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Biomedical subjects

I Bruschweiler

Publications and source records attributed to I Bruschweiler.

12 recordsLinked to original sources
PubMed1998

[Closed trauma of the abdominal aorta--current update].

This study constitutes an update on current knowledge in the literature concerning closed traumas of the abdominal aorta. The morbidity of such lesions, in case of initial survival, depends on both rapid diagnosis and prompt treatment of hypovolemia and ischemia. The presence of associated intestinal lesions renders diagnosis difficult, modifies surgical treatment, and aggravates prognosis.

Abdominal Injuries↗
PubMed1997

Screening for patent foramen ovale and prevention of paradoxical embolus.

Paradoxic embolus is uncommon. Definite diagnosis requires demonstration of thrombus astride a patent foramen ovale (PFO) in a patient presenting cerebral or peripheral arterial embolism. With current echocardiography techniques, it is now possible to identify subjects with a PFO at risk for paradoxal embolism, however, the possibility of screening rekindles debate on prophylaxis and treatment. In the present report, we describe a case involving a woman who presented acute ischemia of the lower extremities with all the pathophysiologic features of paradoxical arterial embolism.

Aged↗
PubMed1997

Aortocaval fistula associated with abdominal aortic aneurysm: a diagnostic challenge.

The purpose of this study is to determine the clinical features with the best preoperative diagnostic value for aortocaval fistulas (ACF) associated with abdominal aortic aneurysm (AAA). A review of our experience of seven patients presenting ACF between 1980 and 1994 as well as an extensive study of the literature provide a clearer picture of the signs and symptoms allowing diagnosis of ACF: edema of the lower extremities and signs of venous hypertension are the most predictive findings; continuous abdominal murmur is noted in 66% of cases and is of good diagnostic value.

Aged↗
PubMed1996

Lower limb trauma with injury to the popliteal vessels.

A retrospective analysis of blunt trauma to the lower extremity with injury to the popliteal vessels was undertaken in an attempt to determine the major predictors of outcome and to expose the shortcomings of our management. Thirty-one patients with lower extremity trauma including a popliteal artery injury were admitted to our clinic between 1979 and 1993. Two patients died of hemorrhagic shock or from associated lesions. Amputation of the leg was performed primarily in one patient because of massive tissue damage and secondarily in five patients because of uncontrolled local infection (two patients), excessive tissue damage (two patients), and persistent ischemia (one patient who later died). A peripheral neurologic deficit resulted in 12 of 24 non-amputated extremities. Three additional patients suffered sequelae from bone and joint damage. In all, nine patients recovered completely from their limb injury. Severe ischemia of the leg was found to be an indicator of major limb damage and was a strong determinant of poor outcome. Of 18 patients with severe ischemia, two died (one after amputation), five were amputated, and eight were left with a peripheral neuropathy. Only two patients recovered completely. Of 13 patients with relative ischemia, five recovered completely and four sustained a peripheral neuropathy. The deleterious effects of delayed revascularization were evident in four patients who developed a peripheral neuropathy secondarily. Morbidity from the ischemic insult could have been reduced in seven patients: the diagnosis was missed in two, its seriousness not realized in one, and a non-optimal management led to an excessive ischemic time in four. The magnitude of skeletal and soft tissue injury, alone or in combination, was also strongly associated with an increased morbidity. Most patients with blunt lower limb trauma and popliteal vascular injury are left with serious sequelae from associated neuro-musculo-skeletal damage and from ischemia. Although the magnitude of the first variable is determined by initial trauma and cannot be altered, a constant awareness of possible arterial injury in lower limb trauma, and adherence to a plan of management according to the ischemic state of the leg, should help avoid the additional deleterious effects of prolonged ischemia.

Adolescent↗
PubMed1995

Correction of pectus excavatum combined with open heart surgery in a patient with Marfan's syndrome.

