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Biomedical subjects

M Hakimi

Publications and source records attributed to M Hakimi.

At least 19 recordsLinked to original sources
PubMed2005

Influence of elastic and non-elastic external Dacron mesh support on para-anastomotic hypercompliance in end-to-end anastomoses.

OBJECTIVE: To quantify the influence of elastic and non-elastic external mesh support on para-anastomotic hypercompliance in end-to-end anastomoses (ex vivo). MATERIALS: Six end-to-end anastomoses prepared from ovine carotid arteries without mesh support and with external elastic and non-elastic dacron mesh support. METHODS: Compliance profiles of the anastomised arterial segments were measured successively, in the same anastomotic configuration without mesh support, with external elastic dacron mesh support and with external non-elastic dacron mesh support (randomized order). A pulsatile ex vivo perfusion system using a laser scan micrometer to monitor outer systolic and diastolic diameter was employed. RESULTS: Median pre-anastomotic and post-anastomotic hypercompliance without external mesh support were 1.45 and 1.19%/100 mmHg, respectively, above reference compliance. Use of the elastic mesh support significantly reduced the median hypercompliance to 0.68%/100 mmHg (pre-anastomotic) and to 0.34%/100 mmHg (post-anastomotic) above reference compliance. The non-elastic mesh support caused approximately the same significantly reduced median hypercompliance to 0.53%/100 mmHg (pre-anastomotic) and 0.43%/100 mmHg (post-anastomotic). CONCLUSIONS: Both elastic and non-elastic external mesh support significantly reduced pre- and post-anastomotic hypercompliance.

Anastomosis, Surgical↗
PubMed2005

Implementation of health education, based on ethnographic study, to increase the colostrum and decrease early solid food feeding.

Traditionally, mothers provide banana to their neonates as well as discharge their colostrum prior to breastfeeding, increasing the risk of perinatal morbidity and mortality. Health education modules, based on ethnographic study, to discourage these detrimental practices were developed for use by community leaders. Two thousand six hundred and seventy neonates were followed from birth to 28 days. Overall, neonatal banana feeding decreased 18.3% and colostrum feeding increased 32.8%. Religious leaders, who had strong community influence, had the highest health module execution. Moreover, their influence on the community was important. Overall, the use of ethnographic study data to identify specific cues to action of individuals in a community, such as community religious leaders, is an effective and appropriate method for reducing the detrimental customs of both early solid-food feeding of banana and colostrum discharge prior to breast-feeding, positively affecting community perinatal morbidity and mortality.

Adolescent↗
PubMed2004

[Popliteal artery aneurysms from a vascular surgeon's point of view].

Popliteal artery aneurysms (PAA) are a dangerous complication of general atherosclerosis or other diseases. PAAs with a diameter of less than 2 cm are observed despite the fact that small aneurysms may also result in peripheral embolism. The spectrum of complications in the course of the disease ranges from multiple embolism into the crural arteries or complete thrombosis of the popliteal artery associated with complete ischaemia. Rupture is rare even in large aneurysms. Interventional therapy using covered stents does not lead to results comparable with surgery and is not considered as standard therapy. Surgical technique in asymptomatic aneurysms includes resection/exclusion of the PAA with reversed vein PI-PIII vein bypass. In case of acute ischaemia the therapy has to be modified according to anatomic aspects and has to be combined in some cases with intraoperative lysis. Amputation rate may be as high as 40%. Large aneurysms (>3 cm) should be treated by aneurysmorrhaphy or resection with graft interposition rather than simple bypass. In our study with short follow-up only 3 of 10 patients were asymptomatic. Survival rate, limb salvage and patency amounted to 100%.

Aged↗
PubMed2003

[Functional results two years after the treatment of a delayed diagnosed scapho-capitate fracture syndrome].

