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Biomedical subjects

A C Benhamou

Publications and source records attributed to A C Benhamou.

At least 37 records · Page 2Linked to original sources
PubMed1980

[Severe ischemic accidents from ergotism. A report on 3 cases. Value of a new antidote : sodium nitropruside (author's transl)].

The autors describe 3 recent cases of severe ischemic accidents from ergotism affecting different regions. Two of the cases resulted from taking Gynergene (ergotamine tartrate) for a short period, while the other case followed continuous administration of Desernil (Methysergide) for 3 years. The third case was treated at a late stage by continuous peridural anesthesia and various vasodilators without success and led to very severe mutilations in two young women. The third case was treated by continuous infusions of sodium nitropruside (SNP) under hemodynamic control, and recovery was rapid and complete. The value of SNP as an antidote for severe ergotism is discussed, together with its mode of administration, and precautions necessary when prescribing this extremely powerful vasodilator treatment for this indication.

Adult↗
PubMed1979

[Surgical treatment of chemodectomas of the neck (author's transl)].

About 16 cases of chemodectomas of the neck, with surgical management during the five past years, the authors present an actualisation about surgery of these tumors of the paraganglionnary system at the level of the neck. After recording the different means of the diagnosis, particulary carotid arteriography, they insist about the necessity of a complete excision of these tumors because of local risks due to the neurovascular compression and infiltration, and because of general risks due to malignant metastasis. Three major risks run with surgery in these cases: hemorrhagic, neurologic, and vascular risks (because of the possible extension to the carotidian axis). 14 total excisions and 1 incomplete excision were performed; 1 no-operated tumor was noted because of the death of the patient before surgery due to a metastatis paraplegia. 4 resections of the carotidian axis with 1 repair by end to end anastomosis and 3 by a vein graft were necessary. No mortality after surgery in these patients was encountered. No recurence, no metastatic phenomen in our patients after the total excision of the primary chemodectoma of the neck even for one histologically maligant tumor, three years ago.

Adult↗
PubMed1979

[Splenic trauma complicating translumbar aortography : a report on 2 cases (author's transl)].

Two very rare cases of splenic trauma following high translumbar aortography are described. Two types of clinical picture are observed : severe intraperitoneal hemorrhage, subcapsular and then intraperitoneal, from rupture of the spleen, and septic peritonitis following rupture of an intra- and perisplenic abscess. The authors review the frequency, mechanism, and prevention of complications following translumbar aortic puncture.

Aged↗
PubMed1979

[Treatment by a direct surgical approach of a false arterio-venous traumatic aneurysm between the vertebral artery and the internal jugular vein at the level of the atlas (author's transl)].

The authors report a case of traumatic arteriovenous fistula between the vertebral artery and the internal jugular vein at the level of the atlas, treated successfully by a direct surgical approach which permitted exclusion after simple dissection. The relative ease of the surgical approach of the suboccipital segment of the vertebral artery may permit one to extend this technique to other more common indications, in particular due to atheroma.

Adult↗
PubMedDate not supplied

Resection and reconstruction of the carotid bifurcation with polytetrafluoroethylene grafts; operative technique. Preliminary results in 25 procedures and indications.

Although carotid endarterectomy is the standard procedure, the purpose of this paper is to describe a new surgical technique and indicate its role in the surgery of cervical cerebrovascular disease. The technique consists of resection of the pathologic carotid artery bifurcation followed by its total replacement with a bifurcated thin-wall polytetrafluoroethylene (PTFE) graft constructed by the surgeon. Prosthetic graft reconstruction of the carotid bifurcation (PGRCB) was performed in 21 patients (25 procedures) from November 1984 to May 1987. Many patients were over 70 years old. The indications for surgery were transient ischemic attacks (TIA)'s in 10 patients (high-grade stenosis), established stroke with mild deficit in 3 patients (high-grade stenosis). Eight patients (high-grade stenosis) were asymptomatic and 4 had vertebro-basilar symptoms. In 11 procedures the indications were the same as for standard carotid endarterectomy (significant stenosis and/or ulcerated plaque). In 14 cases, the procedure was justified by extensive lesions involving a long segment of the internal carotid artery (2 restenoses, 12 calcified lesions). In the perioperative period, there were no deaths and no TIA's. The 25 procedures were assessed one month postoperatively by ultrasonic imaging and venous substraction angiography. All the grafts were patent with perfect restoration of the carotid bifurcation anatomy. Systematic follow-up study was carried out in 1987. Three patients had died of non-neurologic causes and one was lost to study. The remaining 19 procedures were evaluated with an average follow-up of 19 months (range 7 to 32 months). The patients were asymptomatic and all the grafts remained patent including one stenosis (greater than 50%) at the common carotid artery anastomosis. Because recent studies have documented a much higher rate of technical defects or recurrent stenosis after carotid endarterectomy, we believe that PGRCB merits consideration, particularly in difficult endarterectomies, and in recurrent carotid stenosis. Furthermore it seems acceptable to advocate PGRCB in aneurysms of the internal carotid artery and in post-irradiation arteritis.

Aged↗
PubMedDate not supplied

The white clot syndrome or heparin associated thrombocytopenia and thrombosis (WCS or HATT) (26 cases).

