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Biomedical subjects

K Sieunarine

Publications and source records attributed to K Sieunarine.

At least 19 recordsLinked to original sources
PubMed2001

Intramuscular haemangiomas: hookwire localization prior to surgical excision: report of four cases.

BACKGROUND: Haemangiomas of skeletal muscle are a rare entity, although they are still noted to be one of the most common deep tissue tumours of the lower limb. All such lesions are benign with no recorded evidence of metastasis; but they are associated with a 17-20% local recurrence rate which is thought to be related to inadequate primary surgical excision rather than histological subtype. METHODS: The present case series briefly discusses the pathophysiology, clinical manifestations, diagnostics, differential diagnosis and treatment modalities of intramuscular haemangiomas. The article then focuses on the recent introduction of ultrasound-guided hook-wire localization, which has enabled a great increase in complete surgical excision, resulting in much lower rates of local recurrence and a more pleasing functional and cosmetic result because unnecessary dissection is avoided. RESULTS: Preoperative ultrasound-guided hookwire localization of deep and often non-palpable intramuscular haemangiomas was very helpful in enabling a more complete surgical excision to be carried out. CONCLUSION: Hookwire localization using ultrasound guidance is an invaluable tool in directing the surgeon intraoperatively when excising deep intramuscular haemangiomas.

Adolescent↗
PubMed2001

An epidemiological view of vascular trauma in Western Australia: a 5-year study.

BACKGROUND: Although Australia encounters vascular injury less frequently than countries such as the USA, the predominance of blunt trauma with associated complex injuries continues to pose problems for clinicians. The present paper reviews Royal Perth Hospital's experience of vascular trauma epidemiology. METHODS: All individuals who presented to the Royal Perth Hospital (RPH) with a vascular injury between August 1994 and January 2000 were identified from a prospective trauma database. Injuries were classified using the Abbreviated Injury Score (AIS 90 code). The five major vascular injury groups as defined by AIS 90 (neck, thorax, abdomen, upper limb and lower limb) were analysed in turn to determine which injuries were most frequent, what the common causes were, effects of alcohol and drugs, common associated injuries, investigations performed, mortality, proportion of rural vascular trauma with transfer details and lengths of hospital stay. RESULTS: During the study period, 153 patients (1% of total trauma workload) sustained 175 vascular injuries. The commonest causes of injury for each group were stabbing (neck and lower limb), motor vehicle accident (thorax and abdomen) and work machinery (upper limb). Mortality was highest for thoracic injury (14/32; 44%) followed by abdominal injury (10/29; 34%). The ratio of blunt to penetrating vascular trauma is high and is increasing, as is the ratio of truncal to extremity vascular trauma. The most common artery-vein combination injury was to the femoral vessels. CONCLUSIONS: The injury patterns emerging from the present study will hopefully help all medical personnel to recognize the potential for vascular injury in a trauma setting.

Abdominal Injuries↗
PubMed2000

Hybrid open-endoluminal technique for repair of thoracoabdominal aneurysm involving the celiac axis.

PURPOSE: To describe a technique combining endoluminal and open approaches for the repair of thoracoabdominal aneurysms involving the celiac axis. CASE REPORT: Two patients with type I thoracoabdominal aneurysm and suboptimal cardiac reserve underwent transluminal stent-graft implantation. To achieve satisfactory distal seal, the caudal end of the endograft was circumscribed with a Dacron band that was sutured to the aorta and endograft through a midline incision. The patent celiac artery in both patients was ligated to stop retrograde filling of the aneurysm sac. The patients developed no problems perioperatively, and exclusion of the aneurysms was confirmed by follow-up imaging. Three years after endografting, both patients had excluded aneurysms without evidence of endoleak or device migration. CONCLUSIONS: This combined approach is another treatment option for thoracic aneurysms that have an anatomically suitable proximal attachment zone with a compromised distal neck.

Aged↗
PubMed1999

Endoscopic thoracic sympathectomy for primary palmar hyperhidrosis: intermediate term results.

BACKGROUND: The authors' experience of the efficacy and safety of endoscopic thoracic sympathectomy in the treatment of primary palmer hyperhidrosis was examined. METHODS: A retrospective study of 71 patients (126 sympathectomies) was undertaken. Data were retrieved by hospital records and telephone interview. RESULTS: Follow-up was possible for 92 sympathectomies in 53 patients. Overall, satisfactory results were achieved in 93% of patients and complications were uncommon. Compensatory hyperhidrosis was the most common complication, which occurred in 64% of patients; the trunk and feet were the most common sites. Horner's syndrome occurred in five patients, although in two it was a permanent complication. No patient expressed dissatisfaction with the procedure as a consequence of this complication. Pneumothorax occurred in 17.5% of cases, although the vast majority were incidental findings on a postoperative chest X-ray, and none required drainage. With the newer techniques of access, patient dissatisfaction with the cosmetic appearance has fallen from 27.3 to 6.4%. Overall 90% of patients said they would have the operation again, which represents a high level of patient satisfaction. CONCLUSIONS: Endoscopic thoracic sympathectomy is a safe and effective technique for primary palmer hyperhidrosis. Evolution of the technique has resulted in improvement in patient satisfaction.

