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Biomedical subjects

H Javid

Publications and source records attributed to H Javid.

At least 19 recordsLinked to original sources
PubMed1983

Disruption of aortic arch branches due to nonpenetrating chest trauma.

From 1967 through 1979, six patients sustained non-penetrating chest trauma with disruption of the Innominate, carotid, and subclavian arteries. Diagnosis was established in each case by aortography. Two patients with subclavian artery injuries underwent exploration through lateral thoracotomies, and three patients underwent sternotomy for innominate artery disruptions. A cervical approach was used for a common carotid artery disruption. One patient had innominate and left common carotid artery disruption. Two patients with subclavian injuries had associated bronchial disruptions. Cardiopulmonary bypass was used in one patient and should be available in all cases. One patient died with multiple vessel and bronchial disruption. A variety of repairs were used, varying from simple oversewing of the subclavian artery to elaborate graft replacement of the innominate and left common carotid arteries.

Accidents, Traffic↗
PubMed1983

Coronary revascularization in septuagenarians.

Despite a 15 year experience with the aorta-coronary bypass operation, indications for its use remain unsettled, especially in the elderly. Between January, 1974, and June, 1980, 2,667 patients underwent coronary artery revascularization with an overall mortality of 3.8% (101/2,667). During the last 12 months the mortality has decreased to 1%. There were 2,562 patients below the age of 70, with a mortality of 3.5% (90/2,562), in contrast to 105 patients over the age of 70, with a mortality of 10.5% (11/105) (p = 0.002). In patients less than 70 years of age there was a significant difference between the mortality of men, 3.12% (67/2,146), and that of women, 5.53% (23/416) (p = 0.015). This disparity of operative risk was far more pronounced in patients over 70 years of age: men 6% (5/84) and women 28.6% (6/21) (p = 0.002). The overall operative mortality of women, 6.6% (29/437), was significantly different from the overall mortality of men, 3.2% (72/2,230) (p = 0.001). An in depth analysis of past medical history, risk factors, and catheterization data is presented in those patients over the age of 70. The average number of vessels bypassed was 2.40: men 2.47 and women 2.09 (p = NS). The ages varied from 70 to 81 years with a mean of 72.5. Smoking (p = 0.012) and diabetes (p = 0.0078) were significant risk factors for coronary disease. Smoking (p = 0.032) and abnormal pulmonary artery pressures (p = 0.0429) were significant variables affecting mortality. A 97.1% follow-up was obtained up to 78 months. Coronary artery revascularization can be performed in men below the age of 70 with acceptable mortality, but there is a twofold increase above the age of 70. Women can undergo revascularization below the age of 70 with a significantly higher risk than males. Those above the age of 70 are at severe risk and should undergo revascularization only after careful selection.

Age Factors↗
PubMed1981

Acute ascending aortic dissection: surgical management.

The success of total aortic root replacement in conditions such as annuloaortic ectasia and complicated redo surgery has stimulated its use in acute dissection of the ascending aorta. We believe this radical approach is, in most cases, unwarranted, considering the excellent results with valve conservation. From 1970-1978, 20 consecutive patients with acute anterior aortic dissection and aortic insufficiency were operated at Rush-Presbyterian-St. Luke's Medical Center. Only one patient (5%) required reoperation for hemorrhage. The three operative deaths (15%) were associated with right coronary artery disruption, aortic-right atrial fistula and preoperative intrapericardial false lumen rupture. In eight patients, valve resuspension was combined with primary aortic repair and nine with ascending graft interposition, but aortic valve replacement was required in three because of annuloaortic ectasia or tissue friability. One patient treated by primary repair in 1971 underwent successful reoperation for redissection 7 years later (1.4% per patient-year risk of late reoperation), but the remaining 16 patients, followed 2-10 years, remain free of aortic insufficiency or recurrent aneurysm. This experience supports the use of valve reconstruction rather than replacement in most cases of acute anterior dissection of the aorta.

Acute Disease↗
PubMed1981

Lesions of the thoracic aorta and its arch branches simulating neoplasm.

Abnormal radiographic densities in the midportion of the chest are most commonly caused by neoplasms, cysts, or inflammatory disease. However, vascular lesions may present an identical x-ray appearance, with no distinguishing clinical history or physical findings. The cardiothoracic surgeon must be aware of this similarity in order to ensure the most appropriate diagnostic and therapeutic approach. In our experience, the most frequent problem in differential diagnosis is a lesion of the thoracic aorta or its arch branches simulating neoplasm. Nine such cases are presented, with pertinent conventional radiographs angiograms, and computed tomographic (CT) scans. These are considered in anatomic sequence: (1) ruptured sinus of Valsalva aneurysm; (2) ascending aortic aneurysm; (3) tortuosity or aneurysm of the innominate and subclavian arteries; (4) transverse arch aneurysm; (5) pseudocoarctation; and (6) descending aortic aneurysm. Such vascular lesions must be considered early in the evaluation of any juxta-aortic chest density, particularly if the patient is hypertensive and has other manifestations of atherosclerosis. Angiography and computed tomography establish the diagnosis in most instances, although both are less reliable when thrombus fills all or part of an aneurysm. If these methods fail to establish a vascular origin, the possibility of neoplasm is pursued. When neither a vascular nor neoplastic origin can be proved, surgical exploration is indicated in the otherwise good-risk patient.

Adult↗
PubMed1981

Leg wound complications associated with coronary revascularization.

