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Biomedical subjects

B Satiani

Publications and source records attributed to B Satiani.

At least 55 records · Page 3Linked to original sources
PubMed1982

Hand ischemia.

Hand ischemia is an uncommon, but potentially catastrophic, clinical entity. The large number of etiologic factors and lack of universal agreement regarding treatment have created a confusing clinical situation. Diagnosis is most frequently made by a detailed history and physical examination. Both invasive and noninvasive tests are employed for diagnosis and in planning treatment. Growing experience and improved surgical techniques have enabled vascular surgeons to deal more effectively with the ischemic hand.

Arteriosclerosis↗
PubMed1981

Aortofemoral bypass for severe limb ischemia. Long-term survival and limb salvage.

Long-term survival, graft patency and limb salvage in 74 patients with 96 severely ischemic limbs after aortofemoral bypass grafting is presented. Results in 73 limbs reconstructed for rest pain and 23 limbs reconstructed for ulceration or gangrene were compared by life table analysis, with follow-up of up to 98 months. The operative mortality was 4 percent. Overall 5 and 8 year survival was 74.8 and 52.3 percent, respectively. Overall graft patency at 5 years was 80.8 percent (rest pain 74.4 percent versus ulceration or gangrene 100 percent). Overall limb salvage was 76.7 percent at 5 years (rest pain 83 percent versus ulceration or gangrene 55 percent) (p < 0.001) and 68 percent at 8 years. Distal reconstructions were necessary in 19 limbs (21 percent); limbs with ulceration or gangrene required further attempts at salvage more often (34 percent versus 16 percent for rest pain) (p < 0.01). Aortofemoral bypass for impending limb loss yields satisfactory long-term results, and the extent of tissue loss preoperatively is an important prognostic factor. Prognosis for survival and limb salvage is worse and the need for additional distal reconstruction greater in patients with ischemic ulcer or gangrene.

Adult↗
PubMed1981

Experiences in the management of pancreatic trauma.

A 30-year experience in the management of 283 consecutive patients with acute pancreatic trauma was reviewed. Of these injuries 224 were penetrating; 59 were from blunt trauma. Diagnosis was made by laparotomy in all patients, although elevated serum amylase suggested this injury in 23 (56%) of 41 patients with nonpenetrating injuries. Operative measures were initially involved with correction of associated injury when present (961 organ injuries in 278 patients: 3.5 injuries per patient). During the earlier years, Penrose drains were placed to the site of injury. Significant pancreatic complications (fistula in 13, suppurative pancreatitis or abscess in six, pseudocyst in three) were noted in 19 (46%) of the 41 patients so managed. Routine sump drainage dramatically reduced the incidence of pancreatic complications to 2% in the 198 patients having external drainage alone. Distal resection was performed in 29 patients, without later pancreatic insufficiency. Most disappointing were the results from Roux-en-Y internal drainage: fistula developed in five and lethal bacterial pancreatitis in three of the seven patients so treated. Five patients died from exsanguination during exploration for major vascular trauma, and all three patients undergoing pancreaticoduodenectomy succumbed within 20 hours after operation. The overall mortality was 13.8%, with only seven deaths out of the last 100 patients treated. Profound hemorrhagic shock and its complications (19), suppurative pancreatitis (eight), and post-traumatic respiratory insufficiency (three) accounted for 30 of the 39 fatalities.

Acute Disease↗
PubMed1981

Abdominal aortic aneurysms.

Abdominal aortic aneurysms are usually atherosclerotic in origin and infrarenal in location. They most commonly occur in patients over 50 and often are entirely asymptomatic. Although not essential for diagnosis, arteriography is necessary for proper planning of the operative procedure. Ultrasound and computerized axial tomography provide equal or superior diagnostic accuracy. The mortality rate from rupture of even small aneurysms is greater than the elective operative mortality. In the absence of absolute contraindications, aneurysms larger than 4.5 cm. should be surgically treated.

Age Factors↗
PubMed1981

False aneurysms following arterial reconstruction.

False aneurysms are increasingly being seen after the widespread utilization of arterial reconstructive surgical procedures involving implantation of prosthetic materials. The most common site of occurrence is the femoral location. The average interval between the primary procedure and the diagnosis of a false aneurysm in 42 months. THe exact cause remains uncertain, although multiple factors are most likely involved. these include degeneration of the host arterial wall, local endarterectomy, type of anastomosis, suture and graft material, various mechanical factors, hypertension and infection. Although small asymptomatic false aneurysms in easily accessible locations can be watched, a variety of complications, such as graft occlusion, rapid enlargement and rupture, venous and neural compression and distal embolization can occur. Early elective resection and repair are recommended in most patients.

