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Biomedical subjects

G Soots

Publications and source records attributed to G Soots.

At least 19 recordsLinked to original sources
PubMed1992

[Primary Aspergillus endocarditis. Apropos of a case and review of the international literature].

The authors report a case of primary aspergillus endocarditis with endophthalmitis and vertebral osteomyelitis. No underlying disease and no predisposing factors were found. Valve replacement plus combined antifungal chemotherapy proved to be effective as the patient is asymptomatic 18 months after the first symptoms. 48 cases of aspergillus endocarditis, without prior cardiac surgery have been reported in the literature. Aspergillus endocarditis was valvular or mural. Extracardiac dissemination was common but endophthalmitis and osteomyelitis were infrequent. In 11 cases, the diagnosis was made by histologic examination of embolectomy or ocular, skin biopsy tissue. All patients were febrile. Blood cultures showed no Aspergillus species. Clinical manifestations of endocarditis were described in less than fifty per cent of cases. Echocardiographic visualization of vegetations was obtained in 5 cases. Many patients experienced embolic phenomena. Mortality from Aspergillus endocarditis is extremely high (96%). Surgery is the main treatment, consisting of valve replacement. Antifungal chemotherapy should be combined. The proper duration and dosage and the combination of antifungal drugs have not been clearly defined.

Amphotericin B↗
PubMed1991

Cold blood cardioplegia and warm cardioplegic reperfusion in heart transplantation.

The major cause of early death after heart transplantation is graft failure. In 99 consecutive heart transplantations two protocols of myocardial protection were employed. In group 1 (n = 38) initial cold crystalloid cardioplegia combined with cold saline storage and peroperative surface cooling was used. In group 2 (n = 61) cold crystalloid cardioplegia was injected initially and cold blood cardioplegia (Buckberg) was infused every 30 min as soon as the graft arrived in the operating room. No surface cooling was used. Warm blood cardioplegic reperfusion was administered before removal of the aortic clamp. There were 8 early (within 30 days) deaths in group 1 and 6 in group 2 patients. In group 1 there were 5 cardiac deaths against 3 in group 2. Mean ischemic time was 153 +/- 37 min in group 1 and 158 +/- 51 min (p greater than 0.05) in group 2. The post-transplantation need for catecholamines was ten times higher in group 1 patients than in group 2. The first endomyocardial biopsy (after 1 week) showed cytologic lesions compatible with ischemia in 40% of group 1 and only 9% in group 2 patients. We conclude from this initial experience that intermittent cold blood cardioplegia and warm blood cardioplegic reperfusion are useful in heart transplantation in restoring the damage suffered by the graft during brain death and graft storage.

Adult↗
PubMed1990

End-to-side aortoprosthetic anastomoses: long-term computed tomography assessment.

Fifty-two asymptomatic patients underwent routine computed tomographic evaluation of aortobifemoral bypass grafts implanted end-to-side on the aorta five to 10 years after operation. Anteroposterior diameters were measured at the level of the stem and the limbs of the graft, the aortoprosthetic anastomosis, and the infraanastomotic aorta. The stems of the prostheses were found to be dilated between 30 and 110% (mean 58%) of initial values. The limbs of the graft were dilated between 15 and 150% of initial values, the mean being 52%. The anteroposterior diameter of the aortoprosthetic anastomosis measured between 27 and 48 mm with a mean of 32 mm. Eight patients (15%) had an anastomotic false aneurysm. The aorta distal to the prosthetic anastomosis was completely occluded in 48 cases (92%). A mural thrombus was encountered at the level of the aortoprosthetic anastomosis in 21 (40%) patients. These findings raise questions as to the possible role of side-to-end aortoprosthetic anastomoses in the genesis of anastomotic dilatations, false aneurysms, intraprosthetic thrombosis, and thrombosis of the branches of aortofemoral bifurcation prosthetic grafts.

Adult↗
PubMed1990

[Cystic adventitial disease of the popliteal artery].

This strange lesion has been described as colloid degeneration, adventitial cyst, adventitial cystic disease, cystic degeneration of the popliteal artery. The disease was also observed in other localizations and the first case, which was described in 1946 by Atkins and Key (I) concerned an iliac artery. Bizard (2) in 1978 reported a case of the common femoral artery. Ejrup and Hiertonn (4) described the first popliteal localization in 1954. Bergan in 1970 reported 40 cases and collected 115 operated cases in Rutherford's Vascular Surgery (5). Usually a young patient complaints from a recent severe intermittent claudication. At surgery a cystic lesion is found into the adventitia of the popliteal artery, containing gelatinous material which may be easily evacuated without opening the lumen of the artery. This lesion is totally different from atheroma and also from medial cystic necrosis as described by Erdheim.

Adolescent↗
PubMed1989

[Durability of the Carpentier-Edwards porcine bioprosthesis in aortic or mitral positions. 10 years' results on 458 surgically treated cases].

