Biomedical subjects

A Arifi

Publications and source records attributed to A Arifi.

4 recordsLinked to original sources

PubMed2000

Management of massive hemoptysis: a single institution experience.

BACKGROUND: Massive hemoptysis is a life threatening condition. Several therapeutic strategies have been applied in the clinical setting, with variable results. We reviewed our recent experience on this subject. MATERIAL AND METHODS: In a 5-year period, fifty-four patients (41 males, mean age 57.9 years) were treated for massive hemoptysis in our unit. The underlying pathology included bronchiectasis (n=31), active tuberculosis (n=9), pneumoconiosis (n=3), lung cancer (n=2) and pulmonary angiodysplasia (n=1). These patients often present with continuous bleeding with large volume of hemoptysis, or with recurrent episodes of bleeding. Bronchoscopic assessment and interventions were performed upon admission in all patients. Surgery was considered if the patient had acceptable pulmonary reserve and a bleeding source was clearly identified. If the patient was not considered fit for surgery, bronchial artery embolization was attempted. RESULTS: Hemoptysis ceased with conservative management in 7 patients (13%) only. Twenty seven (50%) patients received surgical resection. The procedures included lobectomy (n=21), bilobectomy (n=4) and pneumonectomy (n=2). The in-hospital mortality after surgery was 15%. Postoperative morbidity occurred in 8 patients, including prolonged ventilatory support, bronchopleural fistulae, empyema and myocardial infarction. Twenty-one patients not suitable for surgery were treated with bronchial artery embolisation, which was successful in 17 patients without any complications. CONCLUSION: The clinical outcome for massive hemoptysis reflects the generalized nature of a destructive disease process involving both lungs and a limited respiratory reserve. Surgery is associated with high risk of morbidity and mortality, and should be performed only in selected patients. Meanwhile, aggressive conservative therapy including bronchial artery embolization should be pursued.

Adolescent↗

PubMed1999

No change in O2 saturation but measurable difference in thenar flexor power after radial artery harvest.

OBJECTIVES: Objective measures of morbidity will be required to establish the radial artery (RA) as a viable long term alternative to saphenous vein. The RA is the dominant arterial supply to the thenar musculature. We hypothesised that RA harvest should decrease O2 saturation and thenar muscle power. METHODS: RA was harvested from non-dominant (ND) limbs only (left n = 58, right n = 21). Oximeter values of O2 saturation were taken from the thumb of the dominant (D) and non-dominant (ND) limb pre and post operatively. A syringe filled with 25 cc of air is emptied against a one way valve connected to a pressure generator MX 100 by MEDEX, Inc, Ohio, USA. Three measures of thenar flexor power (TFP) were taken and mean values obtained in the ND and D limbs. RESULTS: O2 saturation ranged from 92 to 98% in the thumb of the ND limbs 24 h post RA harvest. The values for TFP (mean +/- SD) were 1246 +/- 246 mmHg (ND) and 1240 +/- 258 mmHg (D) pre-operatively and 1216 +/- 250 (ND) and 1259 +/- 233 (D) post operatively. The changes in TFP between the ND and D limbs (37.0 +/- 60.6 ND and 1.86 +/- 65.9 D) were significant for the D against the ND limb (P < 0.001). This reduction in TFP for the harvested limb was also found when considering handedness (28.0 +/- 24.2 and 40.3 +/- 69.2 for the left and right handed patients respectively). CONCLUSION: Our findings confirm the hypothesis that there are objective differences in TFP pre and post RA harvest at 3 months. Further studies are required to assess the clinical significance and persistence of the loss of TFP.

Adult↗

PubMed1998

Less invasive aortic root replacement.

We performed aortic root replacement using partial upper sternotomy in a patient with Marfan's syndrome. This approach was necessary because of severe pectus excavatum and spinal deformities. Although this method is technically feasible, we would not advocate it for routine use.

Adult↗

PubMed1998

Valve replacement with a stentless bioprosthesis: versatility of the porcine aortic root.

OBJECTIVE: Stentless valves convey important hemodynamic benefits but are used selectively depending on aortic root structure. The Freestyle valve (Medtronic, Inc, Minneapolis, Minn) is a versatile device that can be implanted by different methods depending on operating conditions. We aimed to demonstrate that a stentless valve could be used in every patient without increased risk of morbidity or mortality. We documented the effects of this valve on clinical outcome and left ventricular mechanics. METHODS: The Freestyle valve was implanted by the modified subcoronary method into 200 consecutive unselected patients who received a tissue valve in the aortic position and by root replacement in 2. Forty-three percent were older than 75 years. Forty percent underwent coronary bypass. Detailed clinical and echocardiographic follow-up (Food and Drug Administration protocol) was used out to 3 years. RESULTS: Mean ischemic time was 43+/-6 minutes for isolated aortic valve replacement and 63+/-14 minutes with concomitant procedures. Thirty-day mortality was 6%, none of the deaths being valve related. Hemodynamic function improved progressively with falling valve gradients and increased effective orifice areas. Left ventricular mass fell within normal limits over 2 years, but at 3 years there was a non-valve-related upswing. No instances of valve thrombosis, hemolysis, or paravalvular leak were noted. Less than 5% had mild to moderate aortic regurgitation. CONCLUSIONS: The Freestyle valve can be used in virtually every patient with aortic valve disease and provides superlative hemodynamic outcome. Hospital mortality and morbidity are similar to those reported for stented valves in an elderly population.

Aged↗