PubMed Health⌕ Search

Biomedical subjects

C Juhan

Publications and source records attributed to C Juhan.

At least 55 records · Page 3Linked to original sources
PubMed1991

[Treatment of ilio-femoral venous thromboses with surgical thrombectomy].

Surgical thrombectomy which has been commonly performed in the past is now abandoned by most teams. Nevertheless some surgeons have gone on performing venous thrombectomies with good results. We have performed venous thrombectomy in 91 acute ilio-femoral vein thrombosis associated with inferior vena cava or superficial vein involvement in respectively 35% and 86% of the cases. The mean estimated age of the clot was 5 days. Ilio-femoral thrombectomy was carried out under general anesthesia using a Fogarty catheter introduced through a common femoral venotomy and the removal of the distal clots by mean of massages maneuver. In case of vena cava involvement, direct caval venotomy was carried out by a right sub-costal approach. A temporary arterio-venous fistula in the groin was associated in 89% and a partial interruption of the vena cava in 55% of the cases. No operative death and no peri-operative pulmonary embolism were observed. Post-operative ilio-femoral vein patency rate was 85% without recurrence after closure of the arterio-venous fistula. A venous thrombectomy in selected cases appears to be more efficient than intra-venous heparin or thrombolytic therapy. Indications of venous thrombectomy are ilio-femoral or ilio-caval vein thrombosis of less than 7 days duration. Patients who are non ambulatory or with limited life expectancy are not likely to benefit from surgery. Venous thrombectomy is not recommended in patients with inflammatory or tumoral pelvic or retroperitoneal lesions, coagulopathies, peripheral arterial or significant heart diseases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Etiology of prosthetic anastomotic false aneurysms: pathologic and structural evaluation in 26 cases.

To determine the etiology of anastomotic false aneurysms (AFAs), 26 textile graft specimens, removed because of AFA, were studied morphologically, histologically and by scanning electron microscopy. No cases of suture-related failures leading to AFA were found. Nine cases of frayed grafts were documented but were not the cause of AFA formation. In three cases, chemical degradation of the fibres, which may have been secondary to lipid infiltration, may have contributed to AFA formation. There were no cases of overt clinical infection, but the presence of bacteria was documented by scanning electron microscopy in 20 cases. The role of bacteria is not well defined, but they may be a factor in host arterial-wall degeneration as a cause for AFA formation.

Adult↗
PubMed1990

[Intra-arterial thrombolytic therapy of lower limb ischemia].

Between 1984 and 1989, 35 patients with recent arterial or graft occlusions have been treated with intra-arterial infusion using sequential association of Urokinase (U.K.) and Lys-Plasminogen. Occlusion was thrombotic in 68.5% of the cases ans embolic in 31.5%, involving 28 native arteries and 7 bypass grafts. The mean duration was 16 days (2 to 90). Continuous infusion of U.K.: 84,000 U.I./H and bolus of Lys-Plasminogen 15 microKatals every 30 minutes were delivered through a catheter embedded into the clot. Intra-venous heparin was always associated. The mean duration of lytic drug infusion was 8 H. Complementary arterial reconstruction by vascular surgery of percutaneous transluminal angioplasty was performed in 23% of the patients. Patients with recent alimentary tract bleeding, hemorragic stroke in the last six months or severe high blood pressures were contra-indicated. Complete lysis was obtained in 23 cases (66%), partial lysis in 7 (20%) and no lysis in 5 (14%). The clinical result was excellent in 24 cases (68.5%), good in 3 (8.5%) and bad in 8 (23%) in which amputation was always necessary. 5 local hematoma (14%) treated by surgery or transfusion and one death (3%) due to neurological complication occurring 24 hours after the end of the procedure were observed. The literature survey has shown that the results of low doses of Streptokinase (S.K.) local infusions were not better, and that higher doses of S.K. or U.K. delivered during a shorter infusion time increased the efficacy of lysis and decreased the rate of hemorragic complications. We have proposed the local thrombolytic treatment to the limb threatening ischemic cases when the traditional medical or surgical techniques where thought to be associated to a high risk of failure or complication. The specific indications are the acute or sub-acute ischemic situation due to atheromatous artery thrombosis, distal or old embolism where the Fogarty catheter is inefficient, and graft thrombosis. Severe acute ischemia with neurologic involvement are not good indications. Local thrombolysis can be successful on arterial occlusion even after one month duration.