The Authors report a new iatrogenic complication of preventive or curative standard heparinotherapy. This so called "white clot syndrome" or "Heparin associated thrombocytopenia and thrombosis" is an anatomico-clinical entity characterized by severe, multiple, recurrent, arterial and/or venous thromboembolic accidents which are sometimes fatal. They appear, paradoxically, under heparin treatment and are concomitant with thrombocytopenia (generally less than 100 10(9)/l). Antiplatelet immunoallergic phenomena, via type IgG antibodies, induced by heparin, are the most commonly admitted in physiopathology; however they remain controversial. Treatment of "WCS" includes urgent suppression of standard heparin, administration of antivitamin K, or the new generation of low molecular weight heparin. This series presents 26 cases of HATT treated by LMWH (CY 216 CHOAY). Severe complications must be surgically cured. Prevention of WCS or HATT is mandatory by the systematic survey of platelet count during heparinotherapy.

Aged↗
PubMedDate not supplied

Doppler spectrum analysis and vascular imaging in the diagnosis of extracranial carotid artery disease.

Ultrasound methods are well suited for the exploration of the carotid system. High resolution echography can visualize atheromatous defects on the vessels walls with a resolution better than one mm, whereas Doppler examination detects haemodynamic disturbances due to these plaques. Conventional Doppler examination can reveal moderate or severe stenosis (greater than 60%); the recent development of frequency analysis of the Doppler audio signal makes now possible the detection of very light haemodynamic disturbances due to low grade stenosis even as small as 15%. Spectral distribution abnormalities have been classified in four grades according to their amplitude. The combination of the morphological and functional data provided by echography and Doppler spectrum analysis has drastically increased the diagnostic possibilities of the ultrasound methods in the field of the extracranial vascular pathology. With a new duplex system which combines echography and C.W. Doppler examination (duplex probe) it is possible to detect, and quantify carotid stenosis (in percentage of the lumen reduction), and to evaluate blood flow volume in ml/mn.

Carotid Artery Diseases↗
PubMedDate not supplied

Iatrogenic vascular injuries. A review of 125 cases (excluding angiographic injuries).

From the files of an insurance company and from a number of our own files as expert medical witness to the court we have been able to collect 125 cases of malpractice suits following a iatrogenic vascular injury. An analytic study has revealed the following: --12 vascular injuries occurred after stripping of varicose veins of the lower extremities; --4 accidents occurred during arterial surgery; --35 lesions followed orthopedic surgery; and --2 general surgery. Besides these 53 injuries following surgical procedures, 72 injuries are described following non-surgical diagnostic or therapeutic procedures: --sclerotherapy of varicose veins or angiomas: 34 cases; --injection of anesthesic agents: 20 cases; --injections, infusions, catheterisms: 16 cases; and --endoscopic procedures: 2 cases. Vascular risk exists in almost all medico-surgical procedures and requires constant and careful attention since professional responsibility is easily involved. Early recognition and early correction of the vascular lesion reduce the incidence and the gravity of the complications.

Anesthetics↗
PubMedDate not supplied

"Redo" surgery for late aorto-femoral graft occlusive failures.

Experience of late failures of Dacron aortofemoral grafts is presented; about 70 cases observed during the past eight years on whom 105 subsequent operations were performed. One third of these patients were first operated upon by another surgical team. During the same period, 850 patients were submitted to reconstructive surgery of the abdominal aorta and iliac arteries either for atherosclerotic or for aneurysmal disease. It appears that conservative procedures like thrombectomy of the occluded limb are often insufficient, impossible, inappropriate or dangerous, even after restoration of a good deep femoral outflow. On the other hand, aggressive restoration of limbflow is generally necessary, with other various and ingenious direct or indirect reconstructive techniques for restitution of a good inflow and outflow. These techniques are usually successful (85%) and gain time against the major etiology of these late failures viz the development of atherosclerotic disease.

Aged↗
PubMedDate not supplied

[Axillary-femoral by passes. Technic. Complications. Results (92 patients) (author's transl)].

Between January 1970 and October 1977, 95 operations of revascularisation of 124 lower limbs were carried out using the axillary artery in 92 patients. 84 patients had very severe ischemia, acute or chronic, which threatened the survival of the limb. In all, direct surgery was too dangerous (77 cases) or impossible owing to local or regional problems (7 cases). The results gave a mortality during the first two months of 13% in which infective complications of the technic accounted for 3.5%. The latter were frequent (12%) but a certain number of them could have been prevented (6%). 55 patients (65%) had a good result at two months (weight-bearing conserved) whilst 20%, i.e. 18 patients were amputated, of which five had a permeable by pass which permitted conservation of the knee. We observed the highest percentage of deaths (3/8 i.e. 37%) in bilateral emergency revascularisations for acute ischemia. We observed a very low percentage of early thrombosis (4%) in axillary bifemoral by pass performed for chronic ischemia. The operation is of great value when no other direct surgical technic is possible and only in these cases. 8 patients underwent an axillary by pass to treat infective complications of aorto-iliac surgery. 4 early deaths showed the severity of this complication (50%). Tactical aspects are discussed briefly.

Aged↗
PubMedDate not supplied

Carotid artery surgery in patients over 70 years of age.

Between 1965 and 1979, 934 patients underwent 1,057 operations for extracranial carotid stenosis at this institute, and over a recent 30-month period 463 patients underwent 511 operations of this type. This number is equal to the total of operations performed during the years 1965-1976. The increase in the frequency of carotid artery surgery has been more marked in patients of over 70 years. The percentage of elderly patients has increased from 17.5% to 27% in the recent period. In the latter group of 511 operations, results were good in 93.17% of cases, while there was a mortality rate of 1.95% (1% of which were directly related to the surgery), in 1.95% the neurologic condition deteriorated and in 3.13% there was no change. In the first period the mortality rate for patients over 70 years of age was 7.69%. In the second it was 3.27% (1.63% of which were due to non-neurologic causes), 4.09% deteriorated, in 2.18% there was no change and good results were obtained in 90.46%.

Aged↗