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Housman B, Lee DS, Wolf A, Nicastri D, Kaufman A, Rizk N, Housman A, Song K, Hakami A, Flores RM. Major modifications to minimize thoracic esophago-gastric leak and eradicate esophageal stricture after Ivor Lewis esophagectomy. J Surg Oncol 2021; 124:529-539. [PMID: 34081346 DOI: 10.1002/jso.26550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/20/2021] [Accepted: 05/19/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND The Ivor Lewis esophagectomy (ILE) remains the procedure of choice for localized middle or lower esophageal carcinoma. Nevertheless, anastomotic leak remains a common complication with rates from 3% to 25% and a stricture rate as high as 40%. The frequency of these complications suggests that the procedure itself may have inherent limitations including the use of potentially ischemic tissue for the esophagogastric anastomosis. We introduce a modified technique that reduces operative steps, preserves blood supply, and uses a modified esophagogastric anastomosis. METHODS All consecutive patients undergoing ILE with the described modified technique were identified. An esophagram was performed on postoperative day six or seven. To ensure that all cases were identified, anastomotic leaks were defined as any radiographic evidence of contrast extravasation. RESULTS A total of 110 patients underwent the modified esophagectomy with 2 anastomotic leaks (1.82%) and zero strictures. There was 1 late death but no early deaths (<30 or 90 days) or early re-admissions (<30 days). The average number of risk factors was 2.12, and 98 patients (90%) had at least 1 risk factor in their medical history. CONCLUSIONS The modifications proposed simplify procedural steps, limit unnecessary dissection and introduce a technique that ends the practice of connecting ischemic tissue. We believe this technique contributes to surgical durability and reduces the rate of postoperative leak and eliminates stricture.
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Affiliation(s)
- Brian Housman
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Dong-Seok Lee
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Andrea Wolf
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Daniel Nicastri
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Andrew Kaufman
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Nabil Rizk
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Arno Housman
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Kimberly Song
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Ardeshir Hakami
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Raja M Flores
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
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Alhetheel A, Albarrag A, Hakami A, Shakoor Z, Alswat K, Abdo A, Al-Hamoudi W, Alomar S. In the peripheral blood mononuclear cells (PBMCs) of HCV infected patients the expression of STAT1 and IRF-1 is downregulated while that of caspase-3 upregulated. Acta Virol 2021; 64:352-358. [PMID: 32985214 DOI: 10.4149/av_2020_313] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Several peripheral blood mononuclear cell (PBMC) defects have been linked with hepatitis C virus (HCV) infection, including alterations in cytokine secretion and increased cell death. This study was performed to investigate the expression levels of signal transducer and activator of transcription 1 (STAT1), interferon regulatory factor 1 (IRF-1), and caspase 3 in PBMCs of patients infected with HCV. STAT1, IRF-1, and caspase 3 expression levels were compared in PBMCs from 19 untreated (naïve) HCV+ patients, 8 treated (sustained responder [SR]) HCV patients, and 20 HCV- healthy controls. Moreover, PBMCs from naïve HCV+ patients and SR-HCV patients were also evaluated for HCV RNA expression. The expression levels of STAT-1 and IRF-1 were significantly downregulated in PBMCs from naïve HCV+ patients (P Keywords: PBMC; hepatitis C virus; STAT1; IRF-1; caspase-3.