Adolescent↗
PubMed1999

Blood lipid profile in ischaemia reperfusion injury.

BACKGROUND: Lipid components are considered to play an important role in ischaemia reperfusion injury although the mechanism of their action remains unknown. Accumulation of lipid metabolites in ischaemic tissues is a consistent observation, but exactly how these lipids are cleared from the tissues by the circulating blood during reperfusion is still open to speculation. In the present study, levels of blood lipids (fatty acids, phospholipids, triglycerides, cholesterol, lysolecithin and lysolecithin platelet activating factor (lyso PAF)) and the enzyme phospholipase A2 were determined in an experimental animal model (dogs) of ischaemic reperfusion injury. METHODS: The injury was induced by 4 h of aortic clamping followed by 2 h of reperfusion (unclamping). Blood samples were collected before clamping and at predetermined time intervals (0, 15, 60 and 120 min) after the release of clamp. The lipid contents were analysed and compared with sham-treated control dogs. RESULTS: The results showed significantly elevated levels of triglycerides and phospholipase A2, during ischaemia and reperfusion in experimental animals indicating tissue damage in the ischaemic phase continuing into the reperfusion phase and the risk of systemic damage from these toxic substances. Total fatty acid content in the circulating blood showed decreasing trends during the same time interval, which suggested possible reduced clearance of accumulated fatty acids from the affected tissues. Serum cholesterol, phospholipids, lyso PAF and lysolecithin did not show any significant variation compared with control dogs. CONCLUSIONS: It is possible that the delayed clearance of fatty acids may be due to the presence of fatty acids binding proteins in the ischaemic tissue, which trap these fatty acids in the tissues during ischaemic reperfusion injury. The prolonged retention of the accumulated fatty acids in the tissues in association with elevated triglycerides and phospholipase A2 activity may contribute to ischaemia reperfusion injury.

Animals↗
PubMed1998

The Perth HLB bifurcated endoluminal graft: a review of the experience and intermediate results.

Endoluminal grafting for abdominal aortic aneurysm based upon Dacron-coated Z stents was commenced in March 1993. A modular system for treatment of infrarenal aorto-iliac aneurysmal disease was developed in 1994. The experimental model, method of delivery, graft construction and initial results were reported. Since 1994, 108 bifurcated HLB (Perth) endografts for infrarenal aorto-iliac aneurysmal disease have been implemented. Initial technical success in deployment and exclusion of the aneurysm was achieved in 94 (87%) cases. Secondary endovascular procedures were performed in six cases and were successful in excluding the aneurysm. Ninety patients are alive currently. Twelve have died of co-morbid conditions. Six have died of aneurysmal disease, either from rupture or the result of treatment attempts. Fifteen early endoleaks (within 30 days) have been detected with three persisting. Four have sealed without further intervention, six after the secondary procedure and two patients have died. Conversion to open aneurysmal repair has been performed in five cases: three early and two late. Two of the early group but none of the late intervention group died. No graft infections have been detected to date. With increasing experience criteria for patient selection for endoluminal grafting and the type of graft to be inserted, have been developed. These criteria, lessons learnt and technical points of importance are discussed.

Aged↗
PubMed1997

Comparison of transperitoneal and retroperitoneal approaches for infrarenal aortic surgery: early and late results.

The retroperitoneal approach to the infrarenal aorta was purported to have a shorter recovery and reduced degree of surgical stress than the transperitoneal approach. Hence, this study aimed to determine any advantages of one approach over the other. One hundred patients undergoing infrarenal aortic surgery between 1989 and 1992 were randomized to the transperitoneal or retroperitoneal approach; 64 operations were for aneurysms (32 transperitoneal, 32 retroperitoneal) and 36 for occlusive disease (18 transperitoneal, 18 retroperitoneal). Parameters monitored were operating time, cross-clamp time, blood loss, fluid requirement in first 24 h, analgesia requirements, gastrointestinal function, morbidity, mortality and length of stay in intensive care and hospital. A minimum 3-year follow-up was obtained to assess mortality and wound problems. Inter-group demographic data were comparable. There was no significant difference between the two approaches for: operating time 190 versus 202 min, P = 0.26); cross-clamp time (72 versus 81 min, P = 0.93); blood loss (1095 versus 1072 ml, P = 0.56); 24-hour fluid requirements (6900 versus 7000 ml, P = 0.45); analgesia requirements (60 versus 55 mg, P = 0.37), gastrointestinal function, morbidity (P = 0.75), mortality, and length of stay in intensive care (2 versus 2 days, P = 0.80) and hospital (10.5 versus 10 days, P = 0.76). In the long term there were significantly more wound problems (bulging, hernias and wound pain) in the retroperitoneal group. Long-term mortality was similar in both groups.

