameter, diseases burden, conduit size, timing of presentation, and hormonal factors. However, despite advances in medical therapy and surgical technique, many conflicting reports exist regarding outcomes in women, with more recent, large database studies demonstrating that women have lower patency and limb salvage rates and increased mortality rates. This chapter examines these factors because they relate to open surgical infrainguinal treatments in women and the effects of sex on outcome.
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- 2021
13. What we still do not know in the treatment of infrainguinal peripheral artery disease in women
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Vivian Gahtan and Michael C. Soult
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medicine.medical_specialty ,Arterial disease ,business.industry ,Internal medicine ,medicine ,Cardiology ,Disease ,business - Published
- 2021
14. A rare case of fibromuscular dysplasia involving multiple vascular beds
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Lillian Malach, Carlos F. Bechara, Christian Renz, Nader Tehrani, Matthew Blecha, and Michael C. Soult
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Pathology ,medicine.medical_specialty ,Carotid arteries ,Coronary Vessel Anomalies ,Fibromuscular dysplasia ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Celiac Artery ,Mesenteric Artery, Superior ,Risk Factors ,Rare case ,Medicine ,Fibromuscular Dysplasia ,Humans ,Radiology, Nuclear Medicine and imaging ,Carotid Stenosis ,Vascular Diseases ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Prognosis ,Aneurysm ,Dysplasia ,Surgery ,Female ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery - Abstract
Objective Fibromuscular dysplasia rarely involves vessels other than the renal and carotid arteries. We present a case of a rare fibromuscular dysplasia involving multiple vascular beds in a young female patient with history of spontaneous coronary artery (SCAD). Methods This is a case report with review of the literature using PubMed search for other cases of fibromuscular dysplasia that involves multiple vascular beds and its association with SCAD. The patient agreed to publish her case including her images. Results Fibromuscular dysplasia involving multiple vascular beds in a young female patient with prior coronary dissection is rarely reported in the literature. Conclusion Fibromuscular dysplasia affecting multiple vascular beds is rare but should be suspected in patients with SCAD, particularly young female patients.
- Published
- 2020
15. Acute Limb Ischemia Due to Arterial Thrombosis Associated With Coronavirus Disease 2019
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Krishnan Warrior, Nida Ahmed, Michael C. Soult, Kevin Simpson, and Paul A. Chung
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medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,business.industry ,medicine.medical_treatment ,Medical record ,Embolectomy ,Case Report ,General Medicine ,arterial thrombosis ,medicine.disease ,Thrombosis ,coagulopathy ,Peripheral ,coronavirus disease 2019 ,Internal medicine ,acute limb ischemia ,Hyperlipidemia ,D-dimer ,Cardiology ,medicine ,Coagulopathy ,business ,d-dimer - Abstract
Objectives To describe a case of acute limb ischemia caused by arterial thrombosis due to coronavirus disease 2019. Design Clinical observation of a patient. Setting Academic medical center. Patient A 59-year-old female with history of hypertension, hyperlipidemia, and prior smoking. Intervention Clinical observation and data extraction from electronic medical records. Measurements and main results We report a case of peripheral arterial thrombosis associated with coronavirus disease 2019, resulting in acute limb ischemia of the right lower extremity. This event was heralded by a sudden and significant elevation in d-dimer levels. At the time of surgery, a long, gelatinous clot was retrieved from the right popliteal artery. Perioperatively, she continued to have absent pedal Doppler signals and after multiple embolectomy attempts, required distal arterial cut down with removal of additional thrombi and resultant improvement of distal arterial flow. Conclusions This case demonstrates the importance of regularly checking d-dimer levels and vigilant monitoring for arterial thrombotic events, as they can rapidly become catastrophic.
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- 2020
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16. Extended Use of the Candy-Plug Technique with the Cook Dissection Stent
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Carlos F. Bechara, Nader Tehrani, and Michael C. Soult
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Aortic dissection ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Stent ,Lumen (anatomy) ,General Medicine ,030204 cardiovascular system & hematology ,medicine.disease ,Thrombosis ,030218 nuclear medicine & medical imaging ,Surgery ,03 medical and health sciences ,Aortic aneurysm ,0302 clinical medicine ,Aneurysm ,Celiac artery ,Blood vessel prosthesis ,medicine.artery ,medicine ,Cardiology and Cardiovascular Medicine ,business - Abstract
Inducing false lumen (FL) thrombosis is crucial to achieve aortic remodeling when treating aortic dissection. One method to achieve FL thrombosis is modifying a graft and placing a plug inside it known as the candy-plug (CP) technique. CP stent graft is typically placed at the level of the celiac artery (CA) as noted by the original authors. Here, we present a case where the CP had to be placed distal to the CA but also require placing a bare metal dissection stent in the true lumen to oppose the radial force and expand the true lumen as well as to prevent re-entry tear in the visceral segment in the future.
