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Biomedical subjects

S Virmani

Publications and source records attributed to S Virmani.

14 recordsLinked to original sources
PubMed2006

Length of insertion for pulmonary artery catheters to locate different cardiac chambers in patients undergoing cardiac surgery.

BACKGROUND: Although, guidelines related to length of insertion of a pulmonary artery catheter to reach a particular cardiac chamber are available, these are not backed by clinical studies. We measured the length of insertion of pulmonary artery catheters to locate the right ventricle, pulmonary artery and pulmonary capillary wedge positions in 300 adult patients undergoing elective cardiac surgery. METHODS: The pulmonary artery catheters were inserted using a standard technique through the right internal jugular vein. The right ventricle, pulmonary artery and wedge position of the catheter were confirmed by the characteristic waveforms, and the length of insertion to these points was measured. RESULTS: The right ventricle was reached at 24.6 (3) cm (95% CI 24.2-24.9 cm), pulmonary artery at 36 (4) cm (95% CI 35.6-36.5 cm) and wedge position at 42.8 (5.7) cm (95% CI 42.2-43.5 cm). The length of catheter to reach the right ventricle, pulmonary artery and wedge position was significantly more in patients undergoing valve surgery as compared with those undergoing coronary artery bypass grafting [26 (3.8) and 24 (2.5) cm; 38.5 (4.6) and 35 (3.2) cm; and 47.8 (6.9) and 41.2 (4.1) cm, respectively, P<0.001]. The length of insertion to reach pulmonary artery and pulmonary capillary wedge position was directly related to height of the patient (Pearson's correlation 0.157 and 0.15, respectively). CONCLUSIONS: We have provided the norms related to length of insertion of pulmonary artery catheter, which should be useful in accurate placement of the catheter and minimize complications related to coiling of the catheter.

Adolescent↗
PubMed2006

Bounds on multipartite entangled orthogonal state discrimination using local operations and classical communication.

We show that entanglement guarantees difficulty in the discrimination of orthogonal multipartite states locally. The number of pure states that can be discriminated by local operations and classical communication is bounded by the total dimension over the average entanglement. A similar, general condition is also shown for pure and mixed states. These results offer a rare operational interpretation for three abstractly defined distancelike measures of multipartite entanglement.

Journal Article↗
PubMed2001

Asymptotic relative entropy of entanglement.

We present an analytical formula for the asymptotic relative entropy of entanglement with respect to positive partial transpose states for Werner states of arbitrary dimension. We then demonstrate its validity using methods from convex optimization. This is the first case in which the asymptotic value of a subadditive entanglement measure has been calculated.

Journal Article↗
PubMed2001

Comparison of the effects of a cell saver and low-dose aprotinin on blood loss and homologous blood usage in patients undergoing valve surgery.

OBJECTIVE: To compare 2 important techniques of blood conservation, use of a cell saver and low-dose aprotinin, in terms of blood loss and homologous blood usage in patients undergoing cardiac valve surgery. DESIGN: Prospective, randomized. SETTING: Tertiary care hospital. PARTICIPANTS: Sixty adult patients undergoing elective valve surgery. INTERVENTIONS: The patients were divided into 3 groups of 20 each. In group 1, aprotinin in the dose of 30,000 KIU/kg was added to the pump prime, with a further dose of 15,000 KIU/kg added at the end of each hour of cardiopulmonary bypass. In group 2, a cell-saver system was used to collect all blood at the operation site for processing in preparation for subsequent reinfusion. Group 3 patients acted as a control group and underwent routine management, which included collection of autologous blood during the pre-cardiopulmonary bypass period. A hemoglobin of <8 g/dL was considered as an indication for bank blood transfusion in the postoperative period. MEASUREMENTS AND MAIN RESULTS: The chest tube drainage was significantly less in group 1 compared with groups 2 and 3, with total drainage (median [interquartile range]) amounting to 250 mL [105 to 325 mL] vs. 700 mL [525 to 910 mL] in group 2 and 800 mL [650 to 880 mL] in group 3 (p < 0.001). The patients in groups 1 and 2 required significantly less bank blood (median [interquartile range]) as compared with group 3 (350 mL [0 to 525 mL], 350 mL [0 to 350 mL], and 1050 mL [875 to 1050 mL]; p < 0.001), respectively. Cell saver provided 410 +/- 130 mL of hemoconcentrated blood in group 2. The average preoperative hemoglobin concentration was 11.3 g/dL, and it was around 9 g/dL on the 7th postoperative day. The hemoglobin concentration at various stages during hospitalization in all 3 groups was similar. CONCLUSIONS: Low-dose aprotinin and a cell saver are effective and comparable methods of blood conservation. Aprotinin helps by decreasing the postoperative drainage, and a cell saver helps by making the patient's own blood available for transfusion.

Adult↗
PubMed1999

Pharmacologic support of circulation in patients undergoing cardiac surgery.

