Biomedical subjects

A Azizzadeh

Publications and source records attributed to A Azizzadeh.

6 recordsLinked to original sources

PubMed2000

Reversal of twice-delayed neurologic deficits with cerebrospinal fluid drainage after thoracoabdominal aneurysm repair: a case report and plea for a national database collection.

Delayed neurologic deficits are an uncommon yet devastating complication of thoracoabdominal aortic aneurysm repair. The mechanisms involved in the development of delayed spinal cord ischemia remain ill defined. We report a case of complete reversal of delayed neurologic deficits with postoperative cerebrospinal fluid (CSF) drainage. After a thoracoabdominal aneurysm extent I repair, the patient experienced delayed paraplegia at 6 hours and again at 34 hours after the operation, with elevated CSF pressure (>10 mm Hg) on both occasions. Prompt CSF decompression completely reversed the neurologic deficits within hours after onset. The findings in this case further support the role of CSF drainage in spinal cord protection for patients who undergo thoracoabdominal aneurysm repair and make a plea for a national database collection.

Aged↗

PubMed1998

Complete ear replantation without venous anastomosis.

Traumatic amputation of the entire auricle is a rare occurrence. Management ideally consists of microvascular reconstruction of auricular arterial, venous, and nerve continuity. However, appropriately sized veins are often not available and venous drainage must be accomplished with leech therapy. In occasional cases where leeches are unavailable or cannot be made to attach, mechanical drainage and anticoagulation can give satisfactory drainage. The authors present a case of mechanical wick venous drainage of a complete ear replantation, resulting in virtually normal appearance and function of the ear. In addition, the ear regained normal touch and two-point sensibility, although the great auricular nerve had not been repaired.

Adult↗

PubMed1998

Spinal cord protection in descending thoracic and thoracoabdominal aortic aneurysm repair.

During aneurysm repair of the descending thoracic or thoracoabdominal aorta, the likelihood of neurological complications increases greatly after only 30 minutes of spinal cord ischemia. However, the manifestation of paraplegia or paraparesis relates not only to aortic cross-clamping time, but to multiple factors that may include aortic dissection, previous aortic surgery, advanced age, preoperative renal insufficiency, rupture, and most significantly, aneurysm extent. At greatest risk is the patient with type II thoracoabdominal aortic aneurysm. For this patient the simple cross-clamp technique, which uses no protective surgical adjuncts, heightens the threat of neurological deficit. With the surgical adjuncts of cerebrospinal fluid drainage and distal aortic perfusion, the probability of neurological deficit is appreciably lowered.

Aortic Aneurysm, Abdominal↗

PubMed1998

Insulin secretion is inhibited by subtype five somatostatin receptor in the mouse.

BACKGROUND: Recently five somatostatin receptor subtypes (SSTRs) were cloned, allowing the development of highly specific agonists to these SSTRs. Previous studies have shown a species specificity phenomenon with respect to the inhibition of insulin secretion by these selective agonists. This study was undertaken to determine which SSTR (2 or 5) is responsible for the inhibitory effect of somatostatin on glucose-stimulated mouse insulin secretion. METHODS: Intact mouse islets (n = 10) were stimulated with D-glucose in the presence or absence of receptor-specific somatostatin agonists. RESULTS: D-glucose (16.7 mmol/L) augmented insulin secretion by 158% above that seen with 3.9 mmol/L D-glucose. In the presence of DC 32-92 (SSTR5) selective agonist, D-glucose (16.7 mmol/L) augmented insulin secretion by 64% above that seen with 3.9 mmol/L D-glucose. The presence of SSTR 5 selective agonist resulted in a significant (P < .05) inhibition of glucose-stimulated insulin secretion. The identification of SSTR5 within the mouse pancreas was established by reverse transcriptase polymerase chain reaction and confirmed by Southern blot analysis. CONCLUSIONS: These results suggest that the inhibitory effect of somatostatin on insulin secretion is mediated through the subtype 5 receptor within the mouse islet.

Animals↗

PubMed1997

Observations on delayed neurologic deficit after thoracoabdominal aortic aneurysm repair.

PURPOSE: To describe the phenomenon of delayed-onset neurologic deficit after thoraco-abdominal aortic aneurysm repair and to discuss management of this type of deficit in a case series. METHODS: Since September 1992 we have used cerebrospinal fluid drainage and distal aortic perfusion routinely to reduce the risk of neurologic deficit in thoracoabdominal aortic aneurysm patients. All patent intercostal arteries were reattached when this was technically feasible. Delayed neurologic complications occurred in eight patients who underwent operation for thoracoabdominal aortic aneurysm between September 1992 and March 1997, between 1 and 14 days after awakening from anesthesia. All patients had immediate cerebrospinal fluid drainage on recognition of their symptoms. RESULTS: Patients were evaluated by an independent neurologist and were classified by a modified Tarlov score between 0 and 5. All eight patients improved at least two points by discharge. The mean change in Tarlov score from onset to discharge was 2.4 +/- 1.1 (p = 0.008). CONCLUSIONS: Cerebrospinal fluid drainage significantly improved late-onset neurologic deficit that occurred between 1 day and 2 weeks after operation in our series. Immediate drainage should be considered when signs of neurologic deficit first begin to appear.

Adult↗

PubMedDate not supplied

Thoracic aortic aneurysms.

Remarkable progress has been made in the surgical treatment of thoracoabdominal aortic aneurysms. The decline in mortality and complication rates can be attributed to improvements in perioperative care and in surgical technique, particularly the adoption of adjunct distal aortic perfusion and cerebrospinal fluid drainage. Neurologic deficit is no longer a major threat to patients, as the use of adjuncts has brought the incidence down to 2.4% for all thoracoabdominal aortic aneurysms. However, we continue to pursue research to improve organ preservation, particularly for the most troublesome extent II thoracoabdominal aortic aneurysm.

Aortic Aneurysm, Thoracic↗