Aneurysm↗
PubMed1981

Motor speech malfunction following carotid endarterectomy.

Cranial nerve injury during carotid endarterectomy is a well-recognized complication of this procedure. The evaluation of the extent of the injury and the persistence of the malfunction is difficult to accomplish with conventional methods. A protocol designed to evaluate motor speech function was administered to 36 patients prior to carotid endarterectomy, 2 days after surgery, and 6 weeks postoperatively. The protocol included assessments of hypoglossal nerve function, superior-recurrent laryngeal function, glossopharyngeal nerve function, and integrated motor speech ability. Direct laryngoscopy also was performed at the same time intervals. The total number of operations was 40. Hypoglossal nerve palsy was present in eight (20%) and superior-recurrent laryngeal nerve palsy was found in 11 (27.5%). Seven (17.5%) had malfunction of the vocal cords by the second postoperative day. Only seven (17.5%) of the above cases were detected by the spontaneous speech sample. The malfunction persisted by the sixth postoperative week in one patient (2.5%) with hypoglossal palsy and in two (5%) with superior-recurrent laryngeal palsy (one of them with ipsilateral vocal cord paralysis). We think that motor speech-related difficulties are far more common following carotid endarterectomy than is generally believed, and although these difficulties are, by far, temporary in course, they deserve attention, especially in cases of planned bilateral carotid endarterectomy.

Carotid Arteries↗
PubMed1980

Kinking of a Warren shunt as a cause of recurrent variceal hemorrhage.

Upper gastrointestinal hemorrhage after portal decompression requires appropriate endoscopic and radiologic evaluation for unrelated causes. Splenoportography may be more definitive than selective visceral angiography and in the present case showed a patent but kinked venovenous anastomosis with a high splenic pulp pressure. A mesocaval interposition shunt controlled the hemorrhage. Various technical factors responsible for anastomotic narrowing and kinking of the Warren shunt are briefly mentioned.

Blood Vessel Prosthesis↗
PubMed1980

Anastomotic arterial aneurysms. A continuing challenge.

Aneurysms occurring at the site of arterial reconstruction continue to pose a challenge to surgical ingenuity. Our experience with the surgical treatment of 29 nontraumatic anastomotic aneurysms (AA) in 24 patients is analyzed. Twenty-two aneurysms presented in the femoral region. Dacron((R)) grafts and braided Dacron sutures had been used in 70 and 86% of AA, respectively. Immediate or late reoperation had been necessary 14 times in eight patients. Average time elapsed between the initial procedure and AA repair was 65 months. Indications for repair were expansion/rupture (nine patients), graft occlusions (12 patients), aortoenteric fistula (two patients) and presence of AA (six patients). The predominant operative finding was suture line dehisence due to an attenuated arterial wall (13 patients), problems with suture material (three patients), infection (two patients), and indeterminate (13 patients). The majority of the aneurysms (20) were partially excised and arterial limbs revascularized with interposition Dacron grafts, usually to the profunda femoris artery. Two of three postoperative deaths ensued in patients with aortoenteric fistulas. Omission of silk suture material has not eliminated AA and indeed, braided synthetic suture material had been used in most of the original procedures. A significant number of AA sites had had multiple reoperations. Operative findings suggested structural degeneration of the native artery as an important etiologic factor. Important technical principles in uninfected AA include: early control of inflow and outflow vessels, avoidance of dissection of the entire AA, and interposition of a new Dacron graft to the outflow vessel. No immediate limb loss and no recurrences occurred with this approach, with a maximum follow-up period of 72 months. Early elective repair of most AA is emphasized to avoid graft occlusion and potential technical mishaps associated with repair of large aneurysms.

Aged↗
PubMed1980

Immediate prognosis and five year survival after arterial embolectomy following myocardial infarction.

One hundred and twenty-two patients with 135 arterial emboli, 31 of whom had had a recent myocardial infarction, were seen during a 12 year period. Six patients died after embolectomy, resulting in a 19 per cent in-hospital mortality, and in five patients, amputation was required. The median time from infarction to embolization was 14 days. Length of follow-up period after operation ranged from four to 73 months, with a mean of 36 months. Life table analysis of patients alive 30 days after operation revealed a cumulative five year survival rate of only 26 per cent, recurrent myocardial infarction being responsible for 60 per cent of the deaths. This is in contrast with an approximate 60 to 70 per cent five year survival rate reported in the literature for patients having an infarction only. Although the immediate mortality was greater than that for patients with arterial emboli without infarction, an aggressive approach directed toward limb salvage is urged in these patients, as manifested by the 84 per cent salvage rate in this series.