Maintenance of adequate oxygen balance to all tissues is one of the primary objectives when dealing with patients undergoing cardiac surgery. Cardiac output is one of the major components of oxygen delivery so that its maintenance is an important consideration. Due to pre-operative cardiac lesion and myocardial dysfunction secondary to the events related to cardiac surgery and cardiopulmonary by-pass, circulatory support by pharmacological or mechanical means is frequently required after surgery. Therefore, inotropes and vasodilators are used to improve the myocardial performance after cardiac surgery. Epinephrine, dopamine and dobutamine are commonly used inotropes. Dopexamine and phosphodiesterase inhibitors such as amrinone, milrinone and enoximone are some of the newer agents that have been introduced in clinical practice. Amongst the vasodilators, sodium nitroprusside and nitroglycerin are commonly used. Alpha adrenergic blockers such as phentolamine and phenoxybenzamine and calcium channel blockers such as diltiazem are some other vasodilators that can be used. Many units still regard epinephrine as an inotrope of choice and use its predominant beta agonist effect in the dose range of 0.02 to 0.04 mg/kg/minute. Some prefer dobutamine and others a combination of inotrope and vasodilator or an inodilator. Phosphodiesterase inhibitors can be useful in certain situations such as pre-existing ventricular dysfunction or when stunning of the myocardium is suspected with down regulation of beta receptors. Dopamine is useful in the renal vasodilating dose to improve renal perfusion and improve output. There is no ideal inotrope at present and each one has its own drawbacks. The clinician must learn to use the inotropes (especially the newer ones) based on his own clinical experience.

Cardiac Surgical Procedures↗
PubMed1997

Cuspal fracture resistance and microleakage of glass ionomer cements in primary molars.

The purpose of this study was to comparatively evaluate the fracture strength and microleakage among two new glass ionomer cements. One hundred and ten primary first and second molars were divided into two main groups, one group comprising of fifty teeth for microleakage evaluation and second group of sixty for fracture strength. Both the groups were subdivided equally into four based on the materials used, consisting of the same number of teeth respectively, in each. Two controls were used for cuspal fracture strength and an additional trial group was added for microleakage evaluation. Ideal, non retentive class II were prepared and restored with amalgam, Fuji IX, Fuji II LC and Vitremer. The statistical analysis revealed highly significant differences among all the subgroups except between subgroup 3 vs. 4 and 1 for cuspal fracture strength. Similarly microleakage values were significantly different statistically among sub groups 4 and 5 vs 1 and 2. The present study revealed that Fuji IX was the best in terms of cuspal fracture strength and Fuji IX with an additional application of light cure resin sealant gave the lowest degree of microleakage.

Analysis of Variance↗
PubMed1987

Familial coarctation of the aortic arch with bilateral ptosis: a new syndrome?

A Newfoundland family with the apparently unique syndrome of complex coarctation of the aortic arch, bilateral stenoses of the subclavian arteries, bilateral ptosis, sensorineural deafness, and bronchial asthma is reported. This syndrome appears to have affected at least four generations, and has the characteristics of autosomal dominant inheritance.

Aortic Coarctation↗
PubMed1986

Echocardiography of intracardiac filling defects in infants and children.

Intracardiac masses are rare in infants and children. Early detection is essential to their successful management. We present seven patients in whom echocardiography established the diagnosis and was crucial in the management. Three of the masses were primary cardiac tumors and four were thrombi. Patient 1: an infant with a calcified left ventricular fibroma. Patient 2: a neonate who presented with cyanosis due to obstruction of the right ventricular inflow tract by a fibroblastic tumor. Patient 3: an infant with a right atrial myxoma presenting as sepsis. Patient 4: a child who had a pulmonary embolus after a pulmonary valvotomy and was found to have a right ventricular thrombus. Patient 5: a child with a right atrial thrombus following a Fontan procedure for univentricular atrioventricular connection. Patient 6: a child with a left ventricular thrombus due to a dilated cardiomyopathy in association with epidermolysis bullosa. Patient 7: An infant with bilateral lobar emphysema, an aorticopulmonary window with left ventricular fibroelastosis, who developed a left ventricular thrombus.

Child↗
PubMed1985

Left-axis deviation in otherwise healthy children.

Eighteen children with left-axis deviation on the electrocardiogram but no other detected abnormalities are reported. The implications of this finding are discussed. No untoward cardiovascular events occurred during the period of follow-up and the electrocardiographic findings remained unchanged. This, therefore, appears to be a benign entity in the short term but longer follow-up is required before the ultimate prognosis can be determined.

Adolescent↗
PubMed1975

A simplified parameter of LV function in children with congenital heart disease.

Myocardial state in children with various congenital anomalies was assessed using pressured-derived parameters; Vmax and Vpm. A simple approach, based on the relationship between peak value of the first derivative of the left ventricular isovolumic pressure and its associated total pressure, for identifying patients with impaired myocardial function is described.

Adolescent↗
PubMedDate not supplied

Successful one stage repair of coarctation of the aorta and aneurysm of the ascending aorta in a child.

A case of successful one stage repair of aortic coarctation and ascending aortic aneurysm in a 10 year old boy with cystic medial necrosis and congenital bicuspid aortic valve is presented. The patient underwent correction of both lesions at the same operation through two separate incisions. The coarctation was repaired first. The aortic valve was found to be hemodynamically normal and was not replaced. The patient leads a normal life at five and half years after operation and is playing ice hockey with no limitations. Close and long-term follow-up is considered essential in view of the potential complications.

Aorta, Thoracic↗