PubMed Health⌕ Search

Biomedical subjects

F Robicsek

Publications and source records attributed to F Robicsek.

At least 37 records · Page 2Linked to original sources
PubMed1990

Can AIDS be prevented after injury with contaminated instruments?

Particulate matter comparable in size with that of human immunodeficiency virus was subcutaneously injected into experimental animals. Such matter remained at the inoculation site long enough to suggest the possibility that human immunodeficiency virus can be destroyed in loco before it invades the host's circulation. These findings may be useful in developing a method to prevent acquired immunodeficiency syndrome after accidental injury with human immunodeficiency virus-contaminated instruments.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Enhancing the applicability and effectiveness of intraaortic balloon counterpulsation.

Severe maneuvers designed to enhance the applicability and effectiveness of intraaortic balloon pulsation are presented. (1) Insertion of balloon catheter directly into the ascending aorta. The technique uses an indwelling silastic snare that allows direct insertion of a balloon catheter into the ascending aorta in the course of open heart operations without the necessity of returning the patient to the operating room and reopening the chest at the time of balloon catheter removal. (2) Elimination of electric artifacts in the course of intraaortic balloon assist. A method is presented that utilizes optical rather than electric signals to operate the intraaortic balloon pump and eliminates pacer interference as well as other electrical artifacts. (3) Enhancing assist effectiveness by balloon positioning. In a series of clinical observations, it was found that the effectiveness of balloon assist may be enhanced by as much as 75% by appropriate positioning. The previously held concept that placing the balloon in a subclavian location is optimal is challenged and it is recommended that the proper position of the balloon catheter be determined by using appropriate hemodynamic measurements in different locations. (4) Control of bleeding following removal of percutaneously inserted transfemoral balloon catheter. The technique utilizes a balloon catheter which is introduced into the puncture hole of the femoral artery after minimal surgical dissection and allows direct suturing of the bleeding source.

Artifacts↗
PubMed1990

Biological thresholds of cold-induced phrenic nerve injury.

The effects of controlled cooling on phrenic nerve signal conduction were investigated by cooling an isolated segment of the phrenic nerve with a constant but variable temperature probe. The conduction of a standard electrical stimulus applied to the nerve proximal to the cooled section was measured by detector electrodes sutured to the diaphragm. Nerve conduction of the applied stimulus ceased between 10 degrees and 12 degrees C but returned within seconds after the probe was removed. The delay in the return of conduction increased as nerve temperature decreased until at a temperature of 4 degrees C the ability to conduct did not return after 4 hours. The amount of fat surrounding the nerve and the blood flow rate along the cooled portion of the nerve were observed to ameliorate the effects of low temperature on stimulus conduction. Total body cooling also appears to offer some protection against loss of conduction.

Animals↗
PubMed1989

Traumatic tears of the thoracic aorta: improved results using the Bio-Medicus pump.

Traumatic disruption of the descending thoracic aorta is a relatively rare but dramatic injury. Controversy remains regarding the use of shunts during operative repair. Discouraged by our results using the "no shunt" technique, we adopted the recently reported technique using the Bio-Medicus pump for left atrium-femoral artery bypass without heparin sodium. At Charlotte Memorial Hospital and Medical Center, 39 patients were treated for tears of the descending thoracic aorta between January 1979 and October 1988. Eight patients died before repair could be completed. Four patients underwent repair using femorofemoral bypass with 1 death and no instances of paraplegia. Fifteen patients had repair using the no-shunt technique with 4 deaths and three instances of paraplegia. Since January 1986, 12 patients have been treated using the Bio-Medicus heparinless pump with no deaths and no instances of paraplegia. We present our experience to confirm the reports of others regarding the efficacy of this technique. We believe it reduces the morbidity and mortality associated with this serious injury and aids in the hemodynamic management of the patient during aortic clamping.

Adult↗
PubMed1989

The complex posterior septal space in the Wolff-Parkinson-White syndrome. Surgical experience with 47 patients.

