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Biomedical subjects

D M Shah

Publications and source records attributed to D M Shah.

At least 199 records · Page 11Linked to original sources
PubMed1985

Hypertrophic cardiomyopathy and pregnancy: report of a maternal mortality and review of literature.

The first case of maternal mortality with hypertrophic obstructive cardiomyopathy is reported. An additional successfully managed case of hypertrophic obstructive cardiomyopathy and pregnancy is reported. Systemic arterial embolization, which has not been previously reported in hypertrophic obstructive cardiomyopathy with pregnancy is discussed. English language literature on hypertrophic obstructive cardiomyopathy and pregnancy is reviewed, and a management plan has been outlined.

Adult↗
PubMed1985

Separated chorioamnion and elevated chorion: sonographic features and clinical significance.

The clinical presentation and outcome of pregnancy was analyzed in thirteen patients in whom a free-floating intrauterine membrane was found on sonography. The cases were divided into two groups: those with elevated chorion and those with chorioamniotic separation. Five of seven patients with chorioamniotic separation progressed normally to term and delivered normal infants. In the two pregnancies with chorioamniotic separation that did not progress to term, one was associated with a placental chorioangioma and the other had a dead fetus that had a cystic hygroma indicative of Turner's syndrome. Of the six patients with elevated chorion, all presented with an episode of vaginal bleeding in the early second trimester. Five of six patients with elevated chorion progressed to term with the delivery of normal infants. One patient with extensive elevation of the chorion aborted. Three patients with elevated chorion had a subchorionic clot, whereas this was not present in patients with separated chorioamnion. Follow-up sonographic examination of patients with separated chorioamnion and elevated chorion revealed that most (11 of 13), but not all pregnancies in which an intrauterine membrane was found progressed to term without complications.

Abortion, Spontaneous↗
PubMed1984

Rhesus isoimmunization in twin gestation.

The incidence of Rh isoimmunized twin gestation is extremely low. There are several perinatal risks inherent to twinning. Rhesus isoimmunization further increases hazards of such a compromised gestation. This paper reports three cases of rhesus isoimmunization in twin gestation, discusses the selective problems of such pregnancies, and reviews the pertinent literature.

Amniocentesis↗
PubMed1984

Indocyanine green. Its use as an early indicator of hepatic dysfunction following injury in man.

To evaluate hepatic function, the kinetics of indocyanine green clearance were studied in seven injured patients with hepatic venous catheters. Indocyanine green clearance after a bolus injection of 20 mg was relatively monoexponential on the first day after injury. Following this, a second slower compartment of indocyanine green clearance was uniformly evident, becoming most prominent around the fourth day after injury. Indocyanine green clearance again became more uniform as recovery continued. Fractional indocyanine green extraction ten minutes after injection decreased from 0.9 on the first day after injury to 0.2 three days later, and then returned to 0.7 on the seventh day after injury. These decreases in indocyanine green clearance preceded an increase in total serum bilirubin concentration to a mean value of 1.9 mg/dL. Indocyanine green clearance was thus found to be an early and sensitive indicator of impaired hepatic function.

Adolescent↗
PubMed1984

Polytetrafluoroethylene grafts in the rapid reconstruction of acute contaminated peripheral vascular injuries.

Conventional wisdom dictates that autogenous tissue interposition be used in contaminated wounds when direct vascular repair is not feasible. Although there are few reports of successful use of PTFE grafts in grossly contaminated wounds, doubt still exists regarding the use of any prosthetic material in such wounds for reconstruction of vascular injury. Twenty-five vascular reconstructions were performed in 20 patients during a 3.5 year period. These patients had life-threatening multiple trauma and severe local tissue damage along with their arterial and venous injuries in open contaminated wounds after blunt (16 patients) and penetrating (4 patients) trauma. In all patients, 6 mm PTFE was used for interposition bypass for arterial injuries, and in five of these patients, 8 mm PTFE was used for concomitant venous interposition bypass. One patient died and there was one arterial and one venous graft thrombosis in the same patient 3 months after a shotgun blast injury to the groin, but there was no limb loss. All other grafts remained patent without wound infection, sepsis, or anastomatic disruption. Under the circumstances of these peripheral vascular injuries, PTFE was an acceptable choice for primary reconstruction in our patients. Its ready availability in many calibers, sparing of autogenous vein for future use, and its expedience in vascular reconstruction comprise the advantages of using PTFE in multiply traumatized patients without producing the feared evidence of infected prosthetic grafts.

Arteries↗
PubMed1984

Instrumental evolution of the valve incision method of in situ saphenous vein bypass.

The previously stated advantages of the valve incision method of in situ saphenous vein arterial bypass have now been confirmed by others. However, this method has been limited by its time-consuming technical demands. Considerable experience with this bypass in conjunction with retrograde serial valve disruption with instruments of similar design principle (by Hall and Cartier) has been accumulated in Europe. However, the combination of the trauma of blunt valvular fracture and the sensitivity of endothelium to frictional shear has precluded use of these instruments in veins less than 4 mm in size, and the results have not been significantly better than those obtained with reversed vein bypass. An instrument (valve cutter) that achieves serial valve incision safely and consistently without mandatory exposure of each valve site has now been developed. Of the last 166 consecutive bypasses, the saphenous vein was suitable for use of this instrument in 116 instances (70%). The patency of these bypasses as determined by life-table analysis has shown no significant difference when compared with bypasses performed under similar conditions in which the cutter was not used. On the basis of this investigative and clinical experience, the majority of in situ saphenous vein arterial bypasses can be safely facilitated and simplified by use of this instrument.