We report a patient with Marfan's syndrome and pectus excavatum who underwent open heart surgery with simultaneous correction of the sternal malformation. Permanent internal stabilization, achieved by bilateral overlapping of the bevelled ends of the lowest ribs and reinforced with sternal closure wires offered a maintained postoperative chest wall stability, avoided the potential postoperative complications of cardiac compression, and improved the aesthetic appearance of the anterior chest wall. The increased risk of bleeding due to extensive dissection was minimized by postponing the repair of pectus excavatum to when protamin is administered after termination of cardiopulmonary bypass.

Aortic Aneurysm↗
PubMed1995

[Management of blunt injury of the popliteal artery].

PURPOSE: this retrospective study was undertaken to analyse our results with blunt popliteal artery injury and to detect flaws in our approach. MATERIAL AND METHOD: between 1979 and 1993, 31 consecutive patients with a blunt injury to the popliteal artery were retrospectively reviewed. RESULTS: 4 patients were in shock on admission from a popliteal artery bleed. One patient died before treatment. Primary amputation of the leg was performed in one patient because of extensive tissue destruction. Arterial reconstruction was performed in the remaining 29 patients: 1 patient died of associated injuries, 5 underwent subsequent limb amputation because of infection (in 2), tissular destruction (in 2) and persistent ischemia (in 1). A neurological deficit (mostly of the peroneal nerve) occurred in 13 patients. Increased ischemic time was noted in 6 patients because of non-optimal management: diagnosis of a popliteal artery occlusion was missed in 2 patients, and a rigid approach resulted in an excessive delay in revascularization in 4 patients. DISCUSSION: even though morbidity of blunt popliteal artery injury is greatly determined by the initial trauma, superimposed ischemia further jeopardizes the outcome. A more expeditive revascularization could be achieved in some patients by performing on-table angiograms, immediate fasciotomy to release tissue hypertension and by proceeding with the vascular repair before orthopedic reconstruction. However, if a complex orthopedic repair must be performed initially because of major instability, indwelling shunts should be inserted in the popliteal vessels to insure limb perfusion. CONCLUSION: it is postulated that a rational plan of management of blunt popliteal artery injury would decrease the adverse effect of ischemia, and would reduce overall morbidity.

Adolescent↗
PubMed1994

Reversed flow in the internal carotid artery after occlusion of the common carotid artery.

Patency of the internal carotid artery in case of common carotid artery occlusion is usually maintained by a flow of blood from the external carotid into the internal carotid artery. A case where a reversed flow of blood was established from the cerebral circulation into the internal carotid artery and eventually into the external carotid artery is presented. Careful reading of the cerebral views of the standard carotid angiogram allowed detection of a retrograde flow into the internal carotid artery. Surgical exploration confirmed the patency of the internal carotid artery; the occluded common carotid artery was bypassed by a prosthesis, which restored an antegrade flow into the internal carotid artery.

Carotid Artery, Common↗
PubMed1994

[Sub-adventitial rupture of the external iliac artery in closed traumas of the pelvis. Apropos of 2 cases].

Major vascular injuries in closed fracture of the pelvis occur in approximately 1% of cases. In this setting, subadventitial rupture of the external iliac artery is rare. The lesion is responsible for acute ischemia of the lower limb, and may present diagnostic challenges due to frequently associated major local injuries, delayed disappearance of distal pulses, and concomitant neurological damage. Serial clinical examinations along with the use of arteriography are instrumental in avoiding undue delays.

Adult↗
PubMed1993

Blunt injuries to the innominate artery.

Two patients with aneurysm secondary to blunt traumatic subadventitial rupture of the distal innominate artery (IA) are reported. IA rupture was identified because of a cervical bruit in one patient and detected during thoracic aortography in the other patient. The patients had associated cardiovascular lesions consisting of traumatic aneurysm of the subclavian artery and rupture of the aortic valve, respectively. Both lesions were surgically repaired by resection of the lacerated intima and direct closure of the adventitia. In the patient who underwent repair of the aortic valve with simultaneous cardiopulmonary bypass the IA was approached after cannulation of the right common carotid artery. In the other patient the IA was repaired without use of a shunt under close EEG monitoring. Injury to the IA is rare because the artery is short and relatively well protected by the bony cage. Other cardiovascular lesions may be associated with IA rupture and a routine search should be made.

Adult↗