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Biomedical subjects

B Satiani

Publications and source records attributed to B Satiani.

72 records · Page 4Linked to original sources
PubMed1979

Hypertension following carotid endarterectomy.

Seventy-nine patients undergoing staged bilateral carotid endarterectomy were studied to determine the relationship of perioperative hypertension to postoperative neurologic deficits. Six of the eight neurologic deficits following 158 endarterectomies (5%) occurred after the first operation, all being temporary. Comparison of the mean blood pressures in patients with and without postoperative strokes revealed no statistically significant differences. Patients on antihypertensive medications were at a significantly higher risk of developing postoperative strokes. A trend towards higher blood pressure was noted following the second endarterectomy, particularly when they were staged more than 60 days apart. Based on our findings, a cautious approach is warranted in the treatment of postendarterectomy hypertension.

Adult↗
PubMed1979

Deep vein thrombosis following aortic surgery: prospective evaluation of I125 fibrinogen and impedance plethysmography.

A prospective comparison of I125 Fibrinogen uptake testing (FUT) and Impedance Plethysmography (IPG) was made in 22 patients (44 limbs) following aortic reconstructive surgery to determine the incidence of postoperative deep venous thrombosis (DVT). Normal FUT was obtained in 34 limbs, whereas ten limbs had abnormal uptake over the calf area consistent with venous thrombosis. Nine of the ten limbs with a positive scan underwent phlebography. All venograms and IPG readings obtained were normal. No evidence of DVT following aortic surgery was noted in this study. A high incidence of false positive FUT was evident. IPG is noninvasive, reliable and relatively inexpensive and is therefore recommended if prospective evaluation for DVT in patients undergoing aortic surgery is desired.

Adult↗
PubMed1978

Factors influencing intraoperative gastric regurgitation: a prospective random study of nasogastric tube drainage.

A prospective study was conducted to determine the incidence of "silent" gastric regurgitation and aspiration during general anesthesia in 146 patients randomized with respect to presence of a nasogastric tube. A bland dye was instilled in the stomach to serve as the determinant marker. The overall incidence of regugitation was 8.9% and of aspiration, 2.1% in spite of the uniform use of an endotracheal tube. The incidence of regurgitation was twice as high when anesthesia was given by an inexperienced anesthetist (11% vs 5.6%) and in patients without nasogastric tubes (12% vs 6%), although such differences were not statistically significant. The primary agent used, difficulty of endotracheal intubation, location of surgical incision, and duration of anesthesia did not alter the incidence of regurgitation or aspiration. No correlation was found between the detection of subclinical aspiration and the development of postoperative pulmonary complications.

Adolescent↗
PubMed1978

Hepatic abscesses: improvement in mortality with early diagnosis and treatment.

This study demonstrates that hepatic abscesses are highly lethal when untreated. There was an overall mortality of 29 per cent; however, if autopsy cases are excluded the mortality was only 13 per cent. Positive blood cultures (especially if multiple or anaerobic organisms), significant anemia, elevated bilirubin levels, multiple abscesses, and being Caucasian were identified as factors associated with increased mortality. Early diagnosis coupled with aggressive surgical and antibiotic therapy is needed.

Adolescent↗
PubMed1978

An assessment of carotid phonoangiography and oculoplethysmography in the detection of carotid artery stenosis.

Carotid phonoangiography (CPA) and oculophlethysmography (OPG) examinations for the detection of extracranial carotid occlusive disease were performed in 308 patients, 103 of whom underwent arch angiography. When correlated with angiographic findings, the overall accuracy of CPA/OPG was 86 per cent. There were 4 per cent false-positive 9.6 per cent false-negative results, and these were further analyzed. Significant carotid bruits demonstrated by CPA strongly suggested the presence of appreciable carotid stenosis. Noninvasive CPA/OPG is an excellent diagnostic tool in patients with non-hemispheric symptoms, in those with asymptomatic bruits, as a screening procedure in potential stroke victims, and for follow-up after cartotid endarterectomy. Caution is advised in relying on this and other noninvasive technics as the sole method for recommending angiography and operative treatment in symptomatic patients.

Adult↗
PubMed1978

Improved limb salvage after arterial embolectomy.

Between January 1965 and August 1977, 122 patients with 135 arterial emboli were treated on the Peripheral Vascular Service at the Ohio State University Hospital. The heart was the source of the embolus in 94 patients (77%), one-third of whom had experienced a myocardial infarct. Thirteen patients died after the operation, which in 102 patients (84%) consisted of embolectomy only, making the hospital mortality 10.6%. Fourteen patients (11.5%) required subsequent amputations during the same hospitalization or on a later admission. The corrected limb salvage rate of 80.9% was unrelated to the length of delay in presentation. Although only 70 patients (57.4%) had palpable distal pulses following operation, 89 (73%) had a functional limb at the time of discharge or on later follow-up. An aggressive approach to the patient with an arterial embolus, regardless of the duration of symptoms, is urged. Embolectomy under local anesthesia is advocated in all cases after prompt correction of fluid and electrolyte imbalance and stabilization of the underlying cardiac disorder, except in patients with frank gangrene and irreversible rigor. In the absence of distal pulses or obvious revascularization, an intraoperative arteriogram is mandatory.

Adult↗
PubMed1978

Role of staging in bilateral carotid endarterectomy.