- Published
- 2021
17. Left subclavian artery revascularization in zone 2 thoracic endovascular aortic repair is associated with lower stroke risk across all aortic diseases
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S. Sadie Ahanchi, Sebastian Larion, Jean M. Panneton, Colin T. Brandt, Michael C. Soult, Obie Powell, and Rhiannon J. Bradshaw
- Subjects
Male ,Time Factors ,medicine.medical_treatment ,Subclavian Artery ,Aorta, Thoracic ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,0302 clinical medicine ,Risk Factors ,Cause of Death ,Medicine ,030212 general & internal medicine ,Cause of death ,Aged, 80 and over ,Aortic dissection ,Endovascular Procedures ,Hazard ratio ,Middle Aged ,Stroke ,Treatment Outcome ,Cardiothoracic surgery ,Retreatment ,Cardiology ,Cardiology and Cardiovascular Medicine ,Adult ,medicine.medical_specialty ,Adolescent ,Aortic Diseases ,Revascularization ,Risk Assessment ,Disease-Free Survival ,Blood Vessel Prosthesis Implantation ,Young Adult ,03 medical and health sciences ,Internal medicine ,medicine.artery ,Humans ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Aorta ,Chi-Square Distribution ,Spinal Cord Ischemia ,business.industry ,Virginia ,Retrospective cohort study ,Protective Factors ,medicine.disease ,Surgery ,Multivariate Analysis ,business ,Chi-squared distribution - Abstract
Background The best management strategy for the left subclavian artery (LSA) in pathologic processes of the aorta requiring zone 2 thoracic endovascular aortic repair (TEVAR) remains controversial. We compared LSA coverage with or without revascularization as well as the different means of LSA revascularization. Methods A retrospective chart review was conducted of patients with any aortic diseases who underwent zone 2 TEVAR deployment from 2007 to 2014. Primary end points included 30-day stroke and 30-day spinal cord injury (SCI). Secondary end points were 30-day procedure-related reintervention, freedom from aorta-related reintervention, aorta-related mortality, and all-cause mortality. Results We identified 96 patients with zone 2 TEVAR who met our inclusion criteria. The mean age of the patients was 62 years, with 61.5% male. Diseases included acute aortic dissections (n = 25), chronic aortic dissection with aneurysmal degeneration (n = 22), primary aortic aneurysms (n = 21), penetrating aortic ulcers/intramural hematomas (n = 17), and traumatic aortic injuries (n = 11). Strategies for the LSA included coverage with revascularization (n = 54) or without revascularization (n = 42). Methods of LSA revascularization included laser fenestration with stenting (n = 33) and surgical revascularization: transposition (n = 10) or bypass (n = 11). Of the 54 patients with LSA revascularization, 44 (81.5%) underwent LSA intervention at the time of TEVAR and 10 (18.5%) at a mean time of 33 days before TEVAR (range, 4-63 days). For the entire cohort, the overall incidence of 30-day stroke was 7.3%; of 30-day SCI, 2.1%; and of procedure-related reintervention, 5.2%. At a mean follow-up of 24 months (range, 1-79 months), aorta-related reintervention was 15.6%, aorta-related mortality was 12.5%, and all-cause mortality was 29.2%. The 30-day stroke rate was highest for LSA coverage without revascularization (6/42 [14.3%]) compared with any form of LSA revascularization (1/54 [1.9%]; P = .020), with no difference between LSA interventions done synchronously with TEVAR (1/44 [2.3%]) vs metachronously with TEVAR (0/10 [0%]; P = .63). There was no significant difference in 30-day SCI in LSA coverage without revascularization (2/42 [4.8%]) vs with revascularization (0/54 [0%]; P = .11). There was no difference in aorta-related reintervention, aorta-related mortality, or all-cause mortality in coverage without revascularization (5/42 [11.9%], 6/42 [14.3%], and 14/42 [33.3%]) vs with revascularization (10/54 [18.5%; P = .376], 6/54 [11.1%; P = .641], and 14/54 [25.9%; P = .43], respectively). After univariate and multivariable analysis, we identified LSA coverage without revascularization as associated with a higher rate of 30-day stroke (hazard ratio, 17.2; 95% confidence interval, 1.3-220.4; P = .029). Conclusions Our study suggests that coverage of the LSA without revascularization increases the risk of stroke and possibly SCI.
- Published
- 2017
18. Outcomes of Catheter-Directed Thrombolysis of Autogenous Vein Bypass Versus Prosthetic Bypass for Acute Leg Ischemia
- Author
-
Michael C. Soult, Paul Crisostomo, Michael Wesolowski, Bernadette Aulivola, Shuchi Zinzuwadia, Carlos F. Bechara, and Pegge Halandras
- Subjects
medicine.medical_specialty ,business.industry ,Catheter directed thrombolysis ,Medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Limb ischemia ,Vein bypass - Published
- 2020
19. Sarcopenia predicts mortality and adverse outcomes after endovascular aneurysm repair and can be used to risk stratify patients
- Author
-
Andrew W. Hoel, Irene Helenowski, Heron E. Rodriguez, Mark K. Eskandari, Michael C. Soult, and Brian T. Cheng
- Subjects
Male ,medicine.medical_specialty ,Sarcopenia ,Radiography ,medicine.medical_treatment ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,Endovascular aneurysm repair ,Risk Assessment ,03 medical and health sciences ,Blood Vessel Prosthesis Implantation ,0302 clinical medicine ,Predictive Value of Tests ,Risk Factors ,medicine ,Humans ,030212 general & internal medicine ,Survival analysis ,Aged ,Psoas Muscles ,Retrospective Studies ,Aged, 80 and over ,Receiver operating characteristic ,business.industry ,Patient Selection ,Endovascular Procedures ,medicine.disease ,Abdominal aortic aneurysm ,Treatment Outcome ,Quartile ,Elective Surgical Procedures ,Surgery ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Tomography, X-Ray Computed ,Body mass index ,Aortic Aneurysm, Abdominal ,Follow-Up Studies - Abstract
Background Endovascular aneurysm repair (EVAR) is currently the most common treatment of abdominal aortic aneurysms. Potential predictors of long-term survival after EVAR include physiologic, functional, and cognitive status, but assessments of these conditions have been difficult to standardize. Objective radiographic findings, such as skeletal muscle atrophy, or sarcopenia, may provide an additional means for selection of patients. This study investigates sarcopenia as a method to predict 1-year survival in patients undergoing EVAR. Methods A single-institution retrospective review was conducted of all patients who underwent elective EVAR from September 2002 to June 2014. Patients with an available periprocedural computed tomography (CT) scan and clinical data were included in the analysis. Normalized total psoas cross-sectional area (nTPA) was measured on axial CT images using the area of the bilateral psoas muscle at the third lumbar vertebral level normalized to the square of patient height. A threshold for optimal estimate of sarcopenia based on nTPA was determined using a receiver operating characteristic curve. Sarcopenia was evaluated as an independent risk predictor using univariate, multivariate, and survival analysis. Results A total of 272 EVAR-treated patients were evaluated, including 237 men and 35 women with a median age of 72 years and mean body mass index of 28.6 kg/m2. There was a significant increase in overall mortality in patients in the lowest quartile of nTPA (Q1, 23.53%; Q2, 13.24%; Q3, 7.35%; Q4, 5.88%; P = .01). The estimated nTPA threshold for increased mortality after EVAR was 500 mm2/m2. Using this threshold, sarcopenia accounted for 57% of the risk effect in our 1-year survival model. Conclusions Sarcopenia can assist in identifying EVAR candidates who are less likely to benefit from surgery. It can be readily evaluated from preoperative CT scans and may be a useful tool in evaluation of abdominal aortic aneurysm patients with applications in risk evaluation and telemedicine.
