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C Juhan

Publications and source records attributed to C Juhan.

At least 37 records · Page 2Linked to original sources
PubMed1997

[Recurrence following surgery of the gastrocnemius veins].

Routine preoperative investigation of chronic venous insufficiency of the lower limbs with echo-Doppler has brought to light the presence of reflux into the gastrocnemius veins in almost 30% of the patients. Surgical treatment to stop this reflux consists in dividing the gastrocnemius vein flush to the popliteal vein. Early postoperative investigation of patients operated on in this way, who are symptomless and with no residual varices, has revealed the presence of persistent, symptomless, postoperative reflux into the gastrocnemius veins. One hundred and six patients were checked six months postoperatively by Duplex Doppler scanning. On the basis of the anatomical and functional findings, postoperative incompetence of the gastrocnemius veins could be classified into several types according to the cause: 1. Persistence of a complete and incompetent gastrocnemius vein, probably missed at operation: 16 patients (15%). 2. Neoangiogenesis: 11 patients (10%). 3. Persistence of an incompetent lower gastrocnemius perforating vein: 17 patients (16%). Thus, echography has revealed that in 44 lower limbs out of 106 (42%) in which the gastrocnemius veins were operated on, six months postoperatively evidence of reflux into the gastrocnemius venous network was present. All these patients were asymptomatic. In a sub-group of 48 lower limbs which had an interval Doppler check at 2 months: 6 already showed a reflux (12.5%), in 11 the gastrocnemius reflux appeared between the second and the sixth months (23%), 31 showed no reflux at 6 months (64.5%). From these findings, certain rules on the surgery of the gastrocnemius veins have been drawn up.

Adult↗
PubMed1997

[Surgery of the perforating veins of the leg: open and endoscopic techniques].

Surgical treatment of incompetent perforating veins of the leg is best carried out through a sub-aponeurotic approach after localisation by coloured Duplex-Scanning. Open techniques are long established. When there is only one perforator, a short 5 cm approach is centred over the previously localised perforator. In the presence of multiple perforators, an extensive approach is necessary. This usually means a single long incision, situated para-tibially in the Linton approach, postero-medially in the Dodd approach or posteriorly in the Felder approach. The advantage of the last two approaches is that they are situated at a distance from any eventual cutaneous lesion. The approach can also be through several separate oblique incisions (De Palma). More recently introduced, endoscopic techniques have the advantage of reducing the incidence of cutaneous complications such as necrosis or infections and of shortening the duration of hospitalisation. Some authors work with re-usable instruments. The perforators are divided after coagulation (Hauer, Sattler). Others use disposable instruments, insufflate the sub-aponeurotic space and clip the perforators to prevent bleeding (Gloviczki). These techniques are currently undergoing evaluation.

Endoscopy↗
PubMed1996

Blunt injury to the internal carotid artery at the base of the skull: six cases of venous graft restoration.

PURPOSE: Blunt injuries to the internal carotid artery (ICA) at the base of the skull are uncommon but potentially dangerous lesions whose management remains unclear. We report a new surgical approach of the intrapetrosal portion of the ICA that was used in six patients with the help of an ear, nose, and throat surgeon. METHODS: During a 70-month period, seven consecutive patients (four women, three men; mean age, 35.7 years; range, 21 to 59 years) were admitted, six after a motor vehicle accident and one after a cervical manipulation. All patients had a neurologic deficit. An arteriographic scan revealed four unilateral ICA lesions: two false aneurysms, one tight stenosis, and one dissection; two cases of bilateral ICA dissection were mentioned, and one case of ICA dissection was associated with a contralateral ICA thrombosis. RESULTS: One patient died before surgery, and six patients underwent a unilateral venous graft restoration, reaching the vertical portion of the intrapetrosal ICA in two patients and the horizontal portion in four. A shunt was used in one patient. Failure to recognize the end of the ICA lesion was responsible for one postoperative asymptomatic graft thrombosis (17%), but this difficulty was overcome by using intraoperative angioscopy in the other patients. No deaths and no new strokes were noted during postoperative and midterm follow-up (mean follow-up, 34 months). Five postoperative facial pareses occurred and were totally regressive within 3 to 6 months in four patients; one total deafness was recorded. CONCLUSION: Venous graft restoration of traumatic ICA lesions at the base of the skull can safely be performed with such an approach, thus producing highly satisfactory results. Before undergoing surgery, the patient must be aware of the risk of facial and auditive disorders, which are generally temporary.