Aged↗
PubMed1997

Conversion from endoluminal to open repair of abdominal aortic aneurysms: a hazardous procedure.

AIM: The purpose of this study was to analyse the technical problems associated with conversion from endoluminal repair of abdominal aortic aneurysms (AAA) to open repair and document the outcome in patients with this clinical course. METHODS: Between May 1992 and May 1996 endoluminal repair of AAA was undertaken in 113 patients. Forty-eight of these had medical co-morbidities which led to them being rejected for open repair at other medical centres. Conversion from endoluminal to open repair was required in 18 patients. Thirteen of these occurred at the original operation (primary conversion) and five occurred at a later operation (secondary conversion). Seven of the 18 patients undergoing conversion had serious medical co-morbidities. Three different methods of open repair were used. The technique selected was determined by the cause of failure leading to conversion. Standard open AAA repair was used in patients requiring conversion for access problems (n = 2) and balloon malfunction, where the device ended up entirely within the aneurysmal sac (n = 1). Modifications to the standard technique were required in patients in which the endograft was correctly positioned immediately below the renal arteries and/or where part of the endograft was within one or both common iliac arteries (n = 11). Supra-coeliac control was required for patients with aortic rupture (n = 1), renal arteries covered by the endograft (n = 2) and situations where the delivery catheter was trapped within the aorta above a twisted bifurcated graft (n = 1). The mean volume of contrast used was 225 ml and the mean operative time was 5.25 h in patients undergoing primary conversion. RESULTS: Conversion to open repair was achieved in all 18 patients. Renal impairment requiring dialysis occurred in three patients. There were three perioperative deaths, all of which were procedure-related (17%), and one late death. All four deaths occurred from among the group of seven patients with preoperative co-morbidities. CONCLUSIONS: Converting an endoluminal to an open AAA repair may require modifications to the standard open technique and result in a much higher than generally accepted morbidity and mortality rate. Patients rejected for open repair because of co-morbidities ran the same chance of requiring conversion as those without co-morbidities (15-17%). If conversion was required, however, they stood a 3 in 7 or 43% chance of dying.

Aged↗
PubMed1997

Endoluminal repair of abdominal aortic aneurysms: strengths and weaknesses of various prostheses observed in a 4.5-year experience.

PURPOSE: To summarize the results of endovascular abdominal aortic aneurysm (AAA) treatment using several endograft designs over a 4.5-year experience and offer comparisons on the various devices. METHODS: From May 1992 to August 1996, 121 AAA patients meeting the criteria for an endoluminal repair were treated with 1 of 5 endograft designs in three configurations. The endografts were implanted in the operating room under fluoroscopic control. Follow-up included contrast-enhanced computed tomography within 10 days of operation, 6 months postoperatively, and annually thereafter. RESULTS: Endografts were successfully deployed in 106 patients (88%). Fifteen cases were converted to open repair. Six procedure-related deaths occurred within 30 days owing to myocardial infarction (3), combined renal failure and septicemia (2), and multisystem failure (1). There were 36 local/vascular complications (30%) and 18 systemic/remote complications (15%). Of the 121 patients undergoing endoluminal AAA repair, 93 (77%) are currently alive and well with their AAAs excluded from the circulation. CONCLUSIONS: Trends in endoluminal AAA repair and prosthetic design point toward simpler devices and earlier treatment of smaller aneurysms once the long-term outcome of aortic endografting has been determined.

Aortic Aneurysm, Abdominal↗
PubMed1997

Successful embolization of persistent endoleak from a patent inferior mesenteric artery.

PURPOSE: To report the successful endovascular occlusion of a persistent endoleak owing to collateral perfusion in a 1-year-old bifurcated aortic endograft. METHODS AND RESULTS: An 81-year-old man underwent endovascular repair of a 5.5-cm abdominal aortic aneurysm (AAA) with a bifurcated stent-graft in 1995; collateral perfusion of the excluded aneurysm by retrograde filling of the patent inferior mesenteric artery (IMA) was noted postoperatively. At his 1-year follow-up, the mid-sac endoleak persisted on contrast-enhanced computed tomography. Using the superior mesenteric artery for access, the stump of the IMA was successfully embolized with glue. CONCLUSIONS: This case, which highlights the importance of documenting a patent IMA prior to AAA endografting, illustrates one option for the management of persistent collateral perfusion of endovascularly excluded aneurysms.

