PubMed Health⌕ Search

Biomedical subjects

I Asfaw

Publications and source records attributed to I Asfaw.

18 recordsLinked to original sources
PubMed1996

Spontaneous right ventricular rupture after sternal dehiscence: a preventable complication?

Mediastinitis and/or sternal dehiscence developed in 143 out of 10,263 patients (1.4%) who underwent cardiac surgery between January 1979-December 1993. Mediastinal drainage, sternal debridement and early wound closure with pectoralis major and/or rectus abdominalis muscle flaps was the treatment employed. Between these two stages of treatment, massive hemorrhage developed in seven patients (0.07%) from a tear of the anterior wall of the right ventricle (RV). Six patients survived. Temporary control of the bleeding was achieved with digital or full palm pressure control of the ventricular tear. This was followed by immediate repair in the operating room (OR). The only death was due to exsanguination in the intensive care unit. The other six patients were taken to the OR. The anterior RV was freed from the underside of the sternum and the RV tear repaired with or without the aid of femoral-femoral bypass. These six then had muscle flap wound closures at that time or shortly after. All six were hospital survivors and are currently alive. We believe that RV rupture results from the sternal edges pulling the anterior surface of the RV apart, since the RV is stuck to the underside of the sternum. This experience indicates that the RV must be freed in all cases during initial sternal debridement. Hopefully this simple maneuver will prevent this horrendous complication.

Aged↗
PubMed1993

Surgical treatment of intractable right-sided infective endocarditis in drug addicts: 25 years experience.

During the past 25 years the authors have performed the following operations in the surgical treatment of intractable right-sided endocarditis in drug addicted patients: 1) Excision of the infected tricuspid valve and replacement with a mechanical or bioprosthetic valve during the same operation. In these patients the overall mortality was 100% due to: (a) inability to control the endocarditis in 80%; (b) re-infection due to a return to drug abuse and (c) fatal complications due to non-compliance with anticoagulant therapy. 2) Tricuspid valvulectomy in 53 patients, tricuspid and pulmonary valvulectomy without replacement in two patients. Six patients (11%) died within six weeks. Five due to the endocarditis and one due to low cardiac output. Ten patients (18%) died six months to 13 years later. In nine of these patients, death was related to continued drug abuse. At 22 years the actuarial survival is 64%. This experience supports the authors conclusion that among drug addicts with intractable right-sided endocarditis, tricuspid valvulectomy or tricuspid and pulmonary valvulectomy without replacement is/are the operation(s) of choice.

Adult↗
PubMed1991

Tricuspid valvulectomy without replacement. Twenty years' experience.

Since September 1970, we have operated on 55 patients with intractable right-sided endocarditis. All patients were addicted to heroin. Fifty-three underwent tricuspid valvulectomy without replacement and in addition two had pulmonic valve excision. Twenty-four patients (49%) returned to their drug addiction. Six patients (11%) required prosthetic heart valve insertion 2 days to 13 years later for medically refractory right-sided heart failure, and four of these died. Overall, 16 patients (29%) died, six (11%) within 45 days after the tricuspid valvulectomy. One (2%) of these deaths was related to the operation and five were due to uncontrollable infection. Ten (18%) deaths occurred 9 months to 13 years after the tricuspid valvulectomy. Nine were due to drug addiction and one to progressive right ventricular failure 2 months after prosthetic heart valve insertion and 10 years after the initial valve removal. Of the 39 patients who are alive, 37 (67%) have not required prosthetic heart valve insertion. From our observations we reached the following conclusions: (1) Drug addiction is a recurrent and lethal disease. Among these patients, tricuspid valvulectomy without replacement is the operation of choice for the management of intractable right-sided endocarditis; (2) after tricuspid valvulectomy without replacement, only six of 55 patients (11%) had required prosthetic heart valve insertion to control medically refractory right-sided heart failure; (3) in a small percentage of patients the absence of the tricuspid valve may lead to severe and permanent impairment of right ventricular function.