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Housman B, Jacobi A, Carollo A, Nobel T, Eber C, Acquah S, Powell C, Kaufman A, Lee DS, Nicastri D, Hakami A, Song K, Kohli-Seth R, Flores R. COVID-19 ventilator barotrauma management: less is more. Ann Transl Med 2020; 8:1575. [PMID: 33437774 PMCID: PMC7791221 DOI: 10.21037/atm-20-3907] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background COVID-19 patients requiring mechanical ventilation may develop significant pneumomediastinum and sub-cutaneous emphysema without associated pneumothorax (SWAP). Prophylactic chest tube placement or sub-fascial "blowholes" are usually recommended to prevent tension pneumothorax and clinical decline. Risk of iatrogenic lung injury and release of virus into the environment is high. Incidence and conservative management data of such barotraumatic complications during the COVID-19 pandemic are lacking. Methods All patients with mediastinal air and SWAP evaluated by the department of Thoracic Surgery at the Mount Sinai Hospital between March 30 and April 10, 2020 were identified. All patients without pneumothorax were treated conservatively with daily chest x-ray and observation. Three patients had prophylactic chest tube placement prior to the study period without thoracic surgery consultation. Results There were 29 cases of mediastinal air with SWAP out of 171 COVID positive intubated patients (17.0%) who were treated conservatively. Patients were intubated for an average of 2.4 days before SWAP was identified. 12 patients (41%) had improvement or resolution without intervention. Two patients progressed to pneumothorax 3 and 8 days following initial presentation. Both had chest tubes placed without incident before there were any changes in oxygenation, hemodynamics, supportive medications, or ventilator settings. There were 3 patients who had percutaneous tubes placed before the study period all of whom had significant worsening of their sub-cutaneous air and air leak. Conclusions Conservative management of massive sub-cutaneous emphysema without pneumothorax in COVID-19 patients is safe and limits viral exposure to healthcare workers. Placement of chest tubes is discouraged unless a definite sizable pneumothorax develops.
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Affiliation(s)
- Brian Housman
- Thoracic Surgery Department, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Adam Jacobi
- Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Andrea Carollo
- Thoracic Surgery Department, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Tamar Nobel
- Thoracic Surgery Department, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Corey Eber
- Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Samuel Acquah
- Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Charles Powell
- Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Andrew Kaufman
- Thoracic Surgery Department, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Dong-Seok Lee
- Thoracic Surgery Department, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Daniel Nicastri
- Thoracic Surgery Department, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Ardeshir Hakami
- Thoracic Surgery Department, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Kimberly Song
- Thoracic Surgery Department, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Roopa Kohli-Seth
- Surgery, Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Raja Flores
- Thoracic Surgery Department, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
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Hakami A. TROUSSEAU’S SYNDROME IN ASSOCIATION WITH LUNG ADENOCARCINOMA. Chest 2020. [DOI: 10.1016/j.chest.2020.05.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Hakami A. GIANT MEDIASTINAL MIXED GERM CELL TUMOR: A RARE CASE REPORT AND REVIEW OF LITERATURE. Chest 2020. [DOI: 10.1016/j.chest.2020.05.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Homoud B, Hakami A, AlMalki M, Shaheen M, Althuabiti A, AlKhathaami A, Khatri I. Diabetic patients with ischemic stroke have higher frequency of comorbid vascular risk factors and poor discharge outcomes. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Paul E, Beynon C, Alzaydani I, Hakami A, Asiri A. An interview-based qualitative study on a healthcare workers’ perspectives of health-care-associated infections and infection control measures in a tertiary care hospital in Abha, Saudi Arabia. J Infect Public Health 2019. [DOI: 10.1016/j.jiph.2018.10.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Paul E, Shobowale E, Alzaydani I, Hawan A, Hakami A, Quasem M, Alkahtani S, Mahfouz M. A hunt for Candida auris in Abha, the asir province of Saudi Arabia. J Infect Public Health 2019. [DOI: 10.1016/j.jiph.2018.10.