The scapho-capitate syndrome (Fenton syndrome) is so rare that diagnosing is a real challenge to every clinician. Therefore, its primary treatment is not always possible. In this case we are reporting about a delayed open treatment of a Fenton syndrome ten days after the original injury. Open reduction was performed via a dorsal approach and the capitate fracture was stabilized with K-wires and the scaphoid fracture with screw fixation. After postoperative immobilization of the wrist using an external fixator for six weeks the patient was already able to work again only twelve weeks after surgery.

Adult↗
PubMed2003

Vomiting, abdominal distention and early feeding of banana (Musa paradisiaca) in neonates.

The objective of this cohort study was to assess the relationship between banana given as early solid food with the symptoms of intestinal obstruction (SIO) among neonates, in a rural community in West Lombok District, West Nusa Tenggara Province, Indonesia. Mothers having newborn infants were interviewed and 3,420 neonates were followed for 28 days. Compared with infants who were not given solid food, the relative risk (RR) for infants given food other than banana as early solid food was 1.87, 95% CI 0.48-8.24, p=0.4, while for infants given banana only as early solid food the RR was 9.15, 95% CI 1.96-42.58, p 0.0005. After adjustment for birthweight, colostrum, and breastfeeding, the odds ratio for infants given banana and the appearance of SIO was 2.99, 95% CI 2.65-5.14; p=0.0012. These data indicate that banana given as early solid food is an important risk factor for the appearance of SIO in neonates.

Gastric Dilatation↗
PubMed2002

Energy intake during economic crisis depends on initial wealth and access to rice fields: the case of pregnant Indonesian women.

Starting in August 1997, Indonesia experienced a radical and rapid deterioration in its economy. Between 1996 and 1998, dietary intake during the second trimester was measured in 450 pregnant women in Purworejo, Central Java, Indonesia. Using six 24 h recalls we describe the consequences of the economic crisis on the energy intake of pregnant Indonesian women. Depending on the date of data collection, women were grouped into 'before crisis', 'transition' and 'during crisis'. Mean energy intake among groups was compared using ANOVA and Student's t-test. All groups of pregnant women already had a mean energy intake before the emerging crisis that was lower than the Indonesian recommended dietary allowances (RDA). Nevertheless, energy intake differed significantly among women with different education levels (P = 0.00) and from different socio-economic groups (P = 0.00). 'During transition', a significant decrease in energy intake was experienced by urban poor women (P = 0.01). Poor women with access to rice fields had a higher rice consumption than other groups throughout the period. Our results most likely reflect the effect of higher rice price on income and welfare. 'During crisis', energy intake improved among vulnerable groups, perhaps reflecting government intervention.

Adolescent↗
PubMed2002

[Management of soft tissue injury in III B open tibial fractures: are local muscle flaps still up-to-date?].

Local muscle flaps for covering pretibial defects have been widely replaced due to the establishment of microsurgical procedures. The intention of the following study is to examine the results of soft tissue covering using local muscle flaps and to find out if its application is still indicated. At our level 1 trauma center 21 patients with III B open tibial fractures were treated with a local muscle flap to repair the soft tissue injury in the proximal and medial part of the lower leg. At the late follow-up after the average of 29 months all soft tissue defects and fractures were healed. Except of slight swelling under full weight stress no obstruction of blood circulation could be verified. 14 patients rated their functional outcome as good to excellent. In view of our results we consider local muscle flaps a suitable alternative to the free myoplasty for situations in which a more elaborate surgery is not feasible in due time, e. g. patients with acute brain edema, organ failure or lack of compliance.

Adolescent↗
PubMed2001

Variability in nutrient intakes among pregnant women in Indonesia: implications for the design of epidemiological studies using the 24-h recall method.

