Biomedical subjects
Publications and source records attributed to B Cham.
The authors describe 7 cases of rupture of the Valsalva sinus. Until rupture the aneurysm is silent. Aortic insufficiency and left to right shunt are major components of this syndrome. Surgical treatment under extra-corporal circulation needs aortotomy and an approach of the ruptured extremity to close the defect and maintaining the integrity of the valvular structures.
Rupture of the pericardium after closed trauma of the thorax is rare. There are two main clinical presentations: one of severe thoracic trauma with hemothorax requiring an operation which permits the diagnosis, the other of pain and pericardial signs on auscultation which should attract attention. The treatment requires closure of the pericardial tear as a routine owing to the risk of fatal complications due to dislocation of the heart.
The authors report personal experience of surgical treatment of 47 aneurysms of the thoracic aorta, showing that the symptoms, the etiology, the treatment and the prognosis are variable depending on the site of the aneurysm. One may note regression of syphilis as a cause and an increase in the number of degenerative and traumatic aneurysms. In aneurysms of the ascending aorta, total replacement of the ascending aorta with reimplantation of the coronary arteries, according to a simplified technic, seems to give the best immediate and long term results.
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Operative and late results in a series of patients operated on the tricuspid valve (replacement or annuloplasty) at the moment of surgery upon mitral and aortic valves are reported. Functional tricuspid insufficiency carries a greater risk than organic tricuspid disease. Considering the duration of the underlying mitral disease, four grades are set up for the mitro-tricuspid patient allowing for prognosis and indication of the type of surgery to be done on the tricuspid valve.
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The study of the electrocardiogram in 87 cases of dyskinetic lesions of the left ventricule, including ventricular aneurysms and plaques of post-infarction dyskinesia, all of which underwent surgery, showed a correlation between the size of the dyskinetic lesion and the number of ST elevations in the electrocardiogram which is closer than the correlation between this size and the height of ST elevation.
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Two case-control studies, one on mortality and the other on malaria morbidity, were carried out in order to evaluate the impact of the Gambian National Insecticide Bed Net Programme during the second year of intervention and to explore the feasibility of such a study for the evaluation of programme effectiveness. For the mortality study, children 1-9 years old who died during the 1993 rainy season were matched by age and sex with 2 healthy controls from the same village. For the morbidity study, children 1-9 years old attending Fatoto or Jahalia Health Centres in The Gambia and who had fever and parasitaemia > or = 5000/microL were matched by age with a child attending the health centres without fever or parasitaemia. An additional healthy control was recruited from the case's village. No impact of insecticide-treated bed nets on mortality was detected and this was in keeping with the results obtained by prospective surveillance. A protective effect of insecticide-treated nets on malaria morbidity was detected when cases were compared with controls recruited at the health centres. However, this disappeared when cases were compared with controls recruited from the cases' villages. The mortality case-control study suggested that reducing the time between onset of disease and treatment may have an important impact on childhood mortality. In order to calculate programme cost-effectiveness, important for informed resource allocations to be made by health managers, it is essential to obtain evidence of effectiveness. This can be done by means of case-control studies, which are easier to carry out and require fewer resources than prospective surveillance. Nevertheless, it is necessary to be conscious of their pitfalls, particularly of the bias involved in the choice of cases and controls. The measurement of insecticide on the nets of the cases or controls is essential for such studies.
This study analyses retrospectively 100 consecutive thoracotomies performed for lung cancer before end 1986. Chest CT scan assessed mediastinal lymph node disease, chest wall invasion and mediastinal invasion, with an overall accuracy of 75, 93 and 91 per cent respectively; mediastinal lymph node disease was significantly more underestimated in the stage III group. Characteristics, type of surgical and adjuvant therapy and follow-up were analysed in the T3 (16 patients) and the N2 (18 patients) group. Complete resection was possible in only a minority of the cases: 3 in the T3 group and one in the N2 group. Of the T3 group, 3 patients have survived more than 3 years and 3 are actually still alive. Of the N2 group, only 2 patients are still alive. Most deaths were due to generalization of the disease.
Following our experience with diaphragmatic pacing in 2 quadriplegic patients with bilateral diaphragmatic paralysis, we here present the indication for and the surgical technique of bilateral implantation of a diaphragmatic pacemaker. This mode of artificial ventilation appears to be superior to positive pressure ventilation for longterm ventilatory assistance of these patients.
Ten patients with traumatic lesions of the thoracic aorta were seen in a hospital. Most were victims of traffic accidents and presented severe associated lesions along with their vascular trauma. We found that the vascular injuries were clinically manifest in only a minority of patients. The remaining ruptures were discovered through CT-scanning of the mediastinum or angiography. We believe that in every major trauma victim aortic lesions should be actively sought for by complimentary examinations to guarantee maximum survival of the patients.