Actuarial Analysis↗
PubMed1988

Physiological manometric tested tricuspid valvuloplasty.

Tricuspid insufficiency associated with severe left-sided valvular heart disease carries a poor prognosis. Twenty-two patients with severe pulmonary hypertension and tricuspid insufficiency underwent a tricuspid valvuloplasty in addition to left-sided single or double valve replacement. The tricuspid valvuloplasty was performed after weaning the patient from cardiopulmonary bypass. The efficacy of the tricuspid valvuloplasty was gauged by continuous right atrial pressure recordings as the annuloplasty was completed. Obliteration of the peak of the V wave of the right atrial pressure recordings indicated that the tricuspid annuloplasty was secured. Twenty-one patients were long-term survivors, and 19 patients are in good condition for an average follow-up of 6.1 years (1 to 12 years postoperatively).

Adult↗
PubMed1987

Management of infective endocarditis: seventeen years' experience.

Infective endocarditis remains a serious illness with a high mortality. In more than 75% of 417 patients, the infection was due to gram-positive microorganisms. The non-drug-addicted patients (33%) were elderly and debilitated with advanced illness that preceded the endocarditis. The drug-addicted patients (67%) were young and were infected with multiple kinds of microorganisms. The blood cultures grew strains of Staphylococcus aureus resistant to methicillin sodium and nafcillin sodium in a majority of patients. Gram-negative microorganisms and fungi were cultured almost exclusively from samples from the drug-addicted patients. The high mortality among the non-drug-addicted patients (28%) was related to their advanced age and debilitating illness. The high mortality among the drug-addicted patients (21%) was related to the complex bacteriology of their infections and the severe anatomical disruption of the valvular complexes of the heart. When cured of their disease after treatment with intravenously administered antibiotics or a valve procedure or both, their long-term survival was related to whether or not they abstained from their habit. If the patient abstained from the use of drugs, the chances of survival were good; if not, death invariably ensued. This experience strongly supports our contention that if a patient returns to the use of drugs and reinfects the valve after initial cure, a second valve operation is contraindicated.

Anti-Bacterial Agents↗
PubMed1987

Nonoperative therapy for squamous-cell cancer of the esophagus.

Based on the surgical pathology and survival for patients in previous trials using a neoadjuvant program of chemotherapy (5-fluorouracil [5-FU]-cisplatin) and radiation (3,000 cGy) before surgery for squamous-cell cancer (SCC) of the esophagus, a nonoperative pilot trial was designed to test if survival and recurrence would differ from our historical controls if routine esophagectomy was eliminated. Twenty patients were treated. The protocol called for the delivery of 5-FU infusion (1,000 mg/m2/d X 4 d) days 1 to 4 and 29 to 32 with cisplatin (100 mg/m2) day 1 and 29 sandwiched around external beam radiation (3,000 cGy over 3 weeks). Mitomycin C (10 mg/m2) day 57 was administered with bleomycin infusion (20 U/d X 4 d) days 57 to 60 and 78 to 81. A radiation boost of 2,000 cGy was administered 200 cGy/d days 99 to 103 and 106 to 110. Clinical pulmonary toxicity forced withdrawal of bleomycin and mitomycin C in the last four patients treated; two further courses of 5-FU-cisplatin were administered instead. The median measurement of the 20 esophageal lesions by barium swallow was 7 cm. Four patients underwent salvage surgery to prevent life-threatening aspiration pneumonia. The median survival for the 20 patients is 22 months, with a range from 6 to 39+ months. The six patients clinically without cancer are alive 22+ to 39+ months (median, 35+ months). Three patients died manifesting only local (infield) recurrence; five died manifesting only distant recurrence; and five developed local and distant recurrence. While the toxicity of the four drug regimen as administered was prohibitive, the survival and quality of survival is superior to the regimen previously used, which routinely used surgery after preoperative chemotherapy and radiation.

Aged↗
PubMed1985

Double traumatic rupture of the thoracic aorta.