Forty-seven consecutive patients with the Wolff-Parkinson-White syndrome due to posterior septal accessory pathways were operated on from August 3, 1983 to March 23, 1989. Seven of these patients had Ebstein's anomaly, another three coronary sinus aneurysms, one a persistent left superior vena cava, and five others complex multiple pathway combinations. Two additional patients required surgery following unsuccessful catheter ablation and one after failed surgery at another institution. Thus nineteen of forty-seven patients (40%) had additional difficulty factors which tend to complicate the operative dissection in this already complex anatomical area. The surgical anatomy of the posterior septal space as well as the essential operative principles and techniques are reviewed. Each of the frequently encountered additional difficulty factors is described with emphasis on the coronary sinus aneurysm, a recently recognized entity.

Adolescent↗
PubMed1989

Presternal muscle padding following midline sternotomy.

The authors present a modification to closure of the sternotomy incision. The procedure consists of detaching the pectoralis muscles on both sides of the edges of the sternum and uniting them presternally.

Electrocoagulation↗
PubMed1989

Balloons.

Explore the source record for details and available documents.

Aortic Valve Stenosis↗
PubMed1989

Experiments with a bowl of saline: the hidden risk of hypothermic-osmotic damage during topical cardiac cooling.

Some of the misconceptions in the application of cardiac hypothermia are that the temperature of cold normal saline solution is necessarily above 0 degrees C, cold saline solution and slush are relatively safe for living tissues, and normal saline will retain normal osmolality even if partially frozen. These postulates were examined in thermodynamic experiments that demonstrated three points: (1) The temperature of unfrozen saline solution may drop way below the freezing point. (2) When liquids and solid components of saline solution are separated, the components will become hypo-osmolar or hyperosmolar. (3) Ice chips and slush ice produced in the operating rooms may reach temperatures as low as -36 degrees C. We recommend that the possibility of these events should be taken into consideration whenever topical cardiac hypothermia is clinically applied.

Cold Temperature↗
PubMed1988

Balloon valvuloplasty in calcified aortic stenosis: a cause for caution and alarm.

Balloon dilation by the percutaneous route has recently been recommended as an alternative to surgical intervention in the management of calcified aortic valvular stenosis. To investigate the validity of balloon valvuloplasty, this procedure was carried out in the operating room under direct vision in 30 patients just prior to excision and replacement of the ossified aortic valve. Changes induced by balloon dilation were evaluated by visual inspection as well as by geometric measurements. By visual observation, balloon valvuloplasty did not have a detectable impact on the valvular anatomy in about 19 of the patients and induced enlargement of the functional aortic orifice judged as "minimal" or "moderate" in only 11. In no patient was there a substantial increase in the functional orifice size. These findings were supported by geometrical measurements. Therefore, we believe that the virtues of this procedure have been grossly overstated by its proponents and that it should be offered only to patients who present a truly forbidding risk by standards of modern surgery.

Adult↗
PubMed1988

Rapidly growing nontuberculous mycobacteria: a new enemy of the cardiac surgeon.

A review of atypical mycobacterial infections complicating cardiac operations is presented. Proven sources of infections at different institutions include contaminated porcine valves and municipal water supply, but the mode of transmission in the great majority of patients remains unclear. There are two principal clinical forms of atypical mycobacterial infections after cardiac operations--endocarditis and sternal osteomyelitis. The latter has characteristics resembling tuberculotic "cold abscess." Specialized laboratory testing is necessary to confirm the diagnosis, and surgeons may have to take the initiative to request special microbiological investigation in cases where infection is clinically suspected but routine cultures are reported as "negative." The prognosis for patients who have any atypical mycobacterial infection after a heart operation is severe. Those infected with the strain chelonei and those whose cardiac chambers were entered during operation fare worse. This dim clinical prognosis may be improved by appropriate and aggressive antibiotic and surgical therapy. Awareness of the urgency of special bacteriological studies is the key to successful management.

Anti-Bacterial Agents↗
PubMed1988

Subintimal retrograde perfusion during repair of aortic dissection: a potential cause of disaster.

During operations done for dissection of the proximal aorta, a selective retrograde perfusion of the false lumen may occur in spite of correct placement of the cannula in the femoral artery. This happens through a re-entry orifice at the level of the descending thoracic aorta and may seriously compromise the cerebral and coronary circulation. This paper describes this observation in a patient successfully treated and discusses the diagnosis and treatment of this potentially catastrophic complication.

Aortic Dissection↗
PubMed1988

Laser ablation of ventricular tachycardia.

