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Biomedical subjects

E Kieffer

Publications and source records attributed to E Kieffer.

At least 19 recordsLinked to original sources
PubMed1995

[Effects of platelet-rich plasma on hemostasis and transfusion requirement in vascular surgery].

OBJECTIVE: To assess the effect of intraoperative autologous platelet-rich plasma (PRP) transfusion on haemostasis, blood loss and blood requirements during vascular surgery. STUDY DESIGN: Randomized clinical trial. PATIENTS: Twenty patients undergoing elective abdominal infrarenal aortic aneurysmectomy, using autologous transfusion techniques (predonation programme and/or preoperative normovolaemic haemodilution and/or intraoperative use of a cell-saver), were randomly allocated either into the PRP group (n = 10) or the Control group (n = 10). METHOD: In patients of PRP group, 10 mL.kg-1 of PRP were obtained over 40 to 50 min, prior to induction of anaesthesia, and compensated simultaneously with an equivalent amount of hydroxyethyl starch. Each PRP unit was transfused to its donor after aortic declamping. Blood samples were obtained before induction, before incision, at wound closing and at the end of PRP unit transfusion for determination of biological variables. RESULTS: The PRP units transfused in the patients of PRP group contained 755 +/- 117 mL of plasma with a platelet count of 62 +/- 31 G.L-1. The intra and postoperative blood losses were similar in both groups (1622 +/- 758 and 233 +/- 322 mL respectively in PRP group vs 1890 +/- 1331 and 291 +/- 303 mL respectively in Control group). In both groups, three patients required an additional transfusion of homologous blood. The results of biological tests (haematocrit, platelet and white cell counts, prothrombin time, aPTT, thrombin time, fibrinogen, D-dimers, proteins, calcium) were also similar between groups at the various times of sampling. The reinfusion of the PRP unit did not increase the platelet count. CONCLUSIONS: This study demonstrates that intraoperative infusion of autologous PRP does not decrease blood loss and homologous transfusion requirements in patients undergoing elective abdominal infrarenal aortic aneurysmectomy. This result can be related to the relatively moderate enrichment in platelets obtained with the centrifugation speed used in this study.

Aortic Aneurysm, Abdominal↗
PubMed1994

Aprotinin to decrease bleeding and intraoperative blood transfusion requirements during descending thoracic and thoracoabdominal aortic aneurysmectomy using cardiopulmonary bypass.

The purpose of this retrospective study was to assess the efficacy of aprotinin, an antifibrinolytic agent, in reducing bleeding and blood transfusion requirements in patients undergoing descending thoracic or thoracoabdominal aortic aneurysmectomy using cardiopulmonary bypass (CPB). Sixty-nine consecutive patients underwent thoracic or thoracoabdominal aneurysmectomy using CPB in a 2-year period. None of the 29 patients operated on in 1990 (group 1) received aprotinin, whereas all 40 patients operated on in 1991 (group 2) were placed on a high-dose regimen of aprotinin. There were no significant differences between the two groups. Administration of aprotinin was associated with a decrease in CPB time (p = 0.02), surgical duration (p = 0.05) and intraoperative blood loss (p = 0.008) as well as a reduction in intraoperative packed red cells (p = 0.01), Cell-Saver units (p = 0.05), fresh-frozen plasma units (p = 0.002), and platelet concentrate (p = 0.01) requirements. These data suggest that aprotinin is effective in reducing bleeding and blood transfusion requirements during descending thoracic or thoracoabdominal aortic aneurysmectomy using CPB.

Adult↗
PubMed1992

[Multiple cholesterol embolism mimicking periarteritis nodosa].

