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Biomedical subjects

A Pouchè

Publications and source records attributed to A Pouchè.

At least 19 recordsLinked to original sources
PubMed2001

[Gastroduodenal artery pseudoaneurysm ruptured at the pancreatic head].

The presence of splancnic aneurysms associated with pancreatitis represents an uncommon evidence (10%) but extremely formidable for the high mortality related to the elevate risk of rupture (50%). A case of a broken gastroduodenal artery pseudoaneurysm plugged in the pancreatic head in a patient with chronic pancreatitis surgically treated is reported. The Authors believe that in presence or in suspicious of peripancreatic pseudoaneurysm bleeding, showed by abdominal echography or CT scan, is mandatory the execution of splancnic and peripancreatic vessels angiography to determine the correct localization of the aneurysm, essential to determining the best surgical treatment. Gastroduodenal artery before the origin from the right epatic artery has been tied in presence of an anatomic variant of origin and division of the hepatic arteries, previously showed with the angiographic examination. The exclusion and the complete thrombosis of the false aneurysm was demonstrated with the intraoperatory Doppler control and confirmed by CT scan before the dismission. This surgical strategy avoid a pancreatic resection, potentially burdened from an higher risk of mortality and morbidity as than the artery exclusion.

Aneurysm, False↗
PubMed2000

[Vascular trauma of the upper extremities].

The aim of this study was to evaluate short- and long-term results of the treatment of upper extremities vascular trauma considering aetiology of the lesions, percentage of limb salvage and residual functional disability. The Authors retrospectively evaluated 17 patients accounting for 21 vascular lesions of the upper extremities (16 arterial and 5 venous injuries). Age, sex, modality of trauma, site of the vascular lesions and of the associated injuries, diagnostic procedures at the admission, ischemic time, arterial and venous repair performed were analyzed. The over all peri-operative mortality was 5.8%. Of the 16 arterial injuries long-term reconstruction viability was obtained in 15 patients (93.7%). In all cases limb salvage was obtained. In 3 patients invalidating functional defects due to associated injuries of the major brachial plexus were observed. The Authors believe that associated nervous lesions are the main factor determining invalidating residual disability. In this series ischemic time, technique of vascular repair performed, associated skeletal injuries didn't influence the functional outcome of the reconstruction.

Adult↗
PubMed2000

[Vascular trauma of the lower limbs].

BACKGROUND: This study was conducted to evaluate the results of treatment of vascular trauma of the lower extremities and those factors associated with limb loss. DESIGN: a retrospective evaluation of a series with lower extremities vascular trauma. SETTING: University Hospital. METHODS: Thirty-one patients accounting for 45 vascular lesions of the lower extremities (27 arterial and 18 venous injuries), over a 15 years period ending December 1998. Age, sex, modality of the trauma, site of the lesion and associated skeletal injuries, diagnostic procedures, ischemic time, arterial and venous repair performed were analyzed. RESULTS: Perioperative mortality was 7.4%. For arterial injuries, limb salvage was obtained in 22 patients (81.5%). Five amputations (18.5%), 1 primary and 4 secondary have been performed. Amputation rate was 26.7% for popliteal lesions versus 8.3% for other locations, 40% when a skeletal lesion was associated versus 5.9% for those without such injuries, 37.5% for reverse saphenous vein interpositions versus 5.6% for arterial repair without interposition. CONCLUSIONS: In this study, the factors influencing limb loss in vascular trauma of the lower extremities are popliteal location, the association with skeletal injuries, the need of saphenous vein interposition for arterial repair.

Accidents, Occupational↗
PubMed1995

[Hepatic injuries: diagnostic and therapeutic features].

Sixty-four consecutive patients with hepatic trauma were examined. Five (7.8%) patients were managed nonoperatively and 59 (92.2%) underwent immediate laparotomy. Nonoperative management is appropriate in hemodinamically stable patients. It requires increasing use of computed tomography instead of peritoneal lavage to evaluate stable patients with blunt abdominal trauma. Patients with complicated associated injuries must be excluded. Analysis of patients who underwent immediate abdominal exploration showed that grade I through grade III injuries of AAST classification are the most common in blunt hepatic trauma (84.75%). Associated intra-abdominal injuries requiring operation for ongoing hemorrhage were observed in 50% of these patients. In the management of grade I through grade III hepatic injuries a simple suture was a safe and highly effective treatment. More complex injuries actively bleeding were controlled by finger fracture technique to achieve intrahepatic hemostasis with selective vascular ligation. Hepatic resection was exceptionally required (2%). On the contrary, resection was required in grade IV injuries with extensive parenchymal destruction and in grade V lesions for a better vascular control of the ruptured suprahepatic veins.

