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Biomedical subjects

M M Elahi

Publications and source records attributed to M M Elahi.

At least 19 recordsLinked to original sources
PubMed2006

Free radicals in blood: evolving concepts in the mechanism of ischemic heart disease.

There has been a considerable debate over past decade on how reactive oxidant species (ROS) in blood augment the cell signaling processes involved in the pathogenesis of coronary heart disease. In particular, it is not clear whether ROS is an important component of the cross-talk between blood and elements of the vasculature during the initial and latter stages of vascular injury and development of atherosclerotic lesions. Features like the recruitment of the circulating activated monocytes, T cells and granulocytes occur extensively in patients with acute coronary syndromes. It is not known what drives the infiltration of these cells into the vessel wall in the active stages of atherosclerosis and whether ROS plays an intermediate part. Currently, the thinking is that although inflammatory processes may be prompted by different etiological factors from that of coronary heart disease, the presence of ROS in circulating blood is the key intermediary related to vascular injury and organ dysfunction. We review, the clinical and experimental data of the mechanisms involved, and evaluate the wider implications of this concept.

Animals↗
PubMed2005

Complications related to intra-aortic balloon pump in cardiac surgery: a decade later.

BACKGROUND: Our centre in 1995 reported 26% of vascular complications in cardiac surgical patients treated with intra-aortic balloon pump (IABP). However, during the last decade there have been improvements in IABP technology and insertion techniques. We aimed to evaluate the impact of these changes on the incidence of IABP-related complications in cardiac surgery. METHODS: Demographics, indications, technique and complication rate in 186 consecutive patients treated with IABP from January 1994 to December 1998 (Group I) were compared with 323 consecutive patients treated with IABP from January 1999 to December 2003 (Group II) at our regional cardiothoracic centre. Data was variably expressed as mean with or without range and either standard deviation or range. Statistical significance was accepted at P<0.05. RESULTS: There were 121 (65%) and 194 (60%) males in Group I and II, respectively. The mean age was 66+/-12.1 (17-88) years and the mean duration of IAPB use was 43.5h (range 3-144 h). Overall complication rate was 10% in Group I and 2% in Group II whereas vascular complications accounted for 3% in Group-I and 1% in Group-II. Logistic regression analysis demonstrated cardiogenic shock being strongly correlated to in-hospital mortality (OR 4.68; P=0.004) followed by older age (OR 3.12; P=0.034) and ejection fraction <35% (OR 1.78; P=0.03). CONCLUSION: The study demonstrated a significant decrease in the IABP-related complications even though complexity of cases referred for surgery has increased. Henceforth, the risk of 1% vascular complications should play little influence on decision-making regarding the use of IABP.

Adolescent↗
PubMed2005

Leg wound infections following cardiac surgery: a scoring system for assessment and management.

OBJECTIVE: Well-defined criteria are needed to provide guidance for the appropriate management of leg wounds following saphenous vein harvest in coronary artery bypass graft surgery (CABG). METHOD: A score named DISINFECT was devised to carefully define the variables to be considered for assessing saphenous vein harvest wounds. RESULTS: This preliminary study included 100 consecutive patients undergoing first-time isolated CABG requiring the saphenous vein as a conduit. Wounds were assessed and the points combined to create a daily score (D) according to the presence of increased C-reactive protein/white blood cells (I), surrounding tissue (S), quality of the incision (I), new skin (N), foreign material (F), exudate (E), positive cultures (C) and temperature (T). CONCLUSION: Taking into account the stages of wound healing, severity of infection and appropriate use of antibiotics, this method of wound management would improve the consistency with which leg wounds are managed, reduce hospital stays and increase resistance to hospital-acquired infection.

Aged↗
PubMed2001

Measurement of the systemic inflammatory response predicts cancer-specific and non-cancer survival in patients with cancer.

The assessment of prognosis in patients with advanced cancer remains problematical. The value of C-reactive protein concentration in this context has not been clearly defined. Patients with a diagnosis of colorectal (n = 182), gastric (n = 87), breast (n = 99), or bronchogenic (n = 404) cancer and who had measurements of C-reactive protein and albumin were identified. Median survival, from the time of sampling, ranged from 478 days in the colorectal cancer patients to 60 days in patients with bronchogenic cancer. On univariate analysis, there was, in each tumor type, a significant relationship between the duration of survival and both log10 C-reactive protein and albumin concentrations (P < or = 0.0002). On multivariate analysis, in each tumor type, log10 C-reactive protein remained a significant independent predictor of survival (P < or = 0.0002). When all four groups of cancer patients were analyzed (n = 772), the hazard ratio for a 10-fold increase in C-reactive protein concentration in cancer-specific survival was 2.21 (95% confidence interval = 1.92-2.56, P < 0.0001) and the corresponding hazard ratio for non-cancer survival was 5.48 (95% confidence interval = 3.55-8.46, P < 0.0001). The results of the present study indicate that in advanced cancer patients the presence of a systemic inflammatory response and the magnitude of that response predict the duration of cancer-specific and non-cancer survival.

