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Biomedical subjects

K K Sharma

Publications and source records attributed to K K Sharma.

At least 145 records · Page 8Linked to original sources
PubMedDate not supplied

Minimally invasive atrial septal defects repair.

This study reviews the current method of atrial septal defect closure at our institute with a minimally invasive approach without median sternotomy. From September 1997 to August 1998, 37 patients (13 males, 24 females) with mean age 36.5 years (range 18-67 years) underwent atrial septal defect closure by right anterior thoracotomy. Femoral vessels were cannulated through a small groin incision and extracorporeal circulation was established. Venous drainage was assisted with a centrifugal pump. Aortic crossclamping was performed through the intact chest wall using a special transthoracic clamp with sliding rod design inserted through a separate tiny 3 mm incision in the right second intercostal space in the mid clavicular line. Mean duration of cardiopulmonary bypass and aortic crossclamp time was 35 +/- 14 and 23 +/- 7 minutes respectively; mean endotracheal intubation time after surgery 6.2 +/- 3 hours; mean ICU stay 10.6 +/- 2.8 hours; mean length of thoracotomy incision 7.2 +/- 1.8 cm; and, mean hospital stay 4.2 +/- 1.8 days. There was no post-operative neurological dysfunction or femoral cannulation related complication. There was no perioperative or late mortality. No residual atrial septal defect was observed by transoesophageal echocardiography in any patient. The procedure described here provides secure closure of the atrial septal defects in minimally invasive fashion with good results.

Adolescent↗
PubMedDate not supplied

Robotically enhanced coronary artery bypass surgery.

BACKGROUND: Robotically enhanced telemanipulation surgery is a fast developing technique which allows totally endoscopic cardiac surgery with utmost precision and perfection on both beating heart as well as arrested heart. METHODS AND RESULTS: Between December 2002 and February 2004, 125 patients underwent robotically enhanced coronary artery bypass surgery using the da Vinci telemanipulation system (Intuitive Surgical Inc., California). Eleven patients underwent totally endoscopic coronary artery bypass surgery. Of them 9 were done on beating heart while 2 were done on arrested heart. One hundred and fourteen patients had endoscopic takedown of internal mammary artery followed by minimally invasive direct coronary artery bypass in 63 patients and left anterolateral thoracotomy in 51 patients. The internal mammary artery mobilization time was 42 min (35-74 min) while the left internal mammary artery to left anterior descending artery anastomosis time ranged from 20 to 36 min for the totally endoscopic coronary artery bypass patients. In 1 patient, the right internal mammary artery was anastomosed to diagonal artery totally endoscopically. The mean internal mammary artery flow by Doppler measurement done in patients undergoing minimally invasive direct coronary artery bypass was 64 ml/min. Seven patients required conversion to median sternotomy and coronary bypass surgery on beating heart. The mean intensive care unit stay was 1.2 days and the mean hospital stay 4.5 days. There was 1 in-hospital mortality. All 11 patients who underwent totally endoscopic bypass surgery had coronary angiography done at 3 months interval which showed 100% patency in 10 patients while one patient had 50% anastomotic narrowing for which coronary angioplasty was done in the same sitting. CONCLUSIONS: Using telematic technology, a complete endoscopic anastomosis is possible in both single vessel and suitable double vessel disease patients. The use of robotics is now extended to achieve complete myocardial revascularization by harvesting both the internal mammary arteries and making a small thoracotomy for direct anastomosis as well.

Adult↗
PubMedDate not supplied

Port-access approach for cardiac surgical procedures: our experience in 776 patients.

BACKGROUND: Recent advances in minimally invasive technology has expanded the application of the right thoracotomy approach for mitral valve surgery and atrial septal defect closure. The present study examines the feasibility, safety and efficacy of this technique. METHODS AND RESULTS: Between September 1997 and December 2004, 430 patients underwent mitral valve surgery through right anterolateral thoracotomy. The mitral valve was repaired in 62 patients, and 368 patients underwent mitral valve replacement. During same period, 336 patients underwent surgical closure of atrial septal defect. In all cases femoral artery and femoral venous cannulation was used for cardiopulmonary bypass. There was no approach-related limitation to surgical exposure, nor complication in cannulation of femoral vessels through the groin. Mean duration of cardiopulmonary bypass and cross-clamp time was 90 +/- 48 min and 51 +/- 29 min, respectively. Mean intubation time was 14.8 hours (range: 8-28 hours). Mean duration of intensive care andhospital stay was 26 hours (range: 18-38 hours) and 7 days (range: 5-17 days), respectively. In the atrial septal defect group, the mean cardiopulmonary bypass time and aortic cross-clamp time was 29 +/- 14 min and 19 +/- 8 min, respectively. Mean intensive care unit stay and mean hospital stay was 9.8 +/- 2.6 hours and 4.0 +/- 1.9 days, respectively. Hospital mortality was 0.46% (2/430) in the mitral valve group while there was no hospital mortality in atrial septal defect group. At a mean follow-up of 38.0 +/- 6.2 months there was one late death and two re-operations in the patients who underwent mitral valve surgery. CONCLUSIONS: Port-access approach is safe, offers faster recovery, cosmetic advantage, more patient satisfaction: it obviates the complications due to re-entry in redo cases and offers same efficacy as conventional operation. Furthermore, it is an excellent approach for mitral valve surgery in patients who had previous cardiac procedures. It has become our standard approach for repair of atrial septal defect and isolated mitral valve procedures.

Adolescent↗
PubMedDate not supplied

Dietary strategies for risk-factor modification to prevent cardiovascular diseases.

To study the role of diet in cardiovascular risk-factor intervention, 458 high-risk individuals were asked to eat for either a cardiovasoprotective diet (group A, n = 228) or their usual diet (group B, n = 230) in a randomized single-blind fashion. Ages varied between 25 and 63 yr, and 414 were men. Group A received significantly more calories in relation to the amount of complex carbohydrates, vegetable proteins, polyunsaturated fats, fiber, potassium, magnesium, and vitamin C and fewer calories in saturated fat and cholesterol compared with group B. Age, risk factors, nutritional factors, complications, and laboratory data were similar at entry to the study. Dietary adherence was obtained by questionnaire. After 1 yr, there was a significant (P less than 0.02) decrease in total risk factors (32.0%) in group A compared with group B, and 1-yr mean serum cholesterol was significantly lower than the initial mean cholesterol in group A. There was a significant (P less than 0.02) decrease in total complications (38.3%) in group A compared with group B in association with a significant (P less than 0.02) decrease in cardiovascular end points (38.3%), including postexercise electrocardiographic changes, fatal and nonfatal myocardial infarction, and sudden death. Overall mortality and mortality due to ischemic heart disease was less in group A (8 and 3.5%) than group B (11 and 4.8%). However, because of the few cases, differences were insignificant. It is possible that diet causes a significant reduction in blood cholesterol and modification of other risk factors leading to a decrease in complications and cardiovascular end points in patients with risk factors of coronary heart disease.

Adult↗
PubMedDate not supplied

Medico-social profile of male teenager STD patients attending a clinic in Pune.

A study of 250 male teenager STD cases was carried out to determine the association between certain medicosocial factors e.g. age, type of infection, educational status, source of infection, knowledge about mode of acquiring infection and prophylaxis etc. Salient findings of the study such as gonorrhoea being the commonest type of STD, curiosity being the main reason for first sexual exposure and prostitutes being the major source of infection have been highlighted in this communication.

Adolescent↗