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Biomedical subjects

F M Ameli

Publications and source records attributed to F M Ameli.

At least 55 records · Page 3Linked to original sources
PubMed1986

Current concepts in the management of varicose veins.

Varicose veins are a very common problem, affecting women more than men. The major concern is usually the unsightly appearance of the veins. Various options to deal with this problem are discussed-- compression stockings, compression sclerotherapy and surgery. For good results and patient satisfaction, the cause and natural history of varicose veins must be understood. Depending on the type of varicose vein, different modalities of treatment are required and may need to be combined. "Cosmetic" varicosities can usually be managed conservatively with compression stockings. Sclerotherapy is best used for dilated superficial or residual varicose veins, recurrent varicosities or leg perforators. Operation should be reserved for very large varicose veins or an incompetent long or short saphenous vein. A sound understanding of the problems and discussion of anticipated results with the patient will prevent unrealistic expectations.

Adult↗
PubMed1984

The use of transcutaneous oxygen tension measurements in the diagnosis of peripheral vascular insufficiency.

Transcutaneous tissue oxygen tension (PtcO2) was evaluated as a noninvasive diagnostic test for peripheral arterial insufficiency; PtcO2 was measured at rest, during exercise, and following exercise at three leg sites in 36 controls and 138 patients with exercise-induced leg pain. Resting foot PtcO2 differed significantly in controls and in patients with rest pain (32/138) and was 60.1 +/- 6.82 mmHg and 3.66 +/- 3.68 mmHg, respectively (p less than 0.001). Abnormal resting PtcO2 values occurred in 80% of claudicants (85/138) and 20% had normal values. However, all vascular claudicants exhibited a decline in PtcO2 following exercise, a finding that distinguished them from controls (p less than 0.001). The PtcO2 values in 21 patients who were subsequently shown not to have vascular disease did not differ significantly from controls (p greater than 0.5). Comparison with angiograms (48) showed that PtcO2 following exercise had a 100% sensitivity and specificity in detecting the presence of arterial disease. If resting values alone are considered, sensitivity falls to 77%. This study demonstrates that measurement of PtcO2 at rest and particularly after exercise is a simple and sensitive noninvasive diagnostic test for peripheral arterial insufficiency. This test will serve to distinguish between vascular and other causes of exercise-induced leg pain.

Adult↗
PubMed1984

Intraoperative single-dose heparin prophylaxis against deep-vein thrombosis.

This randomized prospective study examines the efficacy of intravenously administered heparin as prophylaxis against deep-vein thrombosis, detected isotopically with iodine 125, in 37 patients scheduled to undergo major abdominal procedures. Twenty patients were given 5000 units of sodium heparin on opening the abdominal cavity, while 17 patients who did not receive heparin acted as controls. The effect of heparin was reversed at the end of the operative procedure by protamine. Three control patients had deep-vein thrombosis postoperatively but only one heparin-treated patient did. Complications in the treated group included excessive blood loss intraoperatively in one patient and an incisional hernia postoperatively in another. Although the results are not statistically significant, this study suggests that a single dose of heparin given intravenously during operation is a safe and effective means of prophylaxis against deep-vein thrombosis in patients who undergo general surgical procedures. Studies are now being carried out to determine the optimal dose of heparin, time of administration and duration of anticoagulation.

Adult↗
PubMed1984

The role of intraoperative heparin in reducing the incidence of postoperative deep venous thrombosis.

A prospective study to determine the incidence of postoperative DVT in patients undergoing vascular surgical operations was carried out. Twenty-eight patients who underwent vascular surgical procedures were studied. Five thousand units of intravenously given heparin was administered intraoperatively to each patient, with no other prophylaxis against DVT being used. DVT was detected by means of radioactive fibrinogen uptake studies. Two patients had DVT develop, an incidence of 7.1 per cent which is lower than the 30 to 40 per cent that might be expected in patients of the same age undergoing general surgical procedures. Both DVT developed in the late postoperative period. It is suggested that the single dosage of heparin given to these patients protects them against the development of DVT and is responsible for the low incidence of DVT observed in these patients.

