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Biomedical subjects

Hratch L Karamanoukian

Publications and source records attributed to Hratch L Karamanoukian.

34 records · Page 2Linked to original sources
PubMed2002

Hybrid robotic coronary artery surgery and angioplasty in multivessel coronary artery disease.

BACKGROUND: Complete surgical revascularization that includes left internal thoracic artery grafting to the left anterior descending coronary artery remains the gold standard of treatment for coronary artery disease. Not all patients are good candidates for sternotomy. Therefore, we sought to identify a strategy that would combine the long-term advantages of internal thoracic artery grafting to lessen surgical trauma while still allowing complete revascularization. METHODS: A total of 54 consecutive patients from four institutions underwent hybrid revascularization combining surgery and angioplasty. All internal thoracic artery grafts were endoscopically harvested with robotic assistance using either the Aesop or Zeus system, and all anastomoses were manually constructed through a 4- to 6-cm anterior thoracotomy incision. Angioplasty was carried out to achieve total revascularization to ungrafted vessels. RESULTS: There were no early or late deaths, myocardial infarctions, strokes, or wound infections. Of the patients, 37 (69%) were extubated in the operating room. Length of stay in the intensive care unit averaged 24.4 hours and hospital stay 3.45 days. In all, 16 patients (29.6%) required transfusion of packed red blood cells. Late complications included 1 patient with stent occlusion at 3 months and 2 patients with in-stent restenosis. Three patients were treated for postpericardiotomy syndrome. Mean follow-up was 11.7 months. Event-free was survival 87.1% and freedom from recurrent angina 98.3%. CONCLUSIONS: Hybrid endoscopic atraumatic internal thoracic artery to anterior descending coronary artery graft surgery combined with angioplasty is a reasonable revascularization strategy in multiple vessel coronary artery disease in selected patients. Longer follow-up and more patient data in a randomized study are needed to determine the patient cohort most likely to benefit from this approach.

Adult↗
PubMed2002

New strategies in nonoperative management of meconium ileus.

PURPOSE: The aim of this study was to develop new nonoperative strategies for the management of meconium ileus in an attempt to improve on the current unacceptable failure rate. METHODS: Mice were constipated with subcutaneous morphine injection. Each then received an enema solution (perflubron, surfactant, Tween-80, Gastrografin, Golytely, DNase, N-Acetylcysteine, Viokase, or normal saline). After the enema solution was administered, stool output was quantitated. Histologic examination of the intestines was performed on a second group of mice that also received enemas. Finally, viscosity measurements were taken of human meconium at baseline and after variable incubation periods with each test solution. RESULTS: For relieving constipation in vivo, Gastrografin enema was most efficacious. All agents were equally benign to the intestinal mucosa. In vitro, only 4% N-Acetylcysteine and perflubron were less effective at decreasing meconium viscosity than normal saline at T = 0 hours, with N-Acetylcysteine producing greater reduction in viscosity than normal saline at T = 6 hours. CONCLUSIONS: Our results show that surfactant and Gastrografin are the most effective for the in vivo relief of constipation. This is accomplished without mucosal damage. These agents also significantly reduce viscosity in vitro, and we speculate that they may be beneficial in relieving constipation caused by meconium ileus in cystic fibrosis patients.

Animals↗
PubMed2002

Survey of resident training in robotic surgery.

Robotics has been recognized as a major driving force in the advancement of minimally invasive surgery. However, the extent to which General Surgery residents are being trained to use robotic technology has never been assessed. A survey was sent to program directors of accredited General Surgery training programs to determine the prevalence and application of robotics in surgical training programs. Responses were tabulated and analyzed. Thirty-three per cent indicated interest in minimally invasive surgery. Twelve per cent of responders have used robotics in their practice, and 65 per cent felt robotics will play an important role in the future of General Surgery. Currently residents from 14 per cent of the responding training programs have exposure to robotic technology, and residents from an additional 4 per cent of these programs have limited didactic exposure. Program directors from 23 per cent of responding programs identified plans to incorporate robotics into their program. Robotics have been shown to make standard endoscopic surgical procedures more efficient and cost-effective as well as allowing a variety of procedures that were only possible with conventional methods to be completed with minimally invasive techniques. This new technology promises to be a large part of the future of surgery and as such deserves more attention in the training of General Surgery residents.