- Published
- 2018
20. Impact of Hospitalist Comanagement on Outcomes in the Vascular Surgery Inpatient Population
- Author
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Kaavya Adam, Laurel Gordon, Carlos Bechara, Paul Crisostomo, Pegge Halandras, Michael C. Soult, and Bernadette Aulivola
- Subjects
Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2019
21. Timing of Minor Amputation Following Lower Extremity Revascularization Impacts Healing Outcomes
- Author
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Carlos F. Bechara, Tia Sutton, Paul Crisostomo, Michael C. Soult, Sanya Lulla, Bernadette Aulivola, Pegge Halandras, and Sean P. Nassoiy
- Subjects
Lower extremity revascularization ,medicine.medical_specialty ,Amputation ,business.industry ,medicine.medical_treatment ,medicine ,Surgery ,General Medicine ,Minor (academic) ,Cardiology and Cardiovascular Medicine ,business - Published
- 2019
22. Torso Computed Tomography Can be Bypassed after Thorough Trauma Bay Examination of Patients who Fall from Standing
- Author
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W Helman Terzian, Leonard J. Weireter, L.D. Britt, Michael C. Soult, Kedar S. Lavingia, and Jay N. Collins
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Glasgow Coma Scale ,Poison control ,Physical examination ,General Medicine ,Hemothorax ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Pneumothorax ,Blunt trauma ,medicine ,Abdomen ,Injury Severity Score ,business - Abstract
Reliance on CT imaging in the evaluation of low-impact blunt trauma is a major source of radiation exposure, cost, and resource utilization. This study sought to determine if torso (chest and abdomen) CT could be avoided in patients with ground level falls. This was a retrospective chart review of patients admitted to the trauma service between January 2013 and April 2014. The mechanism of injury was ground level fall or fall from sitting. Patient demographics, physical examination (PE) findings, imaging results, length of stay, and complications were reviewed. History and physical data were based on chief resident or attending documentation. A significant thoracic injury was defined as a hemothorax, a pneumothorax, greater than three rib fractures, or aortic injury. A significant abdominal injury was defined as a solid organ injury, an intra-abdominal hematoma, a hollow viscus injury, aortic injury, or a urologic injury. The trauma service evaluated 156 patients. Nine patients were excluded for intubation or Glasgow Coma Scale (GCS) < 13. Of the 147 remaining, mean age was 69 years, mean GCS was 14.8. A chest CT was obtained in 111 (76%). Eight (7%) had a significant thoracic injury. All patients with significant thoracic injury had positive examination findings. No patient with a normal PE was found to have a significant thoracic injury (negative predictive value of 100%). An abdominal CT was obtained in 86 (59%). Five (6%) were found to have a significant abdominal injury. All patients who had a significant radiographic injury had an abnormal PE (negative predictive value of 100%). In conclusion, thorough history and physical in the trauma bay allow the clinician to obtain selective torso CT imaging. Routine torso CT warrants re-evaluation in low-impact injury mechanisms as there appears to be little benefit compared with the resource utilization and expense.
- Published
- 2015
23. Can Routine Trauma Bay Chest X-ray be Bypassed with an Extended Focused Assessment with Sonography for Trauma Examination?
- Author
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Timothy J. Novosel, Scott F. Reed, Michael C. Soult, L.D. Britt, Rebecca C. Britt, Jay N. Collins, and Leonard J. Weireter
- Subjects
medicine.medical_specialty ,business.industry ,Thoracic cavity ,Decompression ,Radiography ,Ultrasound ,Retrospective cohort study ,General Medicine ,medicine.anatomical_structure ,Blunt ,Predictive value of tests ,Medicine ,Focused assessment with sonography for trauma ,Radiology ,business - Abstract
The objective of this study was to investigate the feasibility of using ultrasound (US) in place of portable chest x-ray (CXR) for the rapid detection of a traumatic pneumothorax (PTX) requiring urgent decompression in the trauma bay. All patients who presented as a trauma alert to a single institution from August 2011 to May 2012 underwent an extended focused assessment with sonography for trauma (FAST). The thoracic cavity was examined using four-view US imaging and were interpreted by a chief resident (Postgraduate Year 4) or attending staff. US results were compared with CXR and chest computed tomography (CT) scans, when obtained. The average age was 37.8 years and 68 per cent of the patients were male. Blunt injury occurred in 87 per cent and penetrating injury in 12 per cent of activations. US was able to predict the absence of PTX on CXR with a sensitivity of 93.8 per cent, specificity of 98 per cent, and a negative predictive value of 99.9 per cent compared with CXR. The only missed PTX seen on CXR was a small, low anterior, loculated PTX that was stable for transport to CT. The use of thoracic US during the FAST can rapidly and safely detect the absence of a clinically significant PTX. US can replace routine CXR obtained in the trauma bay and allow more rapid initiation of definitive imaging studies.
- Published
- 2015
24. Outer membrane vesicles alter inflammation and coagulation mediators
- Author
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Kamal H. Wahab, Yuliya Dobrydneva, Michael C. Soult, Claretta J. Sullivan, and L.D. Britt
- Subjects
Lipopolysaccharides ,Endothelium ,Lipopolysaccharide ,Thrombomodulin ,Inflammation ,Monocytes ,Umbilical vein ,Thromboplastin ,Endothelial activation ,Tissue factor ,chemistry.chemical_compound ,Cell-Derived Microparticles ,Sepsis ,Escherichia coli ,Human Umbilical Vein Endothelial Cells ,medicine ,Humans ,Thrombophilia ,Platelet activation ,Blood Coagulation ,Chemistry ,Cytoplasmic Vesicles ,Platelet Activation ,Cell biology ,P-Selectin ,medicine.anatomical_structure ,Immunology ,Surgery ,medicine.symptom ,E-Selectin ,Bacterial Outer Membrane Proteins - Abstract
Outer membrane vesicles (OMVs) were previously shown to be capable of initiating the inflammatory response seen in the transition of an infection to sepsis. However, another tenet of sepsis is the development of a hypercoagulable state and the role of OMVs in the development of this hypercoagulability has not been evaluated. The objective of this study was to evaluate the ability of OMVs to elicit endothelial mediators of coagulation and inflammation and induce platelet activation.Human umbilical vein endothelial cells (HUVECs) were incubated with OMVs and were analyzed for the expression of tissue factor (TF), thrombomodulin, and the adhesion molecules P-selectin and E-selectin. Supernatants of OMV-treated HUVECs were mixed with whole blood and assessed for prothrombotic monocyte-platelet aggregates (MPA).OMVs induce significantly increased expression of TF, E-selectin, and P-selectin, whereas, the expression of thrombomodulin by HUVECs is significantly decreased (P0.05). The lipopolysaccharide inhibitor clearly inhibited the expression of E-selectin following incubation with OMVs, although its impact on TF and thrombomodulin expression was nominal. Incubation of whole blood with supernatant from HUVECs exposed to OVMs resulted in increased MPAs.This study demonstrates that, at the cellular level, OMVs from pathogenic bacteria play a complex role in endothelial activation. Although OMV-bound lipopolysaccharide modulates inflammatory proteins, including E-selectin, it has a negligible effect on the tested coagulation mediators. Additionally, endothelial activation by OMVs facilitates platelet activation as indicated by increased MPAs. By influencing the inflammatory and coagulation cascades, OMVs may contribute to the hypercoagulable response seen in sepsis.
