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Biomedical subjects

F Robicsek

Publications and source records attributed to F Robicsek.

At least 91 records · Page 5Linked to original sources
PubMed1994

Conservative operation in the management of annular dilatation and ascending aortic aneurysm.

Ascending aortic aneurysm associated with annular dilatation is generally handled by resection and replacement of the aortic root. Such an extensive operation may be avoided by a much simpler surgical intervention, ie, aortoplasty, valve replacement, and aortic wall reinforcement. Such an operation may be performed in cases where the shape of the aneurysm is a relatively regular "pear" or "teardrop" shape and is not extremely large. It also may be applied in cases of aortic stenosis with post-stenotic dilatation. The procedure requires barely more operative time and effort than a "simple" aortic valve replacement.

Aortic Aneurysm↗
PubMed1994

Hemodynamic considerations regarding the mechanism and prevention of aortic dissection.

We describe the hemodynamic principles that we postulate are responsible for the development of aortic dissection. Two types are differentiated: the "hypertensive" and the "Marfan" types. The former is characterized by moderate aortic dilatation and considerable blood pressure elevation, the latter by considerable aortic dilatation only. The role of wall stress in the development of the intimal tear and the propagation of the process of dissection are discussed. We recommend that patients who are at high risk for developing aortic dissection--those with Marfan's syndrome and dilated aortas--should undergo aortoplasty and wall reinforcement as a simple, safe, and effective way to prevent aortic dissection.

Aortic Dissection↗
PubMed1994

The freedom from atherosclerosis of intramyocardial coronary arteries: reduction of mural stress--a key factor.

The phenomenon that coronary arteries which course entirely intramyocardially remain immune to atherosclerosis was investigated in 250 patients undergoing coronary bypass surgery. In 26 the circumflex artery gave off major branches whose distal portions ran entirely intramyocardially, which required coronary bypass grafting because of proximal disease. Of these, 24 had no atherosclerosis in the intramyocardial segment, one had a calcified plaque, and one had a recanalized thrombus. The cause of this phenomenon was studied further in 14 canine hearts by measuring intramyocardial pressure. The intramyocardial pressure in the subepicardial region was as high as 63% of the left ventricular cavity pressure and in the subendocardial region it was even greater than the left ventricular cavity pressure, which indicates that the pressure gradient across the artery wall is significantly reduced, and sometimes even eliminated. It is therefore concluded that the freedom from atherosclerosis of the intramyocardial coronary arteries is due to the lack of mural stress, i.e. the lower or absent transmural pressure gradient.

Animals↗
PubMed1994

The use of cyanoacrylate adhesive (Krazy Glue) in cardiac surgery.

The authors report four cases of patients in desperate clinical situations where cyanoacrylate adhesive (Krazy Glue) was successfully used to control hemorrhage. Clinical observations were supplemented with bacteriological studies which showed that commercially available cyanoacrylate adhesive showed lack of bacteriological contamination.

Adolescent↗
PubMed1994

Pressure trap created by vein valve closure and its role in graft stenosis.

Saphenous vein graft stenosis has become the leading cause of reoperation in coronary bypass operations. We investigated the role of vein valves in vein graft stenosis by studying 14 human saphenous veins placed in a simulator of the left side of the heart in parallel with the arterial system. The vein had a variable resistance and a capacitance simulating the distal vascular bed. The pressures at the proximal and distal ends of the vein and the venous flow were measured while the following were changed: venous flow 200 to 0 ml/min, aortic pressure 150/120 to 80/60 mm Hg, cardiac output 3 to 5 L/min, and compliance of distal vascular bed 0 to 1 ml of air. The pressures at both ends of the vein were the same when venous flow rate was greater than 60 ml/min and the vein valve remained open. As the venous flow decreased the valve began to open and close in each cardiac cycle. The flow rate at which the valve began to close ranged from 30 to 10 ml/min. When the valve closed, it trapped the pressure in the segment distal to the valve. Because the segmental hypertension is expected to accelerate atherosclerotic changes, the pressure trap created by closure of the vein valve could be an important cause of vein graft stenosis.

Arteriosclerosis↗
PubMed1993

Development of the surgical stapling device.