Adult↗
PubMed1979

Pneumothorax complicating a fracture of the clavicle.

Fractures of the clavicle, while common, are associated with few serious complications. The authors report the case of a 29-year-old man with a simple fracture of the middle third of the clavicle that was associated with a 30% pneumothorax. The force and mechanism of the injury, severe pleuritic pain and reduced breath sounds suggested the diagnosis which was confirmed roentgenographically. The possibility of pneumothorax must be considered in any patient with a fracture of the clavicle, especially in the unconscious patient who has sustained multiple injuries.

Adult↗
PubMed1977

Methysergide therapy causing vascular insufficiency of the upper limb.

A 41-year-old woman, who was receiving methysergide maleate for the treatment of severe headaches, had occlusion of the left brachial artery, confirmed by arteriography. The occlusion was believed to result from the use of methysergide and the drug was therefore withdrawn. Within 4 days the distal pulses were normal, as confirmed by arteriography, and she was asymptomatic.

Adult↗
PubMedDate not supplied

Predictors of surgical outcome in patients undergoing aortobifemoral bypass reconstruction.

We report a prospective study with 2 years of follow-up including 105 consecutive symptomatic patients (58.1% claudication and 41.9% severe ischemia) undergoing aortobifemoral bypass surgery (ABF/BP). Proportional-hazards, stepwise regression, and life-table analyses were used to determine predictors of the following outcome criteria: graft patency, amputation, mortality, symptomatic recurrence, and palliation. The operative mortality was 5.7% and the 2-year cumulative mortality was 15.5%. Most deaths (61.5%) were cardiac-related. There were 3 predictors of mortality: the presence of more than 1 surgical risk factor (relative risk [RR] 6.2; p less than 0.001), advanced age (RR 2.9; p = 0.03) and the presence of ischemic heart disease (RR 1.5; p = 0.045). No patient required amputation. Early graft patency rate was 94.3% and the 2-year cumulative patency was 92.8%. The only predictor of graft failure was preoperative ankle/brachial index (ABI) of less than 0.4 (RR 6.1; p = 0.003). Early symptomatic relief was 98.1% and at 2 years it was 77.3%. There were 2 predictors of symptomatic recurrence: postoperative smoking (RR 2.4; p less than 0.001) and impaired runoff (RR 2.5; p = 0.017). Cumulative palliation was 87.6% at 1 month and 66.5% at 2 years postoperatively. There were 2 predictors of palliation: the presence of more than 1 surgical risk-factor (RR 1.8; p = 0.001) and postoperative transcutaneous oximetry (PtcO2) of less than 35 mmHg (RR 3.1; p = 0.04). We conclude that the best predictors of outcome in patients undergoing ABF/BP surgery were the number of preoperative risk factors, age, ischemic heart disease, ABI, PtcO2, postoperative smoking, and angiographic runoff.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Selection of amputation level and prediction of healing using transcutaneous tissue oxygen tension (PtcO2).

Pre-operative measurement of transcutaneous tissue oxygen tension (PtcO2) by reflecting oxygen delivery at proposed amputation sites may allow accurate prediction of post-operative healing. Thirty-eight patients requiring amputation had PtcO2 measured with a Clark electrode on the foot, anteriorly and posteriorly below knee and above the knee while lying supine. PtcO2 greater than 24 mmHg was chosen to predict healing and indicated 13 above-knee (AK) and 25 below-knee (BK) amputations. Clinical criteria indicated 12 AK and 26 BK amputations. PtcO2 and clinical judgement differed on five occasions, a lower amputation was indicated by PtcO2 twice and by clinical selection three times (PtcO2 16 mmHg). Amputation was performed at the more distal level indicated (25 BK, 13 AK). Foot PtcO2 in both groups did not differ significantly, 4.08 +/- 2.00 mmHg (BK) and 3.9 +/- 1.29 mmHg (AK) (p greater than 0.5), nor did above knee PtcO2 (p greater than 0.3). Anterior below knee PtcO2 in both groups differed significantly, 34.92 +/- 10.84 mmHg (BK) and 9.5 +/- 5.60 mmHg (AK) (p less than 0.001). Likewise, posterior PtcO2, 39.64 +/- 6.85 mmHg (BK) and 14.1 +/- 4.43 mmHg (AK) (p less than 0.001). Amputation sites healed primarily within two weeks except the site with a pre-operative PtcO2 of 16 mmHg, where healing was delayed and occurred by second intention. These results indicate that PtcO2 is a valid predictor of primary healing following amputation.