Adolescent↗
PubMed1994

Unusual localizations of hydatid disease: a 18 year experience.

The Authors report their experience with rare localizations of hydatid cysts during a period of 18 years. In 8 patients (14%) other organs than liver or lungs were involved: in particular one case of hydatid cyst of the spleen, one of the pancreatic area and one of the soft tissue of the back presented as primary locations. In 5 patients the disease of the liver was associated to hydatid cysts in other sites: 3 multiple peritoneal localizations, one in the abdominal rectus muscle and one of the gallbladder. Four cases (10% of the patients with liver disease) of cyst ruptures in the biliary tree were reported. In all cases differential diagnosis was more challenging than usual, but imaging devices combined with immunobiological tests could solve the diagnostic problem. Surgical treatment was as radical as possible considering the benign character of the disease. Postoperative results were satisfying: no recurrence but one was found at follow up.

Adolescent↗
PubMed1994

Superior mesenteric artery emboli during renal PTA: successful surgical treatment after fibrinolysis failure.

The paper presents a rare case of iatrogenic embolization of the superior mesenteric artery which required an emergency operation after an unsuccessful fibrinolytic treatment. An old woman, who had undergone renal percutaneous angioplasty (r-PTA), presented sudden but transient abdominal pain. Angiographic control of the angioplasty showed the goal of r-PTA but also an embolic occlusion of the main trunk of the superior mesenteric artery that did not respond to a selective fibrinolytic treatment. Within a few hours, the abdominal pain appeared again and induced an exploratory laparotomy which showed an extensive ischaemia of the whole jejunum. A successful embolectomy was performed associated with the resection of about 20 cm of necrotic jejunum. The postoperative period was uncomplicated. The case underlines several topics: close collaboration is necessary between interventional radiologists and surgeons in order to get a surgical "stand-by" during PTA procedures; the embolic occlusion of the superior mesenteric artery can produce irreversible, even if segmentary intestinal damage, also within a very short time after onset and, therefore, it seems to be at high risk for a fibrinolytic approach.

Aged↗
PubMed1989

[Splenic autografts in omental and subcutaneous pouches. An experimental study].

An accurate morphological study has been done on splenic grafts in rats after 7-15-30 days from their implant in omental or subcutaneous pouches. Observation after 7 days confirmed the necrosis of all the central portion of the implants. Anyway, marginal parts of the graft survived to ischaemia and showed to be supplied by vessels, coming from the contiguous tissues. In these parts the rigenerative process had begun from the structures of red residual pulp, by reticular cells proliferating so to rigenerate the capsula limiting the place of the central necrotic area. After 15 days the neocapsula was completed and from it neoformed trabecolae departed accompanied with chords, sinus capillary, venular and arteriolar vessels which reformed the structure of red pulp both in peripheral and central area, now undistinguishable. After 30 days lymphocytes aggregating around the neoformed vessels promoted a rudimental reconstruction of the white pulp too. In conclusion, splenic implants are able to get over the ischaemic phase and after 30 days the red pulp is morphologically reconstructed and probably functioning, while the white pulp is still primordial.

Animals↗
PubMed1988

Value and limits of "critical auscultation" of neck bruits.