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Flores R, Taioli E, Yankelevitz DF, Becker BJ, Jirapatnakul A, Reeves A, Schwartz R, Yip R, Fevrier E, Tam K, Steiger B, Henschke CI, Flores R, Kaufman A, Lee DS, Nicastri D, Wolf A, Rosenzweig K, Gomez J, Beasley MB, Zakowski M, Chung M, Yankelevitz D, Henschke C, Futamura R, Kantor S, Wallace C, Bhora F, Raad W, Evans A, Choi W, Buyuk Z, Friedman A, Dreifuss R, Verzosa S, Yakubox M, Aloferdova K, Stacey P, De Nobrega S, Futamura R, Kantor S, Wallace C, Hakami A, Tam K, Wallace C, Pass H, Crawford B, Donnington J, Cooper B, Moreirea A, Sorensen A, Kohman L, Dunton R, Wallen J, Curtiss C, Scalzetti E, Ellinwood L, Aye R, Vallieres E, Louie B, Frivar A, Mehta V, Manning K, Chona M, Smith A, Connery CP, Torres E, Cruzer D, Gendron B, Alyea S, Lackaye D, Studer L, Flores R, Henschke C, Taioli E, Yankelevitz D, Becker B, Jirapatnakul A, Reeves A, Schwartz R, Yip R, Fevrier E, Tam K, Steiger B. Initiative for Early Lung Cancer Research on Treatment: Development of Study Design and Pilot Implementation. J Thorac Oncol 2018; 13:946-957. [DOI: 10.1016/j.jtho.2018.03.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 01/31/2018] [Accepted: 03/04/2018] [Indexed: 01/15/2023]
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Nesrallah M, Hakami A, Bart G, McDonald CR, Varin C, Brabec T. Measuring the Kerr nonlinearity via seeded Kerr instability amplification: conceptual analysis. Opt Express 2018; 26:7646-7654. [PMID: 29609317 DOI: 10.1364/oe.26.007646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 03/06/2018] [Indexed: 06/08/2023]
Abstract
Whereas the Kerr nonlinearity is well understood in the perturbative limit of nonlinear optics, there is considerable discussion about its functional form and magnitude at extreme intensities, at which point matter starts to ionize. Here, we introduce a concept to answer this question and theoretically analyze its feasibility. We demonstrate that seeded Kerr instability amplification provides clear signatures from which functional form and magnitude of the Kerr nonlinearity can be extracted in the non-perturbative limit of nonlinear optics.
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Fillingham MA, VanderZaag AC, Burtt S, Baldé H, Ngwabie NM, Smith W, Hakami A, Wagner-Riddle C, Bittman S, MacDonald D. Greenhouse gas and ammonia emissions from production of compost bedding on a dairy farm. Waste Manag 2017; 70:45-52. [PMID: 28931476 DOI: 10.1016/j.wasman.2017.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 09/08/2017] [Accepted: 09/12/2017] [Indexed: 06/07/2023]
Abstract
Recent developments in composting technology enable dairy farms to produce their own bedding from composted manure. This management practice alters the fate of carbon and nitrogen; however, there is little data available documenting how gaseous emissions are impacted. This study measured in-situ emissions of methane (CH4), carbon dioxide (CO2), nitrous oxide (N2O), and ammonia (NH3) from an on-farm solid-liquid separation system followed by continuously-turned plug-flow composting over three seasons. Emissions were measured separately from the continuously-turned compost phase, and the compost-storage phase prior to the compost being used for cattle bedding. Active composting had low emissions of N2O and CH4 with most carbon being emitted as CO2-C and most N emitted as NH3-N. Compost storage had higher CH4 and N2O emissions than the active phase, while NH3 was emitted at a lower rate, and CO2 was similar. Overall, combining both the active composting and storage phases, the mean total emissions were 3.9×10-2gCH4kg-1 raw manure (RM), 11.3gCO2kg-1 RM, 2.5×10-4g N2O kg-1 RM, and 0.13g NH3 kg-1 RM. Emissions with solid-separation and composting were compared to calculated emissions for a traditional (unseparated) liquid manure storage tank. The total greenhouse gas emissions (CH4+N2O) from solid separation, composting, compost storage, and separated liquid storage were reduced substantially on a CO2-equivalent basis compared to traditional liquid storage. Solid-liquid separation and well-managed composting could mitigate overall greenhouse gas emissions; however, an environmental trade off was that NH3 was emitted at higher rates from the continuously turned composter than reported values for traditional storage.
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Affiliation(s)
- M A Fillingham
- Agriculture and Agri-Food Canada, Ottawa, Ontario, Canada; Carleton University, Ottawa, Ontario, Canada
| | - A C VanderZaag
- Agriculture and Agri-Food Canada, Ottawa, Ontario, Canada.
