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Biomedical subjects

B Satiani

Publications and source records attributed to B Satiani.

At least 37 records · Page 2Linked to original sources
PubMed1988

Natural history of nonoperated, significant carotid stenosis.

One-hundred sixty-seven patients with 190 carotid arteries (109 asymptomatic) demonstrating 50-99% stenosis by arteriography (80), duplex scanning, or other noninvasive techniques were followed from 1-84 months (mean 24.2) for evidence of brain infarct, transient ischemic attacks, or vertebrobasilar symptoms. Thirty-nine arteries (20.5%) were symptomatic at last follow-up, including 13 (6.8%) producing ipsilateral strokes. Twenty-eight sides underwent carotid endarterectomy, 16 for symptomatic lesions at a mean interval of 14.5 months after the initial diagnostic study, with no neurologic deficit. Twenty-seven patients (16.2%) died, eight from stroke (30%), and 12 from cardiac causes (44%). In initially symptomatic sides, the incidence of any subsequent neurologic event (28.7%) or stroke/transient ischemic attack (25%) was significantly greater than in asymptomatic arteries (14.6% and 12%, respectively) (p less than .05). Carotid arteries with greater than 80% stenosis by arteriography and duplex scanning had a 46% incidence of further symptoms and 41.6% stroke/transient ischemic attack rate compared to 19.6% and 15%, respectively, in arteries with less than 80% stenosis (p less than .01). Cumulative life table analysis at 12, 24 and 36 months showed greater than 80% stenosed arteries to have stroke/transient ischemic attack free rates of 69%, 50.5%, and 21.6% compared to 91%, 83.7%, and 76% for arteries with less than 80% stenosis (p less than .05). At a mean follow-up of over two years, nonoperated carotid stenosis (greater than 50%) carries a 20.5% risk of neurologic symptoms and a 6.8% risk of stroke, 61.5% of strokes being fatal. Symptomatic carotid stenosis had a significantly greater incidence of ensuing neurologic events than asymptomatic arteries.(ABSTRACT TRUNCATED AT 250 WORDS)

Arterial Occlusive Diseases↗
PubMed1987

Normothermic rapid volume replacement in traumatic hypovolemia. A prospective analysis using a new device.

Inadequate infusion flow rates and hypothermia are significant problems encountered in managing traumatic hemorrhagic shock. The Rapid Solution Administration Set (RSAS) allows normothermic volume restoration at flow rates of up to 2200 mL/min via a single peripheral venipuncture. The RSAS was utilized in 33 consecutive multiple-trauma patients with a mean trauma score (TS) of 6.8. Admission systolic blood pressure averaged 66.9 mm Hg. A mean of 5692 mL of packed red blood cells, 5515 mL of blood products, and 12,052 mL of crystalloid solution per patient was infused within 24 hours of admission mostly via the RSAS. Mortality was 45% at 24 hours following arrival and 61% overall. The mortality was 93.8% (15/16) in patients with a TS of 5 or less and 29.4% (5/17) in patients with a TS over 5. The initial postinfusion patient temperatures averaged 35.2 degrees C. All abnormal preinfusion coagulation values normalized within 24 hours in the survivors, and no significant complications occurred with the use of the RSAS. The RSAS seems to provide an uncomplicated means of normothermic volume replacement. The 24-hour survival in potentially salvageable patients may be improved. Its use in patients with lethal injuries (TS less than or equal to 3) requires further evaluation.

Adolescent↗
PubMed1987

Reconstruction of the external carotid artery.

The external carotid artery (ECA) is an underestimated but important collateral to the cerebral hemisphere and eye in patients with severe disease of the internal carotid artery. Fifteen symptomatic patients with total occlusion of the internal carotid artery underwent ECA reconstruction. Ipsilateral ECA reconstruction was performed upon all patients with no mortality or neurologic deficits. Contralateral disease of the carotid artery was noted in 11 and required correction in seven patients. Follow-up study of the patients ranged from one to 68 months (a mean of 26.8 months) after operation. Vertebrobasilar symptoms persisted in two patients, both with contralateral disease. One of these patients successfully underwent extracranial-intracranial bypass. One ipsilateral and one contralateral stroke occurred during follow-up study, both in patients with contralateral disease. Eleven patients were alive and asymptomatic at last follow-up examination. Symptomatic selected patients with occlusion of the internal carotid artery and ECA stenosis or cul-de-sac formation should be considered for operation. ECA reconstruction is associated with little morbidity and three-fourths of the patients remain asymptomatic. A high incidence of contralateral disease of the carotid artery is present. Extracranial-intracranial bypass should only be considered when symptoms persist after correction of contralateral disease of the carotid artery and any ECA lesions.

