Search PubMed⌕ Search

Biomedical subjects

B Satiani

Publications and source records attributed to B Satiani.

At least 19 recordsLinked to original sources
PubMed2001

Three cases of digital ischemia successfully treated with cilostazol.

Three patients were evaluated for refractory digital ischemia. The first patient presented with chronic, post-traumatic, unremitting, cold, painful, right fourth and fifth fingers. The symptoms had failed to improve despite topical nitroglycerin and a calcium channel blocker. Baseline digital plethysmography documented impaired perfusion within the affected digits. Cilostazol (Pletal) was added to the medical regimen and at the 8-week follow-up the fourth and fifth fingers were warm with repeat plethysmography displaying normal perfusion. A second patient had CREST syndrome-associated painful bilateral index finger ulcerations that had evolved despite taking a calcium channel blocker. Consequently the patient was started on cilostazol and within 4 weeks the digital ulcerations and pain had resolved. The third patient with traumatic right fifth digital arterial thrombosis was seen for persistent pain and cyanosis in spite of undergoing thrombolysis and subsequent anticoagulation with vasodilator therapy. Digital plethysmography established fixed ischemia within the fifth finger; subsequently, cilostazol was prescribed. Four weeks later the digital pain and cyanosis had essentially resolved. A follow-up plethysmographic waveform documented restored perfusion. Although approved for the treatment of intermittent claudication, cilostazol was successfully utilized in the setting of severe digital ischemia.

Adult↗
PubMed1997

Screening for major deep vein thrombosis in seriously injured patients: a prospective study.

The purpose of the study is to determine the prevalence of acute deep venous thrombosis (DVT) in severely injured trauma patients, to investigate the cost effectiveness of a noninvasive surveillance program, and to assess the merit of current methods of prophylaxis against DVT. One hundred and forty-eight patients (295 limbs) with a mean age of 36.5 years, mean trauma score of 13.3, mean injury severity score of 22.4 with predominantly blunt injuries (88.5%), were part of the study. The mean length of stay was 17.6 days. Venous duplex scans (VDS) were performed on inpatients on days 2-5, day 11, and day 30 following admission. Sequential compression device and/or subcutaneous heparin was used in 99% of patients with compliance being monitored by trauma nurse clinicians. A total of 272 VDS were performed with total charges of $111,520. DVT was found by VDS or venography in eight limbs (2.7%) of six patients (4%), our of the limbs being symptomatic. Two additional patients had pulmonary embolism, both with normal VDS. Routine serial VDS in severely injured patients who undergo aggressive prophylaxis against DVT is not cost effective and therefore not justified.

Adult↗
PubMed1993

Pelvic necrosis: a complication of infected aortic graft excision.

Infection is a devastating complication of synthetic aortic graft surgery. Patients with significant occlusive atherosclerosis of the internal iliac arteries undergoing aortic graft removal for graft infection may be at risk of pelvic and midbody necrosis. An unusual and fatal complication of this nature associated with the management of synthetic aortic graft infection has been encountered in two patients treated by extra-anatomic revascularization and staged removal of the infected aortic prosthesis. The hallmark of their presentation was pelvic and midbody necrosis in the presence of excellent distal perfusion with palpable pulses. Marginal pelvic circulation was therefore compromised further by graft removal and absence of retrograde pelvic perfusion. The finding of focal ischemic changes in the pelvic area of a patient with increasing serum creatinine phosphokinase activity, leukocytosis, myoglobinuria and paraplegia following infected aortic graft removal signals a grave and fatal prognosis.

Abscess↗
PubMed1993

Contralateral disease progression after carotid endarterectomy.