Ten men aged 56 to 84 were hospitalized with a diagnosis of periarteritis nodosa, whereas they had multiple cholesterol embolism. The diagnosis was corrected post mortem in the first 3 patients and subsequently in live patients. The particularly misleading clinical manifestations were neurological (polyneuritis in 5 cases, mononeuritis in 1, central nervous system disorders in 3), pulmonary (alveolar haemorrhage in 2 cases, respiratory failure of unknown mechanism in 4) and pericardial (2 cases). Five patients had eosinophilia (more than 500 eosinophils/mm3). The elements that led to the correct diagnosis were the presence of vascular risk factors in all 10 patients (but hyperlipidaemia in only one), severe complications of the atheromatous disease in all cases, a precipitating or aggravating factor in 8 patients (anticoagulant therapy in 7, arteriography in 6) and the finding of purple or necrotic toes (6 cases). Histological (5 cases) and/or ophthalmological (2 cases) evidence was obtained in only 6 patients. Seven patients died 1 to 3 years after the onset of the disorders. Studies on low-density lipoprotein metabolism are in progress to determine the mechanism of clinical manifestations unexplainable by embolism.

Aged↗
PubMed1992

Arteriovenous fistula of the internal maxillary artery in a child: case report.

Direct arteriovenous fistulae supplied by the external carotid artery are unusual. Rarely, congenital fistulae have been described involving the head and neck. We describe the first case of congenital internal maxillary arteriovenous fistula in a child. Balloon embolization is currently considered the method of choice for treatment of direct arteriovenous fistula.

Arteriovenous Fistula↗
PubMed1992

Pathogenesis of acquired aneurysms of the abdominal aorta.

The incidence of abdominal aortic aneurysm has recently increased. There is still no accurate definition of abdominal aortic aneurysm. The diameter of abdominal aortic aneurysms is the only factor permitting evaluation of the risk of rupture of aneurysms whose growth remains unpredictable. Abdominal aortic aneurysm is a multi-factorial disease associated with aortic aging and atheroma. It differs from stenotic disease by the intensity of degenerative or destructive phenomena in the media. Particular hemodynamic conditions in the infrarenal abdominal aorta seem to enhance the development of aneurysm at this level. While certain constitutional anomalies of the extracellular matrix of proteins seem to enhance the development of abdominal aortic aneurysm, protease activity of as yet undetermined origin also seems to play a prominent role. Family cases of abdominal aortic aneurysms have been reported but the mechanisms responsible remain to be determined. Several genetic markers have been suggested. The most reliable marker of aortic aneurysm is arteriomegaly.

Aorta, Abdominal↗
PubMed1992

Dipyridamole-thallium-201 scintigraphy in the diagnosis and prognosis of coronary artery disease in patients undergoing noncardiac surgery.

Although most of the published studies using DTS as a preoperative screening test show various shortcomings, the following conclusions can be drawn: 1. DTS should not be used as a routine preoperative test in vascular surgical patients. DTS possesses insufficient accuracy when used in patients without clinical findings suggestive of CAD. 2. DTS may prove more useful in stratifying patients with an intermediate probability of developing cardiac complications. In such a population the test will not offer an "all or nothing" linear results, but rather, when included with the clinical findings and the nature of the surgical procedure, a complex stratification. 3. Because of progress in the perioperative management of high-risk patients, positive findings on preoperative DTS may not correlate perfectly with perioperative cardiac occurrences. 4. Because several factors influence thallium uptake after dipyridamole, DTS does not have perfect specificity, which leads to the prescribing of an excessive number of coronary angiographies. Some patients will be seen as having a false-positive DTS test. 5. The use of DTS as a preoperative screening test leads to cardiac catheterization and hence to revascularization independent of symptomatology. Studies must be undertaken to determine whether this approach will improve short- and long-term patient survival.

Coronary Disease↗
PubMed1992

[Peripheral calcific embolism after percutaneous mitral valvuloplasty].

The authors report a case of calcific embolization after percutaneous mitral valvuloplasty. The nature of the embolism was confirmed by anatomopathological examination after popliteal embolectomy. This complication would appear to be extremely rare but represents an additional risk in patients with calcific mitral stenosis.

Adult↗
PubMed1992

[Rupture of abdominal aorta aneurysms. Study of 92 cases operated on over a ten year period (1980-1989)].