Adult↗
PubMed2000

Osteosynthesis and bony healing between two consecutive free fibular bone grafts.

This case report describes a recurrent squamous cell carcinoma in the oral cavity requiring two consecutive free fibula transfers at different times. In a unique application of the fibula, rigid miniplate fixation was used between the two independent free flaps to reconstitute the contour of the mandible for an extensive composite oromandibular defect, extending from the left angle to the right ascending ramus. This application underscores the utility of the free osteocutaneous fibular flap for reconstruction of complex mandibular defects.

Adult↗
PubMed2000

Excision of the submandibular gland by an intraoral approach.

To improve the outcome in patients with benign diseases of the submandibular gland, we have developed an entirely intraoral technique for excision of the submandibular gland. This procedure is anatomically safe and can be performed with minimal morbidity. We believe the essential surgical steps are as follows: (1) infiltration with Xylocaine plus epinephrine with an adequate waiting period for hemostasis; (2) careful identification of the submandibular duct/lingual nerve relationship; (3) anterior retraction of the mylohyoid muscle to expose the superficial lobe; (4) superiorly directed, extraoral, manipulation of the submandibular gland; and (5) close and blunt dissection to the gland laterally to avoid injury to the facial artery and vein.

Adult↗
PubMed1999

A new predictive modality of cranial bone thickness.

The objective of this study was to evaluate A-mode ultrasound in the assessment of cranial bone thickness utilizing an in vivo animal model. A prospective study was performed that identified four standardized calvarial points in 10 Landrace porcine skulls. The individual points were scanned with an A-mode ultrasonic transducer to obtain bone thickness measurements. The same points were measured subsequently using digital calipers for objective comparison. The accuracy of each of the measurement modalities was evaluated for inter- and intrarater reliability. The association between ultrasonic and caliper measurements was evaluated using Student's t-test, Pearson's correlation coefficient, and linear regression models to assess the effect of confounding variables. The mean difference between the ultrasonic and the caliper values was 0.31 +/- 0.22 mm (standard deviation). The statistical analyses employed strongly supported the predictive value of ultrasound as a function of the true calvarial thickness (p < 0.05, r > 0.88, R2 = 0.89). The results suggest that ultrasound is an accurate reflection of cranial bone thickness in an in vivo animal skull model. The development of a portable, noninvasive ultrasonic device can have substantial clinical implications for craniomaxillofacial surgery.

Animals↗
PubMed1999

Surgical treatment of cholesteatoma in children.

We retrospectively reviewed patients surgically treated for cholesteatoma to determine the impact of surgical procedures on preoperative hearing status and whether there was preservation, improvement, or deterioration. We reviewed 173 patients treated over a 15-year period. One hundred eighteen (68%) patients had acquired cholesteatoma and 55 (32%) patients had congenital cholesteatoma. One hundred (58%) patients had extensive disease on presentation that required canal wall-down mastoidectomy. Patients with attic cholesteatoma underwent canal wall-up mastoidectomy, and those with cholesteatoma localized to the middle-ear space were adequately treated with tympanotomy. Hearing was preserved in 101 cases (59%), improved in 30 (17%), became worse in 23 (13%), and could not be accurately assessed in 19 (11%) due to lack of documentation. A second surgical procedure for recidivistic (recurrent or residual) disease was required in 53 (30%). Ipsilateral facial paralysis was noted in 3 (1.7%) patients immediately after recovery from anaesthesia, and 1 (0.5%) patient had a sensorineural hearing loss. This study confirmed the aggressiveness of cholesteatoma in children and demonstrated the need for careful preoperative evaluation, meticulous surgical technique, and prudent postoperative follow-up.

Adolescent↗
PubMed1998

Paediatric hearing loss in rural Pakistan.

OBJECTIVE: The present study was designed to generate population-based data on the prevalence and causes of hearing loss in rural Pakistani children. A community screening programme was utilized to identify and evaluate the hearing impaired. METHODS: The study was performed in conjunction with the Ministry of Population Welfare in Sialkot District, Punjab Province. School-aged children between the ages of 5 and 15 years were screened and examined for hearing impairment according to World Health Organization (WHO) protocols. Case-control analysis of audiometric, physical examination, and risk factors for hearing loss were performed, followed by chi-square analyses. RESULTS: A total of 607 children comprised the study population, with an overall point prevalence of hearing impairment of 7.9%. Fifty percent of all hearing loss was conductive in nature, amenable to either medical or surgical therapy. The risk factors most associated with conductive hearing loss were otorrhea and multiple ear infections greater than 5. In cases of severe hearing loss, 70% were the result of consanguinous marriages. Almost no cases of hearing loss were attributable to measles, mumps, rubella, and the TORCH infections. CONCLUSION: This study has generated some badly needed population-based data on the magnitude of the problem of hearing loss in rural Pakistan. It is hoped that the results of this work will stress the importance of hearing health in Pakistan and to encourage other professionals to pursue similar projects.

Adolescent↗
PubMed1997

Ultrasound in the assessment of cranial bone thickness.