Humans↗
PubMed1984

Reversal of fibronectin and opsonic deficiency in patients. A controlled study.

Plasma fibronectin is an opsonic glycoprotein which augments reticuloendothelial phagocytic clearance of nonbacterial particulates. We evaluated the influence of intravenous infusion of plasma cryoprecipitate on circulating immunoreactive fibronectin and associated opsonic activity at 0.5, 2.0, 4.0, 10, and 21 hr postinfusion in septic (n = 8) and nonseptic (n = 6) surgical and/or trauma patients with documented plasma fibronectin deficiency. The study was a randomized, double-blind, crossover clinical protocol in which fibronectin-poor (0.116 +/- 0.025 mg/ml) cryoprecipitate extracted plasma (placebo) was compared to fibronectin-rich (2.139 +/- 0.161 mg/ml) plasma cryoprecipitate. Septic injured patients (149.37 +/- 17.11 micrograms/ml) had lower (p less than 0.05) plasma fibronectin levels than nonseptic injured patients (212.17 +/- 7.14 micrograms/ml) and both were less (p less than 0.05) than normal (330 +/- 30 micrograms/ml). As tested in vitro with a peritoneal macrophage monolayer assay, cryoprecipitate manifested opsonic activity related to its fibronectin concentration. Intravenous infusion of fibronectin rich cryoprecipitate reversed both the immunoreactive fibronectin and opsonic deficiency, while infusion of the placebo at a comparable total protein load did not reverse either deficient parameter. Reversal of fibronectin deficiency was more sustained in nonseptic injured patients as compared to septic injured patients. Thus, reversal of opsonic deficiency in septic and nonseptic injured patients is observed after infusion of plasma cryoprecipitate and not with infusion of fibronectin deficient plasma at comparable protein loads. Also, cryoprecipitate extracted plasma may serve as an appropriate control solution for randomized studies evaluating the therapeutic value of fibronectin-rich plasma cryoprecipitate.

Adolescent↗
PubMed1984

In situ vein branch angioplasty.

This technique has proved useful in dealing with a variety of difficult technical problems encountered during the performance of "in situ" vein bypass. Among these are the management of fibrotic valves, endothelial damage with platelet adhesion, accidental valvulotome perforation or stenosis of short segments of the saphenous vein. The lumen of even quite small veins can easily be visualized and a subsequent repair accomplished without compromise of the venous lumen, while the patch remains in continuity with the saphenous vein.

Humans↗
PubMed1984

In situ vein bypasses to distal tibial and limited outflow tracts for limb salvage.

To better define the limits of tibial reconstruction with saphenous vein bypass, we have analyzed our experience with the in situ vein valve incision technique in 83 cases of bypasses to the ankle or foot and 13 cases of bypasses to discontinuous tibial vessels. Bypasses to the ankle and foot had a 36-month cumulative patency rate of 70.4%. No statistical difference was noted with the use of small-caliber veins. The length of the bypass did not prejudice the long-term patency rate. Discontinuous tibial vessels can be used satisfactorily as an outflow tract for limb salvage.

Adult↗
PubMed1984

Peroneal artery bypass: a reappraisal of its value in limb salvage.

In general the surgical literature has expressed pessimism about the value of bypass to the peroneal artery for limb salvage. The combination of greater technical difficulty, low patency rates, and hemodynamic failures have led to the establishment of this prejudice. In a review of 284 arteriograms in limbs with infrapopliteal arterial occlusion, the peroneal artery was the least diseased in 40% and was the only available vessel in 37% of instances. One hundred fifty-two peroneal bypasses have been performed in a 7-year period, 116 by the in situ method, 23 with excised vein, and 13 by nonautogenous conduits. During the same period 125 anterior tibial and 114 posterior tibial bypasses were also done. The mean preoperative ankle/brachial indices were 0.27 for peroneal, 0.25 for anterior tibial, and 0.29 for posterior tibial bypasses. These were converted to mean postoperative indices of 0.84, 0.86, and 0.92, respectively. Corresponding transmetatarsal/brachial indices were 0.72, 0.75, and 0.90. Rest pain was relieved in all these patients, and in 94 patients with tissue loss, there were 11 major amputations, nine healed forefoot amputations, and 20 healed digital ray amputations. Hemodynamic failures were two in the peroneal, two in the anterior tibial, and three in the posterior tibial group with one perioperative amputation in each. The cumulative limb salvage rate at 3 years for the peroneal group was 81%. This experience has shown that the patency and limb salvage rates obtained are comparable to those for the anterior and posterior tibial arteries and that hemodynamic failure is an uncommon occurrence.(ABSTRACT TRUNCATED AT 250 WORDS)

Amputation, Surgical↗
PubMed1984

Retrograde valve incision for insitu vein-arterial bypass utilising a valvulotome.