- Published
- 2014
25. Thoracic ultrasound can predict safe removal of thoracostomy tubes
- Author
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Timothy J. Novosel, Leonard J. Weireter, Michael C. Soult, Jay N. Collins, and L.D. Britt
- Subjects
Adult ,Male ,medicine.medical_specialty ,Radiography ,Thoracostomy ,Critical Care and Intensive Care Medicine ,medicine ,Humans ,Prospective Studies ,Prospective cohort study ,Device Removal ,Retrospective Studies ,Ultrasonography ,Surgical team ,business.industry ,Ultrasound ,Pneumothorax ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Surgery ,Clinical trial ,Chest Tubes ,Female ,Radiology ,business - Abstract
Background Chest x-rays (CXRs) have been the mainstay for the management of thoracostomy tubes (TTs), but reports that ultrasound (US) may be more sensitive for detection of pneumothorax (PTX) continue to increase. The objective of this study was to determine if US is safe and effective for the detection of PTX following TT removal. Methods This was a retrospectively reviewed, prospective process improvement project involving patients who had a TT managed by the surgical team. Bedside US was performed by experienced surgeon sonographers before and after TT removal. Initially, a CXR was obtained before and after TT removal, with sonographers blinded to CXR findings. Subsequently, routine CXR was no longer obtained, and TT removal was determined by US. Results One hundred twenty-nine TTs were placed during the study. Initially, water seal and postpull US were performed on 49 TTs, with 6 tubes having only postpull imaging. US was able to detect all significant PTXs seen on CXR but identified one false-positive. Subsequently, 74 TTs had US imaging on water seal and after pull. Water seal US allowed the safe removal of 70% of the TTs. Twenty patients had no slide on water seal US and required follow-up CXR. Most importantly, US had a 100% negative predictive value for PTX during TT removal. Conclusion US is safe and effective for the rapid diagnosis of PTX. This has allowed the discontinuation of routine CXR for the evaluation of PTX during TT removal for patients with adequate lung slide seen on thoracic US lung windows. Level of evidence Diagnostic test, level II. Therapeutic study, level IV.
- Published
- 2014
26. Basic Ultrasound Training Can Replace Chest Radiography for Safe Tube Thoracostomy Removal
- Author
-
Timothy J. Novosel, Jay N. Collins, Kedar S. Lavingia, Leonard J. Weireter, L.D. Britt, and Michael C. Soult
- Subjects
Surgical team ,medicine.medical_specialty ,Pleural effusion ,business.industry ,Radiography ,Medical record ,General Medicine ,medicine.disease ,Hemothorax ,Thoracostomy ,Surgery ,Pneumothorax ,medicine ,business ,Hemopneumothorax - Abstract
An ultrasound (US) examination can be easily and rapidly performed at the bedside to aide in clinical decisions. Previously we demonstrated that US was safe and as effective as a chest x-ray (CXR) for removal of tube thoracostomy (TT) when performed by experienced sonographers. This study sought to examine if US was as safe and accurate for the evaluation of pneumothorax (PTX) associated with TT removal after basic US training. Patients included had TT managed by the surgical team between October 2012 and May 2013. Bedside US was performed by a variety of members of the trauma team before and after removal. All residents received, at minimum, a 1-hour formal training class in the use of ultrasound. Data were collected from the electronic medical records. We evaluated 61 TTs in 61 patients during the study period. Exclusion of 12 tubes occurred secondary to having incomplete imaging, charting, or death before having TT removed. Of the 49 remaining TT, all were managed with US imaging. Average age of the patients was 40 years and 30 (61%) were male. TT was placed for PTX in 37 (76%), hemothorax in seven (14%), hemopneumothorax in four (8%), or a pleural effusion in one (2%). Two post pull PTXs were correctly identified by residents using US. This was confirmed on CXR with appropriate changes made. US was able to successfully predict the safe TT removal and patient discharge at all residency levels after receiving a basic US training program.