Accidents, Traffic↗
PubMed1996

Evaluation of low molecular weight heparin during and after aortic and carotid surgery: dose finding study.

Forty-four patients undergoing abdominal aortic surgery and twenty-eight patients undergoing carotid surgery were randomly treated with different anticoagulant regimens. During surgery, an unfractionated heparin (UFH) intravenous bolus of 50 IU/kg was compared with a low molecular weight heparin (LMWH) bolus of either 120 IU/kg, 80 IU/kg, 40 IU/kg or 20 IU/kg. Six hours after surgery and for 48 hours, an UFH infusion was compared with an LMWH infusion of either 10,000 IU/day or 6,000 IU/day and then, a single LMWH subcutaneous injection of 3,075 IU was administered. Heparin activity was measured by factor Xa inhibitor and by prolongation of APTT which were studied 15, 30 and 60 minutes after cross-clamping, at the end of surgery and six hours later, and on days 1, 2, 3 and 6. After a descriptive analysis of clinical and pharmacokinetic profiles of each regimen, optimal LMWH treatment is proposed.

Aged↗
PubMed1996

[Manipulations of cervical vertebrae and trauma of the vertebral artery. Report of two cases].

Vertebrobasilar-distribution stroke is a rare but sometimes severe complication of chiropractic neck manipulation. We report two patients with dissections of the vertebral arteries authenticated two and six days after the cervical manipulation. In the first case, a Wallenberg's syndrome occurred due to a dissection of the right intracranial vertebral artery; the patient was treated with anticoagulant therapy but little improvement of the disorder was noted. The second patient had transitory neurologic manifestations which led to the discovery of an intimal tear of the ostium of the right vertebral artery with a floating clot. Further embolic complications were avoided by performing a venous bypass between the right common carotid and the vertebral artery at the base of the skull. Therapists should be aware of vertebrobasilar complications after spinal manipulations and should ask for early explorations (brain CT, cerebral angiography) to institute rapidly the most appropriate treatment.

Aortic Dissection↗
PubMed1995

[Selective indications of cardiac studies before aortic surgery].

OBJECTIVES: There is no consensus on heart explorations required before infra-renal reconstruction surgery of the aorta. We proposed a selective approach in 81 consecutive patients undergoing elective surgery. METHODS: Four clinical criteria were recorded: age over 70 years, diabetes mellitus and a clinical history of coronary artery disease or heart failure. RESULTS: For 23 patients (group 1), none of the criteria were positive. Surgery was performed in all without prior exploration. There was one death (4.8%) and one post-operative cardiac event (4.8%) in this group. The 58 other patients (group 2) had at least one of the criteria and had complementary heart explorations before surgery. There were 2 deaths (3.4%) and 5 cases of cardiac morbidity (8.6%) in this group. CONCLUSION: The lack of any statistical difference between the two groups with and without risk criteria has led us to propose selective indications for preoperative explorations based on specific clinical criteria.

Adult↗
PubMed1995

Acute popliteal arterial injury: the role of angioscopy.