A 23-year-old woman was involved in an automobile accident and sustained a double traumatic rupture of the aorta, at the isthmus distal to the left subclavian artery and at the base of the innominate artery. A successful repair was accomplished within 4 hours of the injury using profound hypothermia and total circulatory arrest. To our knowledge, this case represents the first successful surgical repair of a double traumatic rupture of the aorta. Followup at 2 years showed an excellent postoperative recovery and the patient gainfully employed.

Adult↗
PubMed1983

Combined modality therapy for esophageal squamous cell carcinoma.

Of 55 patients with esophageal squamous cell carcinoma, 30 with localized disease were treated with a combined modality for curative intent. Treatment consisted of mitomycin C (10 mg/m2 day 1) and continuous infusion 5-FU (1000 mg/m2 day, days 1-4, 29-32) (CT), radiation (XRT) (3000 rad, days 1-21) with nutritional support, and surgery (days 49-64). Surgery consisted of celiotomy, esophagectomy and esophagogastrostomy +/- postoperative ventilatory support. Postoperative CT plus an additional 2000 rad XRT was restricted to patients with histologic positive tumor. Since five resected patients with subclinical metastatic tumor had an inferior survival equal to 25 patients treated essentially for palliation, pretreatment celiotomy seems warranted to identify patients with an inferior prognosis. Of 18 resected patients without disseminated tumor evaluable for this combined modality: six were tumor free, three had intramural and nine transmural tumor; the median survival is 76 weeks and five of six living patients are disease free at 95-190 weeks; and local recurrence occurred in two and in two of seven unresected patients. Since toxicity was minimal except for postoperative pneumonitis (13%) and local recurrence low (13%), two courses of chemotherapy and 5000 rad XRT perhaps obviates the need for resection.

Abdomen↗
PubMed1981

Complete eradication of squamous cell carcinoma of the esophagus with combined chemotherapy and radiotherapy.

Chemotherapy (with 5-fluorouracil and either mitomycin-C or cis-platinum) combined with radiotherapy was used either for palliation or as preoperative therapy in 67 patients with squamous cell carcinoma of the esophagus. In 25 patients having chemotherapy and 5000-6000 rads, good local palliation was obtained in 11 (49%) without surgery. In the remaining 25 patients, swallowing was restored with a variety of procedures (primarily Celestine tube or gastric bypass). The average survival time was seven months and two patients are still alive at 9 and 12.5 months. Of 42 patients receiving preoperative chemotherapy and radiotherapy, 35 had surgery. Of these, 13 (37%) had complete eradication of their tumors with no histologic evidence of carcinoma in the resected esophagus or associated lymph nodes. In another six (17%), the only evidence of tumor was small microscopic foci of cancer cells in the wall of the esophagus. The 6-, 12-, and 24-month survival rates for patients having surgery after the combined preoperative chemotherapy and radiotherapy were 83 per cent, 52 per cent, and 30 per cent, respectively. These results are far superior to those previously obtained.

Adult↗
PubMed1981

Eradication and palliation of squamous cell carcinoma of the esophagus with chemotherapy, radiotherapy, and surgical therapy.

Between April, 1977, and March, 1981, 86 unselected patients with proved squamous cell carcinoma of the esophagus were treated with a combination of chemotherapy and radiotherapy followed by operation whenever feasible. The preoperative chemotherapeutic agents used initially were 5-fluorouracil, and mitomycin C. After December, 1979, cis-platinum was used instead of mitomycin C. Radiotherapy (3,000 rads) of the tumor was begun at the same time as the chemotherapy. An esophagectomy was performed on suitable candidates 3 to 4 weeks after the chemotherapy and radiotherapy were completed. The mucosal lesion disappeared in 69 of the 86 patients, and dysphagia was relieved at least temporarily in 57 of 62 patients. Recurrent dysphagia resulting from fibrosis at the tumor site caused a secondary stenosis in 11 patients. Excellent palliation was obtained in five patients with bronchoesophageal fistulas who had an initial substernal gastric bypass followed by chemotherapy and radiotherapy. Of the 48 patients who had an esophagectomy, 15 (31%) had no tumor in the resected specimen. Eleven of these 15 patients are still alive with no evidence of disease. All patients with a lesion less than 5.0 cm in length had complete regression of the tumor. We believe that this combination of chemotherapy, radiotherapy, and surgical therapy provides excellent palliation, increases resectability, and has a potential for cure.