- Published
- 2014
27. There is Limited Value in the One Month Post EVAR Surveillance CT Scan
- Author
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Brian T. Cheng, Andrew W. Hoel, Heron E. Rodriguez, Mark K. Eskandari, and Michael C. Soult
- Subjects
medicine.diagnostic_test ,business.industry ,medicine ,Surgery ,Computed tomography ,General Medicine ,Cardiology and Cardiovascular Medicine ,Nuclear medicine ,business ,Value (mathematics) - Published
- 2018
28. PC152. Impact of Hospitalist Co-Management on Outcomes in the Vascular Surgery Inpatient Population
- Author
-
Carlos F. Bechara, Pegge Halandras, Paul Crisostomo, Kaavya Adam, Bernadette Aulivola, Michael C. Soult, and Laurel Gordon
- Subjects
education.field_of_study ,medicine.medical_specialty ,business.industry ,Population ,Emergency medicine ,medicine ,Surgery ,Vascular surgery ,Cardiology and Cardiovascular Medicine ,education ,business - Published
- 2019
29. PC068. Carotid Intervention Compared With Medical Management Decreases Stroke and Mortality in Patients with Amaurosis Fugax or Retinal Artery Occlusion
- Author
-
Martin Walsh, Paul Crisostomo, Steven Goicoechea, Bernadette Aulivola, Michael C. Soult, Carlos F. Bechara, and Pegge Halandras
- Subjects
medicine.medical_specialty ,Retinal Artery Occlusion ,business.industry ,Amaurosis fugax ,medicine.disease ,Intervention (counseling) ,Internal medicine ,medicine ,Cardiology ,Surgery ,In patient ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Stroke - Published
- 2019
30. PC204. Endovascular Mechanical Thrombectomy Without Tissue Plasminogen Activator Does Not Decrease Major Bleeding Compared With Pharmacomechanical Interventions With Tissue Plasminogen Activator
- Author
-
Charles Marquardt, Carlos F. Bechara, Kathryn Swain, Bernadette Aulivola, Michael C. Soult, Pegge Halandras, and Paul Crisostomo
- Subjects
Mechanical thrombectomy ,medicine.medical_specialty ,business.industry ,medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Tissue plasminogen activator ,Major bleeding ,medicine.drug - Published
- 2019
31. Outer membrane vesicles from pathogenic bacteria initiate an inflammatory response in human endothelial cells
- Author
-
Natalie E. Lonergan, Michael C. Soult, Woong-Ki Kim, Bhairav Shah, L.D. Britt, and Claretta J. Sullivan
- Subjects
Lipopolysaccharides ,Lipopolysaccharide ,Virulence Factors ,medicine.medical_treatment ,Virulence ,Cell Membrane Structures ,Microbiology ,chemistry.chemical_compound ,Sepsis ,E-selectin ,Escherichia coli ,Human Umbilical Vein Endothelial Cells ,medicine ,Humans ,Escherichia coli Infections ,Inflammation ,biology ,Interleukin-6 ,Cell adhesion molecule ,NF-kappa B ,Endothelial Cells ,NF-κB ,Flow Cytometry ,Intercellular adhesion molecule ,Cell biology ,Cytokine ,chemistry ,Fimbriae, Bacterial ,biology.protein ,Surgery ,Bacterial outer membrane ,Cell Adhesion Molecules ,Bacterial Outer Membrane Proteins - Abstract
Introduction Gram-negative bacteria release outer membrane vesicles (OMVs) during growth that contain various membrane components involved in eliciting an inflammatory response, including lipopolysaccharide and virulence factors. However, little is known about the role of OMVs in sepsis. The objective of this study was to determine how OMVs, derived from Escherichia ( E. ) coli , elicit the cellular responses involved in activating the inflammatory cascade, and to determine whether additional virulence factors in pathogenic OMVs augment the inflammatory response. Methods Human umbilical endothelial cells were inoculated with OMVs from non-pathogenic E. coli (npOMV) or pathogenic E. coli (pOMV) and analyzed for adhesion protein synthesis, cytokine production, and necrosis factor (NF)-κB translocation. Results Flow cytometry demonstrated that human umbilical vein endothelial cells exposed to npOMV or pOMV significantly increased expression of E-selectin and intercellular adhesion molecule, with a large population of cells demonstrating increased expression of both proteins. Interleukin-6 levels were significantly elevated by 4 h after exposure to npOMV and pOMVs. NF-κB translocation to the nucleus was shown to be induced by npOMV and pOMVs. However, the role of additional virulence factors associated with pOMVs remains undefined. Conclusions Both npOMVs and pOMVs are capable of initiating the inflammatory cascade in endothelial cells. OMVs trigger NF-κB translocation to the nucleus, resulting in up-regulation of adhesion molecules and cytokines, presumably for the recruitment of leukocytes. By eliciting an inflammatory response, OMVs could facilitate the transition from a localized infection to a systemic response, and ultimately sepsis.
- Published
- 2013
32. Duplex ultrasound criteria for in-stent restenosis of mesenteric arteries
- Author
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Jean M. Panneton, S. Sadie Ahanchi, Joseph C. Wuamett, Michael C. Soult, Christopher L. Stout, and Sebastian Larion
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,genetic structures ,Constriction, Pathologic ,030204 cardiovascular system & hematology ,Constriction ,03 medical and health sciences ,0302 clinical medicine ,Restenosis ,Celiac artery ,Celiac Artery ,Mesenteric Artery, Superior ,Predictive Value of Tests ,Recurrence ,medicine.artery ,Mesenteric Vascular Occlusion ,medicine ,Humans ,030212 general & internal medicine ,Superior mesenteric artery ,Splanchnic Circulation ,Vascular Patency ,Aged ,Retrospective Studies ,Aged, 80 and over ,Ultrasonography, Doppler, Duplex ,medicine.diagnostic_test ,business.industry ,Ultrasound ,Endovascular Procedures ,Angiography ,Virginia ,Reproducibility of Results ,Middle Aged ,medicine.disease ,SMA ,Stenosis ,ROC Curve ,Area Under Curve ,Surgery ,Female ,Stents ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Blood Flow Velocity - Abstract
Duplex ultrasound (DUS) criteria are well defined for evaluating high-grade stenosis (≥70%) of the native superior mesenteric artery (SMA) and celiac artery (CA). It has been shown that native vessel criteria overestimate the degree of in-stent restenosis (ISR) and that velocity criteria for SMA and CA ISR are not well established. The objective of this study was to define DUS velocity criteria for high-grade ISR of the SMA and CA.A retrospective review of all patients who underwent SMA or CA stenting from a single institution was performed from 2004 to 2013. Patients were excluded if they did not have a DUS examination 4 months before angiography to assess stent patency or adequate angiographic visualization of the ISR.There were 103 paired DUS scans and angiograms analyzed: 66 SMA studies and 37 CA studies. The average peak systolic velocity (PSV) for SMAs was 367 cm/s with 70% ISR and 536 cm/s with ≥70% ISR. The average PSV for CAs was 302 cm/s with 70% ISR and 434 cm/s with ≥70% ISR. For an ISR ≥70% in the SMA, a PSV ≥445 cm/s produced the highest sensitivity (83%) and specificity (83%), with a positive predictive value of 81% and a negative predictive value of 86%. For an ISR ≥70% in the CA, a PSV ≥289 cm/s produced the highest sensitivity (100%) and specificity (57%), with a positive predictive value of 79% and negative predictive value of 100%.Increasing PSV correlates with an increasing degree of ISR for both the SMA and CA. Stented vessels have increased PSV, and therefore native PSV criteria are unreliable for the determination of ISR. The PSV criteria for ≥70% stenosis are higher for ISR than for native visceral vessel stenosis. The proposed new velocity criteria define ≥70% ISR as ≥445 cm/s in stented SMAs and ≥289 cm/s in stented CAs.
