PubMed Health⌕ Search

Biomedical subjects

Nina Ghosh

Publications and source records attributed to Nina Ghosh.

4 recordsLinked to original sources
PubMed2006

Cardiac tamponade in a patient with moderate hemophilia A and factor VIII Inhibitors.

Cardiac tamponade is a rare, life-threatening complication of hemophilia. The management of pericardial bleeding in hemophilia A patients with inhibitors is particularly challenging because antibodies to factor (F) VIII render the use of high-dose FVIII ineffective. Fortunately, the management of uncontrollable bleeding in patients with hemophilia and inhibitors has improved since the introduction of treatments that bypass the need for FVIII and FIX. A case of hemopericardium complicated by cardiac tamponade occurring one month following an upper respiratory tract infection in a patient with hemophilia and FVIII inhibitors is presented. Management of the present case was based on current guidelines on the use of recombinant FVIIa for acute bleeding in patients with hemophilia and inhibitors. The subsequent development of hemothorax in the present case indicates that a more protracted course of recombinant FVIIa is justified following pericardiocentesis for pericardial bleeding in hemophilia with inhibitors. Alternative approaches to the management of this complication are also reviewed.

Cardiac Tamponade↗
PubMed2005

Laser lead extraction: is there a learning curve?

Laser extraction of device leads offers an attractive alternative to countertraction and electrosurgical dissection sheath, potentially increasing efficacy and reducing complications. Wider adoption of this technology depends on relative ease of use. We report the experience of a new center to define the "learning curve." We performed 76 laser lead extractions in 75 patients (age 63 +/- 17 years, 59 male) from July 2001 to January 2004. Two experienced device implanters who were novice extractors underwent a 2-day site visit to a high volume extraction center for training. Lead extractions were performed in the operating room with immediate surgical backup. The indication for extraction was infection in 39 (systemic in 15), erosion or pain in 11, and lead related or debulking in 25. Complete removal was achieved in 139 of 145 leads (14 ICD, 131 pacemaker). Partial removal (<4 cm retained) was achieved in five leads (4%), and one lead could not be extracted. Complete success was 95% in the first third of patients, 94% in the second third, and 100% in the latter third. Fluoroscopy time fell from 19 +/- 22 minute in the first third of patients to 11 +/- 8 minute in the second third to 8 +/- 4 minute in the latter third (ANOVA P = 0.02). No major complications occurred. Local bleeding required minor left subclavian vein repair in two individuals. Symptomatic venous thrombosis occurred in 3 of the first 11 cases 1-21 days after extraction, but did not occur in the next 64 consecutive patients who received a 1-month anticoagulation regimen (27% vs 0%, P < 0.001). One patient developed venous thrombosis 3 weeks following cessation of warfarin therapy. Practice guidelines reasonably recommend appropriate training prior to independent performance of lead extraction. The current study suggests that experienced device implanters with appropriate operative backup taking a limited, but intensive training program can be safe and effective at lead extraction in a short time, in part a reflection of the improved technology.

Aged↗
PubMed2004

Immediate evaluation of angioplasty and stenting results in supra-aortic arteries by use of a Doppler-tipped guidewire.

Intra-arterial Doppler sonography may complement arteriography by providing immediate physiological evidence of hemodynamic adequacy and by obviating unnecessary angioplastic dilation. We used a Doppler-tipped guidewire in 16 patients and obtained velocity measurements at the site of stenosis immediately before and after carotid artery stenting (CAS) in 10 patients. Intra-arterial Doppler sonography confirmed hemodynamic improvement immediately after stent placement and correlated well with post-CAS duplex Doppler sonography results. Thus, intra-arterial Doppler sonography can be feasibly incorporated into CAS procedures for hemodynamic evaluation and can provide anatomic information that complements information provided by angiography.

Adult↗