Most surgeons who use staplers today attribute their invention to researchers who worked during the mid-fifties in the Soviet Union. While the modern staplers are derivates of those instruments, it also needs to be emphasized that they were preceded by stapling devices which were used extensively as early as the first decade of this century. The early history of surgical staplers is full of imaginative new ideas and technical solutions clearly identified as the instruments we use today were developed. The great men in Hungary and Germany who invented the early staplers should be remembered for their accomplishments.

Germany↗
PubMed1993

The management of severe adherence of mediastinal structures to the sternum during cardiac reoperations.

The author's method for sternal re-entry in cases of extremely dense mediastinal adhesions is described. The anterior lamina and the spongiosa of the sternum is cut with an osteotome and the posterior lamina is divided using the Lebsche knife so as to leave the densely adhered patch of the posterior lamina on the underlying soft tissue. These bone fragments may be left in loco or, if the course of the operation requires it, they may be gently raised and peeled off. Removal of such a portion or portions of the posterior lamina does not appreciably weaken the sternum and safe sternal closure may be accomplished without difficulty.

Heart Valve Diseases↗
PubMed1993

Clinical significance of epicardial pacing wire cultures.

Routine cultures of epicardial pacing wires removed 5 to 10 days postoperatively were obtained in 205 adults who underwent cardiac operations through median sternotomy. The study was conducted in a double-blind prospective fashion in which clinicians were unaware of culture results. With the exception of 10 out-of-town patients who were followed up only until the day of hospital discharge, the patients were followed for at least 6 weeks (195 patients) for evidence of poststernotomy wound infections. Deep wound infection rate was slightly less than 1% in this patient population, with less than 0.5% having had superficial wound problems. Of the 205 patients, 27 had positive epicardial pacing wires cultures, with a total of 30 microbial isolates. Of 30 isolates, 26 were consistent with local skin flora (Staphylococcus, Streptococcus, Enterococcus, and diphtheroids). Wound infection developed in none of these patients. The remaining four cultures were of either Enterobacter or Serratia. In two of these four patients deep sternal infections developed. In the remaining 178 patients whose wire cultures were negative, no deep sternal infections developed. The fact that all clinically manifested deep sternal infections were associated with positive epicardial pacing wires cultures suggests that epicardial pacing wires cultures may be useful in the treatment of high-risk patients or of those in whom deep sternal infections are suspected.

Academic Medical Centers↗
PubMed1992

"Very long" aortic grafts.

During the past 2 decades, we have been using the so-called "very long" (ascending to infrarenal aorta or ascending aorta to common femoral artery) bypass grafts in selected patients. Our experience with this method includes patients with dissecting as well as arteriosclerotic aneurysms of the descending aorta, thoracoabdominal aneurysms, patients in need of aortic surgery with previous abdominal aortic surgery, radiation treatment, aortic thrombosis, and complex aortic coarctation in the adult. The technique proved to be relatively easy to perform, was well tolerated by most patients and replaced more complicated and higher risk "conventional" operations. The advantages and shortcomings of the method as well as long range clinical observations are presented.

Aorta↗
PubMed1992

Vascular surgery: possible adverse effect on extent of subsequent lower limb amputation.

The influence of previous vascular surgery on the level of amputation was examined retrospectively in 345 amputations (66 bilateral) in 279 patients with peripheral vascular disease. Seventy-two patients (38% diabetic) had previous vascular surgery on 74 limbs and 207 (65% diabetic) had no history of vascular surgery on 271 limbs. In patients with previous vascular surgery, above-knee amputation was done on 55% of limbs versus 71% of limbs in patients with no previous vascular surgery (P < .05), despite a lower incidence of diabetes in the former group. We conclude that although reconstructive vascular surgery is an effective treatment for vascular insufficiency, occasionally it not only fails, but is associated with an increased incidence of above-knee amputation.

Aged↗
PubMed1992

Comparison of knitted and woven aortoiliac and aortofemoral Dacron prostheses in the same patient: a 10-year prospective study.

This study represents the final and concise evaluation of all data obtained in a ten-year follow-up period and is a continuation of our previously published investigations. A specially manufactured bifurcated aortic graft with one limb woven and the other knitted was implanted in the aortoiliac or aortofemoral position in 158 patients. During an observation period ranging up to 10 years, no statistically significant difference was found either in platelet adherence or in clinical patency. According to the results of this and previous studies, the pore size of Dacron grafts in these positions does not seem to play any significant role either in platelet adherence or in patency rate. A high mortality rate from cardiovascular disease in the same patient population was also noted.

Aged↗