Biomedical subjects
Publications and source records attributed to F Caes.
A case of successful replacement of two coexistent chronic post-traumatic aneurysms of the thoracic aorta is presented. Presumably, these aneurysms at the aortic isthmus and the descending thoracic aorta resulted from two different deceleration traumas.
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Primary aortocolic fistulas are a rare but lethal complication of aortic or iliac aneurysms. A case of fistula between a nonaneurysmal aortic bifurcation and sigmoid colon caused by an ingested chicken bone is presented. This cause of rectal bleeding, which has never been described, might have been suspected after careful examination of abdominal x-ray films. Surgical management included removal of the foreign body and primary repair of the colonic and aortic rent and appeared to be adequate.
The reliability of auscultation, continuous wave (CW) Doppler imaging, and intravenous digital subtraction angiography (IV DSA) in the assessment of carotid artery disease has been evaluated in comparison with conventional angiography in 30 patients. With auscultation, specificity and sensitivity for internal carotid artery (ICA) stenosis of 50% or more were 81% and 67% respectively. CW Doppler imaging detected ICA stenosis of 50% or more with a sensitivity of 83% and a specificity of 92% and ICA occlusion with a sensitivity of 60%. The specificity of IV DSA was 95% and the sensitivity for ICA stenosis of 50% or more and ICA occlusion were 75% and 100% respectively. Combining CW Doppler and IV DSA findings raised sensitivity for ICA stenosis of 50% or more and ICA occlusion to 89% and 100% respectively and specificity to 95%. The combination of CW Doppler and IV DSA is a safe and accurate test battery in the detection and categorization of carotid disease.
A patient with group B streptococcal endocarditis and large vegetations resembling mitral valve myxoma is described. Group B streptococcal endocarditis and the differential diagnosis of vegetations and cardiac tumors are briefly reviewed.
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During the past four years, 106 women underwent aortography and peripheral runoff studies for peripheral vascular disease. Eleven patients presented with "small vessels" and were selected for this study. They were significantly younger than the rest of the group (a mean age of 52 versus 66 years). A clear history of claudication was elicited in all patients. Rest pain was present in four patients. Most patients were small in stature but not obese. Weak or absent femoral and distal pulses and abdominal or femoral bruits were common. Angiography demonstrated a narrow infrarenal aorta, narrow iliac and common femoral arteries and a straight course of iliac arteries. Atherosclerotic lesions involved mainly the aortoiliac segment, but were confined to the superficial femoral artery in two patients. Reconstruction was achieved by endarterectomy or transluminal angioplasty in segmental aortoiliac disease and aortobifemoral or aortobi-iliac graft in diffuse disease. Femorpopliteal or iliopopliteal graft or lumbar sympathectomy was performed in patients with significant femoral disease. In one patient, an acutely occluded femoral segment was replaced by a venous interposition graft. Two patients were treated conservatively. There were no operative deaths. Nine patients were markedly improved at follow-up examination. Graft thrombosis occurred in one patient with combined aortobi-iliac and iliopopliteal graft. The high incidence of single bifurcating lumbar arteries at the fourth and fifth lumbar vertebrae supports the hypothesis that aortic hypoplasia may result from embryonic overfusion of the dorsal aortas. Lipid abnormalities existed in 54 per cent of the patients. All women were heavy smokers and 73 per cent had a positive family history of cardiovascular disease.
The growth-promoting effect of caerulein on antral gastric mucosa was explored using Wistar rats. Implanted osmotic minipumps were used to administer submaximal doses of either caerulein or saline to normal rats for up to 4 days. In one group, reflux of bile and pancreatic juice into the stomach was avoided by previous surgical diversion of the distal common bile duct to the jejunum. DNA synthetic and mitotic activity in the antrum epithelium were estimated by 3H-thymidine pulse labelling and autoradiography during the administration of the peptide. The rate of cell migration was determined in animals killed 1, 2 and 3 days after the 3H-thymidine pulse. Administration of caerulein to normal rats provoked significant increases in both labelling and mitotic indices, and a significant acceleration of the upward cell migration in the glandular tubes. In the animals with distal diversion of bile and pancreatic secretions both labelling and mitotic indices were also increased over control values under the effect of the peptide. These data indicate that administration of caerulein stimulates cell proliferation in the antral gastric mucosa. This effect cannot be explained through increased reflux of pancreaticobiliary secretions in the stomach.
The growth promoting effect of gastrin on the glandular stem cells and parietal cells of the oxyntic mucosa has been confirmed by several observations. Gastrin has no effect on the antral mucosa. Cholecystokinin, another trophic hormone, stimulates cell proliferation in the exocrine pancreas, duodenum and gallbladder but not in the oxyntic mucosa. More recently, we have observed that caerulein stimulates epithelial cell proliferation in the antrum. The following is seen after acute administration of this cholecystokinin analog: a, after 18 h, there is an increased nuclear 3H-thymidine uptake in the progenitor cells of the antral mucosa and b, after 24 h, there is a mitotic peak. Continuous delivery of caerulein through implanted osmotic minipumps increases not only the mucosal DNA synthesis index and mitotic index, but also the migration rate of the epithelial cells along the glandular tubes.
The major postprandial factors known to influence epithelial cell proliferation in the colon are intraluminal factors. In this study, a transverse colostomy was created in rats in order to avoid the intraluminal stimulation of the distal colon after feeding. After a 48-h fasting period, the animals were refed whereas controls were kept fasted. Refed animals with their controls were killed at respectively 0, 8, 12, 18, and 24 h after the time of refeeding. Autoradiography of in vitro labeled mucosal samples was used for determining the proliferative parameters in the colonic crypts. The uptake of [3H]thymidine in mucosal scrapings was measured for estimating DNA synthetic activity. Refeeding increased the labeling index of the crypts (p less than 0.01) and the mucosal DNA synthesis (p less than 0.01) not only in the proximal colon but also in the excluded distal colon. The increase in labeling index was followed by a significant mitotic peak in both segments. These data indicate that direct intraluminal stimulation is not the only mechanism involved after feeding. There are other potent physiological stimulants of epithelial cell proliferation in the colon which are released postprandially.
The effect of a transverse colostomy was compared to a sham operation and to transsection of the colon with reanastomosis in rats. The autoradiographic study after labeling with tritiated thymidine showed a significant decrease in proliferative activity at 5 days and at 3 weeks in the colonic segment distal to the colostomy. This observation was confirmed by the occurrence of mucosal atrophy and by a significant decrease in the mucosal DNA synthesis activity. It was concluded that the intraluminal presence of fecal bulk is an important factor in the maintenance of cell renewal in the colon of rats. Other factors seem, however, to be involved since a delayed but significant decrease in proliferative parameters was also observed proximal to the colostomy; no mucosal atrophy occurred in the latter segment.
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.
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 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.
Fasciitis necroticans (F.N.) is a rapidly progressing necrotizing process of subcutaneous tissue and fascia which results in large soft tissue defects and severe systemic toxicity. During the last five years nine patients with F.N. were admitted at our department of surgery. Antibiotic prophylaxis immediately after the eliciting trauma was associated with a significant delay in treatment. Early recognition and surgical treatment are the most important factors influencing survival.
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.