From January 1980 to December 1989, 92 ruptured abdominal aortic aneurysms (AAA) were operated upon in emergency at our institution. During the same period, 747 AAA were operated in election or in the absence of rupture. The mean age of patients was 72.8 +/- 9.1 (52-95). There were 81 men and 11 women. Etiology of the AAA was common degenerative in all cases except in one case of aortic dissection and one case of infectious aneurysm. 27 (29.3%) patients presented antecedents of bronchopathy, 31 (33.7%) antecedents of hypertension and 36 (39.1%) antecedents of coronary heart disease. All patients were operated upon under general anesthesia, in two (2.1%) cases through a thoraco-abdominal exposure, in one case through a lombotomy, in one case, using exclusion and an extra anatomic bypass and through a midline transperitoneal laparotomy in all 88 (96.9%) other cases. The mean diameter of the AAA was 9 +/- 3.9 (4-25) cm. The rupture was intra-peritoneal in 26 (28.3%) cases, intra caval in 5 (5.4%) cases, intra duodenal in 2 (2.2%) cases and retro peritoneal in all the other 59 (64.1%) cases. The aorta was cross clamped above the renal arteries in 15 (16.3%) cases, under the renal arteries in 48 (52.2%) cases and at both levels in 29 (31.5%) cases. Surgical treatment consisted in an aorto-aortic tubular graft in 45 (48.9%) cases, a bifurcated aortic graft in 32 (34.8%) cases, an exclusion with extra anatomic bypass in one (1%) case and could not be completed before the death of the patient in 14 (15.3%) cases. There were 56 (60.9%) deaths, 27 (29.4%) in the per operative and 29 (31.5%) in the post operative periods after a mean time of 5.7 +/- 9.2 (0-36) days. The cause of the death was hemorrhage in 25 (44.4) cases, cardiac complications in 28 (50%) cases, renal insufficiency in 1 (2%) case, pulmonary complications in 1 (2%) case and septic complications in one (2%) case. During the period of the present study, rupture of an AAA remained, in our institution as in other institutions an often fatal condition. This condition could probably be avoided with a policy of early detection and surgical treatment.

Aged↗
PubMed1991

[Surgical treatment of aneurysms of the thoraco-abdominal aorta].

Surgical treatment of thoraco-abdominal aortic aneurysms, E. Kieffer. Thoracoabdominal aneurysms have a high potential for rupture, that justifies extensive indications for surgery. Mortality and spinal cord injury rates depend on age and general condition of the patient as well as extent and etiology of the aneurysm and the possibility of preoperative visualization of spinal cord arteries.

Adult↗
PubMed1991

Surgical reconstruction of the internal carotid artery with contralateral occlusion without use of shunt.

Between 1979 and 1989, 133 carotid artery reconstructions were performed in 130 patients with contralateral internal carotid artery occlusion. These 133 reconstructions represent 7.3% of 1815 revascularizations of the internal carotid artery for atheromatous lesions performed during the same period. There were 113 men (87%) and 17 women (13%) whose mean age was 64.8 years (range 38 to 83 years). Forty-two patients (32%) had coronary artery disease and 77 (59%) were hypertensive. Nineteen patients (14%) were asymptomatic; 16 (12%) had symptoms of isolated vertebrobasilar insufficiency; 19 (14%) had ipsilateral carotid symptoms (on the side of operation); 67 (51%) had contralateral symptoms (on the side of occlusion); and 12 (9%) had bilateral carotid symptoms. All procedures were performed under general anesthesia without the use of a shunt. Nine patients (6.8%) died in the postoperative period (eight of neurologic and one of respiratory causes). Twelve patients (9%) sustained a cerebral vascular accident (eight ipsilateral and four contralateral). Four of these cerebral vascular accidents were diagnosed upon awakening, the remaining eight occurred after an initial uneventful recovery. Combined neurologic mortality and morbidity was 9.8%. Patients with occlusive lesions of the contralateral carotid artery undergoing internal carotid artery reconstruction are at high risk for postoperative cerebral vascular accidents. It is in this group of patients that the various methods of monitoring and cerebral protection should be evaluated.

Adult↗
PubMed1991

Leiomyosarcoma of the inferior vena cava. Experience with 7 patients and literature review.

