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Biomedical subjects

M Kassan

Publications and source records attributed to M Kassan.

5 recordsLinked to original sources
PubMed1991

Experience in managing 70 patients with ruptured abdominal aortic aneurysms.

Seventy cases of ruptured abdominal aortic aneurysms (RAAAs) repaired over a 14-year period from 1975 to 1989 were analyzed. Age, heart disease, chronic obstructive pulmonary disease (COPD), hypertension, diabetes, or specific postoperative complications did not correlate with mortality. If the time interval from arrival at the hospital to skin incision (emergency room (ER) or operating room (OR] was less than six hours, there was no correlation with survival. Mortality correlated significantly with admitting systolic blood pressure, blood pressure at the time of skin incision, a comparison of ER to OR time of less than or more than six hours, blood loss of less than compared to more than ten units, and time in the operating room of less than five hours compared to more than five hours. Both time in the operating room and blood loss correlated with technical problems. Prior to 1985, 11 general and vascular surgeons had repaired RAAAs with a mortality of 76%. Since 1985, six vascular surgeons repaired RAAAs with a significant decrease in mortality (54%). Our data indicate that patients profoundly hypotensive on admission or at the time of incision are unlikely to survive regardless of other factors; patients with a systolic blood pressure greater than 100 mm Hg have the best chance of survival; a delay of up to six hours prior to surgery in patients with a systolic blood pressure greater than 100 mm Hg does not increase mortality; and a smaller number of surgeons operating on RAAAs increases survival.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

Guidelines in concentric mastopexy.

The scope and technique of concentric mastopexy remain unclear and controversial. In our hands, the procedure has application for mild nipple ptosis, glandular ptosis, and areola asymmetry, as well as the tuberous breast. Early disappointment has changed to increasing satisfaction as we have gained confidence in predicting our results based on the identification of three simple principles of concentric mastopexy. The first and most important, which states Doutside less than or equal to Doriginal + (Doriginal - Dinside), requires that the outer concentric circle must be drawn not to exceed the original areola diameter by more than the original areola diameter exceeds the inner concentric circle diameter. The second principle, Doutside less than or equal to 2 X Dinside, recommends that the outer circle diameter be drawn not to exceed twice that of the inner circle, to prevent poor scarring or over flattening of the breast. The third principle, Dfinal = 1/2(Doutside + Dinside), allows prediction of the final areola size as the average of the diameters of the inner and outer concentric circles. These three principles allow excision of a maximum amount of areola and periareola skin without the side effect of poor scars, dilated areola, or misshapened breasts. Applying these three principles to concentric mastopexy with or without augmentation mammaplasty, one may confidently correct a wide variety of deformities, producing more symmetrical, attractive breasts with areolae of a predictable size.

Breast↗
PubMed1989

Genioplasty.

In 1988, I performed 15 chin procedures, seven osteotomies, and eight implants. During that same period, 38 rhinoplasties were done, but only five patients (15 per cent) had a simultaneous genioplasty. While the chin is important in nasal surgery, correction is also indicated for other aesthetic problems. Genioplasty, whether by osteotomy or implant, continues to present a unique opportunity to improve facial aesthetics with minimal risk. The current challenge is to define patient selection better, refine the technique (for example, bone substitutes and fixation hardware), and, most important, establish genioplasty firmly in the practice of plastic surgeons who perform aesthetic procedures on the face.

Cephalometry↗
PubMed1986

The costs and dynamics of surgical morbidity and mortality.

The implementation of prospective payment systems for hospitals, most notably the Medicare diagnosis-related group (DRG) mechanism, will encourage surgeons and hospitals to characterize populations that create financial risk. Our previous studies have demonstrated that certain factors (identifiers) such as emergency admission or necessity for blood transfusion would predict higher cost patients per DRG and that some populations (i.e., surgical intensive care unit admissions) would generate significant financial risk under DRG reimbursement. The purpose of this project was to test the assumption that surgical complications and deaths would generate financial risk under DRGs and that the degree of risk would vary by the dynamics of the complications and death. We examined all surgical admissions (n = 5596) to a large voluntary teaching hospital to determine all general and vascular surgical complications and deaths (170 admissions; complication rate 3.1%) for 1983 and 1984. Total charges (exclusive of physicians' fees) of these patients were $4,683,670 (mean per patient, $27,551) versus DRG revenues of $2,378,703 (mean per patient, $13,992) resulting in a loss of $2,304,967 (mean per patient, $13,558). Charges and financial risk generated by the origin of the surgical morbidity and death differed as follows: iatrogenic origin only (N = 41)--mean charge per patient, $15,321 (19.5% of whom had unusually long hospital stays or unusually high costs [outliers]; origin intrinsic to the patient's disease only (N = 75)--mean charge per patient, $28,391 (38.7% outliers); and combined iatrogenic origin and patient's disease (N = 54)--mean charge per patient, $35,669 (48.0% outliers) (group 1 versus groups 2 and/or 3; p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Costs and Cost Analysis↗