Aged↗
PubMed1986

The role of echocardiography in patients with acute peripheral arterial embolization.

Forty-seven patients with acute arterial embolism requiring urgent embolectomy had postoperative echocardiography (36 2-D, 11 M-mode) in an attempt to identify a cardiac source of emboli. On the basis of history, physical examination, electrocardiogram, and chest roentgenogram, 37 patients were believed to have an apparent cardiac source. All histories and physical examinations in this group reaffirmed significant underlying cardiac disease. Nine of the 47 patients had no discernible source based on clinical data, and one had an arterioarterial embolus. In the presence of a clinically obvious source, although echocardiography (26 2-D, 11 M-mode) helped to clearly define evident cardiac disease in these patients, it failed to demonstrate a cardiac embolic source in those without clinical evidence of cardiac disease or to influence subsequent management. The continued use of echocardiography for the sole purpose of identifying a potential cardiac embolic source should be reconsidered.

Adult↗
PubMed1986

Normothermic rapid volume replacement for hypovolemic shock: an in vivo and in vitro study utilizing a new technique.

Hypovolemic shock secondary to intraoperative or traumatic hemorrhage requires urgent, aggressive resuscitation to achieve a successful outcome. Common difficulties encountered include the need for venous access, restoration of blood volume, and most important, maintenance of normothermia. The rapid solution administration set utilized in this study addresses the above limitations. Venous access is quickly accomplished by the percutaneous insertion of a large-bore catheter into the central venous system. The set requires only one central venous entry site for adequate fluid resuscitation. Expeditious restoration of blood volume is accomplished by gravity-induced infusion of crystalloids, colloids, and blood products at flow rates of up to 1,600 ml/minute. High flow rates are obtained by utilizing low-resistance filters and large-bore perfusion tubing. Avoidance of transfusion-induced hypothermia is addressed by incorporation of an extracorporeal heat exchanger into the administration set. The infusate temperature is maintained at 37 degrees C regardless of the administration rate or the initial fluid temperature. In vitro and canine in vivo testing demonstrated no significant hemolysis of the transfused blood and allowed maintenance of normothermia.

Animals↗
PubMed1986

Predictors of success in bypass grafts to the isolated popliteal segment.

Of 130 infrainguinal bypasses, 25 grafts to an isolated popliteal segment (IPS) were examined for clinical, anatomic and hemodynamic predictors of success. Fourteen autogenous veins (AV) and 11 polytetrafluoroethylene (PTFE) grafts were performed, all for limb salvage. A discontinuous tibial vessel was present in 72 per cent but only 24 per cent were graftable. A mean of 1.7 named collaterals were seen in IPS. Mean preoperative ankle pressure (APR) was 26.29 and ankle to brachial index (ABI) was 0.17. Segmental pressure gradient indices were also measured. Mean follow-up time was 13.6 months (a range of two to 43 months). One hundred per cent immediate graft patency and patient survival rates were obtained. Postoperative APR improved to 86.3 millimeters of mercury and ABI to 0.63 (p less than 0.05). Crude late patency rate was 72 per cent and limb salvage rate was 76 per cent. Cumulative life table patency rate was 58.8 per cent and limb salvage was 68 per cent at 36 months. Patency rate for AV (84.1 per cent) was better than PTFE (41.7 per cent). In 39 concurrent tibial grafts, cumulative patency rate at 36 months was 68 per cent for simple bypass grafts. Success could not be predicted by the length of the IPS, number of collaterals, profunda disease, number of discontinuous or graftable tibial vessels, APR or ABI and profunda popliteal collateral index. The tibial gradient index reflecting poor runoff was significantly greater in failed grafts (p less than 0.05). Bypass grafts to the IPS are a safe and reliable alternative to tibial bypass grafts. The AV performed better than PTFE grafts. The tibial gradient index appears to be a promising indicator for predicting graft success.

