PubMed Health⌕ Search

Biomedical subjects

H H Moosa

Publications and source records attributed to H H Moosa.

18 recordsLinked to original sources
PubMed1993

Organization and development of a university multidisciplinary wound care clinic.

BACKGROUND: A multidisciplinary wound care clinic was established to diagnose and treat patients with nonhealing ulcers of the lower extremity. METHODS: The clinic was organized under the direction of the departments of vascular surgery and dermatology with support by the departments of plastic surgery, hyperbaric medicine, orthopedic surgery, and podiatry, and a research nurse. RESULTS: In the first 4 years and 3 months, 683 patients were evaluated. One hundred seventy-one patients underwent outpatient testing in the noninvasive vascular laboratory and 30 patients underwent angiography. Causes of the ulcers were venous stasis, 280 patients (41%); diabetic neuropathy, 182 patients (27%); arterial insufficiency, 119 patients (17%); rheumatologic disorders, 38 patients (6%); trauma, 15 patients (2%); and in 49 patients (7%) a variety of other disorders. One hundred seventy-nine operations were performed including 86 operating room debridements, 48 amputations (43 toe, 4 below knee, 1 above knee), 23 arterial bypasses, 1 venous bypass, 14 skin grafts, 2 pedicle flaps, and 5 excisions of tumor. Fifty-six patients with cellulitis were admitted to the hospital for intravenous antibiotics and 12 patients were treated with hyperbaric oxygen therapy. One-hundred thirty-two patients were entered into randomized prospective trials of topical growth factors on Institutional Review Board approved protocols. CONCLUSIONS: We concluded that a multidisciplinary approach to wound care is beneficial to patients with chronic wounds and provides a mechanism for clinical investigation on the healing of problem wounds.

Academic Medical Centers↗
PubMed1991

Mechanisms of vein graft atherosclerosis: LDL metabolism and endothelial actin reorganization.

We have explored the effect of arterial hemodynamics on endothelial cell morphology and low-density lipoprotein metabolism in human saphenous vein segments harvested from tissue donors. An arterial pulsatile perfusion system was used to impose physiologic pressures and flows for 20 hours on saphenous vein and companion (control) femoral artery segments. A venous perfusion apparatus was also employed for the perfusion of a second (control) saphenous vein segment for the same period of time. Calculations of fluid shearing and wall tensile stresses were performed and related to induced changes in endothelial cell geometry and cytoskeletal actin organization and the incorporation, degradation, and localization of intact low-density lipoprotein within the vessel wall. Our results indicate that, compared with native arteries and veins, a 20-hour exposure of test saphenous veins to arterial hemodynamics induced (1) a significant increase in endothelial cell luminal surface area and perimeter independent of alignment with flow, (2) disassembly of the dense peripheral band of actin with a concomitant assembly of stress fibers, and (3) a two- to fourfold elevation in the undegraded low-density lipoprotein content, localized primarily within the subendothelial intima. Although the exact mechanisms underlying these results are uncertain, the focal accumulation of intramural low-density lipoprotein may be related to the loss of normal barrier function during endothelial cell enlargement, which is accompanied by transient cytoskeletal reorganization during the adaptation to arterial flow.

Actins↗
PubMed1991

Probability of rupture of an abdominal aortic aneurysm after an unrelated operative procedure: a prospective study.