BACKGROUND: We report the natural history of the carotid artery contralateral to the ipsilateral endarterectomized carotid artery. METHODS: The incidence of new symptoms and disease progression of the patient contralateral side after unilateral carotid endarterectomy (CE) was studied by clinical follow-up and serial duplex scanning in 127 patients. RESULTS: During a mean follow-up of 44 months, new hemispheric events occurred in nine (7%) and significant progression was recorded in 27 (21%) patients. In 97 patients with initial stenosis of less than 50% (group I), contralateral progression to greater than 50% was noted in 22% and new symptoms (one transient ischemic attack and one cerebrovascular accident) in 2% of patients; three patients underwent CE. In 30 patients with initial stenosis between 50% and 99% (group II), new symptoms (all transient ischemic attacks) occurred in seven (23%) (group II vs group I; p < 0.003) and nine underwent CE (group II vs group I; p < 0.001). Progression in 26 patients with 50% to 79% stenosis within group II to greater than 80% was noted in 19% of patients (difference not significant compared with group I). CONCLUSIONS: Overall, new symptoms occurred in 7% and significant contralateral disease progression in 21% of patients; subsequent CE was performed in 9.4% of patients. Initial presence of greater than 50% contralateral stenosis is a predictor of future hemispheric symptoms, which are likely to be transient ischemic attacks. New symptoms did not necessarily correlate with disease progression. Because disease progression was observed in patients with varying degrees of initial contralateral stenosis, serial clinical and duplex scanning in all patients undergoing unilateral CE is recommended.

Aged↗
PubMed1993

Angiographic follow-up after laser-assisted balloon angioplasty.

PURPOSE: The purpose of this study was to obtain angiographic documentation of patency and recurrence rates after laser-assisted balloon angioplasty. METHODS: A prospective assessment of laser-assisted balloon angioplasty (LABA) was performed in 35 limbs of 33 patients with femoral popliteal atherosclerotic disease. There were 21 male and 12 female patients with a mean age of 60.6 years. Indications were intermittent claudication in 19, rest pain in nine, and ischemic ulcer/gangrene in seven limbs. There were 23 totally occluded (mean length 6 +/- 3.8 cm) and 12 stenotic arteries. LABA was achieved with a pulsed Nd:YAG laser with 10 to 25 W and a 2.2/3 mm sapphire probe, followed by balloon dilatation in all but four limbs. RESULTS: Immediate technical success (< or = 50% residual stenosis) was achieved in 27 (77%) of 35 limbs. Mean ankle/brachial index improved from 0.49 to 0.80 (p < 0.05). Major complications included three perforations, three dissections, and two emboli. Two additional limbs required operation at less than 30 days for a 30-day patency rate of 71.4%. Long-term clinical and noninvasive follow-up ranged from 1 to 55 months (mean 17.68 months). Twenty-nine angiograms were obtained from 3 to 49 months after LABA. Nineteen limbs underwent at least one angiogram, seven underwent two, and three limbs underwent three angiograms. Eleven of the 19 limbs showed evidence of restenosis greater than 50%, all within 12 months. The cumulative patency rate was 71.5% at 1 month, 39.7% at 6 months, and 31.3% at 12, 24, and 36 months. CONCLUSIONS: LABA with the Nd:YAG laser has a 30-day success rate of 71.4%. Angiographic follow-up demonstrates a high incidence of restenosis (> 50%), usually within 12 months. Approximately 50% of limbs eventually required reintervention within 1 year. In view of the disappointing early results, the use of LABA must remain strictly investigational.

Angiography↗
PubMed1991

Extracavitary vascular trauma.

Extracavitary vascular injuries involving the cervical area and the extremities constitute about 50% of all vascular injuries. Initial evaluation and resuscitation of patients with vascular injuries should follow standard Advanced Trauma Life Support protocols. Diagnosis of the injury is heavily reliant on physical examination, supplemented by arteriography in specific instances. Intraoperative management utilizes all the basic principles of vascular surgery. Postoperative nursing care focuses on the entire patient including the detection of early complications of vascular repair. Recent advances in transportation, resuscitation and operative techniques have lead to a decrease in mortality and morbidity.

Angiography↗
PubMed1991

Noninvasive diagnosis of deep venous thrombosis.

Deep venous thrombosis of the lower extremity poses a diagnostic challenge. Clinical signs and symptoms are often misleading, and sensitive and specific tests are essential for diagnosis. The cost, patient discomfort and risk of morbidity associated with contrast venography have led to the development of noninvasive diagnostic techniques such as Doppler ultrasound, impedance plethysmography and duplex ultrasound scanning. If noninvasive tests unequivocally indicate deep venous thrombosis, treatment may be started without the need for contrast venography.

Anthropometry↗
PubMed1991

Hand ischemia.

Explore the source record for details and available documents.

Aged↗
PubMed1990

The influence of contralateral disease on the natural history of nonoperated significant carotid stenosis.