One percent of 2,545 patients undergoing coronary revascularization with the saphenous vein over a 5 year period sustained leg wound complications which necessitated extra care. Fourteen complications were minor and required only drainage, a new antibiotic, and dressing changes. Thirteen major wound complications required wide debridement and, of these, five could be closed only with skin grafts. Eight wounds were infected, two with Staphylococcus aureus and six with mixed gram-negative flora. Ninety-three percent of these wounds were in the thigh. Average weight of patients with leg wound complications was 73.5 +/- 3.5 kg and not different from that of a randomly selected control group (73.8 +/-1.2 kg). However, 40% of the patients were women, a much higher incidence than control (p less than 0.005). Hospital stay increased significantly from 12.1 +/- 0.5 days for the control group to 24 +/- 2.6 days for the group with wound complications (p less than 0.005). Average hospital stay was 33.6 +/- 3.8 days (p less than 0.001) in those patients with major wound complications (estimated hospital cost $9,900). Leg wound complications of saphenous vein harvest are infrequent but serious. Efforts to prevent this complication should include minimal dissection, careful hemostasis, and closure in layers. Development of skin slough, infection, and necrosis necessitating débridement and drainage is a major and expensive complication. Wide excision and direct closure are necessary to minimize hospital stay and reduce the requirement for skin grafting.

Bacterial Infections↗
PubMed1980

Carotid artery disease, carotid endarterectomy, and behavior.

Thirty-five carotid endarterectomy patients and 17 peripheral vascular surgery controls were evaluated psychologically preoperatively and postoperatively. The endarterectomy sample was restricted to patients with transient ischemic attacks. Neuropsychological tests included measures of language, attention, memory, problem solving, and sensory and motor skills. Personality tests included measures of general psychopathology, with specific evaluation of anxiety and depression. Mean scores of the endarterectomy and control groups were not statistically significantly different preoperatively for any test. Postoperatively, only the endarterectomy group showed mean improvement on measures of memory and verbal fluency. Both groups showed improvement on several other neuropsychological measures, and in reduction in state anxiety and on another indicator of psychopathology. Endarterectomy patients whose cognition improved postoperatively were younger, better educated, and had lower admitting systolic blood pressure; they also tended to have a lesser incidence of generalized vascular disease.

Anxiety↗
PubMed1980

Requirements for a method of transvenous inferior vena cava interruption.

Six requirements were defined that would characterize a safe and effective technique of transvenous inferior vena cava (IVC) interruption: (1) the instrument should be placed transjugularly under local anesthesia; (2) the instrument should have "built-in" capability for venography; (3) the technique should produce complete occlusion of the IVC; (4) the occluder must adapt to any variable in IVC diameter; (5) the intracaval device must have no sharp edges, pins, or points; and (6) the technique must permit simultaneous heparin therapy. These specifications were met by a catheter-delivered detachable balloon that could be inflated to any needed diameter. This technique was used in 96 patients, with a follow-up period to ten years. Time and experience confirm the validity of the six requirements for a safe and effective technique.

Adolescent↗
PubMed1980

Simultaneous aortic and renal artery reconstruction.

From 1970 to 1978, 39 patients underwent simultaneous aortic and renal artery reconstruction. Of these, 37 had severe single or bilateral renal lesions in combination with an aortic aneurysm, or symptomatic or asymptomatic aortoiliac disease. Two patients had renal arteries that originated from an abdominal aortic aneurysm. Thirty-two patients were hypertensive, one had chronic renal failure, and three others had asymptomatic renal lesions that were bypassed prophylactically. Operations performed included aortic replacement plus: single renal graft; bilateral renal grafts; renal graft plus contralateral nephrectomy; and renal graft plus mesenteric revascularization. All early postoperative deaths (four) occurred in patients with aneurysmal disease. Twenty-nine patients were available for long-term evaluation. In patients who were hypertensive preoperatively, 64.0% experienced long-term cure or improvement. Cardiac and cerebral disease, lower extremity claudication, and the need for subsequent cardiovascular surgery occurred with substantial frequency during the follow-up period.

Aged↗
PubMed1980

Descending aortic aneurysmectomy without adjuncts to avoid ischemia.

Encouraged by reports on the safety of simple aortic cross-clamping for resection of descending aortic aneurysm, we began utilizing this technique more liberally in 1976. This study was undertaken to examine the results of operation in 36 patients, equally divided into two distinct groups. In Group 1, either extracorporeal circulation or indwelling temporary shunts were employed during the period of aortic occlusion. In Group 2, simple aortic cross-clamping was utilized to manage the lesion. No adjuncts were used to avoid ischemia in the latter group. The only 2 early deaths and two instances of paraplegia occurred in Group 1. In general, there were fewer complications in Group 2, with approximately two-thirds of the patients experiencing an uneventful postoperative course. These differences are considered important since the two groups were similar in respect to the extent and nature of the lesions and other factors contributing to operative risk.

Adolescent↗
PubMed1980

Sternal wound complications. Management and results.

Of 4,124 patients undergoing median sternotomy for cardiac operations, 1.8% had sternal wound complications. These included wound drainage, skin separation, unstable sternum, and sternal dehiscence with or without infection. Septicemia and mediastinal abscess were found in all 19 patients who died. Incision and drainage of skin and subcutaneous tissue with frequent changes of dressing or irrigation (Method A) is recommended for those patients with (I) serosanguineous drainage only or (2) a stable sternum and superficial infection without systemic reaction. Surgical débridement of the sternum and mediastinum with reclosure followed by mediastinal irrigation via drainage tubes with 0.5% povidone-iodine solution (Method B) is recommended for patients with (1) a draining, unstable sternum, (2) infection involving the retrosternal space, or (3) infection causing a systemic reaction unresponsive to Method A. None of the eight patients in the latter group with more serious infections died when managed by Method B, and only one had recurrent infection. In contrast, of 28 patients of the latter group not treated with Method B, 11 died of infection-related causes and 13 returned with recurrent infection.

Abscess↗