Sanjeev Kaul

Bio: Sanjeev Kaul is an academic researcher from University of Medicine and Dentistry of New Jersey. The author has contributed to research in topics: Arteriovenous fistula & Poison control. The author has an hindex of 7, co-authored 10 publications receiving 463 citations.

Isolated traumatic brain injury: age is an independent predictor of mortality and early outcome.

Abstract: Background Geriatric trauma patients have a worse outcome than the young with comparable injuries. The contribution of traumatic brain injury (TBI) to this increased mortality is unknown and has been confounded by the presence of other injuries. The purpose of this study was to investigate the role

Angiographic findings and embolotherapy in renal arterial trauma.

Abstract: To evaluate the angiographic findings and embolotherapy in the management of traumatic renal arterial injury This is a retrospective review of 22 patients with renal trauma who underwent arteriography and percutaneous embolization from December 1995 to January 2002. Medical records, imaging studies and procedural reports were reviewed to assess the type of injury, arteriographic findings and immediate embolization results. Long-term clinical outcome was obtained by communication with the trauma physicians and by clinical chart review. Arteriography was performed in 125 patients admitted to a State Trauma Center with suspected internal bleeding. Renal arterial injury was documented in 22 and was the result of a motor-vehicle accident (10), auto–pedestrian accident (1), gunshot (4) or stab wounds (6) and a fall (1). Percutaneous renal arterial embolization was undertaken in 22 of 125 (18%) patients to treat extravasation (11), arterial pedicle rupture (5), abnormal arteriovenous (3) or arteriocalyceal (2) communication and pseudoaneurysm (3). One of the pseudoaneurysms and one of the arteriovenous fistulae were found in addition to extravasation. All 22 patients (16 men, 6 women) were hemodynamically stable, or controlled during arteriography and embolotherapy. Selective and/or superselective embolization of the abnormal vessels was performed using coils in 9 patients, microcoils in 9 patients and Gelfoam pledgets in 3 patients. In one patient Gelfoam pledgets mixed with polyvinyl alcohol (PVA) particles were used for embolization. Immediate angiographic evidence of hemostasis was demonstrated in all cases. Two initial technical failures were treated with repeat arteriography and embolization. There was no procedure-related death. There was no non-target embolization. One episode of renal abscess after embolization was treated by nephrectomy and 3 patients underwent elective post-embolization nephrectomy to prevent infection. Follow-up ranged from 1 month to 7 years (mean 31 months). No procedure-related or delayed onset of renal insufficiency occurred. In hemodynamically stable and controlled patients selective and superselective embolization is a safe and effective method for the management of renal vascular injury

Acute complications associated with greenfield filter insertion in high-risk trauma patients.

Abstract: Background Use of Greenfield filters (GFs) to prevent fatal pulmonary embolism (PE) in trauma patients is generally well accepted. Nonetheless, a surprisingly small number of trauma surgeons insert filters in their patients. Among the reasons cited is fear of complications. Methods We observed three femoral arteriovenous fistulae (AVF) in trauma patients who had inferior vena caval placement of filters for PE prophylaxis in one 12-month period (academic year 1999). In an effort to document the magnitude of this problem, we evaluated trauma patients who had a GF inserted in academic year 2000. Results During that year, 133 consecutive patients (8.6% of trauma admissions) received 133 GFs through a percutaneous approach. The most common isolated indications for GF insertion included closed head injuries (n = 28), multiple long bone fractures (n = 27), pelvic and acetabular fractures (n = 6), spinal cord injuries (n = 16), and vertebral fractures (n = 3). Five patients had documented deep venous thrombosis (DVT) diagnosed by duplex ultrasonography before GF placement, and 11 patients had other indications requiring a filter. There were 37 patients with more than one indication requiring filter placement. Most patients (57%) underwent preinsertion duplex scanning of their lower extremity veins; 77% of patients underwent postinsertion scanning. Filters were inserted an average of 6.8 +/- 0.6 (SE) days after trauma. No AVF were suspected clinically or detected ultrasonographically. No operative or postoperative complications occurred. DVT was observed in 30% of patients despite 92% prophylaxis; there was a 26% incidence of de novo thrombi detected. None of the patients evidenced DVT clinically. Conclusion Our data indicate that complications of GF insertion for prophylaxis against PE from DVT complicating trauma patients continue to be negligible. In addition, the incidence of insertion-site thrombosis may be lower than expected. Moreover, femoral AVF is a rare complication of this procedure.