Adult↗
PubMed1979

The etiology of post-traumatic empyema and the role of decortication.

Decortication post-traumatic empyema (PTE) was performed in 27 patients from 1972 through 1977. All 27 patients had penetrating chest wounds and were refractory to antibiotics and tube thoracostomy. Factors associated with PTE included unrecognized diaphragmatic perforation, large hemothorax greater than 500 ml, pulmonary contusion, extrathoracic extension of hematoma within the chest wall, and incomplete expansion of the lung with initial tube thoracostomy. Prophylactic antibiotic usage did not prevent PTE nor lead to negative intrapleural cultures preoperatively. The timing of decortication varied with indication: two patients with infected pneumothorax had surgery within 1 week; 15 patients with infected pleural clot had surgery within 4 weeks; ten including nine who were readmitted to the hospital had surgery more than 4 weeks after injury. Prevention of PTE requires early recognition of hemo- or pneumothorax, early tube thoracostomy with complete evacuation of blood and expansion of lung, careful daily monitoring of subsequent fluid accumulation, and prompt evacuation when such fluid accumulates. Once PTE becomes well established and refractory to standard modalities, decortication with evacuation of the empyema cavity should be performed as soon as possible.

Adolescent↗
PubMed1976

The open jejunum: a patch for large duodenal defects.

A practical solution is presented for the difficult problem posed by a large duodenal defect in a very sick patient. A segment of jejunum opened along its antimesenteric border was applied as a mucosally lined patch, with a favorable result.

Aged↗
PubMed1976

Fixation of Celestin tube to the anterior abdominal wall. A new technique.

Palliative intubation in the management of an unresectable carcinoma of the esophagus can be accomplished by "push through" or "pull through" techniques. The most frequently encountered complication is tube dislodgment-proximal or distal migration. Dislodgment occurs more freqeuntly with the "push through" tubes such as the Souttar tube than with the "pull through" tubes such as the Celestin tube. The incidence of migration reported for the "pull through" tubes varies from 3 to 14 per cent. In order to prevent migration, we sutured the tube to the anterior abdominal wall in 6 patients. The sixth patient developed a gastrocutaneous fistula and fasciitis at the point of anterior abdominal wall fixation. In the next 4 cases, we used a two-suture technique, in which no single suture passed from the gastric lumen to the anterior abdominal wall fascia. The Celestin tube was fixed to the gastric wall over a Dacron felt pledget and this pledget was then anchored to the rectus fascia. This technique has prevented both migration of the tube and complications related to gastric perforation.

Abdominal Muscles↗
PubMed1975

Interventricular septal defects from penetrating injuries of the heart: a report of 12 cases and review of the literature.

In the past 7 years, 1967 through 1973, 12 patients who had interventricular septal defects from penetrating stab wounds of the thorax were treated at Detroit General Hospital. In 10, the defects were confirmed by cardiac catheterization. Four of the 12 patients were symptomatic and required surgery. Two of these patients had pulmonary-to-system flow ratios less than 2:1. Both these patients had left ventricular dysfunction as a result of coronary artery and myocardial damage from the penetrating trauma to the left ventricle. One of the 4 patients had an injury to the tricuspid valve; this is the first reported case of a traumatic interventricular septal defect associated with a left ventricle-right atrium shunt and tricuspid valve insufficiency. Another patient had a laceration of the left anterior descending coronary artery, in addition to the interventricular septal defect. Ligation of the injured artery resulted in a left ventricular aneurysm. Three patients had "multiple defects" in the muscular septum which proved to be a single interventricular septal defect in which the left to right shunt was divided into multiple jets by the trabeculae carneae of the right ventricle.

Adult↗