Accurate identification of arterial injury in the emergency setting constitutes one of the essential prognostic factors in patients presenting with acute popliteal arterial injury (APAI). The modalities of angioscopy performed intraoperatively by the vascular surgeon, including the details of how angioscopy can contribute to therapeutic decisions in this setting, are presented. Between June 1987 and August 1993, 26 patients presenting with 27 APAIs (one patient had a bilateral APAI) were treated at our institution. Eighteen (67%) lesions were due to closed trauma, three (11%) to shotgun pellets, three (11%) to knife wounds, two (7%) to iatrogenic wounds, and one (4%) to a bullet wound. Between June 1987 and January 1992 (group I, n = 20), treatment consisted of 15 (75%) saphenous vein bypasses and five (25%) local repairs. Pre- or intraoperative arteriograms were obtained in 14 (70%) cases. Three (15%) major amputations were required after popliteal reconstruction. Between February 1992 and August 1993 (group II, n = 7), two (29%) saphenous vein grafts and five (71%) local repairs were performed after routine intraoperative angioscopy. Arteriograms were obtained in six (86%) instances. No amputations were necessary in this group. As a complement to arteriography, intraoperative angioscopy can determine the extent and number of injuries, provides direct visualization of the intima of the entire femoropopliteal artery, even when the latter is obscured by thrombus, and ensures a final control of popliteal artery repair at completion. After angioscopy, local repair was possible more often (71% vs. 25%, p = 0.03) and treatment was associated with a better functional result (0% vs. 15% amputation rate, p = 0.04) in group II.

Adolescent↗
PubMed1995

Silent brain infarct after carotid artery surgery: incidence and prevention.

To determine the prevalence and mechanisms of postoperative silent brain infarct, brain CT was routinely performed before and after carotid endarterectomy during the same period of hospitalization. Between June 1991 and May 1993, 69 patients who underwent 74 carotid endarterectomies (five two-staged bilateral procedures) were enrolled in the study. Ipsilateral brain infarct was observed on the preoperative CT scans in 25 cases. Of these 25 infarcts, three occurred in 20 patients (15%), without symptoms, 13 in 41 patients (32%) with transient ischemic attacks (TIAs), and 9 in 13 patients (70%) with cerebrovascular accident. After surgery, two patients (2.7% of procedures) had monoparesia of an upper limb with no corresponding abnormality seen on CT scans, and two (2.7%) had TIAs, associated with CT evidence of a new lesion in one patient. Five silent brain infarcts (6.8%) were detected, including four in the hemisphere contralateral to the restored carotid artery. These study results indicate there is no correlation between the occurrence of postoperative silent brain infarct and the presence of ulcerated stenosis of the carotid artery documented by Doppler ultrasound examination. Silent infarct was not observed in any of the 24 patients (32%) in whom a shunt had been used during the procedure. After a review of the literature, we propose wider use of intraoperative shunts to prevent postoperative silent brain infarct.

Aged↗
PubMed1995

Leukocyte activation study during occlusive arterial disease of the lower limb: effect of pentoxifylline infusion.

Granulocytes play a significant role in vascular diseases. The mechanisms of neutrophil-mediated vascular injury include their increased endothelial adhesion and activation with release of inflammatory mediators. Pentoxifylline (PTX) has a well-demonstrated ability to act on the activated neutrophils. It increases chemotaxis and decreases their adherence to endothelial cells, oxidative burst, and enzyme release. In this preliminary study, we investigated the effects of PTX on ischemia-induced changes in polymorphonuclear neutrophils (PMN) activation and cytokine release. A double-blind, randomized, placebo-controlled trial was carried out in 14 patients (age range 46-86 years) suffering from critical ischemia, as defined by the European Consensus Document, or subacute ischemia due to occlusive arterial disease of the lower limb. Femoral and antecubital venous blood samples on the side of the ischemic leg were obtained from patients immediately before (TO) and after infusion (T24) of PTX or placebo. PMN activation was evaluated by study of cell migration, beta 2 integrin expression (CD11b/ CD18), oxidative burst, and elastase release. Inflammation proteins were analyzed, such as tumor necrosis factor-alpha (TNF-alpha), interleukin-1 (IL-1), interleukin-6 (IL-6), C-reactive protein (CRP), and fibrinogen. Before treatment, our results demonstrate an important activation in both femoral and antecubital venous blood. PMN activation markers, cytokine release, and other inflammation proteins were significantly increased compared with normal subjects. In the experimental group there was no significant difference between femoral and antecubital venous blood. Six patients received PTX infusion and seven patients were in the placebo group. The effect of PTX was evaluated after 24 h of treatment (1,200 mg). In the PTX group the following variables were improved compared with the placebo group: CD11b expression on PMNs, elastase released from PMNs, fibrinogen, CRP, TNF-alpha, and IL6 in plasma. These preliminary results should be interpreted with caution because of the small sample size. Further trials may contribute to more complete understanding.