Few studies have assessed the reliability of dietary intake methods during pregnancy. Between 1996 and 1998, a longitudinal study of dietary intake during pregnancy was carried out among 451 women in Central Java, Indonesia. Six 24-h recalls were performed each trimester. We report here on intraindividual and interindividual variability in energy and nutrient intakes, as well as the reliability of the 24-h diet recall method. Implications of the use of different numbers of replicate days for estimating dietary intake and the relationships between dietary intake and health outcomes are also discussed. Intravariance-to-intervariance ratios were <1 for energy and carbohydrates and >1 for all other nutrients throughout pregnancy. Reliability analyses found good agreement (reliability coefficient >0.7) with three replicates for the macronutrients, but at least six replicates were needed for an agreement of > or =0.6 for the micronutrients. To estimate true individual average intake with a precision of +/-20%, six replicate recalls were sufficient for energy, carbohydrates, vitamin A, iron and vitamin C. In conclusion, mean intake of several nutrients can be reliably measured with the 24-h recall method, using a limited number of days. The nutrient of interest, the primary objectives and method of analyses should all be taken into account when planning sample size and number of replicates.

Adult↗
PubMed2001

An analysis of anemia and pregnancy-related maternal mortality.

The relationship of anemia as a risk factor for maternal mortality was analyzed by using cross-sectional, longitudinal and case-control studies because randomized trials were not available for analysis. The following six methods of estimation of mortality risk were adopted: 1) the correlation of maternal mortality rates with maternal anemia prevalence derived from national statistics; 2) the proportion of maternal deaths attributable to anemia; 3) the proportion of anemic women who die; 4) population-attributable risk of maternal mortality due to anemia; 5) adolescence as a risk factor for anemia-related mortality; and 6) causes of anemia associated with maternal mortality. The average estimates for all-cause anemia attributable mortality (both direct and indirect) were 6.37, 7.26 and 3.0% for Africa, Asia and Latin America, respectively. Case fatality rates, mainly for hospital studies, varied from <1% to >50%. The relative risk of mortality associated with moderate anemia (hemoglobin 40-80 g/L) was 1.35 [95% confidence interval (CI): 0.92-2.00] and for severe anemia (<47 g/L) was 3.51 (95% CI: 2.05-6.00). Population-attributable risk estimates can be defended on the basis of the strong association between severe anemia and maternal mortality but not for mild or moderate anemia. In holoendemic malarious areas with a 5% severe anemia prevalence (hemoglobin <70 g/L), it was estimated that in primigravidae, there would be 9 severe-malaria anemia-related deaths and 41 nonmalarial anemia-related deaths (mostly nutritional) per 100,000 live births. The iron deficiency component of these is unknown.

Acute Disease↗
PubMed2000

Predicting under- and overnutrition among women of reproductive age: a population-based study in central Java, Indonesia.

OBJECTIVES: To evaluate changes over 1 year in weight and body mass index (BMI) among a population-based sample of non-pregnant women in Indonesia and to identify risk factors for developing under- and overnutrition. DESIGN: Cross-sectional studies in 1996 and 1997 in the same population. SETTING: Purworejo District, central Java, Indonesia. SUBJECTS: Non-pregnant women (n = 4132) aged 15-49 years of age who participated in both 1996 and 1997. Based on BMI, women were classified as having chronic energy deficiency (CED), and as being either of normal weight or obese. RESULTS: The mean height of the women was below the fifth percentile of international standards. In 1996, 16.2% had CED, 72.2% were normal and 11.6% were obese. In 1997, the corresponding figures were 14.4%, 71.2% and 14.3%, respectively, revealing a significant mean increase in weight and BMI. Among women classified as normal in 1996, 3.0% developed CED in 1997. Significant risk factors for developing CED were experiences of child deaths and non-use of contraceptives. Among women classified as normal in 1996, 5.3% developed obesity in 1997. Here, significant risk factors included most indicators of wealth as well as occupation. CONCLUSIONS: The results should be important for future efforts to prevent CED and obesity in the general population; conditions which are both associated with health risks.

Adolescent↗
PubMed1999

Aortic root dilation after the Ross procedure.