Diffusion of Innovation↗
PubMedDate not supplied

The telecommunication revolution in the medical field: present applications and future perspective.

In the present review, we analyze the achievements of telecommunication innovations in the medical field focusing on patient care and medical-education aspects. In this regard, the telecommunication revolution has offered medical professionals the possibility to transmit information of any sort zeroing transmission time latency and annihilating spatial distances. Although telemedicine is still in its infancy, multiple applications of this science have already been successfully tested. As an example, robotically mediated telesurgery has it made possible for surgeons to operate standing at a considerable distance from the operating table without even touching or directly seeing the surgical field. Moreover, medical education and medical consulting have acquired new and wider ranges of applicability thanks to the introduction of teleproctoring, telementoring, and teleconsulting. Finally, in the very near future, telepresence surgery will permit "virtual" operations on patients where surgeons can project their manual dexterity, psychomotor skills, and problem-solving ability to remote locations. In this context, telemedicine will support a more equal distribution of medical knowledge and promote excellence in patients' care even in the most disadvantaged environments.

Humans↗
PubMedDate not supplied

Does repair of mitral regurgitation eliminate the need for left ventricular volume reduction?

BACKGROUND: Effects of partial left ventriculectomy (PLV) remain ill-defined because mitral regurgitation (MR) repair by isolated annuloplasty alone has been reported to improve patients with dilated left ventricle and severe MR. METHODS: Among patients undergoing PLV, 120 had paired pre- and postoperative (<1 week) Doppler echocardiograms. Effects of preoperative MR were studied by comparing 45 patients with no preoperative MR (MR-) and 75 patients with significant MR (MR+; MR = 1.51 when MR is enumerated as none = 0, mild = 1, moderate = 2). RESULTS: MR- patients as compared with the MR+ group were older (53.8 vs. 49.2 years, P = 0.047), had less frequent dilated cardiomyopathy (33.3% vs 49.3%,P <0.01), similar ventricular dimension (72.3 mm vs 73.0 mm), septal thickness (9.5 mm vs 9.6 mm), posterior wall, fractional shortening (15.9% vs 16.8%) and ventricular mass (330 g vs 345 g), resulting in comparably reduced functional capacity (NYHA 3.40 vs 3.67). Although the MR- group required significantly less frequent mitral procedure (64.4% vs 84.0%, P < 0.01) and shorter cardiac arrest time, they had similar postoperative MR (0.22 vs 0.39), highly significant parallel reduction in ventricular dimension (P < 0.001 in either group), and improved %FS (P <0.001 in either group), resulting in similar hospital survival (87.1% vs 86.4%) and 90-day survival (71.1% vs 78.7%) with significantly comparable improvement in functional class (P = 0.011 in both groups). Histological severity of interstitial fibrosis (P = 0.80), weight (P = 0.93), and thickness (P = 0.76) of excised myocardium was comparable between the two groups. CONCLUSION: Patients with no preoperative MR were found to benefit from PLV as did patients with significant MR. Beneficial effects of PLV appeared to derive mainly from volume reduction rather than abolished MR in this study.

Adolescent↗
PubMedDate not supplied

Factors affecting ventricular function and survival after partial left ventriculectomy.