Adult↗
PubMed1987

Patency after iliofemoral and iliocaval venous thrombectomy.

Between 1981 and 1984, 42 iliac venous thrombectomies were performed in 41 patients with recent iliofemoral venous thromboses. Of the 42 thromboses, 18 extended into the inferior vena cava. In 31 cases a temporary arteriovenous fistula was constructed and in 21 cases the inferior vena cava was partially interrupted. Early postoperative venography was performed in 40 of 42 thrombectomy cases. One or more late venograms were done one to four years postoperatively. None of the patients died during the hospital stay, and there were no cases of intraoperative or early postoperative pulmonary embolism. Six postoperative hematomas were evacuated. Patency of the iliac veins was maintained in 93% of cases. When performed with care venous iliac thrombectomy associated with a temporary arteriovenous fistula appears to be the appropriate treatment for iliofemoral or iliocaval thromboses less than ten days old.

Adult↗
PubMed1987

[Study and treatment of erection disorders. Value of intracavernous injections].

A multidisciplinary study of 57 patients with erection disorders included in addition to standard examinations: clinical, hormonal, vascular using Doppler and nervous with determination of latency time of bulbocavernous reflex, evaluation of effects of intracavernous papaverine injections completed by a manometric study of cavernous body filing by perfusion. A clear positive result of the papaverine test is considered to reflect integrity of vascularization of corpus cavernosum structure, and renders value less the continuation of vascular investigations. The appearance of an almost normal but delayed erection requiring high-dose papaverine administration is interpreted as being due to insufficiency of arterial origin without anomaly of venous return. The absence of erection after papaverine injection, whether in the presence or absence of an increase in penis volume, results from excessive venous return, insufficient arterial supply or both. Absence of erection despite a cavernous perfusion of more than 70 ml/min is due to excessive venous return that requires localization by cavernography. The onset of erection during cavernous body filling eliminates excessive venous return and results from arterial insufficiency that necessitates pelvic arteriography. A therapeutic attitude of logical consequence is proposed.

Clinical Trials as Topic↗
PubMed1987

[Indirect measurement of residual internal carotid pressure by photoplethysmography during the carotid occlusion test].

A non invasive technique for measuring the systolic arterial pressure in the internal carotid artery during common carotid artery occlusion test is described. Its objective is to predict the efficiency of the collateral circulation through the circle of Willis during surgical carotid artery clamping. Photoplethysmographic curves were recorded on two facial areas supplied by the external carotid artery (earlobe and forehead above the center of one eyebrow). The residual carotid artery pressure during carotid clamping was estimated by considering the ratio of determined by the systolic brachial arterial pressure over the amplitude of the best photoplethysmographic curve obtained, multiplied by the amplitude of the photoplethysmographic curves recorded during the percutaneous compression of the common carotid artery. This method was verified on 15 patients (women: 6, men: 9) with carotid lesions, during carotid endarterectomy. The invasive measurement of the systolic pressure in the internal carotid during carotid clamping was compared with the calculated value. This comparison showed a highly significant correlation between the two values (p less than 0.001). Thus, a simple and non-invasive method of estimating the internal carotid systolic pressure during carotid clamping is described, so that the efficiency of the collateral circulation during this period may be assessed before surgery.

Blood Pressure Determination↗
PubMed1986

[Trial of a new technic of transcutaneous diaphragmatic electrostimulation in man].