About 5-10% of patients after myocardial infarction experience sustained ventricular tachycardias. Drug therapy is successful only in 60% of these patients, so that a number of them is on a high risk of a sudden cardiac death. Indirect surgical approaches like myocardial revascularization, or aneurysm resection have proven to be ineffective in the treatment of these malignant tachycardias. By the development of electrophysiologic techniques a mechanism of the ventricular tachycardias could be identified as a micro-reentry at the border of myocardial infarction. On this base different direct surgical approaches were advocated by Guiraudon, proposing an encircling endocardial ventriculotomy and by Josephson and Harken recommending a subendocardial resection technique. The results of these direct procedures were much better than those of the prior indirect techniques. The mortality in this series was around 10% and there still was a postoperative recurrence of the tachycardia in about 20-30%. Our group started a study in which a Nd:YAG laser was used to photocoagulate areas of myocardium responsible for the initiation of ventricular tachycardia. By its deeper penetration depth the Nd:YAG laser was preferrable to other laser systems like CO2 and Argon-laser. In contrast to cryothermy the Nd:YAG showed three special advantages: First, it was more effective in the normothermic myocardium, it showed not peripheral zone of temporary myocardial injury, potentially causing late failures, and third equal ablation of tissue could be achieved in much shorter time. Patients were considered operative candidates when drug therapy failed. Preoperative investigations included formal cardiac catheterization and an electrophysiologic testing with induction and mapping of the ventricular tachycardia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

A new instrument to facilitate myectomy in subaortic hypertrophic stenosis.

A new instrument, a modified "back-biting" Kerrison rongeur, is presented and recommended for the treatment of hypertrophic subvalvular aortic stenosis. The spike of the instrument allows the instrument to be engaged accurately and effectively into the anterior surface of the muscular ridge and appropriate obstructing tissue to be removed.

Cardiomyopathy, Hypertrophic↗
PubMed1987

Limited value of balloon dilatation in calcified aortic stenosis in adults: direct observations during open heart surgery.

Percutaneous balloon dilatation was recently recommended as a treatment for management of calcified aortic valvular stenosis. This procedure was initially reserved for patients who were not considered surgical candidates; it is now regarded by some as an acceptable alternative for valve replacement. To investigate the validity of this postulate, balloon valvuloplasty was performed under direct vision in the operating room in 16 patients just before excision and replacement of their ossified aortic valve. Changes after valvuloplasty were evaluated by inspection as well as by geometric measurements. The authors found that balloon valvuloplasty did not make a detectable impact on valvular anatomy in about two-thirds of the patients and induced enlargement of the functional aortic orifice judged as "minimal" or "moderate" in one-third of the cases. In no patient was there significant increase in the functional orifice size. Other investigators have shown that hemodynamic and clinical improvement may be induced in some patients by small increases in the aortic orifice; based on the observations herein, such an improvement, if it occurs at all, would be short-lasting; the procedure should be offered only to those who present truly prohibitive risk by standards of modern surgery.

Adult↗
PubMed1987

Left ventricular rupture following coronary occlusion treated by streptokinase infusion: successful surgical repair.

A 68-year-old man suffered a myocardial infarction and was treated initially with streptokinase infusion, followed by coronary balloon angioplasty. Six hours later he suffered rupture of the free wall of the left ventricle, pericardial tamponade, and cardiac arrest. He was treated successfully by cardiac resuscitation, patch closure of the perforation, and coronary bypass grafting.

Aged↗
PubMed1987

Indium 111-labeled platelet deposition in woven and knitted Dacron bifurcated aortic grafts with the same patient as a clinical model.

A study was designed to compare platelet deposition between knitted and woven Dacron grafts in the same patient. Twenty patients received aortoiliac or aortofemoral bifurcated Dacron grafts, each composed of one woven and one double-velour knitted limb. External nuclear graft imaging was carried out after injection of autologous platelets labeled with indium 111. The patients were studied postoperatively in time periods ranging from 6 days to 42 months. Platelet accumulation was almost identical in knitted and woven limbs in all patients. This study appears to indicate that there is no difference in thrombogenicity between knitted and woven bifurcated Dacron grafts in the aortoiliac or aortofemoral positions measured by platelet accumulation.

Aorta, Abdominal↗