Adult↗
PubMedDate not supplied

Effects of cigarette smoking on outcome of femoral popliteal bypass for limb salvage.

A retrospective 5-year follow-up study of 83 femoral-popliteal bypass operations for severe ischemia (79 patients) is presented. There were no operative deaths. At one month, cumulative patency rates (CPR) and limb salvage rates (LSR) were 86.8% and 96.4% respectively. At 5 years, CPR, LSR and cumulative survival were 50%, 79.4% and 71.6% respectively. Post-operative smoking habits were strongly related to CPR and LSR. Smoking more than 5 cigarettes per day adversely affected CPR's. At 5 years, CPR of non-smokers and smokers of up to 5 cigarettes per day (47 patients) was 67.7% and for smokers of more than 5 cigarettes per day (32 patients) it was 44.7% (P less than 0.045). Smoking more than 15 cigarettes per day had an adverse effect on LSR's. Smokers of more than 15 cigarettes per day (17 patients) had a 5-year LSR of 58.5% compared with 89% for non-smokers and smokers of up to 15 cigarettes per day (62 patients) (P = 0.009). For 20 limbs requiring thrombectomy LSR was 100% at 1 year and 57.5% at 5 years. CPR's and LSR's were not significantly influenced by pre-operative smoking, diabetes, run off or level of distal anastomosis relative to the knee joint. Based on zero operative mortality and 96.4% limb salvage at 1 year, it is concluded that an aggressive approach toward revascularization for limb salvage is well justified in most patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Fibromuscular dysplasia of the posterior auricular artery: an unusual aneurysmal lesion.

A 67-year-old patient was admitted to hospital with a pulsatile mass behind his left ear. The clinical diagnosis was a posterior auricular artery aneurysm, and this was confirmed on Digital Subtraction Angiography. The aneurysm was excised and sent for pathology. The findings were felt to be consistent with fibromuscular dysplasia. This appears to be only the second reported case in the literature of a posterior auricular artery aneurysm.

Aged↗
PubMedDate not supplied

Etiology and management of aorto-femoral bypass graft failure.

Over a nine-year period 1973 to 1982, 364 aorto-bifemoral bypass grafts were inserted for aorto-iliac occlusive disease and 45 graft failures were encountered. Twelve patients developed acute graft occlusion, occurring less than 30 days postoperatively (Group I). These failures were almost all due to technical problems, the most common cause was elevation of an intimal flap following local endarterectomy. Five patients (Group II) developed recurrent symptoms without actual thrombosis or occlusion of the graft, but were associated with neointimal hyperplasia at the distal anastomosis and evidence of distal atherosclerosis. Twenty-eight patients were late failures (Group III). These patients thrombosed their grafts more than 30 days postoperatively. Four patients thrombosed both limbs of the graft at separate intervals. Nineteen patients were found to have progressive atherosclerosis affecting their run-off vessels. Six patients were found to have stenosis limited to the distal anastomosis. False aneurysm, kinking of the graft, and proximal suture line stenosis were felt to be determining factors in 3 other incidences of graft failure. The most common treatment in Group I was thrombectomy and securing of the raised intimal flap. The patients in Group II were treated with local endarterectomy and patch angioplasty. Of the patients in Group III, the most common inflow procedure was thrombectomy, carried out in 17 cases. In Group III, 13 of 28 patients underwent profundaplasty to improve outflow. The importance of pre and postoperative angiography in defining the etiology of graft failure is stressed. It is important to rule out problems with the proximal anastomosis. Once inflow has been established, angiography should ensure that an adequate outflow procedure has been performed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