Aged↗
PubMed1985

Prediction of heparin requirements in acute thromboplastic venous disease.

It has been suggested that early heparin requirements are greater in patients with acute deep venous thrombosis (DVT) and pulmonary embolism (PE). Heparin requirements were recorded for 73 patients with suspected DVT and PE. The maintenance dosage (days 1 through 4) of heparin sodium required to achieve therapeutic partial thromboplastin times (PTTs) was significantly higher in patients with DVT (n = 54; mean +/- SD dosage, 1,151 +/- 246 units/hr) compared with patients with no DVT (n = 19; mean +/- SD dosage, 952 +/- 190 units/hr). The first posttreatment PTT was significantly lower in patients with DVT (mean +/- SD PTT, 68.74 +/- 27.96 s) compared with control patients (mean +/- SD PTT, 89.41 +/- 23.25 s). This study supports the clinical impression that initial heparin requirements are greater and heparin clearance is more rapid in patients with acute DVT and PE.

Acute Disease↗
PubMed1985

Surgical and nonsurgical treatment of total carotid artery occlusion.

The natural history of totally occluded internal and common carotid arteries was studied in 102 patients (109 arteries) with a 97 percent follow-up (mean 39.7 months.) Symptomatic occlusions occurred in 72.6 percent of the patients, the reconstructed group (46 patients) having a greater number of symptomatic vessels than the nonreconstructed group (63 patients) (p less than 0.05). Contralateral disease was encountered in 46 percent. Initial mortality was 5 percent. Twenty patients (19.6 percent) were dead at the time of follow-up. Half of these deaths were from strokes and three fourths from atherosclerotic causes. Persisting neurologic symptoms were present in 14 percent of the patients and new events occurred in 5 percent. Fifteen percent of initially asymptomatic vessels were symptomatic at last follow-up. Twenty-one percent of the symptomatic occluded vessels were symptomatic on follow-up, 16 percent being in the reconstructed group and 26 percent in the nonreconstructed group.

Arterial Occlusive Diseases↗
PubMed1985

A prospective randomized trial of aspirin in femoral popliteal and tibial bypass grafts.

A prospective, randomized clinical trial to study the effect of aspirin on late patency of femoral popliteal and tibial bypass grafts is reported. One hundred limbs in 93 patients were randomized to receive daily 650 mgs aspirin postoperatively (ASA, n = 45) or no aspirin (NASA, n = 55). Indication for surgery was limb salvage in 88% and poor runoff (0-1 vessel) was present in 68%. Graft material consisted of autogenous vein (AV) in 63, expanded PTFE in 82 and composite grafts in five limbs. Distal anastomosis was to the popliteal artery in 72 limbs, tibial vessels in 19 and sequential in nine limbs. Patient followup ranged from 1-51 months (mean 12.97). Sixteen (16%) grafts occluded late, eight each in the ASA and NASA groups, (p greater than .05). No significant differences in graft patency existed between ASA and NASA groups in limbs with AV (88.5% vs 92.9%) or PTFE grafts (74% vs 62%) (p greater than .05). A total of 21 (19%) anastomoses occluded. No differences were noted between ASA and NASA limbs, although patency in AV was greater than PTFE (p less than .05). Cumulative patency rates were 84.4% at 12 months, 81.5% at 24 months, 67.3% at 36 months and 52.4% at 48 months (ASA vs NASA, p greater than .05). Therefore, daily administration of 650 mgs of aspirin did not appear to influence late graft patency of femoral popliteal and tibial AV or PTFE bypass grafts at a mean followup period of 12.97 months.

Adult↗
PubMed1985

A critical appraisal of impedance plethysmography in the diagnosis of acute deep venous thrombosis.