- Published
- 2016
33. MRI as an Adjunct to Cervical Spine Clearance: A Utility Analysis
- Author
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Timothy J. Novosel, Jay N. Collins, Rebecca C. Britt, Scott F. Reed, Michael C. Soult, Leonard J. Weireter, and L.D. Britt
- Subjects
medicine.medical_specialty ,Obtundation ,medicine.diagnostic_test ,business.industry ,Physical examination ,Magnetic resonance imaging ,Retrospective cohort study ,General Medicine ,medicine.disease ,Surgery ,Blunt trauma ,Edema ,medicine ,Cervical collar ,Radiology ,Tomography ,medicine.symptom ,business - Abstract
Cervical spine (CS) injury occurs in 1 to 3 per cent of blunt trauma patients. The goal of this study is to evaluate the use of magnetic resonance imaging (MRI) as an adjunct to CS computed tomography (CT) in the presence of persistent pain with a normal physical examination or obtundation. A retrospective chart review was performed on 389 blunt trauma patients undergoing both CS CT and MRI between 2007 and 2010. Abnormal CT findings were found in 199. The remaining 190 patients with normal CT scans underwent MRI for persistent pain (109), neurologic symptoms (57), or obtundation (24). Motor vehicle crashes predominated (50%) followed by falls (19%) and motorcycle crashes (12%). In the patients with persistent pain, CT showed no acute injury (89%) with subsequent MRI demonstrating ligamentous edema or injury not seen on CT in 12 per cent of patients. No patient required an operation for CS instability. All the obtunded patients demonstrated localizing motion of four extremities. MRI of these patients demonstrated ligamentous edema or injury not seen on CT in 20 per cent of patients. No obtunded patient had CS instability or needed operative intervention. A localizing physical examination in conjunction with normal CS CT safely precludes a CS injury requiring cervical fixation. MRI does not add substantially to this decision-making and the cervical collar can be safely removed.
- Published
- 2012
34. Circulating Bacterial Membrane Vesicles Cause Sepsis in Rats
- Author
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Natalie E. Lonergan, Claretta J. Sullivan, Scott Stanley, L.D. Britt, Michael C. Soult, and Bhairav Shah
- Subjects
Male ,Bacterial outer membrane vesicles ,Lipopolysaccharide ,biology ,Cell adhesion molecule ,Vesicle ,Critical Care and Intensive Care Medicine ,medicine.disease ,Rats ,Proinflammatory cytokine ,Microbiology ,Rats, Sprague-Dawley ,Sepsis ,chemistry.chemical_compound ,chemistry ,Escherichia coli ,Emergency Medicine ,biology.protein ,medicine ,Animals ,Bacterial outer membrane ,Interleukin 6 ,Bacterial Outer Membrane Proteins - Abstract
Gram-negative bacteria remain the leading cause of sepsis, a disease that is consistently in the top 10 causes of death internationally. Curing bacteremia alone does not necessarily end the disease process as other factors may cause inflammatory damage. Bacterial outer membrane vesicles (OMVs) are naturally produced blebs from the outer membrane of gram-negative bacteria, which contain various proteins and lipopolysaccharide (LPS). We hypothesize that these vesicles initiate an inflammatory response independent of the parent bacteria. Outer membrane vesicles were isolated from cultures of Escherichia coli, and the concentration of LPS in the OMVs was measured. Adult male Sprague-Dawley rats were separated into five treatment groups: OMV, 2xOMV, LPS, lactated Ringer's, and sham. Our findings show that infused OMVs elicit physiological, histological, and molecular changes in rats that are consistent with sepsis. Hyperdynamic changes in heart rates and mean arterial pressures are observed as well as the elevation of the proinflammatory cytokines tumor necrosis factor α and interleukin 6. Downstream events such as the recruitment of neutrophils into tissues due to the presentation of vascular adhesion molecules also occur in OMV-treated animals. Although soluble LPS elicits stronger responses than did OMVs, responses to the latter consistently exceeded those associated with lactated Ringer's infusion. These results indicate OMVs, independent of the parent bacteria, do initiate an inflammatory response; however, further studies are required to better characterize the temporal biomolecular interactions involved.
- Published
- 2012
35. Torso Computed Tomography Can Be Bypassed after Thorough Trauma Bay Examination of Patients Who Fall from Standing
- Author
-
Kedar S, Lavingia, Jay N, Collins, Michael C, Soult, W Helman, Terzian, Leonard J, Weireter, and L D, Britt
- Subjects
Male ,Radiography, Abdominal ,Thoracic Injuries ,Cost-Benefit Analysis ,Posture ,Abdominal Injuries ,Unnecessary Procedures ,Hospitals, General ,Wounds, Nonpenetrating ,Cohort Studies ,Injury Severity Score ,Trauma Centers ,Cost Savings ,Predictive Value of Tests ,Humans ,Medical History Taking ,Physical Examination ,Aged ,Retrospective Studies ,Aged, 80 and over ,Virginia ,Middle Aged ,Accidental Falls ,Female ,Radiography, Thoracic ,Patient Safety ,Tomography, X-Ray Computed ,Follow-Up Studies - Abstract
Reliance on CT imaging in the evaluation of low-impact blunt trauma is a major source of radiation exposure, cost, and resource utilization. This study sought to determine if torso (chest and abdomen) CT could be avoided in patients with ground level falls. This was a retrospective chart review of patients admitted to the trauma service between January 2013 and April 2014. The mechanism of injury was ground level fall or fall from sitting. Patient demographics, physical examination (PE) findings, imaging results, length of stay, and complications were reviewed. History and physical data were based on chief resident or attending documentation. A significant thoracic injury was defined as a hemothorax, a pneumothorax, greater than three rib fractures, or aortic injury. A significant abdominal injury was defined as a solid organ injury, an intra-abdominal hematoma, a hollow viscus injury, aortic injury, or a urologic injury. The trauma service evaluated 156 patients. Nine patients were excluded for intubation or Glasgow Coma Scale (GCS)13. Of the 147 remaining, mean age was 69 years, mean GCS was 14.8. A chest CT was obtained in 111 (76%). Eight (7%) had a significant thoracic injury. All patients with significant thoracic injury had positive examination findings. No patient with a normal PE was found to have a significant thoracic injury (negative predictive value of 100%). An abdominal CT was obtained in 86 (59%). Five (6%) were found to have a significant abdominal injury. All patients who had a significant radiographic injury had an abnormal PE (negative predictive value of 100%). In conclusion, thorough history and physical in the trauma bay allow the clinician to obtain selective torso CT imaging. Routine torso CT warrants re-evaluation in low-impact injury mechanisms as there appears to be little benefit compared with the resource utilization and expense.