This study evaluated changes in neoaortic root geometry in patients who underwent the Ross procedure. Serial postoperative echocardiographic measurements of the neoaortic root indexed to the square root of body surface area (centimeters divided by meters) were obtained from 30 patients (age range 3.1 to 31.4 years) and compared with paired preoperative and immediate postoperative values. Normal aortic root diameter Z scores were derived from root dimensions obtained from 217 healthy controls. Compared with preoperative values, an immediate stretch of the neoaortic versus pulmonary root (annulus and sinuses of valsalva) was observed at a mean follow-up period of 1 week. Additional aortic annular dilation from baseline prehospital discharge values was observed at 2 to 12 months (baseline vs follow-up annulus Z score: 1.4 vs 2.6, p <0.01, n = 16) and at 16 to 33 months follow-up (0.8 vs 2.0, p <0.05, n = 12). In a similar fashion, there was additional enlargement of the aortic sinus from its stretched state at hospital discharge at 2 to 12 months (baseline vs follow-up sinus Z score: 2.0 vs 3.3, p <0.01, n = 17) and at 16 to 33 months (1.7 vs 3.0, p <0.01, n = 13). There were no differences in root size between 2 to 12 and 16 to 33 months after surgery. There was a decrease in left ventricular size with no alteration in blood pressure or degree of aortic valve regurgitation. Thus, aortic root dilation occurs up to the first year after the Ross procedure but does not appear to progress beyond this time.

Adolescent↗
PubMed1999

Risk factors for failure of aortic valvuloplasty in aortic insufficiency with ventricular septal defect.

BACKGROUND: Aortic insufficiency (AI) associated with ventricular septal defect (VSD) is often repaired using a modification of Trusler's aortic valvuloplasty technique. The purpose of this study was to identify the risk factors for failure of aortic valve (AV) repair in patients who underwent repair of associated VSD. METHODS: A univariate analysis was performed in this retrospective study to identify the possible risk factors for failure of the repair resulting in the need for AV replacement (AVR). RESULTS: The study included 24 patients, 15 (62%) boys and 9 (38%) girls, with a mean age of 9.1 +/- 1.2 (SEM) years. The VSD was perimembranous in 15 (62%) and subarterial in 9 (38%). The prolapsed aortic cusp was the right in 13 (54%), the noncoronary in 6 (25%), and both in 5 (21%). Plication was performed at one end of the free edge of the prolapsed cusp(s) in 12 (50%) and at more than one end in 12 (50%) of the patients. The VSD was closed by use of a patch in 21 (88%) and by direct suture closure in 3 (12%). At the mean follow up of 7.3 +/- 1.3 years, the degree of AI was none in 6 (25%), trivial in 5 (21%), mild in 9 (38%), moderate in 1 (4%), and severe in 3 (12%). The 15-year actuarial freedom from reoperation was 81% +/- 19% (95% confidence limit). By univariate analysis, the possible risk factors for AV repair failure were the degree of AI at hospital discharge (p = 0.004), direct closure of the VSD (p = 0.061), smaller size of the VSD (p = 0.081), and plication of more than one end of the prolapsed cusp(s) (p = 0.095). CONCLUSIONS: Trusler's AV repair is an effective and durable technique for the surgical treatment of patients with VSD-AI syndrome. The adequacy of the initial repair is the most important determinant of the long-term results.

Adolescent↗
PubMed1998

Chronic performance of a transvenous steroid pacing lead used as an epi-intramyocardial electrode.

Excessive surface fibrosis or fat limits effective electrode insertion in patients requiring epicardial pacing. We present chronic performance of a modified transvenous steroid lead used as an epi-intramyocardial electrode in a patient following repair of a univentricular heart after failure of both standard and steroid-eluting epicardial leads. Low implant threshold values remained stable during a 3-year postimplant interval demonstrating an effective and innovative approach to epicardial pacing.

Bradycardia↗
PubMed1997

Coil occlusion versus conventional surgical closure of patent ductus arteriosus.

This retrospective cohort study evaluated the clinical outcome and cost-effectiveness of 2 treatment strategies for children with an isolated restrictive patent ductus arteriosus. Results indicate a superior cost-effectiveness of transcatheter coil occlusion compared with conventional surgery for these patients.

Cardiac Catheterization↗
PubMed1997

Bidirectional cavopulmonary anastomosis with intracardiac repair.

