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Transfusion for shock in US military war casualties with and without tourniquet use. - Annals of emergency medicine
We assess whether emergency tourniquet use for transfused war casualties admitted to military hospitals is associated with survival.A retrospective review of trauma registry data was made of US casualties in Afghanistan and Iraq. Patients with major limb trauma, transfusion, and tourniquet use were compared with similar patients who did not receive tourniquet use. A propensity-matching analysis was performed by stratifying for injury type and severity by tourniquet-use status. Additionally, direct comparison without propensity matching was made between tourniquet use and no-tourniquet use groups.There were 720 casualties in the tourniquet use and 693 in the no-tourniquet use groups. Of the 1,413 casualties, 66% (928) also had nonextremity injury. Casualties with tourniquet use had worse signs of hemorrhagic shock (admission base deficit, admission hemoglobin, admission pulse, and transfusion units required) than those without. Survival rates were similar between the 2 groups (1% difference; 95% confidence intervalÂ -2.5% to 4.2%), but casualties who received tourniquets had worse shock and received more blood products. In propensity-matched casualties, survival rates were not different (2% difference; 95% confidence intervalÂ -6.7% to 2.7%) between the 2 groups.Tourniquet use was associated with worse shock and more transfusion requirements among hospital-admitted casualties, yet those who received tourniquets had survival rates similar to those of comparable, transfused casualties who did not receive tourniquets.Published by Elsevier Inc.
Asymmetric reduction of gold nanoparticles into thermoplasmonic polydimethylsiloxane thin films. - ACS applied materials & interfaces
Polymer thin films containing gold nanoparticles (AuNPs) are of growing interest in photovoltaics, biomedicine, optics, and nanoelectromechanical systems (NEMs). This work has identified conditions to rapidly reduce aqueous hydrogen tetrachloroaurate (TCA) that is diffusing into one exposed interface of a partially cured polydimethylsiloxane (PDMS) thin film into AuNPs. Nanospheroids, irregular gold (Au) networks, and micrometer-sized Au conglomerates were formed in a âˆ¼5 Î¼m layer at dissolved TCA contents of 0.005, 0.05, and 0.5 mass percent, respectively. Multiscale morphological, optical, and thermal properties of the resulting asymmetric AuNP-PDMS thin films were characterized. Reduction of TCA diffusing into the interface of partially cured PDMS film increased AuNP content, robustness, and scalability relative to laminar preparation of asymmetric AuNP-PDMS thin films. Optical attenuation and thermoplasmonic film temperature due to incident resonant irradiation increased in linear proportion to the order of magnitude increases in TCA content, from 0.005 to 0.05 to 0.5 mass percent. At the highest TCA content (0.05 mass percent), an asymmetric PDMS film 52-Î¼m-thick with a 7 Î¼m AuNP-containing layer was produced. It attenuated 85% of 18 mW of incident radiation and raised the local temperature to 54.5 Â°C above ambient. This represented an increase of 3 to 230-fold in photon-to-heat efficiency over previous thermoplasmonic AuNP-containing systems.
Gold nanoparticles reduced in situ and dispersed in polymer thin films: optical and thermal properties. - Nanotechnology
Optical and thermal activity of plasmon-active nanoparticles in transparent dielectric media is of growing interest in thermal therapies, photovoltaics and optoelectronic components in which localized surface plasmon resonance (LSPR) could play a significant role. This work compares a new method to embed gold nanoparticles (AuNPs) in dense, composite films with an extension of a previously introduced method. Microscopic and spectroscopic properties of the two films are related to thermal behavior induced via laser excitation of LSPR at 532 nm in the optically transparent dielectric. Gold nanoparticles were incorporated into effectively nonporous 680 Î¼m thick polydimethylsiloxane (PDMS) films by (1) direct addition of organic-coated 16 nm nanoparticles; and (2) reduction of hydrogen tetrachloroaurate (TCA) into AuNPs. Power loss at LSPR excitation frequency and steady-state temperature maxima at 100 mW continuous laser irradiation showed corresponding increases with respect to the mass of gold introduced into the PDMS films by either method. Measured rates of temperature increase were higher for organic-coated NP, but higher gold content was achieved by reducing TCA, which resulted in larger overall temperature changes in reduced AuNP films.
Ocular complications in the Department of Defense Smallpox Vaccination Program. - Ophthalmology
The purpose of this case series was to present an overview of the nature and frequency of ocular complications in the Department of Defense (DoD) Smallpox Vaccination Program.Retrospective, noncomparative case series.The authors retrospectively evaluated data collected on individuals with an ophthalmologic complaint after receiving smallpox vaccination or after contact with a recently immunized individual. The vaccinee and contact cases occurred secondary to inoculations given between December 13, 2002 and May 28, 2003 as part of the DoD Smallpox Vaccination Program.Data were collected primarily from reports to military headquarters or to the Vaccine Adverse Event Reporting System and individual medical records.The incidence, types, and timing of ocular complications were evaluated. Diagnostic and treatment considerations also were reviewed.Between December 13, 2002 and May 28, 2003, 450,293 smallpox vaccinations were given. We identified 16 confirmed or probable cases of ocular vaccinia, with an incidence of 3.6 per 100,000 inoculations. Of these cases, 12 (75%) were seen in the vaccinees, and 4 (25%) in close contacts. Of the 12 self-inoculation cases, 7 (58.3%) were seen in individuals receiving the vaccine for the first time (primary vaccination), and 3 (25.0%) were seen in individuals previously vaccinated (revaccination); the vaccination status in 2 cases was unknown. Clinical manifestations included lid pustules, blepharitis, periorbital cellulitis, conjunctivitis, conjunctival ulcers, conjunctival membranes, limbal pustules, corneal infiltrates, and iritis, with onset of symptoms 3 to 24 days after inoculation or contact. Five of 9 tested cases were culture or polymerase chain reaction positive for vaccinia. Treatment for most cases was topical trifluridine 1% (Viroptic; King Pharmaceuticals, Inc., Bristol, TN). Vaccinia immune globulin was used in 1 case. In all patients, recovery occurred without significant visual sequelae.When compared with historical data on the ocular complications of smallpox vaccination, the incidence of ocular complications during the DoD Smallpox Vaccination program has been low. In addition, the severity of disease seems to be less than during other vaccination periods. These findings perhaps are the result of improved screening of vaccinees, prevaccination counseling, postvaccination wound care, and the suggested efficacy of trifluridine in the treatment of ocular vaccinia.
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