Within a group of 2,000 patients evaluated, most of them with symptoms of cerebrovascular insufficiency, 441 had a monolateral or bilateral cervical bruit. The 627 sides with an audible bruit were divided into main groups (A) symptomatic (TIA and/or stroke homolateral to the bruit), (B) possibly symptomatic (non-side-related symptoms), (C) asymptomatic (C1, in totally asymptomatic patients; C2, in patients with symptoms dependent on the hemisphere contralateral to the cervical bruit). Each patient was studied by means of clinical (history, blood pressure in both upper limbs, phonoendoscopic auscultation at various levels) and noninvasive instrumental examinations (CW Doppler spectrum analysis). An apparently primitive cervical bruit corresponded to a lesion of the carotid bifurcation in 61% of the cases (positive predictive value) whereas a normal bifurcation was detected in 70% of the cases in which the cervical bruit was considered as secondary (negative predictive value); the diagnostic accuracy of the "critical auscultation" has a value therefore of 63%, with a sensitivity of 84% and a specificity of 40%. The results obtained in the different groups of patients (symptomatic or asymptomatic) were not significantly different (chi-square). Even though maintaining the value of a cervical bruit as a sign of carotid stenosis or occlusion and consequently confirming the importance of neck auscultation, the authors conclude that the critical auscultation as commonly performed is not capable of excluding the presence of a carotid lesion with sufficient reliability, even in totally asymptomatic patients.

Auscultation↗
PubMed1987

Effect of splenectomy and hemisplenectomy on pneumococcal infection and bacteria clearance in the rat.

Median survival times 1 month after intraperitoneal inoculation of Streptococcus pneumoniae Felton UC 41 show that the difference between hemisplenectomized and control rats is not at all significant (chi 2 = 0.04). On the other hand, comparing splenectomized rats with hemisplenectomized and control rats taken together, there is a significant difference: 10% level (chi 2 = 2.84; 1 degree of freedom; p less than 0.10). The blood concentrations of pneumococci at different time intervals after inoculation do not differ between control and hemisplenectomized rats (F = 0.02; 1 and 135 degrees of freedom), but they differ very significantly when the splenectomized rats are compared with the hemisplenectomized rats and controls taken together (F = 10.00; 1 and 135 degrees of freedom; p less than 0.01).

Animals↗
PubMed1986

Late modifications of residual parenchyma after splenic resections.

The increased experience in the field of splenic resections have brought up questions about the evolution of the residual parenchyma. Weight increase and the histologic structure of the splenic remnant were studied during a year following hemisplenectomy in rats. Histological studies show that the residual spleen presents a permanent compensatory hyperplasia rather than a true regeneration. This hyperplasia causes an increase in weight of the residual parenchyma which is moderate and only transitory. Indirect confirmation of findings obtained in rats comes from scintigraphic study of residual human splenic tissue after hemisplenectomy. The residual tissue keeps its original form without increase in volume, and the sectioned surface is always well identified one year after splenic resection.

Animals↗
PubMed1985

[Computerized tomography in the staging of bronchogenic carcinoma. Critical evaluation of 91 cases].

In reviewing 91 cases of bronchogenic carcinoma, traditional radiology (TR) and CT patterns were compared versus surgical/pathologic findings. CT always gave clearer assessment of the mediastinum and thoracic wall invasion. In the evaluation of metastatic spread to hilar and mediastinal lymph nodes the false negative rate was higher with TR than with CT; on the other hand, there was a higher false positive rate with CT. The advantage of CT in the staging of bronchogenic carcinoma is verified and a rationalized flow-chart which includes TR, endoscopy, CT and mediastinoscopy is suggested.

Adult↗
PubMed1977

[Valvular insufficiency after venous thrombosis. Experimental study].

Venous thrombosis can produce lesions of valvular cusps which are generally ascribe to the phase of thrombus organization. Valvular lesions hold a very important role in the genesis of the post phlebitic chronic venous insufficiency. Experimental thrombosis had been induced in dogs with electrical stimulation of femoral veins to study morphological aspects of valvular cusps in various evolutive phases of thrombosis. Results emphasize too early onset and quick evolution of valvular damage. It can contribute to explain frequent failures of attempted therapy about prevention of post phlebitic syndromes.

Animals↗
PubMed1977

[Preliminary experiences with the use of cimetidine in the treatment of acute hemorrhages in the upper gastrointestinal tract].

On the basis of favorable results recently reported in literature with cimetidine in the prevention and therapy of upper gastrointestinal haemorrhages, the Authors have treated a patient with severe haemorrhage from acute gastric ulcer arised after jejunum-ileal massive resection for mesenteric infarction. Result was very good, with stop of haemorrhage and quickly healing of the lesion. This clinical report is of interest particularly in view of high mortality of postoperative haemorrhagic acute gastropaties with therapeutic means, medical or surgical, just now available. At last the particular physiopathological aspects of the case suggested some considerations about mechanisms of action of the Cimetidine.

Aged↗