[Diabetes and transplantation].
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Biomedical subjects
Publications and source records attributed to J B Buchs.
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This paper describes a pump of novel design, with peristaltic effect and pulsatile flow. Special features are the facility for occlusive or non-occlusive pumping, and the absence of moving parts in the flow section. A compressible drive medium allows 'individual' transport of big particles in the pumped fluid. Pumping of a relatively high proportion of solids in liquid is possible. This pump is suitable for handling living structures in cell and tissue separating systems. Pumping of fluids with increased viscosity and abrasives in liquid is also feasible.
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The importance of the arterial blood supply of the median nerve in the carpal tunnel depending on the type of hand vascularization was examined in view of surgical intervention in this region. Special attention was given to the anastomoses of the arterial branches which take part in the median nerve blood supply.
From a series of 84 cases of arterio-venous fistula, created for regular haemodialysis in end-stage chronic renal failure patients, the authors observed only one case of median nerve pathology at the level of the carpal tunnel. They propose three aetiologies: segmental ischaemia of the median nerve from perfusional redistribution, a mononeuritis syndrome aggravated by ischaemia and extrinsic compression of the median nerve by oedema secondary to distal venous reflux following creation of the vascular anastomosis. The authors recommend a termino-lateral anastomosis of a superficial vein (the superficial radial or the cephalic) with the radial artery. Using this approach, they did not observe any distal oedema nor any venous reflux into the hand. When a carpal tunnel syndrome is discovered in a case of arterio-venous fistula, the patient needs to be investigated for venous reflux into the hand and needs fistulography to exclude aspiration of blood from the cubital artery by the palmar arcade.
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The scarcity in brain death donors may impose to use kidneys from non-heart-beating donors. In this paper, we have studied the injuries due to warm in situ ischemia, we also propose a pretreatment to protect the kidneys before removal. We propose the use of intra-aortic catheter for flushing by a femoral surgical approach. Functional studies of these kidneys have been performed during 2 h normothermic ex-vivo perfusion and the recognized good organs have been successful reimplanted after 24 h of cold ischemia.
Two series of perforated duodenal ulcers are studied: 27 cases without anamnesis and 55 cases with medical or surgical treatment before the operations. All operated patients have a long catamnesis (five years and more). 50% of the patients are healed with a suture. Vagotomy and pyloroplasty are not associated. Gastrectomy is performed when the operated has an ulcer story.
Many etiologies have been proposed for renal artery stenosis following renal transplantation. Incorrect operative technique is the most frequent cause, but the condition is often due to vascular parietal lesions resulting from traction on the vessels during removal of kidneys, which causes dislocation of arterial parietal structures. Such traction is inevitable if kidneys are removed separately due to difficulties arising during deep mobilization of the kidneys. Furthermore, this technique involves direct flushing into the renal artery, and this may cause damage to the intima due to the canula. Canula and traction are the major causes of stenosis. The authors present their own cases and propose that kidneys be removed "en bloc". This is the only way to prevent traction on vessels, and it permits flushing through the aorta for cooling.
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