A new method of diaphragmatic pacing by transcutaneous electrical stimulation, using alternative currents with frequency and amplitude modulations, was tested in 12 subjects: 3 were normal and awake (group I); 4 were studied in acute respiratory failure while under mechanical ventilation and central apnea (group II) and 5 were studied while anaesthetized for peripheral venous surgery and breathing spontaneously (group III). Stimulation was performed either during spontaneous ventilation (groups I and II) or during short periods of respiratory depression (group III). Tidal volume was measured by pneumotachography. A positive correlation was found between stimulus intensity and inspired volume. This effect was not due to voluntary control alone, since diaphragmatic stimulation could support 24% of the theoretical minute ventilation in group II subjects and 64% in group III subjects. These preliminary results demonstrate the relative efficacy of this new method of diaphragmatic pacing using computerized alternative currents.

Adult↗
PubMed1986

Naftidrofuryl in chronic arterial disease. Results of a six month controlled multicenter study using Naftidrofuryl tablets 200 mg.

The study was carried out on patients with intermittent claudication (Fontaine's stage II). The arterial and atheromatous origin of the disease was confirmed and localized by angiography or Doppler velocimetry examination. One hundred eighty-six patients were selected initially. Their pain-free walking distance on a treadmill (at a speed of 3 km/hour and an inclination of 10%) had to be 150-300 m. During the first month all patients received 3 placebo tablets daily. At the end of this run-in period (D-30; D 0) and after checking walking distance stability (allowed variation: +/- 20% between the two measurements) the patients were included in the study. One hundred fifty-four patients were selected and 118 remained during the whole study. The study was designed as a double-blind, using two parallel randomly selected groups. Sixty-four patients received for six months Naftidrofuryl (3 X 200 mg tablets daily with meals); 54 patients received placebo under the same conditions. During this period, clinical and paraclinical examinations were carried out every quarter (D 90 and D 180). After checking the initial homogeneity of the Naftidrofuryl and placebo-groups, the comparison between groups indicates a significant improvement in Naftidrofuryl group after 3 and 6 months of treatment. At the end of the study the observed differences in walking distance with Naftidrofuryl are approximately twice the difference in the reference group (D 90: p less than 0.05; D 180: p less than 0.02). The results of this study indicate that Naftidrofuryl is an efficient pharmacological tool for treatment of patients with chronic arterial disease (Fontaine's stage II).

Administration, Oral↗
PubMed1985

[Contribution of complementary examinations in the diagnosis and treatment of emboligenic cardiopathies. Retrospective study apropos of 46 cases].

The aim of this prospective study was to assess the value of complementary investigations in the diagnosis and follow-up of embolic heart disease. Forty-six patients having presented a systemic embolism cardiac origin underwent a standard work up which included clinical examination, ECG, chest X-ray and 2D echocardiography. Other investigations were carried out in some patients: CT cardiac scan (11 cases), gamma scintigraphy with Indium III labelled platelets (6 cases) and angiocardiography (12 cases). The diagnosis of an embolic cardiac lesion was made after the standard investigations in 82% of cases. The remaining 18% of cases hall had echocardiographic abnormalities and enable the diagnosis of clinically imapparent conditions: mitral valve prolapse, aneurysm of the interatrial septum, valvular calcification and cardiomyopathy. A potentially embolic mass was visualised in 18 patients; 6 valvular vegetations, 12 left atrial or ventricular thrombi. The other specialised radionuclide, angiographic and CT investigations only confirmed the echocardiographic diagnosis of intravavitary thrombosis. These results were confirmed surgically in 19% of cases. This study shows that complementary investigations especially echocardiography, allow diagnosis of latent embolic cardiac lesions, some of which may benefit from surgical treatment. In addition, potentially embolic intracardiac masses may be visualised, so confirming the origin of systemic emboli. When surgery is not indicated, echocardiography is a good method of following up the results of medical treatment in some of these masses.

Adolescent↗
PubMed1985

[Photoplethysmography in chronic venous insufficiency].

