5215 Centre Ave
Pittsburgh PA 15232
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Case-based approach to managing angle closure glaucoma with anterior segment imaging. - Canadian journal of ophthalmology. Journal canadien d'ophtalmologie
This is a case-based approach to the diagnosis and management of angle closure glaucoma of a variety of causative factors, with a special emphasis on the use of advanced anterior segment imaging including ultrasound biomicroscopy and anterior segment optical coherence tomography. Although all angle closure is caused by iridotrabecular contact, the cause of angle closure glaucoma is classified based on the site of primary blockage of aqueous movement from anterior to posterior: pupillary block, plateau iris, lens-related, and posterior causative factors. Although gonioscopy is traditionally used to visualize the angle structures and estimate the angle width, objective and reproducible measurement of the anterior chamber angle can best be obtained with advanced anterior segment imaging. In this review article, we demonstrate the utility of anterior advanced imaging to identify underlying mechanisms in cases of angle closure glaucoma in guiding directed management.Copyright Â© 2014. Published by Elsevier Inc.
Low-sodium dietary approaches to stop hypertension diet reduces blood pressure, arterial stiffness, and oxidative stress in hypertensive heart failure with preserved ejection fraction. - Hypertension
Recent studies suggest that oxidative stress and vascular dysfunction contribute to heart failure with preserved ejection fraction (HFPEF). In salt-sensitive HFPEF animal models, diets low in sodium and high in potassium, calcium, magnesium, and antioxidants attenuate oxidative stress and cardiovascular damage. We hypothesized that the sodium-restricted Dietary Approaches to Stop Hypertension diet (DASH/SRD) would have similar effects in human hypertensive HFPEF. Thirteen patients with treated hypertension and compensated HFPEF consumed the DASH/SRD for 21 days (all food/most beverages provided). The DASH/SRD reduced clinic systolic (155-138 mmâ€‰Hg; P=0.02) and diastolic blood pressure (79-72 mmâ€‰Hg; P=0.04), 24-hour ambulatory systolic (130-123 mmâ€‰Hg; P=0.02) and diastolic blood pressure (67-62 mmâ€‰Hg; P=0.02), and carotid-femoral pulse wave velocity (12.4-11.0 m/s; P=0.03). Urinary F2-isoprostanes decreased by 31% (209-144 pmol/mmol Cr; P=0.02) despite increased urinary aldosterone excretion. The reduction in urinary F2-isoprostanes closely correlated with the reduction in urinary sodium excretion on the DASH/SRD. In this cohort of HFPEF patients with treated hypertension, the DASH/SRD reduced systemic blood pressure, arterial stiffness, and oxidative stress. These findings are characteristic of salt-sensitive hypertension, a phenotype present in many HFPEF animal models and suggest shared pathophysiological mechanisms linking these 2 conditions. Further dietary modification studies could provide insights into the development and progression of hypertensive HFPEF.
Sink and swim: kinematic evidence for lifting-body mechanisms in negatively buoyant electric rays Narcine brasiliensis. - The Journal of experimental biology
Unlike most batoid fishes, electric rays neither oscillate nor undulate their body disc to generate thrust. Instead they use body-caudal-fin (BCF) locomotion. In addition, these negatively buoyant rays perform unpowered glides as they sink in the water column. In combination, BCF swimming and unpowered gliding are opposite ends on a spectrum of swimming, and electric rays provide an appropriate study system for understanding how the performance of each mode is controlled hydrodynamically. We predicted that the dorso-ventrally flattened body disc generates lift during both BCF swimming and gliding. To test this prediction, we examined 10 neonate lesser electric rays, Narcine brasiliensis, as they swam and glided. From video, we tracked the motion of the body, disc, pelvic fins and tail. By correlating changes in the motions of those structures with swimming performance, we have kinematic evidence that supports the hypothesis that the body disc is generating lift. Most importantly, both the pitch of the body disc and the tail, along with undulatory frequency, interact to control horizontal swimming speed and Strouhal number during BCF swimming. During gliding, the pitch of the body disc and the tail also interact to control the speed on the glide path and the glide angle.
Peak cardiac power measured noninvasively with a bioreactance technique is a predictor of adverse outcomes in patients with advanced heart failure. - Congestive heart failure (Greenwich, Conn.)
Peak oxygen consumption (VO(2) ) during cardiopulmonary exercise testing (CPET) is a powerful predictor of survival, providing an indirect assessment of cardiac output (CO). Noninvasive indices of CO derived from bioreactance methodology would add significantly to peak VO(2) as a means of risk-stratifying patients with heart failure. In this study, 127 patients (53 Â± 14 years of age, 66% male) with heart failure and an average ejection fraction of 31% Â± 15% underwent symptom-limited CPET using a bicycle ergometer while measuring CO noninvasively by a bioreactance technique. Peak cardiac power was derived from the product of the peak mean arterial blood pressure and CO divided by 451. Follow-up averaged 404 Â± 179 days (median, 366 days) to assess endpoints including death (n=3), heart transplant (n=10), or left ventricular assisted device implantation (n=2). Peak VO(2) and peak power had similar areas under the curve (0.77 and 0.76), which increased to 0.83 when combined. Kaplan-Meier cumulative survival curves demonstrated different outcomes in the subgroup with a VO(2) <14 mL/kg/min when stratified by a cardiac power above or below 1.5 W (92.2% vs 82.1% at 1 year and 81.6% vs 58.3% at last follow-up, P=.02 by log-rank test). Among patients with heart failure, peak cardiac power measured with bioreactance methodology and peak VO(2) had similar associations with adverse outcomes and peak power added independent prognostic information to peak VO(2) in those with advanced disease (eg, VO(2) <14 mL/kg/min).Â© 2010 Wiley Periodicals, Inc.
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