| | - S Burtt
- Agriculture and Agri-Food Canada, Ottawa, Ontario, Canada
| | - H Baldé
- Agriculture and Agri-Food Canada, Ottawa, Ontario, Canada
| | - N M Ngwabie
- Agriculture and Agri-Food Canada, Ottawa, Ontario, Canada; University of Bamenda, Cameroon
| | - W Smith
- Agriculture and Agri-Food Canada, Ottawa, Ontario, Canada
| | - A Hakami
- Carleton University, Ottawa, Ontario, Canada
| | | | - S Bittman
- Agriculture and Agri-Food Canada, Agassiz, British Columbia, Canada
| | - D MacDonald
- Environment Canada, Gatineau, Quebec, Canada
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Affiliation(s)
- Jeffrey Shayani
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Raja M Flores
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Ardeshir Hakami
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
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Hakami A, Al-Ankari AR, Zaki M, Yousif A. Molecular studies on psittacine beak and feather disease virus in Saudi Arabia. Int J Infect Dis 2012. [DOI: 10.1016/j.ijid.2012.05.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Ømark Petersen H, Eckardt J, Hakami A, Olsen KE, Jørgensen OD. The value of mediastinal staging with endobronchial ultrasound-guided transbronchial needle aspiration in patients with lung cancer☆. Eur J Cardiothorac Surg 2009; 36:465-8. [DOI: 10.1016/j.ejcts.2009.03.052] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Revised: 03/27/2009] [Accepted: 03/31/2009] [Indexed: 10/20/2022] Open
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Hakami A, Henze DK, Seinfeld JH, Chai T, Tang Y, Carmichael GR, Sandu A. Adjoint inverse modeling of black carbon during the Asian Pacific Regional Aerosol Characterization Experiment. ACTA ACUST UNITED AC 2005. [DOI: 10.1029/2004jd005671] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- A. Hakami
- Departments of Chemical Engineering and Environmental Science and Engineering; California Institute of Technology; Pasadena California USA
| | - D. K. Henze
- Departments of Chemical Engineering and Environmental Science and Engineering; California Institute of Technology; Pasadena California USA
| | - J. H. Seinfeld
- Departments of Chemical Engineering and Environmental Science and Engineering; California Institute of Technology; Pasadena California USA
| | - T. Chai
- Center for Global and Regional Environmental Research; University of Iowa; Iowa City Iowa USA
| | - Y. Tang
- Center for Global and Regional Environmental Research; University of Iowa; Iowa City Iowa USA
| | - G. R. Carmichael
- Center for Global and Regional Environmental Research; University of Iowa; Iowa City Iowa USA
| | - A. Sandu
- Department of Computer Science; Virginia Polytechnic Institute and State University; Blacksburg Virginia USA
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Hakami A, Cesnjevar R, Singer H, Schulz A, Koch A, Weyand M. Primary correction (PC) versus correction after palliation (CAP) in children with endocardial cushion defects and Down's syndrome (DS). Thorac Cardiovasc Surg 2004. [DOI: 10.1055/s-2004-816633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
A 26 year old man who presented with the first signs of right heart failure was found to have a large congenital aneurysm of the aortic sinus of Valsalva and of the left coronary sinus. These were combined with left heart anomalies in the form of a bicuspid aortic valve, a rare variant of a persistent left superior vena cava with blood flow from the left atrium through the brachiocephalic vein into the superior vena cava and a kink in the aortic arch. An aortic coarctation had been corrected with a patch 12 years earlier. Although the aneurysm was not perforated and there were no clinical signs of infarction, the aneurysm was resected prophylactically and the left coronary artery was reinserted through a bypass with a Gore-Tex conduit. The case is noteworthy because this diagnosis is very rare and its early treatment may prevent several complications. The clinical features, treatment, and outcome are discussed.
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Affiliation(s)
- A Hakami
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.