The insitu vein bypass has become our preferred technique for infrainguinal limb salvage procedures. This article describes the technique of retrograde valve incision utilising a valvulotome and points out some of the potential complications and problems that can occur when utilising this instrument and stresses ways to avoid technical mishaps.

Arteries↗
PubMed1983

Clinical use of the seromuscular jejunal patch for protection of the infected aortic stump.

Pathologic interactions between aortic prostheses and the gastrointestinal tract are very difficult problems in vascular surgery. After excision of the graft and proximal aortic closure, the major unsolved problem has been continued sepsis of the proximal aortic stump with subsequent fatal disruption. To provide healthy tissue for protection of this crucial area, we have devised a method in which a piece of jejunum on its vascular pedicle is opened along its antimesenteric border, the mucosa is removed, and the vascularized muscular wall is anchored to the aortic stump. This seromuscular jejunal patch was used clinically in three patients. Postmortem examinations in two of these patients 4 and 45 days postoperatively revealed no signs of infection, hematoma, or mucocele, and no histologic abnormalities; instead, the examinations did reveal firm tissue adherence between the aortic stumps and the seromuscular patches. The third patient is alive and well 1 year after this procedure. The three patients have demonstrated the feasibility of secure aortic stump protection by placement of well-prepared, vascularized seromuscular jejunal tissue over the potentially infected aortic stump. This technique may prevent postoperative stump dissolution and thus far appears to be a reasonable solution to this usually lethal problem.

Aged↗
PubMed1983

Hepatic perfusion and splanchnic oxygen consumption in patients postinjury.

Hepatic dysfunction following injury is felt to be due to hepatic ischemia. To test this hypothesis we measured hepatic blood flow (HBF) and splanchnic oxygen delivery and consumption in nine multiply injured patients. HBF, measured by indocyanine green clearance, was 0.4 +/- 0.1 L/min/m2 12 hours after injury. It steadily increased to 1.3 +/- 0.1 L/min/m2 by 1 week after injury. Changes in cardiac output were similar and were due largely to changes in HBF. Hepatic hypoperfusion was correlated with subsequent increases in serum bilirubin. High oxygen consumption was associated with high HBF and oxygen delivery, and splanchnic oxygen consumption became a large fraction (range, 21-67%) of total body oxygen consumption. Although splanchnic oxygen delivery was diminished with low HBF, splanchnic oxygen consumption remained normal (37 +/- 2 ml/min/m2) due to increased oxygen extraction. We conclude that hepatic blood flow is markedly reduced after injury. Reduced HBF is correlated with liver dysfunction although normal splanchnic oxygen consumption is maintained.

Accidents, Traffic↗
PubMed1983

The current position of nonresective treatment for abdominal aortic aneurysm.

This is a review of our 5 1/2-year experience with the treatment of infrarenal abdominal aortic aneurysms by thrombosis induced by outflow obstruction while adequate lower limb perfusion is simultaneously ensured by axillofemoral bypass. Sixty high-risk patients who were considered to be unsuitable for direct aortic replacement have been so treated. Preoperative angiographic investigation of the pelvic and visceral vessels is mandatory. Thrombosis of the aneurysm occurred in 42 patients within 72 hours after surgical interruption of the iliac outflow, while in the remainder, persistent patency was dealt with by radiologic deposition of thrombotic material in the remaining outflow arteries. Contrary to our previous report, an augmented computerized tomographic scan has proved to be more accurate than radionuclide flow studies for the determination of complete aneurysmal thrombosis. There were four deaths within 40 days (7%), and the remaining patients were followed for 6 to 48 months. There were three fatal ruptures, all as the result of inaccurate indication of thrombosis by radionuclide flow scan. The rate of survival by life table analysis was 55% at 24 months. There has been no evidence of proximal extension of the infrarenal thrombosis to visceral vessels. This experience suggests that this technique offers a reasonable alternative to the treatment of abdominal aortic aneurysms when the indication is compelling and the risk of direct graft replacement is excessive.

Actuarial Analysis↗
PubMed1983

Metabolic alterations in trauma: lactate and pyruvate levels after aortic surgery.

Arterial lactate and pyruvate concentrations were measured in five patients undergoing abdominal aneurysmectomy. In all cases, a bimodal rise and fall in both lactate and pyruvate levels were observed. Hemodynamic data indicated that cardiac output as well as oxygen delivery and consumption were constant throughout this period. The first lactate peak which was initially related to the cross-clamping of the aorta, but which continued for a period of 5 h after removal of the clamp, was characterized by elevated lactate to pyruvate ratios indicating an anaerobiosis. A transient hyperglycemia was also present during this lactate peak. Ten to 15 h later, when lactate and pyruvate levels were returning to normal levels, a second peak occurred in both lactate and pyruvate lasting 10 h in all five patients. A relatively large increase in pyruvate levels also occurred during this second peak so that the lactate to pyruvate ratios remained normal. This suggests that the second peak was characterized by aerobic metabolism and may have been due to a defect in pyruvate metabolism.

Aorta, Abdominal↗