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Biomedical subjects

M Sivina

Publications and source records attributed to M Sivina.

12 recordsLinked to original sources
PubMed1996

The use of T-bars in laparoscopic ventral hernia repair.

During the past 2 years 15 laparoscopic ventral hernias have been performed at our Community Hospital. Marlex mesh has been the material used. We have noticed some difficulty with the grasping and initial anchoring of the mesh. Percutaneously placed prolene sutures allow the mesh to be drawn upward with some effort. By using laparoscopic T-bars for the initial anchoring of the mesh to the anterior abdominal wall then stapling, the operative time was greatly reduced. This modification in technique allows for quicker placement of the mesh during the repair.

Abdominal Muscles↗
PubMed1996

Laparoscopic ventral hernia repair: a community hospital experience.

From October 1993 to April 1994, laparoscopic ventral hernia repair was performed on 10 patients, all of whom had a history of failed ventral hernia repair and at least two prior ventral hernia repair procedures. Patients presented with complaints of abdominal discomfort, painful mass at the hernia site, or vague abdominal discomfort. No operative deaths occurred. Two patients had minor complications: a seroma at the repair site, which resolved spontaneously, and a superficial wound infection at a trochar site, which responded to an oral cephalosporin. Six patients were discharged within 24 hours of surgery and one patient was operated on as an outpatient and discharged the same day. Follow-up of all patients ranged from 10 to 17 months. No evidence of hernia recurrence has been noted. Some recurrent ventral hernias are amenable to laparoscopic repair, and this technique may be preferable in some patients, especially those who have had an earlier failed open repair with mesh. We do not advocate use of our technique for the first repair of a ventral hernia. Long-term follow-up is still needed to determine recurrence rates compared with conventional open techniques.

Adult↗
PubMed1995

Laparoscopic feeding jejunostomy: a new technique.

Laparoscopic feeding jejunostomy has been performed and reported by others. The need for jejunostomy in certain patient populations, namely, patients with advanced head and neck cancer, esophageal cancer, or stomach cancer, is well accepted. This has led to numerous open techniques and now laparoscopic techniques. We describe in this report a new way of performing a laparoscopic jejunostomy and include intraoperative photographs.

Animals↗
PubMed1994

Retroperitoneal approach used exclusively with epidural anesthesia for infrarenal aortic disease.

BACKGROUND: The retroperitoneal approach for elective infrarenal aortic procedures is an attractive alternative to the standard transperitoneal approach. In an effort to limit the number of extraneous influences on patient outcome, this approach was performed using epidural anesthesia without the use of endotracheal intubation or general anesthesia. METHODS: From June 1991 through July 1993, 62 consecutive patients with aorto-occlusive or aorto-iliac disease underwent infrarenal aortic repair using the retroperitoneal approach. Epidural anesthesia was used exclusively in all cases. Patients were evaluated for age, sex, comorbid conditions, morbidity, operating time, blood loss, ileus, and length of hospital stay. RESULTS: There were 29 aortobiiliac bypasses, 18 aortobifemoral bypasses, and 15 aortic tube grafts. Three patients had an associated renal artery procedure performed. There were 48 men and 14 women. The average age was 74.2 years (range 30 to 88). Comorbid conditions including smoking (69%), coronary artery disease (61%), hypertension (61%), prior myocardial infarction (43%), chronic obstructive pulmonary disease (35%), prior surgery (27%), diabetes mellitus (24%), and a history of cancer (8%) were identified. The average length of surgery was 2 hours and 10 minutes (range 1 hour 20 minutes to 3 hours 15 minutes). The average blood loss was 510 mL (range 200 to 4,000). A nasogastric tube was not used in any patient perioperatively, and oral feeding was started on average by postoperative day 2. The average intensive care unit stay was 1.3 days (range 1 to 7). A mortality rate of 1.6%, and major complication rate of 11% were found. None were of pulmonary nature, which may be ascribed to the absence of endotracheal intubation or general anesthesia. A minor complication rate of 19% was achieved under the presented method. The average hospital stay was 7.7 days (range 5 to 15). CONCLUSION: No large series using the retroperitoneal approach exclusively under epidural anesthesia has been reported. Recent literature on the retroperitoneal approach makes use of general anesthesia with/without epidural anesthesia. This review supports our contention that the procedure of choice for elective infrarenal aortic surgery is the retroperitoneal approach utilizing epidural anesthesia in the absence of endotracheal intubation and general anesthesia. There is a decrease in the physiologic disturbances associated with general anesthesia, notably pulmonary and gastrointestinal, when only epidural anesthesia is used. This translated into a low complication rate, improved patient comfort, early hospital discharge, and subsequent lower costs.

Adult↗
PubMed1988

DDD pacemakers maximize hemodynamic benefits and minimize complications for most patients.