Leiomyosarcoma of the inferior vena cava (IVC) is a rare malignant tumor originating in the smooth muscle of the media. Although rare, it is the most common malignancy in the IVC. One hundred and six cases have been reported thus far in the world literature, usually as isolated case reports. Clinical, radiologic, and therapeutic management and follow-up, including 7 additional cases, have been reviewed and summarized. Clinical manifestations are dependent upon the location of the tumor. The main symptom was a palpable mass for a tumor in segment I, abdominal pain for segment II, the presence of Budd-Chiari syndrome for segment III. Segment II was the most frequent site of leiomyosarcoma of the IVC, alone (n = 41) or with other segments (n = 39). Before laparotomy, clinical recognition was difficult or impossible. Recently, however, newer imaging modalities including ultrasound and CT scan have permitted earlier diagnosis. Metastases, when diagnosed, were either present at diagnosis (n = 20) or appeared as the disease progressed (n = 18). Metastatic disease frequently involved the liver, lung, lymph nodes, or bone. The small number of patients alive without metastases (16/113) must be analyzed all the more carefully because these patients were followed for less than 2 years. When prolonged follow-up is possible, the number of patients alive without neoplastic disease is significantly reduced. We found the prognosis of patients with LMS of the IVC to be poor. Diagnosis was made at autopsy for 27 patients. Among the 86 patients with follow-up information, 59 died within a mean of 16 months, and 26 were alive 25 months after the diagnosis. The main prognostic factor is topography, particularly the highest level of extension of the tumor. The upper-segment tumors have the poorest prognosis. The best therapeutic management is difficult to recommend because most of the cases in the literature did not include a sufficient follow-up. Given the very small number of patients completely free of neoplastic disease after sufficient follow-up, it seems unlikely that leiomyosarcoma of the IVC can now be cured. Patients who received a combination of surgery, radiotherapy and chemotherapy remained free of disease for longer periods. The unanswered question is: what is the best timing for each of these treatments? We recommend diagnosis of leiomyosarcoma of the IVC through biopsy guided by ultrasonography or computed tomographic scan. Therapeutic management should include large doses of chemotherapy preoperatively with or without radiotherapy to reduce tumor size.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Severe pulmonary artery involvement of Takayasu arteritis. 3 cases and review of the literature].

Three cases of pulmonary arterial disease were identified out of a cohort of 75 cases of Takayasu's disease. In the first case, pulmonary hypertension considered to be idiopathic caused massive haemoptysis and the death of a 48 year old Spanish woman; autopsy revealed characteristic stenoses of the common carotid arteries. In the second case, haemoptysis led to pneumonectomy in a 23 year old West Indian woman with a diagnosis of agenesis of the right pulmonary artery. Disease of the supraaortic vessels occurred several months later and a retrospective diagnosis of Takayasu's disease of the pulmonary artery was made. In the third case, systematic pulmonary angiography in a 41 year old French woman referred for Takayasu's disease of the supraaortic arteries showed severe stenosis of the right pulmonary artery. She developed severe haemoptysis four years later which led to an attempted balloon angioplasty of the right pulmonary artery and embolisation of a branch of the right coronary artery thought to be the cause of the haemoptysis. This was complicated by posterior wall myocardial infarction but the haemoptysis did not recur thereafter. These three cases and a review of the literature show that the pulmonary lesions of Takayasu's disease occur mostly on the main right pulmonary artery but they may be more distal and involve the pulmonary arterioles. A coronaro-broncho-pulmonary collateral circulation may develop distal to the stenosed segments. The main complications are pulmonary hypertension and massive haemoptysis. Surgery is possible in cases of stenosis of the right main pulmonary artery. The potential role of endoluminal angioplasty is discussed.

Adult↗
PubMed1991

[Long term results of surgery of aortic aneurysms].