Pulmonary emboli, even small, cause irreparable lung damage. Recurrent pulmonary emboli further increase the amount of non functional lung tissue and may result in incapacitating respiratory disease or death. It is therefore mandatory that the disease be correctly diagnosed and adequately treated. As prevention is better than cure, every patient presenting with clinical signs of deep venous thrombosis (DVT) should be correctly explored. The site and size of thrombosis must be visualized preferably with contrast venography with imaging of the veins of the limbs, iliac veins and vena cava. Risk factors such as obesity, immobilization etc. must be taken into account. Underlying disease such as heart disease and venous insufficiency must be treated. Malignancy must be looked for as in a recent series of patients with primary DVT which were studied, 15% presented with an up till then unknown malignant disease. In patients presenting with recurrent DVT this percentage rose to 20%. When a patient presents with DVT of the femoro-iliac vena cava axis, aggressive treatment must be adopted. Fibrinolysis or if this is contra-indicated, thrombectomy will be used. A vena cava filter may be necessary and longterm anticoagulation is mandatory. The same rationale is applicable in cases of pulmonary embolus whether it is a primary event or a recurrence.
This study reports the retrospective analysis of operative treatment of 20 cases of spontaneous pneumothorax during the last 4 years. Surgical indications included recurrence, recollapse of the lung on clamping the chest tube, nonexpansion of the lung despite adequate drainage or persistent air leak, and giant bulla. A transaxillary thoracotomy was used in all cases to treat sites of air leak and subpleural blebs by resection (14 cases) or oversutering (4 cases) combined with pleural abrasion (19 cases) or apical pleurectomy (1 case). This approach has met with excellent results without major morbidity or mortality.
An observation on symptomatic fibromuscular dysplasia of the internal carotid artery, surgically treated by graduated internal dilatation is presented. Fibromuscular dysplasia is a segmental, nonatheromatous disease of small to medium-sized arteries, affecting mainly renal arteries. Involvement of the internal carotid artery is often an incidental angiographic finding in asymptomatic patients, but can be associated with specific neurologic symptoms requiring surgical treatment. The histopathologic character, the pathogenesis, the clinical manifestation, the diagnosis and the therapeutic possibilities of this affection are discussed.
A new method of myocardial protection, profound selective myocardial hypothermia has been employed in order to avoid the effects of cardiac ischaemia during aortic cross clamping in the course of operations undertaken under extracorporeal circulation. It consists of the irrigation of the aortic root immediately after cross clamping with 4 liters of Ringer Lactate at 4 degrees C which perfuses the entire coronary bed and induces complete uniform profound coling of the intrapericardial mass to a temperature of approximately 10 degrees C with resultant flat electrocardiogram and cessation of all electrical activity of the myocardium. This inactivity remains complete until the aorta is unclamped permitting reoxygenation and rewarming of the heart with resumption of its function. This method has been used in the course of 250 cardiac procedures involving the use of extracorporal circulation including 177 valve replacements, either aortic or mitral and aortic, 54 saphenous vein bypass procedures, either simple or with valve replacement and 19 other assorted procedures including cardiac transplantation and complex congenital malformations. Thermal, electrocardiographic, hemodynamic, histologic, histochemical and enzymatic observations have proven the minimal significance of the ischemic lesions produced in hearts protected in this manner. The total mortality was 6.4% which proves the value of this method and its superiority over the 2 techniques most often used at the present time, coronary perfusion or topical myocardial hypothermia according to Shumway's method.
A total of 37 extra-anatomic femorofemoral bypasses were inserted for severe unilateral iliac artery stenosis or a thrombosed graft limb of an aorto-bifemoral bifurcation graft. All patients were severely debilitated and at high risk for direct aorto-iliac reconstruction. 30% suffered severe claudication; 70% had ischemic restpain or trophic lesions. 43% died during a mean follow-up period of 17 months. This study demonstrates that the extra-anatomic femoro-femoral bypass procedure is an effective alternative therapeutic modality for high-risk patients with an acceptable operative mortality (5.4%) and morbidity to improve the quality of life.
Primary deep vein thrombosis was confirmed by phlebography in 59 cases between Jan. 1981 and Jan. 1984 in the department of Cardiovascular Surgery of the Academic Hospital of the V.U.B. Brussels. Investigations conducted in all patients included blood and urine analyses, chest radiography, electrocardiogram, gynecologic or urologic examinations and abdominal and pelvic ultrasound imaging. Findings demonstrated one or more risk factors in 92% of cases, the principal ones being obesity, a history of thromboemboli and, in women, the use of oral contraceptives. Nine patients had cancer and 4 of these received combined surgery-chemotherapy. All cases of so-called primary deep vein thrombosis should be investigated routinely for risk factors, because of the need and possibilities for treatment in some of them, particularly since procedures are non-invasive, of low cost, and easily performed during initial heparin therapy.