- Published
- 2015
36. Can routine trauma bay chest x-ray be bypassed with an extended focused assessment with sonography for trauma examination?
- Author
-
Michael C, Soult, Leonard J, Weireter, Rebecca C, Britt, Jay N, Collins, Timothy J, Novosel, Scott F, Reed, and L D, Britt
- Subjects
Adult ,Aged, 80 and over ,Male ,Trauma Severity Indices ,Adolescent ,Pneumothorax ,Reproducibility of Results ,Middle Aged ,Young Adult ,ROC Curve ,Trauma Centers ,Predictive Value of Tests ,Feasibility Studies ,Humans ,Wounds and Injuries ,Female ,Radiography, Thoracic ,Tomography, X-Ray Computed ,Aged ,Follow-Up Studies ,Retrospective Studies ,Ultrasonography - Abstract
The objective of this study was to investigate the feasibility of using ultrasound (US) in place of portable chest x-ray (CXR) for the rapid detection of a traumatic pneumothorax (PTX) requiring urgent decompression in the trauma bay. All patients who presented as a trauma alert to a single institution from August 2011 to May 2012 underwent an extended focused assessment with sonography for trauma (FAST). The thoracic cavity was examined using four-view US imaging and were interpreted by a chief resident (Postgraduate Year 4) or attending staff. US results were compared with CXR and chest computed tomography (CT) scans, when obtained. The average age was 37.8 years and 68 per cent of the patients were male. Blunt injury occurred in 87 per cent and penetrating injury in 12 per cent of activations. US was able to predict the absence of PTX on CXR with a sensitivity of 93.8 per cent, specificity of 98 per cent, and a negative predictive value of 99.9 per cent compared with CXR. The only missed PTX seen on CXR was a small, low anterior, loculated PTX that was stable for transport to CT. The use of thoracic US during the FAST can rapidly and safely detect the absence of a clinically significant PTX. US can replace routine CXR obtained in the trauma bay and allow more rapid initiation of definitive imaging studies.
- Published
- 2015
37. RS20. Duplex Criteria for Renal Artery In-Stent Restenosis
- Author
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Joseph C. Wuamett, Michael C. Soult, Sebastian Larion, Jean M. Panneton, and S. Sadie Ahanchi
- Subjects
medicine.medical_specialty ,business.industry ,Duplex (building) ,medicine.artery ,Medicine ,Surgery ,Radiology ,Renal artery ,In stent restenosis ,Cardiology and Cardiovascular Medicine ,business - Published
- 2016
38. Sarcopenia as a Predictor of Mortality After Endovascular Aneurysm Repair
- Author
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Irene Helenowski, Heron E. Rodriguez, Brian T. Cheng, Mark K. Eskandari, Michael C. Soult, and Andrew W. Hoel
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,medicine.disease ,Endovascular aneurysm repair ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Sarcopenia ,medicine ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business - Published
- 2017
39. Basic ultrasound training can replace chest radiography for safe tube thoracostomy removal
- Author
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Kedar S, Lavingia, Michael C, Soult, Jay N, Collins, Timothy J, Novosel, Leonard J, Weireter, and L D, Britt
- Subjects
Adult ,Aged, 80 and over ,Male ,Adolescent ,Virginia ,Internship and Residency ,Pneumothorax ,Middle Aged ,Thoracostomy ,Pleural Effusion ,Trauma Centers ,Education, Medical, Graduate ,Humans ,Female ,Radiography, Thoracic ,Ultrasonics ,Device Removal ,Ultrasonography, Interventional ,Aged ,Retrospective Studies - Abstract
An ultrasound (US) examination can be easily and rapidly performed at the bedside to aide in clinical decisions. Previously we demonstrated that US was safe and as effective as a chest x-ray (CXR) for removal of tube thoracostomy (TT) when performed by experienced sonographers. This study sought to examine if US was as safe and accurate for the evaluation of pneumothorax (PTX) associated with TT removal after basic US training. Patients included had TT managed by the surgical team between October 2012 and May 2013. Bedside US was performed by a variety of members of the trauma team before and after removal. All residents received, at minimum, a 1-hour formal training class in the use of ultrasound. Data were collected from the electronic medical records. We evaluated 61 TTs in 61 patients during the study period. Exclusion of 12 tubes occurred secondary to having incomplete imaging, charting, or death before having TT removed. Of the 49 remaining TT, all were managed with US imaging. Average age of the patients was 40 years and 30 (61%) were male. TT was placed for PTX in 37 (76%), hemothorax in seven (14%), hemopneumothorax in four (8%), or a pleural effusion in one (2%). Two post pull PTXs were correctly identified by residents using US. This was confirmed on CXR with appropriate changes made. US was able to successfully predict the safe TT removal and patient discharge at all residency levels after receiving a basic US training program.