Staging of bilateral carotid endarterectomies 1 to 6 weeks apart has been recommended because of presumed excessive morbidity chiefly related to respiratory problems, hypertension, and neurological deficits. Since data regarding the timing of the second procedure are lacking, an analysis of 79 consecutive patients undergoing bilateral endarterectomies staged from 6 days to 34 months apart (median interval, 52 days) was performed. In addition to postoperative neurological deficits, however, transient perioperative mean systolic and diastolic blood pressures (SBP and DBP) were compared after each side and were correlated with the time interval between the two procedures. No significant difference existed between the two sides in terms of preoperative hypertension, administration of steroids prior to clamping, intraoperative clamp time, the use of shunts, and the duration of operation (P greater than 0.05). Seven temporary neurological deficits occurred after operation, six after the first and one after the second endarterectomy. One permanent deficit following operation on the second side led to the only death (0.6%) in this series. Both neurological deficits (one temporary and one permanent) following the second endarterectomy occurred after procedures staged more than 60 days apart. No differences in mean SBP and DBP existed between patients with and without neurological deficits. Statistical analysis of SBP and DBP recordings during and 6, 12, 24, and 36 hours after operation when the two were staged 7 days (nine patients), 8 to 14 days (five patients), 15 to 30 days (10 patients), 30 to 60 days (17 patients), and more than 60 days (38 patients) apart revealed significantly higher readings after the second procedure, only in patients staged greater than 60 days (P less than 0.05). Therefore, in our experience, neurological deficits were less common after the second endarterectomy, and, although postoperative blood pressures were higher after the second side, these were significant only in patients staged more than 60 days apart. We find no evidence to suggest that increasing the waiting period between bilateral procedures will lower the incidence of undesirable neurological sequelae.

Arterial Occlusive Diseases↗
PubMed1978

Preoperative aortography before abdominal aortic aneurysmectomy?

A review of 100 consecutive patients undergoing abdominal aortic aneurysmectomy was made to assess the value and necessity of preoperative aortography. Comparison of arteriography with physical examination, plain roentgenograms and ultrasonography suggests that angiography is required only for evaluation of specific problems. Indications for the selective use of preoperative aortography are proposed.

Aneurysm↗
PubMed1977

Paget disease of the male breast.

Twenty-two fully documented cases of Paget disease of the male breast are reviewed, and an additional patient is reported. The most common initial symptom was ulceration and excoriation, while a breast mass was palpable in the majority of patients. Nipple changes were surprisingly rare, in contrast to the female. The prognosis of the disease in the male appears to be worse than in the female, with the Paget carcinoma carrying a worse prognosis than the "ordinary" male breast cancer. The subareolar location and the meager volume of tissue interposed between the tumor and chest wall may be an important factor in this regard. Nipple changes or symptoms (ulceration, discharge, enlargement) are mroe apt to be due to cancer in the male than in the female. Therefore, prompt diagnosis is mandatory.

Adult↗
PubMedDate not supplied

Correlation of metabolic acidosis with outcome following injury and its value as a scoring tool.

This study looked at preresuscitation arterial pH as a predictor of outcome in injury. Seriously injured patients admitted to the Trauma Service over a 5-month period were evaluated prospectively. Data collected included basic patient demographics, initial arterial blood gas determinations (ABGs) including pH, bicarbonate (HCO3), base deficit or excess (BASE), admitting trauma score (TS), discharge injury severity score (ISS), total blood products used for initial resuscitation (TBP), and outcome. There were 191 patients averaging 34.7 years old with average TS 13.6, ISS 19.5, initial pH 7.38 +/- 0.09, HCO3 20.9 +/- 4.0, and BASE -3.3 +/- 4.7. The average TBP was 1309 cc, and overall mortality was 13/191 (6.8%). Comparing survivors to nonsurvivors, the ISS (18.2 vs. 38.3), TS (14.1 vs. 7.8), TBP (976 vs. 5881 cc), HCO3 (21.1 vs. 17.6), and BASE (-3.1 vs. -5.8) data were significantly different; pH (7.38 vs. 7.36) and age (34.4 vs. 38.5) were not. Using multiple regression with TBP as the dependent variable, BASE, age, TS, and to a lesser extent pH and HCO3 correlated (r = 0.536; p < 0.001); using outcome as the dependent variable, only TS and age correlated (r = 0.465; p < 0.0001). Although metabolic acidosis (pH, HCO3, BASE) predicts the TBP used, it does not improve on TS and age for predicting outcome.

Acidosis↗
PubMedDate not supplied

Evaluation of the color coded Doppler ultrasound in detecting carotid bifurcation disease.

The color coded continuous wave doppler ultrasound was compared with angiography in 201 arteries, 83 with greater than 50% diameter stenosis and 118 with less than 50% stenosis. Overall accuracy in identifying hemodynamically significant (greater than 50% diameter stenosis) was 87% in the presence of peak velocities greater than 5000 Hz and a blue color coded image. Negative predictive value was 94.5%. False positives were mainly due to the presence of severe external carotid stenosis and increased flow due to contralateral carotid occlusion. Within the limitations of the test being an indirect method, it is a reliable screening method for detecting hemodynamically significant carotid artery disease.

Arterial Occlusive Diseases↗
PubMedDate not supplied

Consumption coagulopathy associated with arterial aneurysms.

Consumption coagulopathy resulting from arterial aneurysm is an uncommon entity. Two patients, one with a femoral artery aneurysm and one with an abdominal aortic aneurysm containing fresh blood clot associated with a coagulopathy are presented. Reasonable preoperative control of the bleeding disorder with appropriate blood products followed by aneurysmectomy is recommended. Except to treat severe bleeding disorders associated with arterial aneurysms, heparin therapy is rarely necessary, as spontaneous reversal of the coagulopathy usually occurs. A high index of suspicion for the presence of an underlying arterial aneurysm as the cause for the consumption coagulopathy is necessary when no other etiology is obvious.

Aged↗