It has been assumed by some authors that patients with abdominal aortic aneurysms may be at increased risk of rupture after unrelated operations. From July 1986 to December 1989, 33 patients (29 men, 4 women) with a known abdominal aortic aneurysm underwent 45 operations. Twenty-eight patients had an infrarenal abdominal aortic aneurysm, and five patients had a thoracoabdominal aneurysm. The abdominal aortic aneurysm ranged in transverse diameter from 3.0 to 8.5 cm (average 5.6 cm). Twenty-seven patients underwent a single operation, and six patients had two or more (range of 1 to 6). Operations performed were abdominal (13); cardiothoracic (9); head/neck (2); other vascular (11); urologic (7); amputation (2); breast (1). General anesthesia was used in 29 procedures, spinal/epidural in 6, and regional/local in 10. One postoperative death occurred from cardiopulmonary failure. One patient died of a ruptured abdominal aortic aneurysm at 20 days after coronary artery bypass (1/33 patients [3%]; 1/45 operations [2%]). Fourteen patients had repair of their abdominal aortic aneurysm at a later date, an average of 18 weeks after operation. Four patients had abdominal aortic aneurysm considered too small to warrant resection (average 3.6 cm). Four patients were considered at excessive risk for elective repair. The five thoracoabdominal aneurysm were not repaired. Four patients are awaiting repair. During this same 40-month period, two other patients, not known to have an abdominal aortic aneurysm, died of a ruptured abdominal aortic aneurysm after another operative procedure, at 21 days and 77 days. All three ruptured abdominal aortic aneurysms were 5.0 cm or greater in transverse diameter.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

Complications of indwelling central venous catheters in bone marrow transplant recipients.

Complications associated with indwelling central venous catheters in patients undergoing bone marrow transplantation are presented. The study group was comprised of 123 patients who underwent transplantation from 1982 to 1988 in whom 139 catheters were placed. One hundred and fifteen of 139 catheters placed had a triple lumen, while 24 had a dual lumen. Percutaneous placement through the subclavian vein was used in 127 of 139 catheters with a low complication rate. Catheters remained in place for 65.0 +/- 55.5 days (mean +/- standard deviation). One hundred and eight catheters remained functional during the course of treatment for these patients and lasted until elective removal or until the patient died. Thirty-one catheters were removed because of a complication. Infection was the most common complication, occurring in 22 catheters. Seven infected catheters were salvaged with antibiotic therapy. Coagulase negative staphylococcus was the most frequent organism identified. Mechanical problems causing catheter malfunction, migration, thrombosis and cuff erosion occurred in 19 catheters; 15 were removed. We concluded that double and triple lumen Silastic (silicone rubber) catheters provide relatively safe and effective access for bone marrow transplant recipients. The triple lumen catheter provides an additional venous access port that facilitates intensive care. The duration of catheter function is sufficient in most patients for therapy during and after bone marrow transplantation. Infection is the most common complication; our results indicate that catheters can be maintained and salvaged in some patients with septicemia. Noninfectious complications are less frequent, although catheters with persistent mechanical problems are less likely to be salvaged.

Bone Marrow Transplantation↗
PubMed1990

The use of cryopreserved venous allografts in free tissue transfers--practical and aesthetic considerations.

A case in which multiple cryopreserved allograft saphenous veins were used as vein grafts for a difficult mandible reconstruction with a free tissue transfer is reviewed. Use of allograft veins was recently reported for lower limb vascular reconstruction but not for free tissue transfers. Such grafts may represent a viable alternative to the use of autologous vein grafts and have the potential to decrease operating time and avoid necessary scars.

Adult↗
PubMed1990

Bullet emboli to the systemic and venous circulation.

The rarity of bullet emboli leads to frequent delays in diagnosis and inadequate early management. Our recent experience with this entity is described, and 153 cases reported in the English-language literature are reviewed and summarized. The majority of cases occurs as a consequence of civilian violence among men in their 20s and 30s. Most bullet emboli follow the direction of blood flow, although 15% of venous bullets cause embolization in a retrograde manner. One in 10 arterial emboli follow a right-heart or venous injury. Arterial bullets are symptomatic in 80% of cases, venous bullets in only one third. The choice of surgical management must be individualized according to the symptoms caused by the bullet and its location in the vascular system. In general, arterial bullet emboli are removed because of symptoms or findings of acute peripheral ischemia. Arterial and venous emboli not causing symptoms should be removed according to the risk of possible displacement and further embolization. Selective intraoperative angiograms and phlebograms can precisely localize the migrating bullet and permit appropriate placement of incisions before removal.