- Published
- 2014
40. Effect of E. coli outer membrane vesicles on monocyte‐platelet aggregates (145.9)
- Author
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Natalie E. Lonergan, Michael C. Soult, Claretta J. Sullivan, Yuliya Dobrydneva, and Kamal H. Wahab
- Subjects
Bacterial outer membrane vesicles ,medicine.diagnostic_test ,Chemistry ,Vesicle ,Monocyte ,medicine.disease ,Biochemistry ,Molecular biology ,Flow cytometry ,Sepsis ,medicine.anatomical_structure ,Genetics ,medicine ,Platelet ,Bacterial outer membrane ,Molecular Biology ,Biotechnology ,Whole blood - Abstract
Bacterial outer membrane vesicles (OMVs) can initiate the inflammatory response in the transition of an infection to sepsis, and sepsis is a prothrombotic state. The role of OMVs in the development of prothrombotic tendency is unknown. The objective: to determine whether OMVs and endothelial microparticles can induce formation of prothrombotic monocyte-platelet aggregates (MPA). Donor blood was incubated either with OMVs from clinical isolate of an enterotoxigenic strain of E. coli or with supernatant from HUVEC (Human Umbilical Endothelial Cells) cultured in the presence of OMV for 24 hrs. MPA were measured in whole blood by flow cytometry as CD61+CD14+ cells. In whole blood from healthy human volunteers, MPA level is 19±2% in unstimulated state and 37±8% in ADP-stimulated state. Incubation of blood with OMVs did not significantly increase MPA neither in unstimulated blood (23±2%), nor in ADP-stimulated blood (24±7%). However, supernatant from HUVEC cultured with OMVs increased level of MPA in ADP-stimul...
- Published
- 2014
41. Duplex Ultrasound Criteria for Renal Artery In-Stent Restenosis
- Author
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S. Sadie Ahanchi, Jean M. Panneton, Sebastian Larion, Joseph C. Wuamett, Michael C. Soult, and Brandon C. Cain
- Subjects
medicine.medical_specialty ,business.industry ,Ultrasound ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Duplex (building) ,medicine.artery ,medicine ,Surgery ,Radiology ,Renal artery ,In stent restenosis ,Cardiology and Cardiovascular Medicine ,business - Published
- 2016
42. Duplex Criteria for In-Stent Restenosis of Mesenteric Arteries
- Author
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Jean M. Panneton, Christopher L. Stout, Sebastian Larion, Sadaf S. Ahanchi, Joseph C. Wuamett, and Michael C. Soult
- Subjects
medicine.medical_specialty ,medicine.anatomical_structure ,Duplex (building) ,business.industry ,medicine ,Surgery ,Radiology ,In stent restenosis ,Cardiology and Cardiovascular Medicine ,business ,Mesenteric arteries - Published
- 2016
43. Merkel cell carcinoma: high recurrence rate despite aggressive treatment
- Author
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Eric Feliberti, Roger R. Perry, Michael C. Soult, and Marc L. Silverberg
- Subjects
Oncology ,Adult ,Male ,medicine.medical_specialty ,Skin Neoplasms ,medicine.medical_treatment ,Sentinel lymph node ,Metastasis ,Internal medicine ,Biopsy ,medicine ,Carcinoma ,Humans ,Retrospective Studies ,Skin ,Aged, 80 and over ,medicine.diagnostic_test ,Merkel cell carcinoma ,business.industry ,Sentinel Lymph Node Biopsy ,Virginia ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Prognosis ,Radiation therapy ,Carcinoma, Merkel Cell ,Surgery ,Female ,Lymph Nodes ,Skin cancer ,Neoplasm Recurrence, Local ,business - Abstract
Background Merkel cell carcinoma (MCC) is a rare aggressive neuroendocrine cancer of the skin whose incidence has been increasing. The objective of the study was to evaluate current treatment modalities, including sentinel lymph node (SLN) biopsy and outcomes and identify prognostic factors in patients with MCC. Methods A retrospective chart review of patients with MCC. Clinical, pathologic, treatment characteristics, disease status, and survival were collected. All slides were reviewed by a single pathologist, and additional pathologic elements were evaluated for prognosis. Results Twenty-six patients were identified in the study period. All patients were Caucasian with an average age of 71.3 y. Twenty-one patients had tumors in sun-exposed locations, and 13 had a prior history of skin cancer. All nonmetastatic patients underwent wide excision. SLN biopsy was successful in 19 patients. The SLN was positive in 21% of patients. Radiation therapy was used in 13 patients. Average follow-up was 26 mo, and median survival was 29 mo. Recurrence occurred in eight patients: four locoregional, two distant, one combined, and one unknown. Recurrence occurred in five patients with stage I disease. Five patients with negative SLN later developed recurrence. The presence of metastasis to the nodes was significant for recurrence. No other pathologic factor was found to have prognostic significance. Conclusions Despite aggressive surgical and radiation treatment, MCC has a high rate of locoregional recurrence, even in early stage disease. SNLB is useful for the staging and management of patients. Further research is needed to identify better prognostic markers.
- Published
- 2012
44. Bacterial Outer Membrane Vesicles Alter Mediators of Inflammation and Coagulation
- Author
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L.D. Britt, Y. Dobrydeneva, Kamal H. Wahab, Michael C. Soult, and Claretta J. Sullivan
- Subjects
Bacterial outer membrane vesicles ,Chemistry ,medicine ,Coagulation (water treatment) ,Surgery ,Inflammation ,medicine.symptom ,Cell biology - Published
- 2014
45. 492. Biodistribution and Integration Assessment of AAV1 gag-PR-RT(ΔRNaseH) after Intramuscular Administration in Rabbits
- Author
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Bruce C. Schnepp, Michael C. Soult, Tara L. Allen, Philip R. Johnson, Pervin Anklesaria, and Keith Munson
- Subjects
Pharmacology ,Biodistribution ,Protease ,viruses ,medicine.medical_treatment ,Biology ,Virology ,Molecular biology ,Reverse transcriptase ,Immune system ,Capsid ,Drug Discovery ,medicine ,biology.protein ,Genetics ,Molecular Medicine ,HIV vaccine ,RNase H ,Gene ,Molecular Biology - Abstract
Clade C HIV-1 is responsible for approximately half of all HIV infections worldwide. An initial AAV2 vaccine containing the Clade C HIV-1 genes for the gag, protease and part of the reverse transcriptase proteins (gag-PR-|[Delta]|RT) is currently being tested in clinical trials. A vaccine based on pseudotyped AAV 1 vectors is being developed to be used either on its own on or in combination with other vectors to improve the immune response. Similar to the AAV2-based HIV vaccine, this vaccine also contains the gag, protease and part of the reverse transcriptase proteins (gag-PR-RT|[Delta]|RNaseH) flanked by the AAV2 ITR but is pseudotyped with the AAV1 capsids.
- Published
- 2006
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