Aged↗
PubMed1995

[Late complications of abdominal aortic prostheses: false aneurysms and aorta-digestive fistulas].

Pseudoaneurysms of the abdominal aorta (PAAA) are late complications of aortic reconstruction that occur with an incidence varying from 4.8 to 6.3% associated with an operative mortality of 21 to 35%. Between 1987 and 1994, 16 patients with a PAAA (14 men and two women, with a mean age of 69.5 years, ranging from 55 to 82 years) were treated in our unit. An anastomotic rupture with a pseudoaneurysm diameter varying from 50 to 75 mm was present in five cases (group 1). The eleven other cases were aorto-enteric fistula, isolated in six cases (group 2) and associated with local and/or general sepsis signs in five cases (group 3). The mean interval from the time of the primary aortic graft, which was performed as treatment for aortic aneurysm in six cases and for aortoiliac occlusive disease in 10 cases, and the diagnosis of the PAAA, was 11.3 years. An in situ replacement of the aortic graft with an interposition of the greater omentum was performed in each patient of groups 1 and 2, associated with an enteric restoration in the latter. Group 3 patients were treated by removal of the infected graft with closure of the aortic stump and extra-anatomic bypass. During the post-operative period, five deaths (31%) and one limb amputation (6%) occurred, i.e. one death in group 1 (20%), one in group 2 (17%) and three in group 3 (60%) associated with a limb amputation (20%).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1995

[Comparative study of color Doppler echocardiography and arteriography in carotid disease].

The increasing accuracy of duplex scanning and the morbidity linked to angiography have led some authors to discard the latter when exploring patients with severe carotid lesions. In order to fully define the respective information obtained by these two explorations and to determine their impact on therapeutic decisions, were examined the file of 122 patients. The comparative analysis of preoperative color duplex scanning and angiographic results, the latter used as a reference, showed a sensitivity of 97% and a specificity of 57%, concerning the ability to detect a significant carotid artery stenosis. On the other hand, color duplex scan and angiography had the same accuracy to screen the presence of an ulceration, but could only detect two third of the ulcerations observed on pathologic examination of 94 surgically-treated patients. At last, angiography was more reliable in detecting a carotid excess of length (p < 0.001), in the identification of internal carotid thrombosis and of dissection on dysplasic arteries. In conclusion, we propose a selective indication of angiography in case of suspicion of proximal periaortic arterial lesions, of complications on dysplastic arteries, of detection of pre-thrombotic carotid lesions and in order to confirm the existence of significant stenosis in asymptomatic patients.

Adult↗
PubMed1994

Dilation of woven and knitted aortic prosthetic grafts: CT scan evaluation.

Because there are few reports in the literature concerning short- and medium-term outcome of woven and knitted aortic prosthetic grafts, we conducted CT evaluations in 58 asymptomatic patients (53 males and five females with a mean age of 63.5 years) undergoing infrarenal aortic reconstruction between June 1988 and June 1991. Joined CT slices after contrast enhancement, centered on the proximal anastomoses, prosthetic bodies, and prosthetic limbs, were obtained in the early (mean 19 days) and late (mean 19 months, range 6 to 40 months) postoperative periods. In end-to-side aortoprosthetic anastomoses (n = 28), early and late CT examinations revealed that the anteroposterior diameter increased 1.9% (p = NS) and 8.8% (p < 0.0001) for woven and knitted grafts, respectively. In end-to-end aortoprosthetic anastomoses, the diameter of the prosthetic body on early CT scans increased 12.6% (p < 0.0001) and 28% (p < 0.0001) for woven and knitted prosthetic grafts, respectively, as compared with diameter values provided by the manufacturer. Dilation continued to progress 2.2% (p < 0.04) for woven and 6.2% (p < 0.0002) for knitted prosthetic grafts on late CT scans. The mean diameter of the prosthetic graft limbs (n = 96) increased 22.3% (p < 0.0001) and 34.6% (p < 0.0001) for woven and knitted prosthetic grafts, respectively, on early CT scans as compared with manufacturers' values. Secondary increases were 3.2% (p < 0.002) and 7.7% (p < 0.007) for woven and knitted prosthetic grafts, respectively. These data show that dilation of aortic prostheses occurs early in most cases, most likely soon after declamping of the graft, as shown by recent intraoperative measurements.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Venous pump of the calf: a study of venous and muscular pressures.

