Biomedical subjects

F Kafie

Publications and source records attributed to F Kafie.

5 recordsLinked to original sources

PubMed1999

Screening and preoperative imaging of candidates for carotid endarterectomy.

Randomized clinical trials have provided us with clinical guidelines regarding the indications for performing carotid endarterectomy in patients who have symptomatic and asymptomatic disease. Logically, any patient with a history of transient ischemic attacks, amaurosis fugax, or stroke should be evaluated for extracranial carotid artery occlusive disease. In asymptomatic patients, however, carotid artery surveillance may be helpful in identifying those at risk before neurological events. Patients at particularly high risk include those identified with (1) manifestations of systemic atherosclerotic disease (peripheral vascular disease, coronary artery disease, renovascular disease); (2) presence of a carotid bruit; (3) advanced age (> 65 years); and (4) ABI less than 0.7. Duplex ultrasonography remains the best and most widely used noninvasive screening method, but its accuracy is highly technologist dependent. A high-quality duplex study may, in itself, be adequate to determine whether the severity of extracranial carotid occlusive disease warrants surgical intervention. Catheter-based arteriography may be used as an adjunct to validate duplex results, but its invasive nature and risk of complications has popularized alternative imaging methods. Of these, magnetic resonance angiography (MRA) and spiral computed tomographic angiography (CTA) show excellent promise as noninvasive imaging techniques for the evaluation of extracranial carotid artery occlusive disease.

Angiography↗

PubMed1998

Local treatment of prosthetic vascular graft infection with multivesicular liposome-encapsulated amikacin.

BACKGROUND: Contaminated surgical fields limit the use of prosthetic vascular grafts. We studied the efficacy of sustained-release amikacin applied locally to contaminated grafts in the prevention of infectious complications. MATERIALS AND METHODS: Thirty-one New Zealand white rabbits underwent placement of a polytetrafluoroethylene (PTFE) interposition graft in a 1-cm segment of the descending aorta. The surgical field was infected with application of 10(5) to 10(8) Staphylococcus aureus organisms suspended in normal saline solution. Nineteen rabbits underwent contaminated aortic graft placement without treatment. Twelve rabbits were treated with local application of 2.5 ml of amikacin encapsulated in lipid particle-based sustained-release dosage form. Rabbits were observed for 2 weeks and then evaluated for the presence of graft infection. RESULTS: Seventy-five percent of the treated rabbits survived without evidence of graft infection or systemic sepsis versus 37% in the untreated group (P < 0.04). Cultures verified the absence of organisms in all surviving rabbits without clinical infection. CONCLUSIONS: Sustained-release lipid particle-encapsulated amikacin applied to contaminated PTFE grafts increased survival and decreased postoperative graft infections. Adjunctive use of local, delayed-release antibiotics in contaminated vascular beds may allow wider clinical use of prosthetic grafts.

Amikacin↗

PubMed1998

Effect of lung volume reduction surgery on pulmonary diffusion capacity in a rabbit model of emphysema.

BACKGROUND: While there is renewed interest in lung volume reduction surgery (LVRS) for treatment of emphysema, many aspects of the operation such as patient selection and surgical end points of excision are uncertain. We studied the effects of LVRS on measured lung volumes and diffusion capacity in an animal model to investigate optimal resection volumes. METHODS: Emphysema was induced in 32 New Zealand white (NZW) rabbits using aerosolized elastase. Helium dilution lung volumes and single breath DLCO were measured concurrently at baseline, following induction of emphysema (preop), and 1 week postoperatively (postop) following LVRS. Bilateral upper and middle lobe stapled lung resections were performed through midline sternotomies with excision of variable amounts of lung tissue from 1.8 to 5.8 g. RESULTS: FRC increased following induction of emphysema and decreased postoperatively. DLCO improved with increasing lung tissue resection up to 3 g of tissue and then decreased as even greater amounts were removed (r = 0.54). CONCLUSIONS: Measured lung volumes increase with development of emphysema and appropriately decrease in response to LVRS in this rabbit model. DLCO improves with moderate resection but then decreases with excessive excision of lung quantities and may help define one physiologic operative end point. In this rabbit model, excision of approximately 30% of lung volume was optimal and prevented further decrease in diffusion capacity.

Animals↗

PubMed1997

Factors related to outcome in blunt intestinal injuries requiring operation.

Associated factors related to outcome following blunt intestinal trauma requiring operative therapy were retrospectively reviewed in all trauma patients admitted to one Level I trauma center. Over 4.5 years, 7598 trauma patients were evaluated, with 62 patients having sustained 92 blunt intestinal injuries requiring operative intervention. Mean age was 34.5 years; mean Injury Severity Score was 22. Mechanism of injury was motor vehicle accident in 50 (81%), with 80 per cent being drivers. Associated intra-abdominal injuries occurred in 46 (74%) patients. Extra-abdominal injuries occurred in 56 patients (90%). Thirty-one patients suffered 82 complications or 2.6 complications per patient (comp/pt). Mortality from operative blunt trauma was associated with admission blood pressure < or = 90 mm Hg (57 vs 13%; P < 0.05), age > or = 24 years (26 vs 0%; P < 0.05), and Injury Severity Score > or = 35 (70 vs 8%; P < 0.05). Morbidity was associated with age > or = 24 years (1.5 vs 0.7 comp/pt; P < 0.05) and delay in operative therapy > or = 24 hours (3.3 vs 1.1 comp/pt; P < 0.05). Overall mortality was 18 per cent.

Abdominal Injuries↗

PubMed1996

Lung volume reduction surgery for emphysema.

There has been dramatic resurgence of interest in surgical treatment of emphysema, particularly "lung volume reduction" procedures. Recent studies have demonstrated improvements in pulmonary function, lung mechanics, exercise tolerance, and quality of life in selected patients following volume reduction procedures. However, considerable uncertainty remains regarding overall benefit, optimal patient selection, operative techniques, and duration of response. This summarizes current approaches to lung volume reduction surgery, available clinical outcome information, selection criteria, and physiologic mechanisms of response, and discusses the potential role for surgical volume reduction in treatment of emphysema. Recent data appear to support the efficacy of bilateral staple lung volume reduction surgery in patients with severe symptomatic heterogeneously distributed emphysema. Further studies will be needed to determine relative value of different operative techniques and benefit in patients with other clinical presentations.

Algorithms↗