BACKGROUND: Patients with hypoplasia of the right ventricle and tricuspid valve have historically undergone a total cavopulmonary connection or a two-ventricle repair with atrial fenestration. METHODS: We reviewed our experience with 9 patients with hypoplasia of the right ventricle and tricuspid valve who underwent a bidirectional cavopulmonary anastomosis with intracardiac repair. Patient diagnoses included pulmonary atresia with intact ventricular septum (n = 3); hypoplastic right ventricle and tricuspid valve with atrial septal defect, ventricular septal defect, and right ventricular outflow tract obstruction (n = 3); unbalanced atrioventricular canal defect (n = 1); inlet ventricular septal defect with coarctation (n = 1); and tricuspid stenosis with atrial septal defect (n = 1). RESULTS: The median age at operation was 36 months. There was hypoplasia of the right ventricle and tricuspid valve in all patients. The tricuspid valve measured 56.5% of normal (range, 43.6% to 70.4%) by echocardiography, and the median ratio of the tricuspid valve to the mitral valve was 0.67 (range, 0.54 to 0.82). At operation, the median tricuspid valve annulus diameter was 65.6% of published autopsy normals (range, 57.8% to 78.5%) with a median Z value of -3.8 (range, -6.6 to -2.1). All patients survived operation. At a median follow-up of 16 months, 5 patients are asymptomatic, and 2 have occasional early-morning periorbital edema. Two patients are on a regimen of diuretics, 1 of whom is also taking an unloading agent. The patient with unbalanced atrioventricular canal died suddenly at home 6 months postoperatively. CONCLUSIONS: Bidirectional cavopulmonary anastomosis with intracardiac repair may avoid the long-term complications associated with the Fontan modifications and eliminates the need of atrial fenestration in most instances. This operation should be considered for select patients with hypoplasia of the right ventricle and tricuspid valve.

Anastomosis, Surgical↗
PubMed1997

Cardiac pacemaker dysfunction in children after thoracic drainage catheter manipulation.

Two children underwent placement of permanent, epicardial-lead, dual-chamber, unipolar pacemaker systems for complete heart block. Postoperatively, both patients demonstrated subcutaneous emphysema-in the area of their pulse generators-temporally related to thoracic catheter manipulation. Acutely, each situation was managed with manual compression of the pulse generator, ascertaining appropriate pacemaker sensing and pacing. Maintenance of compression with pressure dressings, vigilant observation/monitoring, and education of the care givers resulted in satisfactory pacemaker function without invasive intervention.

Catheterization↗
PubMed1997

Arch growth after staged repair of interrupted aortic arch using carotid artery interposition.

BACKGROUND: Between 1980 and 1990, our practice was to perform carotid artery interposition as part of a staged repair of interrupted aortic arch with various associated cardiac defects. METHODS: This procedure was used in 16 patients with IAA type B. The median age at operation was 4.5 days and the median weight, 3.2 kg. Ten of the patients had an associated ventricular septal defect. Six more had complex anatomy. There were two death at carotid interposition, two interim deaths, and two deaths after intracardiac repair. Preoperative echocardiographic and angiographic studies were compared with postoperative studies in 11 survivors of arch repair to assess sequential growth of the interposed carotid artery. Measurements of the carotid artery were normalized to the descending aorta. RESULTS: Preoperatively, the left carotid artery had a median diameter of 3.7 mm and was 42.9% of the descending aortic diameter. Postoperative studies performed at a median age of 5.7 months disclosed that the interposed carotid artery had grown to a median diameter of 7.0 mm and was 69.6% of the diameter of the descending aorta (normal > or = 81%). On follow-up at a median time of 4 years, 6 of 9 patients have no gradient by blood pressure measurements or echocardiographic Doppler studies, and 3 have modest gradients. No patient has required revision of the arch repair. CONCLUSIONS: Survival is good after carotid artery interposition for interrupted aortic arch and growth of the carotid artery approaches that of a normal arch. Carotid artery interposition is a viable alternative for repair of this lesion should primary definitive repair not be feasible.

Anastomosis, Surgical↗