458 patients with a Carpentier-Edwards porcine bioprosthesis (aortic (Ao): 169, mitral (Mi): 289) operated between January 1975 and December 1981, were studied during the first trimester of 1987. Forty seven patients underwent an associated operation. The total follow-up was 3,001 patient-years with a maximum follow-up of 11.4 years and a mean follow-up of 6.5 years. Only 5.6% of patients were lost to follow-up. The patients were aged between 20 and 80 years. The actuarial 9-year survival rate was 69.2 +/- 6.3% for aortic prostheses and 79.6 +/- 3.9% for mitral prostheses. The principal cause of valve failure, appearing with a considerable frequency after 5 years, was primary tissue degeneration which alone represented 67.8% of the causes of valve failure. The rate of absence of valve failure, for all causes combined, was 77.8 +/- 5.9% for the aortic position and 74.9 +/- 4.9% for the mitral position. The actuarial rate of absence of primary tissue degeneration at 9 years was 79.7 +/- 4.1% for aortic prostheses and 75.2 +/- 4.4% for mitral prostheses. The frequency of tissue degeneration decreased with increasing age, representing 2.9%, 1.9% and 1.5% patient-years respectively for the age-groups: 20 to 39 years, 40 to 59 years and 60 to 80 years. However, this difference was not statistically significant. Tissue degeneration was the principal cause for reoperation (n = 59) with an operative mortality of 7.8%.

Actuarial Analysis↗
PubMed1989

[Acute traumatic rupture of the thoracic aorta. Role of delayed surgical treatment].

Acute traumatic rupture of the thoracic aorta (ATRTA) is considered to be an emergency which requires immediate surgery. However surgical mortality is high with an average of 20% in the literature. Twenty-seven patients were observed from 1973 to 1986. Three patients were not operated on (Group I). Twenty patients had immediate surgery (group II) with 60% deaths, 4 patients underwent delayed surgery (Group III) with 25% deaths. Analysis of causes of deaths shows that mortality is mainly due to the severity of associated lesions. Associated lesions were present in 72% of patients who did not survive and in only 37% of the survivors. Associated lesions may be lethal initially (E.G. Brain trauma) or they may be aggravated by the thoracic procedure. Complications from associated lesions may also compromise the outcome of the thoracic procedure. It is well known that the majority of deaths from ATRTA are observed within 24 hours. Immediate repair of the aortic lesion should remain the rule when aortic rupture is isolated or associated with moderate injuries. However, in some cases with severe and multiple associated lesions who survive the initial aortic injury, delayed repair of ATRTA could be considered.

Acute Disease↗
PubMed1979

[Short- and mean results of mitral and aortic valve replacement with a Björk-Shiley disc prosthesis. Thromboembolic and hemorrhagic complications].

96 patients with a Björk aortic valve and 112 patients with a Björk mitral valve were followed up for four and a half years and five years after operation respectively. The actuarial survival rate was 82.5% in the aortic and 73% in the mitral patients. Late death was observed in 7.3% of mitral patients with thromboembolic complications and 4.2% of mitral patients with left ventricular dysfunction, compared to 2.6% of aortic patients with thromboembolism and 3.6% with left ventricular dysfunction. The incidence of thrombolic complications was three times as great with the prosthesis in the mitral position. The probability of absence of thromboembolic complications, studied by actuarial methods, was 93% at 4 1/2 years in aortic prostheses compared to 82% at 5 years in the mitral prostheses. 12 haemorrhagic complications (5.7%), with one fatality, were observed. Aortic valve replacement with a Björk prosthesis is a very satisfactory operation and the results compare favourably with other prostheses. However, the risk of thromboembolic complications should be seriously considered in the surgical indications when this prosthesis is to be used for mitral valve replacement.

Adolescent↗
PubMed1979

[Problems encountered by the anesthetist-intensive care specialist during aorto-coronary bypass surgery].

The authors analysed a series of 400 aorto-coronary bypasses performed between 1970 and April 1978. A notable improvement in the statistics was seen during the second period between 1976 and April 1978. During this period, 248 patients were operated upon with a mortality of 4 per cent. The progress made was in large part attributed to improved preoperative assessment, in particular a complete ventricular assessment, improved peroperative myocardial protection and the use of the intra-aortic counter-pressure balloon and of sodium nitroprussiate.

Anesthesia↗
PubMed1976

[Aneurysm of the ascending aorta and aortic insuffiency].

Basing themselves on 24 cases of aneurysm of the ascending aorta with gross aortic incompetence, the authors give an account of their personal experience of this condition. They emphasise: -- the problems of aetiology posed by this annular dilation of the aorta with its associated elastic tissue dystrophy which is seldom apparent except at histological examination of the aortic wall at percuaneous biopsy; --the operative problems which confront the surgeon, especially because the orifices of the coronary vessels are in the very centre of the aneurysm. The detail their modest surgical experience, and emphasise the advantages of using Bentall's operation systematically; it seems that this is likely to be the operation of choice in the future.

Adult↗
PubMed1975

[Long-term survival in persons with cardiac pacemakers. Study based on 1,159 patients, 499 with regression at 4-10 years].

Analysis of the long-term survival of pacemaker carriers showed a parallelism between two curves: that of the survival in patients treated with a pacemaker as from the second month, and that of a control group with the same age and physical structure. Treatment in the first few years was made problematical by defects in surgical technique: while in 17% of reoperations, the reason was straightforward substitution of the pacemaker owing to wear on the battery, 83% were the consequences of complications. Of these, 23% consisted of shifts in the intracavitary probe, electrode failures, or increase in the threshold. The frequency of infections due to implantation or reoperation was 7,4%, in certain cases with fatal outcome. Bearing in mind that mortality from Adam-Stokes disease was 50% prior to the introduction of pacemakers, it can be maintained that this therapy represents a considerable step forward in cardiology. Mortality was 27% in all patients submitted to implantation.

Adams-Stokes Syndrome↗