Adult↗
PubMed1989

Inflammatory aneurysms of the abdominal aorta.

Inflammatory aneurysms of the abdominal aorta (IAAAs) have distinctive clinical and physical characteristics that separate them from typical atherosclerotic aneurysms. They were identified in 19 (7.2%) of 265 patients undergoing abdominal aortic aneurysm repair. Symptoms were present in 12 (63%) of 19, with one patient presenting with rupture, and multiple symptoms were present in six (32%). Intraoperatively, all aneurysms exhibited dense periaortic inflammation. Adjacent structures most frequently involved were the duodenum in 15 (79%) of 19 patients, the left renal vein in six (32%) of 19, and the ureter in five (26%) of 19. Seventeen (94%) of the 18 patients who underwent elective aneurysm resection survived. The involvement of retroperitoneal structures varied in number and severity, demonstrating that a wide spectrum of inflammation is present in IAAAs, making diagnosis and definition difficult.

Aged↗
PubMed1989

Venous aneurysm after polytetrafluoroethylene arteriovenous dialysis fistula.

True venous aneurysms are uncommon complications in patients undergoing hemodialysis through prosthetic grafts. We report the case of a large cephalic venous aneurysm that occurred proximal to a polytetrafluoroethylene hemodialysis fistula. The incidence, management, and possible cause of this unusual complication of prosthetic arteriovenous fistulas are reviewed.

Aged↗
PubMed1988

Surgical management of severe mammary hidradenitis suppurativa.

Hidradenitis suppurativa is a devastating disease of the apocrine sweat glands. The chronic form is characterized by a malodorous discharge from multiple draining sinuses embedded in dense fibrous tissue, and physical discomfort. The disease commonly affects the axillary, perineal, and perianal regions. A case of hidradenitis suppurativa of the mammary gland necessitating mastectomy is presented here to illustrate the severity of the disease at an uncommon site. As in other regions of the body, aggressive surgical intervention provides a chance for rapid recovery. The surgical treatment should be tailored to the severity of the disease.

Female↗
PubMed1988

Transcutaneous oxygen measurements in lower extremity ischemia: effects of position, oxygen inhalation, and arterial reconstruction.

Transcutaneous oxygen tension (TcPO2) measurement has been successfully applied to the diagnosis and monitoring of patients with peripheral arterial insufficiency. This study was performed to assess the effects of changes in limb position, oxygen inhalation, and arterial reconstruction on TcPO2 values in patients with peripheral vascular disease. In addition, a TcPO2 index (foot TcPO2/chest TcPO2) was compared with the Doppler-derived ankle-to-brachial index (ABI) to determine which was the more effective monitor of the response to revascularization. Foot TcPO2 values of 22 patients with claudication or rest pain were measured before and after vascular reconstruction. TcPO2 increased after revascularization in both groups regardless of limb position or oxygen (O2) administration. The dependent position and O2 inhalation had an additive effect on TcPO2. Preoperative TcPO2 values in patients with rest pain showed the greatest response to the dependent position, increasing from 14 mm Hg to 33 mm Hg at room air and from 21 mm Hg to 53 mm Hg with O2 inhalation. TcPO2 in both patient groups was remarkably enhanced by O2 administration after revascularization. Postoperative supine TcPO2 values measured at room air increased from 50 mm Hg to 124 mm Hg (148%) in patients with claudication and from 40 mm Hg to 109 mm Hg (173%) in patients with rest pain after O2 inhalation. Comparison of the TcPO2 index with the ABI showed that absolute and normalized TcPO2 values are equally effective in monitoring peripheral arterial insufficiency. This study suggests that placing the limb in the dependent position and administering O2 may augment TcPO2 to levels where symptoms may resolve. The response of TcPO2 to O2 inhalation may be an indicator that reflects the response to revascularization.

Arterial Occlusive Diseases↗
PubMed1987

Dermal pericapillary fibrin in venous disease and venous ulceration.

