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Biomedical subjects

D Boulafendis

Publications and source records attributed to D Boulafendis.

9 recordsLinked to original sources
PubMed1998

Surgery for renal artery aneurysms: a combined series of two large centers.

OBJECTIVE: To review the clinical features and results of surgical treatment of renal artery aneurysms from two large centers. PATIENTS AND METHODS: A retrospective analysis of 21 hypertensive patients with renal artery aneurysms operated in two centers during a 24-year period was performed. RESULTS: The presenting symptom was subcostal or flank pain in 8 (38%) and hematuria in 5 (24%) cases. A ring-like calcification was seen on plain X-ray in 6 (29%) cases. All patients were evaluated with renal angiography showing a saccular aneurysm in 13 cases (62%), fusiform in 5 (24%) and dissecting in 3 (14%) cases. All saccular aneurysms were treated with resection followed by reconstruction with vein patch in 10 cases, and with and end-to-end anastomosis in 3 cases. All fusiform and dissecting aneurysms were managed with resection and reconstruction using aortorenal bypass. There was no hospital mortality or significant morbidity. During a follow-up ranging from 6 months to 23 years, there was definite cure of hypertension in 14 (67%) patients and improvement of blood pressure levels in 4 (19%) patients. Three patients continued to be hypertensive. CONCLUSION: Surgery for renal artery aneurysms can be accomplished with good results and should be considered for patients with aneurysms greater than 2 cm, for aneurysms causing renovascular hypertension, significant stenosis, flank pain, or hematuria, for dissecting, expanding and thrombotic aneurysms, and in women with a potential for pregnancy. However, all aneurysms cannot and should not be treated surgically.

Abdominal Pain↗
PubMed1993

Acute type A dissecting aortic aneurysm requiring emergency arch replacement.

The intimal disruption is located or extends to the aortic arch in 10-20% of acute type A aortic dissections. Multiple tears are extremely rare. The reported mortality rate of emergency arch replacement varies from 25% to 40%, and therefore many surgeons elect to perform ascending aortic replacement only in these cases. However, with such an approach, the operative mortality rate of 10% is followed by a late mortality rate of up to 30% from residual aneurysm formation. Emergency arch replacement was carried out in five of 14 patients with an acute type A aortic dissection in whom the intimal tear either originated or extended into the arch, or in whom multiple tears existed. The ascending dissections were resected under moderate hypothermia, whereas the arch was explored under profound hypothermia, surface cooling and circulatory arrest. None of these five patients died; one developed slight hemiparesis, but no patient developed recurrent aneurysm in the follow-up period. These results appear to justify this aggressive approach, if it can be performed with an acceptable mortality rate < 25%, by avoiding the late deaths associated with more conservative surgical treatment.

Adolescent↗
PubMed1985

Primary malignant melanoma of the esophagus in a young adult.

A 31-year-old white man presented with a 30-day history of dysphagia without weight loss. Esophagogram revealed a lobulated mass at the junction of the middle and lower third of the esophagus. Esophagoscopy showed the presence of a pigmented tumor at that level. Histological examination indicated that the tumor was a primary malignant melanoma. Partial esophagectomy was performed through a right thoracotomy incision, revealing hilar lymph nodes invaded by tumor. One month postoperatively, the patient died from extensive brain metastases.

Adult↗
PubMed1984

Right ventricular myxoma.

We recently treated a patient with right ventricular myxoma and a clinical picture of pulmonary embolism and tricuspid valve obstruction who had successful removal of the tumor through the tricuspid valve via a right atriotomy.

Diagnosis, Differential↗
PubMedDate not supplied

Pulmonary embolectomy (answered and unanswered questions).

Pulmonary embolectomy under total cardiopulmonary bypass was carried out in 16 patients with cardiogenic collapsus and hypotension not responding to vasopressors or cardiac arrest. Eleven patients (68.75%) survived and were followed up for years. Our observations are presented with special emphasis on the early and accurate diagnosis, the exact timing of the therapeutic methods, the use of the portable cardiopulmonary bypass-even in the ward, and the possibilities of decreasing the operative mortality rate in less than 30% (from 40% to 22% in our series). Despite the fact that in many countries, especially European, pulmonary artery embolectomy is no more carried out as a primary therapy for massive or submassive embolism since thrombolysis is today considered as the best therapy with a low mortality rate of 8-11%, we still believe that there is a number of patients who could benefit only from surgical intervention. Based on our own experience and that presented in the international literature, an attempt was made to discuss the existing problems, mainly diagnosis and treatment of this formidable condition, reevaluating pulmonary embolectomy.

Algorithms↗
PubMedDate not supplied

Liver cell adenoma presenting as acute abdomen.

A 31-year-old female presented with a sudden onset of acute abdominal pain in the right hypochondrium. Two days later, the patient was in shock and suffering from severe intra-abdominal bleeding. Investigations showed that the bleeding originated in the right lobe of the liver. The patient had been taking oral contraceptives for seven years. She underwent a laparotomy and right lobectomy of the liver which was performed successfully for bleeding cell adenoma. The patient made a full recovery.

Abdomen, Acute↗
PubMedDate not supplied

Perioperative myocardial protection in severe coronary artery and valvular heart diseases with impaired ventricular function.

One hundred patients with severe coronary artery disease, and impaired left ventricular function were studied. Thirteen of these required valve replacements. Eight required repair of a left ventricular aneurysm. In addition, all these patients had three or more coronary artery diseases. The patients underwent aortocoronary bypass using saphenous vein grafts. For myocardial protection, general and topical hypothermia was used during the procedure, along with perfusion of the root of the aorta, with a cardioplegic solution. Additional cardioplegic perfusion was achieved by perfusing the vein graft anastomosed to the left anterior descending coronary artery below the obstruction, or other vein grafts anastomosed to the circumflex artery or the right coronary artery (or its branches if dominant), during total aortic clamping. No mortality occurred in these patients. Only two patients developed perioperative myocardial infarction, but they recovered. The authors believe that this method can offer further myocardial protection during ischemic arrest.

Adult↗