Compulsive performance of the test is paramount to obtaining good results. Sequential multiple tests with prolongation of the filling time to maximize venous filling and ultimately reaching a plateau is essential. Increase in venous filling by increasing the cuff pressure in the proximal lower thigh occluding cuff to 60 instead of 45 centimeters of water is helpful in obtaining optimum venous filling. Unrecognized patient apprehension or muscle contraction may be a reason for false-positive IPGs. Patient relaxation, local heat application or even electromyography attachment may be helpful. The IPG can be repeated after a few hours if a false-positive test result is suspected. If a test falls above the stop line, the NPV is so high that no repetition of the test is necessary and the limb is read out as showing no proximal venous thrombosis. If a test is normal or borderline, the test may be repeated with sequential testing until the test points seem to group together or a clear divergence of either normal or abnormal is achieved. If the contralateral limb is clearly normal and an abnormal test result is obtained in the suspected limb, the test is likely to be reliable. Bilateral abnormal IPGs, especially in the presence of congestive heart failure or severe edema, may indicate a false-positive test finding. Increased edema in the extremity decreases electrical resistivity and balancing the machine may become a technical problem.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1985

Prognostic indicators in femoropopliteal and distal bypass grafts.

Over a period of six years, 265 femoropopliteal and infrapopliteal bypasses were performed in 243 patients with infrainguinal arterial occlusive disease. The cumulative patency rate for all grafts was 70.9 per cent at one year, 59.3 per cent at three years and 48.5 per cent at five years. Femoropopliteal bypasses showed a significantly better patency rate than femoral infrapopliteal grafts and autogenous vein grafts had a significantly higher patency rate than human umbilical vein grafts. No demonstrable difference in patency rates was shown in patients with and without diabetes. Synchronous proximal and distal revascularization for limb salvage in properly selected patients with multisegmental disease achieved a cumulative patency rate of 100 per cent at two years with no operative deaths. Therefore, this procedure is recommended, but individualization of treatment rather than routine synchronous repair is urged.

Actuarial Analysis↗
PubMed1984

Thoracic outlet syndrome.

The diagnosis of thoracic outlet syndrome rests on clinical findings. A study of 21 patients with the syndrome is reported. Six of the patients underwent surgery and the remainder were treated conservatively. Surgery completely eliminated the symptoms in five patients; one patient had minor symptoms after surgery. In the patients managed conservatively, half had partial relief of symptoms and the other half did not respond to therapy. Physical therapy is initially recommended in most patients.

Adult↗
PubMed1982

Prospective randomized study of concomitant lumbar sympathectomy with aortoiliac reconstruction.

Ninety-three consecutive patients for aortofemoral bypass grafting were studied to determine the effect of sympathectomy on early and late patency, the need for subsequent distal procedures, amputation rate, and ankle-brachial Doppler systolic pressure indexes. Sixty-seven patients completed the study. Fifty-three limbs were randomized to receive sympathectomy and 81 no sympathectomy. The mean length of follow-up postoperatively was 11 +/- 2.53 months (maximum 24). Five grafts occluded, two early and three late. Both early occlusions occurred in the nonsympathectomy group and all three late occlusions ensued in the sympathectomy group. Subsequent distal procedures were necessary early (within 30 days) in five limbs, all in the nonsympathectomy group. Nine limbs required distal procedures late, four (5 percent) in the nonsympathectomy group and five (9.5 percent) in the sympathectomy group (p greater than 0.05). Altogether, distal bypass was required in 11 percent of the patients in the nonsympathectomy group versus 9.4 percent in the sympathectomy group (p greater than 0.05). Five limbs were amputated 4 to 14 months after aortofemoral bypass, four (5 percent) in the nonsympathectomy and one (2 percent) in the sympathectomy group (p greater than 0.05). The ankle-brachial pressure index increased significantly after aortofemoral bypass in both groups (p less than 0.05). The mean increase after aortofemoral bypass was more marked in the sympathectomy group (p greater than 0.05). Thus, at a mean follow-up time of 11 months after aortofemoral bypass, there was no significant difference in graft patency, need for subsequent distal bypass, or amputation rate between the sympathectomy and nonsympathectomy groups.

Adult↗