A 44-month retrospective analysis was performed on 666 pacemakers implanted at Mt. Sinai Medical Center. Mapping techniques and endocardial waveform analyses were used during lead positioning to ensure the best electrical environment. The optimal pacing lead type was selected based on the clinical situation. Follow-up evaluations were rigorous. Patient population ranged in age from 28 to 103 with a mean of 78 years at time of implant. Seventy percent of the patients received DDD pacemakers with an 81% survival incidence at 44 months. Of the VVI population (30% of the implants), there was a 62% survival incidence. Most problems associated with the pacing systems were related to the atrial channel. Loss of atrial sensing occurred in 7.5% of the population and was corrected noninvasively in 5.8%. Due to chronic loss of atrial sensing, 1.7% of the population remained programmed to DVI/VVI. A total of 7.7% were chronically reprogrammed from DDD to VVI, 5.6% secondary to atrial fibrillation. Reoperations were necessary in 1.2% of the malfunctioning systems that could not be corrected by reprogramming. The following conclusions were reached: (1) maximizing hemodynamic benefits and minimizing pacemaker complications permitted a survival rate equal to or better than that of the general population, and (2) chronic problems related to the atrial lead and malfunctions of the pacing system were minimized by careful patient selection, appropriate pacemaker and lead selection, endocardial waveform analysis, and thorough follow-up.

Adult↗
PubMed1986

Pacemaker clinic evaluations: key to early identification of surgical problems.

The pacemaker center evaluation was responsible for the timely reoperation of 341 pacemaker patients over the last three years. The most common indication for reoperation was battery end-of-service (46.3%). Battery testing and maintenance of accurate records for trend analysis ensures prompt generator replacement. Atrial and/or ventricular lead malfunction was the second largest indication (26.3%). Lead malfunction detected by bracketing capture and sensing thresholds included: dislodgement, penetration, exit block, fracture, insulation failure, and abnormal sensing. The third largest indication for reoperation was pacemaker pocket erosion and/or infection (15.5%). Examination of the pacemaker pocket site is an integral part of an evaluation. In conclusion, the three largest indications for reoperations can be best demonstrated in a pacemaker center where evaluations are personal and thorough, and accurate record keeping is maintained.

Adult↗
PubMed1984

Intravenous DSA of extracranial carotid lesions: comparison with other techniques and specimens.

Intravenous digital subtraction arteriography (DSA) was performed in 306 patients with suspected ischemic cerebrovascular disease. Forty-eight carotid endarterectomies were performed in 43 of these patients. The percentage stenosis as determined on the intravenous DSA examination concurred (+/- 10%) with the surgical findings in 83.3%. There were 12.5% undercalls (false-negatives) and 4.3% overcalls (false-positives). Of the false-negative and false-positive examinations only three would have affected the clinical management of the patient, yielding an overall sensitivity of 93.7%. Nine surgical lesions had both intravenous DSA and conventional arteriography. Intravenous DSA was correct in six and arteriography in seven of these lesions. There were four surgically confirmed ulcerations. Two were evaluated by intravenous DSA alone. Two had intravenous DSA and arteriography. The latter showed both ulcers; the former, only one. Thirty-seven surgical lesions had both intravenous DSA and high-resolution real-time sonographic imaging. Sonography agreed in 67.5% and intravenous DSA in 83.7% of these lesions. When an abnormal supraorbital Doppler or an abnormal oculopneumoplethysmography/Gee examination is added to the sonographic examination, an overall sensitivity of 93% was obtained in detecting a surgical lesion (stenosis greater than 50%).

Adult↗
PubMed1984

Computer applications to electrophysiologic studies.

The automated studies performed at implant require little extra time and provide essential information for postoperative troubleshooting and patient management. The automated testing and analysis system is but one component in a comprehensive patient management system designed for and dedicated to pacing; the system is an integral part of a complete data management system which includes extensive follow-up and management sections.

Computers↗
PubMed1983

Malignant mesenchymoma of kidney and inferior vena cava.

Herein is reported the first known case of malignant mesenchymoma involving the kidney and secondarily the vena cava in an adult. A thirty-nine-year-old woman succumbed to this malignancy within three months after the diagnosis was established, despite multimodal therapy.

Adult↗
PubMed1983

Implant experience with unipolar polyurethane pacing leads.

A total of 905 unipolar polyurethane pacing leads have been implanted by the first author's group, between April 1978 and February 1982, with a mean implant of 1.4 years. Twelve leads were explanted and analyzed. Eleven of the explanted leads exhibited some degree of surface damage or "frosting." Of the 11, five atrial (Medtronic 6991 U) and one ventricular (Medtronic 6971) lead suffered complete insulation failure. One lead was completely free from surface damage. Clinically, insulation failure presented as muscle stimulation and/or battery depletion. Surface damage appears to be due to an environmental stress cracking (ESC) mechanism. ESC requires both a surface active agent from the hostile biological environment, and stress in excess of a threshold value. The minor surface damage or "frosting" of the eleven explanted leads was typically 10 to 15 microns deep on leads implanted about one year, although one device (15 months) had 30 micron cracks. No lead failures in this series were attributed to this shallow cracking mechanism. The severe cracking of the six Medtronic leads leading to insulin failure was thought to be due to the unusually high tensile stresses imposed by manufacturing processes and ligatures. The incidence of failure was 7% (5/74) for the Medtronic 6991 U and 0.2% (1/454) for the Medtronic 6971. Medtronic lead manufacturing processes have been modified to reduce the high residual tensile stresses and a fixation sleeve has been added to reduce ligature stress.

Arrhythmias, Cardiac↗
PubMedDate not supplied

Acute hemiballismus after carotid endarterectomy--a case report.

A 72-year-old woman who experienced a postoperative stroke after a carotid endarterectomy with the presenting symptom of hemiballismus is described. This unusual presentation was likely the result of a hypotensive episode coupled with a predisposing anatomic variant in the circle of Willis, which compromised blood flow in the posterior cerebral circulation. She responded well to treatment with haloperidol with complete resolution of hemiballistic movements.

Acute Disease↗