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Thorwest M, Balling E, Kristensen SD, Aagaard S, Hakami A, Husted SE, Marqversen J, Hjortdal VE. Dietary fish oil reduces microvascular thrombosis in a porcine experimental model. Thromb Res 2000; 99:203-8. [PMID: 10946095 DOI: 10.1016/s0049-3848(00)00233-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Microvascular thrombosis plays a significant role in the pathophysiology of ischaemic reperfusion injury. A fish oil-supplemented diet containing n-3 polyunsaturated fatty acids (PUFA) reduces thromboxane A(2) (TxA(2)) synthesis and, thus, vasoconstriction and platelet aggregation. The aim of this study was to elucidate whether n-3 PUFA in a porcine model of ischaemia and reperfusion injury 1) inhibit accumulation of platelets and fibrinogen in ischaemia-reperfusion injured tissue, 2) prolong the bleeding time, and 3) inhibit TxA(2) synthesis. Nine pigs were fed a standard diet supplemented with 7 g n-3 PUFA/day for 3 weeks. Nine pigs on the standard diet served as controls. Unilateral myocutaneous flaps were exposed to ischaemia for a period of 6 hours. Contralateral flaps were nonischaemic. Tissue contents of radioactive-labelled platelets and fibrinogen were measured after 4 hours of reperfusion. Platelet count, serum TxB(2), and the cutaneous bleeding time were measured before and after 3 weeks of diet. In the fish oil group, the accumulation of platelets was significantly reduced in all the myocutaneous flaps, except in the ischaemic skin part, when compared to control animals. Fibrinogen was significantly reduced in nonischaemic flaps, but not in ischaemic flaps. After the feeding period, the level of TxB(2) was significantly lowered in the fish oil group (p<0.01). No difference in the bleeding time was observed. Thus, dietary supplementation with n-3 PUFA inhibits the formation of microvasculatory thrombosis in this model.
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Affiliation(s)
- M Thorwest
- Institute of Experimental Clinical Research, University of Aarhus, Aarhus, Denmark
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Hakami A, Santamore WP, Stremel RW, Tobin G, Hjortdal VE. Evaluation of stimulation parameters on aortomyoplasty, using Latissimus Dorsi muscle in a goat model: an acute study. Eur J Cardiothorac Surg 1999; 16:228-32. [PMID: 10485426 DOI: 10.1016/s1010-7940(99)00211-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Dynamic aortomyoplasty using Latissimus Dorsi muscle (LDM) has been shown to improve myocardial function. However, systematic examination of the effects of stimulation parameters on aortic wrap function has not been done. Thus, the present study measures the direct effect of stimulation voltage, pulse train duration, frequency of the pulses, and the duration of the stimulation delay from R wave on the aortic wrap function. METHODS In eight female goats, the left LDM was wrapped around the descending aorta. The muscle was then subjected to electrical stimulation, altering frequency of stimulation pulses (16.6, 20, 25, 33 and 50 Hz), amplitude (2, 4, 6, 8 and 10 V), and number of pulses (2, 4, 6, 8 and 10 pulses) in a train stimulation. Left ventricular, aortic pressure, and pressure generated by LDM on aorta (wrap pressure) was measured. The changes in hemodynamic parameters mentioned above were calculated and compared for different stimulation parameters during unassisted and assisted cardiac cycles. RESULTS Aortomyoplasty counterpulsation using LDM provided significant improvement in wrap pressure (78 mmHg +/- 2), aortic diastolic pressure, and changes in aortic diastolic pressure from 2 to 4 V (P < 0.05). Further increase in amplitude did not make any significant improvements of the above mentioned parameters. Significant augmentation of wrap pressure (82 mmHg +/- 2), aortic diastolic pressure (79 mmHg +/- 3) and changes in aortic diastolic pressure (12 mmHg +/- 1) occurred at 6 pulses (P < 0.05). Other changes in number of pulses did not show any significant improvements. Significant improvement of wrap pressure (80 mmHg +/- 2), aortic diastolic pressure (73 mmHg +/- 3) and changes in aortic diastolic pressure (12 mmHg +/- 1) was observed with a frequency of 33 Hz. To examine a wide range of delays from the onset of the QRS complex to LDM stimulation, stimulation was delivered randomly. The exact delay was determined from the ECG signal and superimposed LDM stimulation pulses. CONCLUSIONS In this study we present a new measurement, wrap pressure. We also present that in aortomyoplasty using LDM, the most significant improvement in wrap pressure, aortic diastolic pressure and changes in aortic diastolic pressure occurs when the stimulation consists of an amplitude of 4 V, a frequency of 33 Hz and a train stimulation of 6 pulses.
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Affiliation(s)
- A Hakami
- Department of Surgery, University of Louisville, KY, USA.
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