Adhesives↗
PubMed1996

Full-thickness burn and venous thrombosis following intravenous infusion of microwave-heated crystalloid fluids.

Use of microwave-heated crystalloid fluid has been recommended as one method of correcting hypothermia during resuscitation. We report a case of full-thickness burns and venous thrombosis after microwave-heated crystalloid was infused in the management of a ruptured aortic aneurysm. This case highlights the severity of the burn injury that can occur with infusion of heated fluids. Measuring the temperature of the fluid before the start of the infusion will avoid this complication.

Aged↗
PubMed1996

The Perth endoluminal bifurcated graft system--development and early experience.

The study aim was to develop a reliable endoluminal graft system that would enable the deployment of a bifurcated graft for infrarenal abdominal aortic aneurysms. A life-size plastic model was made of an abdominal aorta and iliac arteries, with a 50-mm infrarenal abdominal aortic aneurysm. This model was used to develop and test self-expanding graft systems, based on a barbed Gianturco stent and series of stainless-steel 'Z' stents within a woven Dacron graft. The bifurcated system developed involves a trouser graft with one long leg and one short. This graft-system is delivered through one femoral artery with deployment of the proximal aortic end infrarenally and the longer trouser leg within the ipsilateral common iliac artery. The short trouser leg is left hanging free within the distal end of the aneurysm cavity, just above the bifurcation. It is held open by a self-expanding stent and is cannulated from the contralateral femoral artery with a guide wire. A simple straight self-expanding stented graft is then deployed to extend this short trouser leg down into the common iliac artery, effectively creating an extension to the short leg. The graft system has been deployed in 21 patients with satisfactory exclusion of the aneurysm in 17 (81%). There has been one mortality and no conversion to open repair. All 17 aneurysms remain excluded at median follow-up of 30 (range 4-60) weeks. None of the four graft stents that leaked (two proximal and two distal) sealed spontaneously. Deployment of the uncovered Gianturco stent across the renal artery origins in 18 cases (85%) has not been associated with renal artery occlusion or deterioration in renal function at a median follow-up of 30 (range 4-60) weeks. The ability to deploy a bifurcated system increases the potential for endoluminal treatment of abdominal aortic aneurysm.

Aged↗
PubMed1996

A self-expanding endoluminal graft for treatment of aneurysms: results through the development phase.

BACKGROUND: The results of two and a half years' experience of endoluminal treatment of aneurysmal disease (from March 1993 to December 1995) are reported. METHODS: The endoluminal grafts were individually made at Royal Perth Hospital. They are based on Dacron-covered stainless steel self-expanding 'Z' stents with Gianturco barbed stents (Cook Pty, Australia) for proximal anchorage for grafts within the aorta. RESULTS: Fourteen straight tube grafts (nine for aortic aneurysm, four for iliac aneurysm and one for subclavian aneurysm) and 24 bifurcate grafts were deployed; all were in patients considered high-risk for conventional repair. Seventy-two per cent of the straight tube grafts successfully excluded the aneurysm. The bifurcate grafts, in use since July 1994, successfully excluded the aneurysm in 88%. There were two delayed deaths from rupture after the grafts failed to exclude the aneurysms; two patients required conversion to open repair and survived; three patients have persistent endoleaks; and three of the bifurcate grafts subsequently occluded a graft limb but did not require further intervention. Ninety per cent of these complications occurred in the first half of the series (prior to January 1995). CONCLUSIONS: A learning and development curve was clearly apparent. The results thereafter compare favourably to those for open repair in similar high-risk groups, suggesting that these techniques hold promise for all patients with aneurysms.

Aged↗
PubMed1994

Femoral arteriovenous fistulas complicating percutaneous cardiac procedures.

Arteriovenous fistulas resulting from cardiac interventional radiological procedures are reported to be rare. Three patients are presented who developed femoral arteriovenous fistulas after cardiac catheterization. The fistulas were discovered incidentally. The patients had symptoms of intermittent claudication which improved after correction of the fistula alone in two patients, suggesting that the fistulas were contributing to the symptoms of claudication. The reported incidence of 0.28% for arteriovenous fistulas after interventional procedures is probably an underestimate because they are often symptomless and only discovered incidentally during examination for another problem. When discovered they should be corrected because they can cause reduction in blood flow to the affected limb and produce symptoms if occlusive disease is already present.

Aged↗
PubMed1993

Arteriovenous fistula: a rare complication after iliac bone graft.

Arteriovenous fistula, a rare complication arising after iliac bone graft, is reported. The patient presented with symptoms of heart failure. Perforation of the medial iliac wall at the time of bone harvesting most probably caused the fistula. Treatment by balloon occlusion of the fistula via the percutaneous route was successful, thus avoiding a difficult operation.

Angiography↗