Pericapillary fibrin deposition is thought to contribute to the pathogenesis of venous ulceration. To our knowledge, however, there is no previous evidence that pericapillary fibrin is deposited in the tissue adjacent to venous ulcers. We prospectively studied patients with ulcers of the lower extremities for the presence of dermal pericapillary fibrin in the skin adjacent tot he ulcers. On direct immunofluorescence, pericapillary fibrin was found in 14 (93%) of the 15 patients with venous ulceration but in only one (7%) of the 14 subjects with ulcers due to other causes. We also confirmed the presence of dermal pericapillary fibrin in legs with venous disease without ulcerations. We conclude that the pericapillary fibrin is easily demonstrable in the dermis adjacent to venous ulcers. In the evaluation of ulcers due to uncertain causes, the presence of dermal pericapillary fibrin may provide additional diagnostic help.

Biopsy↗
PubMed1986

TcPO2 values in limb ischemia: effects of blood flow and arterial oxygen tension.

Transcutaneous oxygen tension (TcPO2) is determined by blood flow and arterial oxygen tension (PaO2) and has been advocated as a measurement of tissue perfusion in peripheral vascular disease. The purpose of this study was to define the relationship between regional blood flow, PaO2, and TcPO2. TcPO2 sensors were placed on the skin of the anterior tibial regions of the hind limbs of 15 dogs. After occluding collateral blood flow, an external flow probe was placed around the femoral artery and an adjustable clamp was used to produce graded ischemia. Progressive reductions in blood flow were correlated with TcPO2 values at inspired oxygen concentrations (FiO2) of 0.21, 0.50, and 1.00. TcPO2 measured at room air decreased nonlinearly in relation to flow with a marked drop occurring below 20% of baseline flow. TcPO2 measured at increased FiO2 was dependent primarily on PaO2 at flow rates greater than 50% of baseline. With reduction in flow below 25% of baseline, TcPO2 was dependent solely on flow and was not augmented by increases in PaO2. The data suggest that TcPO2 can accurately reflect changes in blood flow to an extremity when flow is severely restricted.

Animals↗
PubMed1985

Salvage of exposed arteriovenous hemodialysis fistulas.

Arteriovenous fistulas constructed with an interposed segment of expanded polytetrafluoroethylene (PTFE) have been used successfully for long-term hemodialysis, but ultimately these fistulas may fail because of graft thrombosis, infection, or pseudoaneurysm. A PTFE graft may become exposed from skin necrosis at an area of repeated puncture for hemodialysis or from wound breakdown at a site of thrombectomy. Removal of an exposed PTFE graft has heretofore been considered inevitable, especially if a suture line is involved, because of the risk of hemorrhage and infection. We describe coverage of an exposed graft by a simple full-thickness skin flap that is locally rotated and report the successful salvage of five fistulas by this technique. Thus the concept that an exposed graft is infected and must be removed may not always be correct.

Arteriovenous Shunt, Surgical↗
PubMedDate not supplied

Oxygen diffusion in chronic venous ulceration.

A diffusion barrier to oxygen caused by fibrin deposition around dilated, proliferating capillaries in patients with venous hypertension may contribute to the development of venous ulceration. This diffusion barrier was studied in 18 patients with venous ulcers using the transcutaneous oxygen (TcPO2) monitor (TCM204 Radiometer, America). TcPO2 sensors were placed adjacent to venous ulcers on lower limbs and on the chest and foot of each patient. Readings were taken after a sensor temperature of 44 degrees C was reached (10-15 minutes). TcPO2 values were markedly decreased in skin adjacent to the ulcers (10 +/- 2 mmHg) compared with those of the chest (64 +/- 2 mmHg) and foot (43 +/- 2 mmHg). Inhalation of 100% oxygen for 10 minutes increased chest TcPO2 in all patients (145 +/- 8 mmHg) and increased TcPO2 in skin around the ulcers in 17 of 18 patients (61 +/- 13 mmHg). This study supports the existence of a local pathologic barrier to oxygen diffusion in patients with venous ulcers.

Aged↗