Actuarial Analysis↗
PubMed1980

A technique for distal tibial arterial anastomosis.

A modification of the usual technique for performing a tibial artery-to-graft anastomosis ensures proper retrograde runoff and minimizes leaks in this area which are hard to control without compromising the graft and lumen of the host artery.

Arteries↗
PubMed1980

Amputation level following unsuccessful distal limb salvage operations.

Distal arterial grafting for limb salvage remains controversial. Among the criticisms is the potential adverse effect of failed distal bypass on subsequent amputation level. Measurement of popliteal pressure with Doppler ultrasound is useful in predicting healing at the below-knee (BK) level and, pressure of greater than or equal to 60 mm Hg was associated with 87% BK healing in 51 limbs undergoing amputation without prior distal bypass. This study examined the outcome in 40 limbs amputated after unsuccessful distal revascularization and compared the final amputation level with that predicted by popliteal pressure measurements obtained prior to bypass. Forty limbs underwent amputation after unsuccessful limb salvage following attempted femoropopliteal grafts (13), femorotibial grafts (10), a combination of both procedures (10) or tibial artery exploration alone (7). Of 33 limbs with initial pressure of greater than or equal to 60 mm Hg, eventual healing at the BK level was achieved in only 17 (52%). Four of seven limbs with initial pressures of less than 60 mm Hg healed at the BK level, and increased popliteal pressure prior to amputation was shown in three of these. Of the total 40 limbs, only 21 (53%) obtained final healing at the BK level. These results indicate that unsuccessful limb salvage attempts adversely affected ultimate amputation level in limbs initially considered to be candidates for BK amputation.

Adult↗
PubMed1980

Prediction of distal reconstruction following aortofemoral bypass for limb salvage.

The predictive value of noninvasive Doppler arterial evaluation was assessed in 42 limbs before and after aortofemoral bypass for severe limb ischemia. The preoperative ankle-brachial systolic index was not of predictive value for the need of further distal reconstructin. A postoperative increase of ankle index by 0.1, or more, indicatd that, probably, no additional distal reconstruction would be necessary. Two-thirds of the limbs in which the ankle index did not improve by 0.1 required further distal bypass. Perioperative noninvasive arterial evaluation is helpful in supplementing clinical assessment and angiograpic data in the decision-making for, or against, distal bypass following aortofemoral bypass for limb salvage.

Arterial Occlusive Diseases↗
PubMed1979

Predictability of present outcome and future recurrence in acute pancreatitis.

Although acute pancreatitis is relatively common, factors useful in predicting immediate outcome or likelihood of recurrence have seldom been studied in greater detail. A ten-year experience with 389 patients hospitalized for 821 separate episodes of acute pancreatitis was reviewed. The overall mortality was 6.7%, being highest on the first admission and considerably greater for white males. Respiratory complications accounting for 27% of the fatalities were the most common causes of death. The incidence of considerable morbidity was 19.5%. Clinical diagnoses of "shock" and "respiratory distress" were associated with mortalities of 88% and 71%, respectively. The overall recurrence rate was 50.1%, with little variation regardless as to the number of previous bouts. Recurrence was more likely if the patient was black, male, older than 30 years of age, and had experienced a second episode of acute pancreatitis. Admission data aid considerably in identifying high-risk patients in whom major complications develop, who die during the present episode, or who have a future recurrent bout of acute pancreatitis.

Acute Disease↗
PubMed1979

Detection of deep venous thrombosis by impedance plethysmography.

Ninety-eight limbs in sixty-seven patients supected of having lower extremity deep venous thrombosis were evaluated by physical examination, venous impedance plethysmography (IPG), and venography. Diagnosis based on physical signs commonly associated with deep venous thrombosis was false-positive in 43 to 66 per cent and false-negative in 26 to 73 per cent when compared with evidence obtained by venography. The overall accuracy of IPG was 94 per cent, with false-positive results occurring in 10 per cent and false-negative results in 4 per cent. IPG is sufficiently accurate to be considered a reliable screening test for lower extremity deep venous thrombosis.

Adolescent↗