The influence of contralateral disease on the natural history of ipsilateral nonoperated carotid stenosis greater than 50% was analyzed in 90 carotid arteries imaged by contrast arteriography or duplex scanning with a mean follow-up of 23.6 months. Ipsilateral stenosis was greater than 80% in 24 arteries and 50-79% in 66 arteries. Contralateral disease was present in 30 (Group I) and absent in 60 (Group II) patients. In Group I, the contralateral disease consisted of total occlusion in nine (30%), greater than 80% stenosis in five (17%), 50-79% stenosis in 12 (40%) with a mean of 78.6%. No significant difference existed in the incidence of initially asymptomatic vessels (57% versus 67%), stroke (13% versus 2%), or transient ischemic attack (17% each) between Groups I and II on the ipsilateral side (p greater than .05). New ipsilateral neurologic events occurred significantly more often in arteries with greater than 80% ipsilateral stenosis than those with 50-79% stenosis (p less than .02). The incidence of subsequent ipsilateral neurologic events (37% versus 22%), strokes, or transient ischemic attacks (20% versus 13%) was no different in Groups I and II, respectively (p greater than .05). Combined ipsilateral and contralateral neurologic events occurred significantly more often in patients with contralateral disease (p less than .05). Whereas in Group I, new ipsilateral symptoms were significantly more common in initially symptomatic vessels compared to asymptomatic ones (61.5% versus 17.6%, p less than .04), no such difference existed in Group II.

Aged↗
PubMed1989

Rapid volume replacement with warmed blood and fluids.

A prospective clinical study was undertaken in 50 consecutive patients suffering from severe traumatic shock to evaluate the clinical efficacy of a set for rapid administration of solutions (RSAS), which allows for rapid infusion and simultaneous warming of blood and fluids. The mechanism of injury was blunt in 37 patients and penetrating in 13. Admission trauma score averaged 7.5, and the injury severity score averaged 46. Average preresuscitation systolic blood pressure was 71 mmHg, pulse was 105 beats/minute, and temperature was 34.3 degrees C. Initial resuscitation was with the RSAS, and total fluid infused in the first twenty-four hours averaged 4,632 mL of blood, 1,914 mL of blood products, and 11,248 mL of crystalloid. The average postresuscitation systolic blood pressure was 120 mmHg, pulse was 96 beats/minute, and temperature averaged 34.9 degrees C. Survival at twenty-four hours was 29/50 (58%). There were no local complications of RSAS use and no evidence of infusion-related coagulopathy. The RSAS provided an effective and safe way to infuse large volumes of blood and fluid at body temperature.

Adolescent↗
PubMed1989

Aberrant right hepatic artery vena cava fistula: a case report.

An unusual case of visceral arterial venous fistula between an aberrant right hepatic artery and the inferior vena cava is presented. A critical review of the anatomic relationships in this location offers a plausible explanation to account for the rarity of this type of fistula. The second issue deals with the ligation of the hepatic artery. We caution against hepatic artery ligation, especially when dealing with an aberrant right hepatic artery.

Adult↗
PubMed1988

Normothermic rapid volume replacement in vascular catastrophes using the Infuser 37.

Twenty patients (Group 1) with a mean age of 38.5 +/- 16 years and an admission Trauma Score of 7.26 +/- 5.9, suffered 27 vascular injuries and were resuscitated with the Infuser 37 (IN-37) with an integral heat exchanger. Admission systolic BP averaged 46.47 mmHg (seven with absent vital signs). A mean of 7,030 ml of blood, 3,313 ml of colloid and 13,630 ml of crystalloid per patient was given in less than 24 hours, mostly through the IN-37. Twelve thoracotomies, nine laparotomies, and one extremity exploration were performed. Twelve patients, seven with a Trauma Score less than 3, died in less than 24 hours of exsanguination. The survival rate was 40% at 24 hours and 25% at 30 days. Six patients (Group 2) with a mean age of 70.33 +/- 8.3 years underwent operation for ruptured aortic aneurysm (5 pts), and elective aortic aneurysm (1 pt) with a 66% survival at 24 hours. Admission systolic blood pressure averaged 84 mmHg. A mean of 3,895 ml of blood, 1,900 ml of colloid and 7,733 ml of crystalloid per patient was administered in less than 24 hours, mostly through the IN-37. The IN-37 provides a safe and simple means of normothermic, rapid volume replacement in hemorrhagic shock. Its use in critically ill but potentially salvageable patients with vascular injuries and aortic aneurysm may avoid the consequences of prolonged hypoperfusion and hypothermia.

Adolescent↗