During 10 years, between 01.01.80 and 01.12.89, 838 patients have been operated on consequently for a A.A.A. in the vascular surgery department of the Hospital Pitié-Salpêtrière (Paris). Post-operative death was 7.3% (51 patients) among 692 operated on without emergency and 41.7% (60 patients) among 146 patients operated on emergency. The study was undertaken with the 727 surviving patients (86.8%) for the long term follow-up. Only 25 patients (3.4%) were lost out, so 702 patients (96.6%) had complete recalls even to their late death until the fourth trimester 1990. Total deaths, were 172 patients, (24.5%) out of the 702 patients in the follow-up. 60 patients (34.9%) died from cancer, 52 patients (30.2%) from heart disease, 21 patients (12.2%) from C.V.A. (cerebro-vascular-accident), 8 (4.6%) from rupture of aneurysm, 6 (3.6%) from renal insufficiency, 5 (2.9%) from prosthesis infection, 10 (5.8%) died from known reasons, 10 (5.8%) from unknown reasons. All these results were studied according to the "actuarial method" and the conclusions were as follow. The actual survival rate at 5 years was 72.1% +/- 5.6% and the average annual death rate was 5.8%. The factors which have influenced the late death are: a) Patients age: survival rate at 5 years and average annual death rate were significantly different whether the patients were less or more than 70 at the time of surgery. b) Surgical circonstances: late survival was significatively less with patients operated on emergency. c) Cerebro-vascular insufficiency. The average annual rates from cardio-vascular and cerebro-vascular accident were significatively more important in patients which previously had cerebro-vascular insufficiency. This work shows out that cardiac death are slightly overcame by cancer, but these two factors represent almost 2/3 (65.1%) of late death. So it should be important for prevention of late death to screen for lung and E.N.T. cancers. Some authors have proposed for prevention of coronarian accidents extensive use of coronarography and myocardial revascularisation. We prefer more acute screening than aggressive methods for patients with coronary problem who had surgery for A.A.A. and specially when they are less than 70 at surgical time.

Adult↗
PubMed1991

In situ fresh allograft replacement of an infected aortic prosthetic graft: eighteen months' follow-up.

We report a case in which an allogenic aortic graft was used to treat the last one of a series of infectious graft complications. The original operation was a Dacron aortobifemoral bypass for aortoiliac occlusive disease in an institution other than ours. The patient was referred for the treatment of the infection of the prosthetic implant. We inserted a prosthetic bypass from the left axillary to the left deep femoral artery, as well as a crossover autogenous saphenous vein graft from the prosthesis to the right deep femoral artery; in the same operation the infected intraabdominal prosthesis was removed with closure of the proximal aortic stump. Subsequent stenosis of the vein graft made it necessary to insert a prosthetic bypass between the descending thoracic aorta and the two deep femoral arteries. Infection of the last named prosthesis made it necessary to remove it and replace it with a tailored allogenic arterial allograft between the infrarenal abdominal aorta and both deep femoral arteries. The patient had an uneventful recovery as the infection was controlled and both lower limbs were salvaged. Eighteen months later the allograft was patent without any signs of degeneration. Further clinical experience under appropriate conditions may prove the use of allografts effective in the treatment of selected cases of aortic prosthetic infection.

Aged↗
PubMed1990

Reconstructive surgery of the renal arteries in Takayasu's disease.

Between 1977 and 1989, 24 patients (19 women and 5 men) with Takayasu's disease underwent renal artery restoration. Mean age was 32.9 years (range 15 to 60 years). All patients were hypertensive and three had moderate, chronic renal failure. Renal artery lesions were unilateral in two patients (8%), bilateral in 17 patients (71%), and unilateral in a solitary kidney in five (21%). Associated lesions of the thoracic or abdominal aorta or both were found in 22 patients (92%). Lesions of the visceral arteries found located in 21 patients (87%) and of the supraaortic trunks in 16 (67%). Initial revascularization of the supraaortic trunks was performed in four patients (17%). Renal artery revascularization was unilateral in 11 patients (46%) and bilateral in 13 (54%). Concomitant aortic reconstruction was performed in 21 patients (87%), visceral artery reconstruction in 17 patients (71%), and supraaortic surgery in seven (29%). One patient who underwent combined aortic and renal artery restoration, and in whom visceral artery involvement had been neglected, died postoperatively of heart failure and intestinal infarction. Three patients were lost to follow-up. Twenty patients have been followed for a mean of 61.3 months (range 4 to 124 months). One patient died at 89 months of intestinal infarction secondary to embolization originating from a false aortic aneurysm. Five repeat renal revascularizations were required in four patients. Hypertension is presently cured in 12 patients (63%), improved in six (31%), and unchanged in one (6%). Even though surgical treatment of arterial lesions in Takayasu's disease often includes complex and repeat revascularization procedures, satisfactory long-term results suggest the use of renal artery reconstruction in this affliction.

Adolescent↗