Venous photoplethysmography (P.P.G.) is a non-invasive diagnostic technique using reflection of infrared light on the skin. The record gives a curve analogous to venous pressure. Normally the venous pressure of the leg decreases in response to calf muscle exercise. We have affixed the P.P.G. transducer to the skin above the medial malleolus and have analyzed the recovery half time (T 1/2) on 170 limbs: 49 normal, 82 with superficial venous insufficiency and 39 with deep venous insufficiency. Reference tests were ascending and retrograde phlebography and venous Doppler evaluation. A tourniquet was used to occlude the superficial venous network. T 1/2 without tourniquet is useful to screen limbs with venous insufficiency. T 1/2 with tourniquet differentiates deep and superficial venous insufficiency. P.P. G. can document the rise of deep venous insufficiency in patients with varicose veins and or repermeation of deep veins or post phlebitic syndrome among patients who have had thrombophlebitis.

Chronic Disease↗
PubMed1983

Fibrinolytic activity in experimental vascular grafts.

The effects of grafting segments of femoral vein in the dog have been studied. The venous segments, either reversed or left in situ, were interposed in the course of the femoral artery; these 'arterialized grafts' were compared with a segment of vein grafted into the venous stream, with normal femoral artery and vein. Histological changes and alterations in fibrinolytic activity were studied after 15, 30 and 90 days. The two types of arterialized venous graft showed similar aspects: normal endothelium (scanning electron microscopy and F VIII immunofluorescence), marked thickening of the smooth muscle cell layer, disappearance of intimal fibrinolytic activity (Todd's technique, quantified by morphometric analysis), associated with a marked increase of antiplasmin activity (Noordhoek Hegt's technique), increase in the activity of vascular plasminogen activator (measured with chromogenic substrates). The venous grafts in the venous stream showed no changes compared to the normal femoral vein. The proliferation of smooth muscle cells following exposure of a segment of vein to arterial conditions appears to be associated with increased synthesis of both an inhibitor of fibrinolysis (antiplasmin), and of vascular plasminogen activator. The contribution of these two factors to the development of the morphological changes in the vessel requires further study.

Animals↗
PubMed1982

[Morphologic study of different types of venous grafts. Correlation trial with parietal fibrinolytic activity].

In this experimental work, morphological aspects of different vein grafts were studied using both light microscopy, transmission electron microscopy and scanning electron microscopy. The correlation was made with their fibrinolytic activity ; 21 dogs were operated on under general anaesthesia ; "venous grafts" (perfusion of the vascular segments with venous blood) were performed by excision of the femoral vein with reanastomosis at the same site (protocol P1). "Arterialised grafts" (perfusion of a segment of vein with arterial blood at arterial pressure) were performed according to two protocols : P2 in which a segment of femoral artery was replaced with a segment of reversed femoral vein ; P3 in which a segment of femoral artery was by passed with the femoral vein left in situ after destroying the valves using a Fogarty balloon without damage of the intima. The factors affected by surgery are, therefore, disconnection of the vasa vasorum by excision of the vessel in protocols P1 and P2 and increased oxygenation and luminal pressure in protocols P2 and P3. In all the cases, endothelial cells retained the morphological characteristics of venous endothelium. However, the vein grafts in the arterial circulation were thickened and the fibrinolytic activity was changed. Pathogenic mechanisms of these changes are discussed.

Animals↗
PubMed1981

Binding of 99mTc plasminogen on fibrin.

Binding of plasminogen to fibrin was studied in vitro and in vivo using 99mTc Glu- and Lys-plasminogen. Binding of Glu-plasminogen on the clot was not observed in vitro, and in vivo in the dog. Conversely, the binding of Lys-plasminogen to fibrin displays a linear relationship to the concentration of Lys-plasminogen, up to doses exceeding equimolarity; thus suggesting the existence of several Lys-plasminogen binding sites on fibrin. Binding levels were identical, regardless of whether plasminogen was incubated in normal plasma or in plasma devoid of antiplasmin. In the dog, Lys-plasminogen bound specifically to the clot, however, clot sites could not be localized by scintigraphy in the dog or in man.

Animals↗