Preoperative knowledge of skull thickness before harvesting cranial bone grafts would be ideal to help minimize intracranial complications. Previous research has demonstrated regional variations in calvaria; however, accurate preoperative and intraoperative methods of skull thickness measurement are not available. The aim of this research represents the first attempt to examine the reliability of ultrasound to determine cranial bone thickness. Four previously studied calvarial sites were marked in 10 adult male cadaveric skulls. The individual points were insonified using an A-mode ultrasonic transducer operating in pulse-echo mode. The times of flight of the waves propagating in the bone samples were compared with caliper measurements. The mean difference in cranial bone thickness was 0.16 mm, with a standard deviation of 0.09 mm. Student's t-test failed to reveal any statistically significant differences between caliper and ultrasonic measurements (p = 0.569) and Pearson's correlation coefficient supported an extremely strong and positive relationship between the two modalities (r > 0.992). Multiple linear regression models predicted that calvarial thickness could be accurately predicted by ultrasound without consideration of cadaveric specimen or sampling point location (R2 = 0.988). The convergent values between ultrasonic and caliper measurements suggest that this modality can accurately and reliably determine skull thickness. A-mode ultrasound can have significant implications in guiding the harvest of in situ split cranial bone grafts, the placement of osseointegrated implants, skull anthropometrics, and related craniomaxillofacial applications.

Aged↗
PubMed1997

Trigeminal neo-neurotization of the paralyzed face.

Sporadic reports throughout the literature have documented the spontaneous return of facial function following deliberate intraoperative sacrifice of the facial nerve. Trigeminal reinnervation of the facial muscles has been suggested as one possible mechanism for this occurrence. Evidence for the phenomenon of trigeminal neo-neurotization has been documented experimentally. The case of a 62-year-old woman who underwent total left parotidectomy with transection of a large facial nerve segment is presented in order to provide further clinical evidence supporting trigeminal neo-neurotization of the facial nerve. Despite the lack of any efforts to reinnervate the patient or graft the facial nerve defect, the patient spontaneously developed return of facial function. Postoperative clinical and electrical testing in this case supports trigeminal-facial reinnervation as the cause for return of facial function. The case report is summarized with a brief discussion, and the relevant literature is thoroughly reviewed.

Electromyography↗
PubMed1997

Paraseptal structural changes and chronic sinus disease in relation to the deviated septum.

OBJECTIVE: This study was conducted to evaluate the use of computerized tomography in the delineation of the ostiomeatal complex to enhance the endoscopic surgeon's understanding of associated and contributing anatomic features. METHODS: The ostiomeatal complex region (OMC) was prospectively evaluated in 122 consecutive patients as a function of the degree of nasal-septal deviation. This data was correlated with paranasal sinus disease, lateral nasal-wall findings, and middle-turbinate abnormalities. RESULTS: Patients with increasing nasal-septal deviations were associated with a higher incidence of OMC obstruction (p < .05). OMC obstruction in the direction of septal angulation was attributable to nasal septal deformity. However, contralateral OMC obstruction was related to middle-turbinate and lateral nasal-wall abnormalities, which appeared with increased frequency on the side opposite to the septal deviation (p < .05). Furthermore, an increased incidence and severity of sinus disease was noted with increasing septal deviation (p < .05). CONCLUSION: Increasing angles of septal deviation are associated with bilateral sinus disease and contralateral middle turbinate abnormalities and ethmoid bulla prominence.

Abnormalities, Multiple↗
PubMed1995

Therapeutic embolization in the treatment of intractable epistaxis.

OBJECTIVE: To determine the effectiveness of therapeutic embolization in the treatment of intractable epistaxis. DESIGN: Cohort. SETTING: Tertiary care hospital. PATIENTS: Consecutive referred sample of 57 patients with intractable epistaxis. INTERVENTION: Percutaneous transfemoral catheterization and angiography of the internal maxillary arteries. Embolization of the most distal branches with 0.1- to 0.9- cm3 medium-sized polyvinyl alcohol particles on the suspected side of bleeding. OUTCOME: Outcome was successful if no further interventional treatment was required for epistaxis. RESULTS: Anatomical abnormalities precluded embolization in three patients. Three of the remaining 54 patients required supplementry embolization. Including these three patients, 52 (96%) of 54 patients had successful control epistaxis. The major neurologic complication rate was 6% (three of 54 patients), with no permanent deficits. CONCLUSIONS: Therapeutic embolization is an effective and safe technique and should be considered as the primary treatment modality in severe epistaxis.

Adolescent↗
PubMed1995

Intraparotid facial nerve schwannoma.

Intraparotid facial nerve schwannomas have been documented sporadically throughout the medical literature. These benign tumours of neurogenic origin should be considered in the differential diagnosis of parotid region masses. A case report is presented, followed by a brief literature review and discussion of appropriate diagnostic and treatment modalities.

Cranial Nerve Neoplasms↗
PubMed1992

Hemangioma of the masseter muscle.

Intramuscular hemangiomas are rare benign tumors of vascular origin. The masseter is the muscle most commonly involved in the head and neck. A case of intramuscular masseter hemangioma is presented, the literature reviewed, and appropriate diagnostic modalities discussed.

Adult↗