BACKGROUND: Partial left ventriculectomy (PLV) helps some patients but is deleterious in others. Selection of patients who will benefit from PLV, and exclusion of those who will not is necessary for safe and effective application of the procedure. METHODS: Sixty-nine consecutive patients who underwent PLV were monitored with pressure-volume relationship analyses, Doppler echocardiography, and histopathologic studies of excised myocardium. These parameters were correlated with postoperative stroke volume (SV, ml), cardiac output (CO, L/min), ventricular function (improved, no change, or deteriorated), and postoperative course (duration of survival and/or hospital discharge). RESULTS: Positive responders (n = 36) with increased SV at reduced end diastolic pressure had significantly larger preoperative end-systolic dimension, smaller SV, and less stroke work with milder fibrosis than non- or negative responders (n = 33). In multivariate analyses, poor preoperative hemodynamics were associated with increased SV and CO, but these improvements did not lead to improved survival. Postoperative survival was negatively affected by larger preoperative left ventricular end-diastolic volume and larger excised-muscle-weight. Milder fibrosis and thicker excised wall were consistently related to improved ventricular function and survival. CONCLUSION: Although effects of PLV are related to preoperative status, factors affecting postoperative ventricular function and survival were often discordant. While poor preoperative ventricular function was associated with functional improvement without survival benefit, milder fibrosis, thicker excised wall and less myocardial resection were positive contributors to improved ventricular function, discharge, and survival. Preoperative evaluation with more cases and variables are needed to identify patients more likely to benefit from PLV.

Adult↗
PubMedDate not supplied

Pediatric burns with snap-cap fireworks.

Snap-caps are marketed as a relatively safe pyrotechnic (explosive) device for children 8 years and older. Individually, the snap-caps pose very little threat because the amount of explosive compounds contained in each is limited to 1 mg. However, the accidental explosion of numerous snap-caps may cause significant burns. This study highlights a series of pediatric patients who presented with severe second- and third-degree burns as a result of accidental explosion of snap-caps. Seven patients with snap-caps-related injuries were treated at the University of California, San Diego Regional Burn Center from January 1996 to April 1999. Study foci included 1) mode and extent of injury, 2) management, 3) associated morbidity, and 4) functional outcome. Six patients (84%) required hospital admission. Four patients (57%) underwent split-thickness skin grafting to repair mean TBSA burns of 4.1% (range, 2-8%). Three patients (43%) received aggressive management of burns with topical medications and dressing changes. The nature and extent of snap-cap injuries support the contention that snap-caps have the potential to harm children to whom they are marketed.

Adolescent↗
PubMedDate not supplied

The hybrid approach to coronary artery revascularization: minimally invasive direct coronary artery bypass with percutaneous coronary intervention.

In the past decade, new developments in cardiology and cardiac surgery have begun to offer patients a variety of new, less invasive options for the treatment of coronary artery disease. One such option is the hybrid approach to coronary artery revascularization. This combines minimally invasive direct coronary artery bypass surgery (MIDCAB) of the left anterior descending artery (LAD) with percutaneous coronary intervention (PCI) of the remaining diseased coronary arteries. This approach, as an alternative to conventional coronary artery bypass surgery, retains the benefit of internal mammary artery bypass to the LAD, accomplished with a minimally invasive technique, substitutes PCI for saphenous vein grafts as treatment for low-grade lesions of other coronary arteries, and may provide a maximally beneficial outcome for many patients. Preliminary outcomes of patients receiving the hybrid approach have been strikingly positive. This report highlights the rationale for the development of this procedure, patient selection, results, and future applications of this emerging method of treating coronary artery disease.

Coronary Artery Bypass↗
PubMedDate not supplied

Intraoperative graft verification in renal transplants.

The success of an arterial reconstruction is dependent on multiple factors, including patient selection, quality of the vessels, type of vascular conduit employed, and the surgical technique adopted. Transit time flow measurement is a technique that is now the standard of care for immediate graft patency verification following coronary artery bypass graft surgery. This study demonstrates that transit time flow measurement can be successfully used to evaluate renal transplant anastomoses: accurate intraoperative measurements provide a rapid objective assessment of renal graft patency.

Blood Flow Velocity↗