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Biomedical subjects

H Van Damme

Publications and source records attributed to H Van Damme.

At least 19 recordsLinked to original sources
PubMed2006

[Giant cell arteritis revealed by scalp necrosis].

Scalp necrosis is an uncommon manifestation of giant cell arteritis (GCA). In this paper, we report our experience with a 78-year old woman in whom extensive scalp necrosis developed as a complication of GCA. A left frontal defect (7 X 4 cm) involving full-thickness scalp was observed. The necrosis extended deeply, involving the epicranium and the outer table of the skull. The therapeutic approach included corticotherapy, anticoagulation and wound care. Severe wound infection (osteitis, subgaleal abscess) occurred, requiring prolonged antibiotherapy. Second intention healing was obtained using a conservative approach. During the healing process, areas of neovascularization developed beneath the exposed part of the outer table and the necrotic bone underwent resorption.

Adrenal Cortex Hormones↗
PubMed2006

[Chronic intestinal angina and bypass revascularization: a case report].

Intestinal angina is a rare affection with a high morbidity-mortality rate if not diagnosed. It is characterized by abdominal pain and postprandial vomiting, weight loss and anorexia. Arteriography allows confirmation of the diagnosis. The following case is a typical example of its clinical presentation and surgical treatment. Different techniques of revascularisation in case of a stenosis of the main digestive arteries are discussed.

Arterial Occlusive Diseases↗
PubMed2006

[Aortoaesophageal fistula caused by a thoracic aortic aneurysm].

Primary aorto-oesophageal fistula, secondary to an aneurysm of the thoracic aorta, are almost fatal. In the literature, only twenty six successfully operated cases have been reported. We report the case of a 78-year-old man with a thoracic aortic aneurysm eroded into the mid oesophagus. Prompt diagnosis of an aorto-oesophageal fistula resulted from clinical history, CT-imaging and oesophagoscopy. The patient was successfully operated by exclusion of the thoracic aneurysm (insertion of a straight cryopreserved arterial allograft), oesophagectomy and cervical oesophagostomy and jejunostomy. The continuity of the digestive tube was later restored after preliminary aortic valve remplacement (stenosis of 0.8 cm2). This case report is the second in which a cryopreserved allograft was successfully implanted in the management of a primary aorto-oesophageal fistula.

Aged↗
PubMed2006

[Carotid stenting revisited].

Recent publications about carotid-stenting are submitted to a critical analysis. The fact that an interventional approach in asymptomatic carotid lesions generates only marginal benefit being universally admitted, it is disturbing to see that modern series devoted to carotid artery stenting include a lot of asymptomatic patients and many symptomatic patients with a degree of stenosis well below the optimal range defined in NASCET (70 to 99%). Moreover, the degree of stenosis is often calculated from an inappropriate method that overestimates the degree of stenosis. Two objections have been made about an "hyper-sélection" of the patients enrolled in the NASCET study and the production of ideal not realistic results, not attainable in community hospitals; both objections have been overruled. The rate of acute perioperative myocardial infarction is mentioned, both in NASCET and ECST, it is around 0.9% vs 7.5% in SAPPHIRE study. Moreover, carotid artery stenting with an embolic protection device has resulted in the production of infra-clinical cerebral micro-infarcts in 40% of the patients. Significantly, the independent study EVA-3S, devoted to symptomatic patients had to be stopped because of the high cerebral morbidity in the dilatation-stenting group. Carotid artery stenting of asymptomatic lesions is futile (and potentially harmful because of microinfarcts) while carotid artery stenting of symptomatic lesions generate emboli.

Aged↗
PubMed2005

[Clinical case of the month. Lower limb revascularization from descending thoracic aorta in occluded axillobifemoral bypass].

We report the case of a patient who had lower limb revascularization by a bypass graft originating from the decending thoracic aorta, after total thrombosis of an axillobifemoral bypass graft. The latter had been performed for surgical repair of a secondary aorto-enteric fistula. We successively discuss the three particular apects of this observation: the secondary aortodigestive fistula, the axillobifemoral bypass and the bypass between the descending thoracic aorta and the femoral arteries.

Anastomosis, Surgical↗
PubMed2005

Factors promoting rupture of abdominal aortic aneurysms.

The risk for rupture of an abdominal aortic aneurysm is widely believed to be related to its maximum diameter. Rupture occurs at the site of maximum wall stress, when it exceeds the tensile strength of the aortic wall. Basic research confirmed that peak wall stress and aortic wall biodegradation contribute to the mechanism of aneurysm rupture. In order to highlight the role of loss in wall strength and increase in focal peak stress, the authors reviewed recent literature. The clinical relevance of these recent insights in the etiopathogenesis of aneurysm rupture is analysed.