PURPOSE: Little data are available concerning the relation between the muscular pumping mechanism and the variation of superficial and deep venous pressure during normal action of the calf pump; therefore we undertook this study to determine the pressure values in three compartments of the calf and in the deep and the superficial venous system and to establish correlation between muscular and venous pressure. METHODS: Nine healthy young women with a mean age of 23 years (range 19 to 28 years) were examined. In the same calf, a muscular catheter was placed in the deep posterior compartment (DPC), in the superficial posterior compartment (SPC), and in the anterior tibial compartment (ATC), and a vascular catheter was placed in the popliteal vein and in the greater saphenous vein (GSV). The five lines of pressure were simultaneously recorded in the following situations: at rest, during Valsalva maneuver, foot flexion, and foot extension. The situation was studied with the patient in the following positions: decubitus, sitting, standing, and squatting. A final continuous recording was carried out after the patient had been walking for 5 minutes. RESULTS: Mean values with standard errors of muscular and venous pressure were established in each situation. At rest and during Valsalva maneuver, the muscular pressures did not vary, whereas venous pressures increased significantly when the patient was sitting and standing. On the other hand, squatting was associated with a rise in the muscular and vein pressures. Foot flexion entailed a significant increase in the ATC pressure and a rise in the GSV pressure, whereas foot extension caused the DPC pressure to rise without venous pressure modifications. Walking was associated with an alternating increase in the DPC, SPC, GSV and popliteal vein pressures when the foot was compressed to floor followed by a significant decrease when the foot pressure was released. CONCLUSIONS: The variations in the deep and superficial venous pressures when the patient is sitting and standing both at rest and during Valsalva maneuver are not associated with an increase in the muscular pressure. On the contrary, during foot movements, the ATC and the DPC are responsible for superficial vein pressure variations without modifications of the SPC pressure.

Adult↗
PubMed1993

[Prevalence of gastrocnemius vein insufficiency using color-coded Doppler ultrasound (modifications of the therapeutic strategy)].

The importance of morphologic and dynamic lesions of the gastrocnemius vein is underestimated. Color-coded Duplex scanning was performed in 483 patients with varicosities and 869 legs with some venous abnormalities were discovered. Two types of lesion on gastrocnemius veins were founded: incompetence and dilatation usually located on the medial gastrocnemius vein. In 29.34% of the limbs, a medial gastrocnemius vein incompetence was present and a dilatation in 15.42%. Medial gastrocnemius vein incompetence was associated with a mid calf gastrocnemius communicating vein incompetence in 25%. Physiopathological hypothesis could be drawn of our observations. Gastrocnemius veins when incompetent should be ligated flush to the popliteal vein. The high prevalence of gastrocnemius vein should be considered in the management of varicose veins and color-coded Duplex scanning routinely performed before surgery.

Adult↗
PubMed1992

[False anastomotic iliac aneurysms. How to detect them?].

We report about 5 iliac anastomotic false aneurysms that occurred in 4 patients 8 to 21 years (average 15.5 years) after aortoiliac prosthetic reconstruction. The diagnosis was not established at once because of atypical clinical signs, in spite of the constant presence of an abdominal pulsating mass. All patients were operated by portal excision and graft replacement. One patient, who had presented with a hypovolemic collapse due to an acute rupture, died. The incidence of iliac false aneurysms after aortoiliac reconstructions is underestimated because the clinical surveillance is not reliable. The analysis of the explorations that were proposed led to prefer computed tomography to ultrasonography and angiography. The period of occurrence of iliac false aneurysms ranges between 6 to 10 years in average after the first operation. We therefore propose to perform a systematic follow-up CT examination on the 5th postoperative year, then every 5 years, and to operate the iliac false aneurysms as soon as their diagnosis is made.

Aged↗