Association between adipokines and critical illness outcomes.

Abstract: BACKGROUNDAdipose tissue is an endocrine organ that plays a critical role in immunity and metabolism by virtue of a large number of hormones and cytokines, collectively termed adipokines. Dysregulation of adipokines has been linked to the pathogenesis of multiple diseases, but some questions have ar

The obesity factor in critical illness: Between consensus and controversy.

Abstract: T prevalence of obesity has increased starkly during the last decades, and this trend includes every age, sex, race and socioeconomic group. According to the most recent epidemiologic data, approximately two thirds of the US population are either overweight or obese, of whom approximately 30% are obese and more than 5% are morbidly obese. Although some reports suggest that the trend of obesity may have begun to stabilize within some segments of the US population, other studies project that obesity prevalence will continue to worsen, with as many as 50% of Americans potentially being obese by the year 2030. Obesity has been linked to increased mortality resulting from acute and chronic comorbidities including diabetes, stroke, and cardiovascular diseases (CVDs). The epidemic of obesity also has reached the intensive care unit (ICU), such that 33% of ICU patients are obese and 7% are morbidly obese. Consequently, obesity complicates all aspects of health care in the ICU by increasing the complexity of management, nutritional support, and changes in the pattern of comorbidities. Furthermore, obesity induces anatomic and physiologic changes that may interfere with the body response to injury and complicate any hospitalization. In this article, we will review recent studies that have examined the impact of obesity in critical illness.

Estimating the global incidence of traumatic brain injury

Abstract: OBJECTIVETraumatic brain injury (TBI)—the “silent epidemic”—contributes to worldwide death and disability more than any other traumatic insult. Yet, TBI incidence and distribution across regions and socioeconomic divides remain unknown. In an effort to promote advocacy, understanding, and targeted intervention, the authors sought to quantify the case burden of TBI across World Health Organization (WHO) regions and World Bank (WB) income groups.METHODSOpen-source epidemiological data on road traffic injuries (RTIs) were used to model the incidence of TBI using literature-derived ratios. First, a systematic review on the proportion of RTIs resulting in TBI was conducted, and a meta-analysis of study-derived proportions was performed. Next, a separate systematic review identified primary source studies describing mechanisms of injury contributing to TBI, and an additional meta-analysis yielded a proportion of TBI that is secondary to the mechanism of RTI. Then, the incidence of RTI as published by the Global...

Traumatic Brain Injury in Older Adults: Epidemiology, Outcomes, and Future Implications

Abstract: Traumatic brain injury (TBI) is a significant problem in older adults. In persons aged 65 and older, TBI is responsible for more than 80,000 emergency department visits each year; three-quarters of these visits result in hospitalization as a result of the injury. Adults aged 75 and older have the highest rates of TBI-related hospitalization and death. Falls are the leading cause of TBI for older adults (51%), and motor vehicle traffic crashes are second (9%). Older age is known to negatively influence outcome after TBI. Although geriatric and neurotrauma investigators have identified the prognostic significance of preadmission functional ability, comorbidities, sex, and other factors such as cerebral perfusion pressure on recovery after illness or injury, these variables remain understudied in older adults with TBI. In the absence of good clinical data, predicting outcomes and providing care in the older adult population with TBI remains problematic. To address this significant public health issue, a refocusing of research efforts on this population is justified to prevent TBI in the older adult and to discern unique care requirements to facilitate best patient outcomes.

Concussion in sports: postconcussive activity levels, symptoms, and neurocognitive performance.

Abstract: Context: Evidence suggests that athletes engaging in high-intensity activities after concussion have more difficulties with cognitive recovery. Objective: To examine the role postinjury ac...