Aorta, Abdominal↗
PubMed2005

[Acute limb ischemia: clinical, diagnostic and therapeutic aspects].

Acute lower limb ischemia, with sudden interruption of tissue perfusion, is a medico-surgical emergency. An early diagnosis is a prerequisite for optimal management. Diagnosis is mainly based on clinical data. Complementary investigations have a limited place, and should not unnecessarily delay the treatment. There are two categories of acute arterial, non-traumatic occlusion: embolism and thrombosis of an atherosclerotic vessel. The distinction between these two entities is not always evident, since ischemia can be the consequence of an arterial embolism in a diseased atherosclerotic artery. We discuss the clinical aspects and the causes of acute lower limb ischemia. The prognosis, outcome and therapeutic management are determined by the cause of the acute arterial obliteration.

Decision Trees↗
PubMed2005

[Analysis of the results of the main randomized trials on carotid endarterectomy for asymptomatic internal carotid stenosis].

The authors analyse the ACAS (1997-93) and ACST (1993-2003) trials, comparing the best medical therapy vs endarterectomy of an asymptomatic 60 % or more stenosis of the internal carotid artery. The ACAS trial does not reveal any benefit of surgery in preventing major stroke during follow-up (stroke rate 3.4% vs 6.02% in medical group, N.S.). Only by considering minor and major strokes together, a beneficial effect of carotid endarterectomy could be evidenced (5.9% stroke reduction at 5 years: 5.1% ipsilateral stroke at 5 years after surgery vs 11% stroke at 5 years under medical treatment). Indeed, following surgery, the stroke risk (ipsilateral) at 5 years attained 5,1% vs 11% following medical treatment of an asymptomatic internal carotid artery stenosis of 60-99%. The ACST trial, set up in 1993, aimed to assess the long-term result of carotid endarterectomy for asymptomatic 60-99% stenosis. Patients randomized for immediate surgery had a slightly more favorable outcome than those allocated to medical treatment. Absolute risk reduction of major stroke at 5 years was 2.5%. Overall, the benefit of operating an asymptomatic carotid artery stenosis is rather low (1% less stroke per year and less than 0.5% major stroke reduction per year). This positive result is obtained only if the operative stroke-death rate remains extremely low (<2.8%). The indication for operating asymptomatic carotid stenosis must be cautiously taken; age of the patient, degree of stenosis and surgeon's experience and results are to be considered.

Aged↗
PubMed2004

Formation of weak polyelectrolyte multilayers studied by spin labeling.

Multilayers of alternately adsorbing poly(allylamine) (PAH) and poly(acrylic acid) (PAA) of opposite charges on silica have been studied by the spin labeling technique, as a function of pH. The two polyelectrolytes have been labeled independently by a nitroxide free radical. Its electron paramagnetic resonance spectrum is mainly sensitive to the local Brownian motion and shows lines typical of two different environments, namely, loops protruding in solution with a fast motion and trains adsorbed on the solid with a hindered motion. These two parts have been evaluated for each of the polymer layers separately, and the thickness of the coatings has been described more precisely by characterizing the four contributions existing, for example, for a bilayer. Complexation is demonstrated by the loss of loops and tails belonging to the first polyelectrolyte. The overall picture emerging from the data is explained in terms of compensation of charges and entropy of confinement.

Journal Article↗
PubMed2004

Crural or pedal artery revascularisation for limb salvage: is it justified?

With the ageing of population, the incidence of limb-threatening ischemia increases. In chronic critical limb ischemia, peripheral arterial occlusive disease almost always involves infrainguinal and infragenicular vessels. Fortunately, recent advances in vascular surgery made arterial reconstruction of crural and pedal vessels possible. Should crural or pedal bypass surgery be offered to these frail, polyvascular patients, or is primary amputation a preferable treatment option in case of advanced limb-threatening ischemia? In order to answer this controversial question, the author analysed recent literature data on the feasibility and durability of infrapopliteal bypasses. The quality of life was also considered as an outcome measure. Finally, the cost-effectiveness of both treatment modalities (limb-saving distal bypass versus primary amputation) was assessed.

Amputation, Surgical↗
PubMed2004

Spontaneous tracheal rupture: a case report.

We report the case of a spontaneous posterior tracheal wall rupture following a cough. A 67-year-old woman with a history of longstanding treatment with corticosteroids (8 years) for Giant Cell Arteritis had general anesthesia for cataract removal. Surgery and anesthesia were uneventful. In the recovery room, the patient coughed and soon after developed subcutaneous emphysema of the neck. Chest radiography confirmed the clinical diagnosis of marked subcutaneous emphysema and showed huge pneumomediastinum and minor right pneumothorax. A thoracic CT scan revealed a large laceration of the posterior tracheal wall (a 4 cm longitudinal tear), extending from the middle of the trachea to the level of the carina. Surgical repair consisted in closure of the dilaceration using an autologous pericardial patch. It seems reasonable to suspect the facilitating role of connective tissue fragility due to chronic corticosteroid administration in the development of this tracheal rupture following cough. Tracheal rupture is a potentially lethal injury, which can be repaired successfully if the diagnosis is made early. Risk factors, diagnosis and principles of treatment of this lesion are discussed.

Adrenal Cortex Hormones↗
PubMed2004

[Primary mycotic aneurysm of the infrarenal aorta: a report of 2 cases].

Infrarenal mycotic aneurysms are rare. The classic symptomatic triad is abdominal pain, fever and a pulsatile, rapidly growing abdominal mass. We present two cases of mycotic abdominal aneurysm, recently managed. The principles of diagnosis and treatment of mycotic aneurysm are reviewed and discussed.

Aged↗
PubMed2003

Crural artery bypass with the autogenous greater saphenous vein.

OBJECTIVE: To evaluate the long-term outcome of greater saphenous vein (GSV) infrapopliteal revascularisation in a single centre over a 10 year period. MATERIAL AND METHODS: Fourty-one variables relating to a consecutive series of 90 crural artery GSV(76% in situ) bypasses in 81 patients (1990-2000) were analysed. The mean age of the 47 men and 34 women was 70 years. Limb-threatening ischaemia was present in 96% of cases, claudication in four patients. In 18 patients, surgery was 'redo'. RESULTS: The perioperative mortality was 3% (n=3). Patient survival was 54% at 4 years. Independent risk factors affecting survival were chronic renal insufficiency (p=0.04), hypertension (p=0.02), and ischaemic heart disease (p=0.01). Four bypasses thrombosed within 30 days. Three of them could be successfully reopened. Mean follow-up was 39 months. The primary patency rate at 4 years was 80%. Chronic renal insufficiency revealed to be the single independent risk factor for graft thrombosis (p=0.03, RR=12.4). The 4-year limb salvage rate was 88%. No independent risk factor affecting the limb salvage could be identified. CONCLUSION: Crural artery revascularisation is a valuable option for the management of limb threatening infrapopliteal arterial occlusive disease.

Adult↗
PubMed2003

[Preoperative cardiac risk evaluation of vascular surgery patients].

Peripheral vascular surgery (carotid, infrainguinal or aortoiliacal) is characterised by an increased cardiac risk with an infarction rate of 1 to 4%. Sixty percent of the vascular patients present a concomitant coronary artery disease, often infraclinically. Preoperative cardiac risk stratification aims at reducing cardiac related morbidity and mortality. A clinical risk profile (patient's past history) and non-invasive cardiac tests allow subdividing the vascular patients into three categories: high risk, intermediate risk, and low risk. High-risk patients (unstable angina, recent infarction, overt congestive heart failure and critical aortic valve stenosis) require immediate intensive management of their underlying cardiac disease. This means delay or annulation of the planned vascular operation. For intermediate risk patients, a clinical cardiac risk index based on patient's past history (stable angina, previous infarction or episode of congestive heart failure, age of 70 years or more and diabetes) offers a rough orientation. These clinical markers lack specificity, since they are found in almost all vascular patients. The adjunction of a non-invasive cardiac testing allows to optimise the cardiac risk evaluation. Stress echocardiography with dobutamine has become a very popular test, with a negative predicting value exceeding 90%, but with a lack of specificity (many vascular patients have an uneventful postoperative outcome, despite a positive dobutamine test). These inconsistent results of cardiac risk evaluation render their routine use questionable. Nowadays, the management of patients requiring vascular surgery is based on the concept that every vascular patient should be considered as suffering from coronary artery disease. A certain degree of myocardial protection should be offered to every vascular surgery candidate. A preoperative treatment with betablockers provides myocardial protection against the operative stress and lowers myocardial oxygen requirement. There are arguments to continue or start aspirin treatment in the preoperative period, in order to lower the risk of sudden coronary thrombosis.

Adrenergic beta-Antagonists↗
PubMed2003

[Prevention of lower limb necrosis and amputation by femoro-crural bypass: indications, techniques and results].

Limb threatening ischemia is a challenge for the vascular surgeon. Recent progress in revascularization procedures allow to minimize the primary amputation rate in the management of chronic critical limb ischemia. The authors discuss the prevalence and causes of chronic critical limb ischemia, with a special interest for diabetic arteriopathy. The technique of crural and pedal vessel revascularization is described, as well as the innovative tourniquet technique for distal bypass surgery. A review of published series of infrapopliteal bypass surgery is made. The experience of the authors during last decade with crural and pedal bypass surgery is analyzed.

Arteries↗