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Biomedical subjects

J Porto

Publications and source records attributed to J Porto.

10 recordsLinked to original sources
PubMed2003

Management and course of hydronephrosis secondary to inflammatory aneurysms of the abdominal aorta.

The objective of this study was to evaluate the management and course of obstructive uropathy secondary to inflammatory aneurysms. From January 1981 to December 2000 a total of 52 patients underwent surgical intervention for inflammatory aneurysms of the abdominal aorta. Eleven of these cases (21%) had obstructive uropathy, which was bilateral in five cases. Preoperative drainage of the urinary tract was done in five ureters in three patients with four double J catheters and one percutaneous nephrostomy; surgical ureterolysis was also carried out in one case. Endoaneurysmorraphy and placement of an aortic graft were performed in all 11 patients. Operative mortality was zero. There was no recurrence of hydronephrosis in seven patients during a mean follow-up of 55 months. Three patients were lost to follow-up and one died. When compared with 41 inflammatory aneurysms in which hydronephrosis did not develop, there were statistically significant differences with respect to lumbar pain and renal insufficiency. The ureter is a structure adjacent to the aorta that is trapped by fibrosis in 21% of patients with inflammatory abdominal aortic aneurysms. The natural tendency of the periaortic fibrosis is to remit following surgery to correct the aneurysm. This results in spontaneous remission of the hydronephrosis, making routine intraoperative manipulation of the ureter unnecessary.

Adult↗
PubMed1996

Congenital factor VII deficiency in a patient with an abdominal aortic aneurysm.

A patient with congenital factor VII deficiency underwent surgery for an inflammatory abdominal aortic aneurysm. No references in the literature have been found on the management of this coagulation defect in patients who require vascular surgery. We present one such case, with special reference to the perioperative management of factor VII replacement therapy.

Aged↗
PubMed1992

Selective deep hypothermia of the spinal cord prevents paraplegia after aortic cross-clamping in the dog model.

We tested, in the dog, the hypothesis that selective deep hypothermia (19 degrees to 12 degrees C) of the spinal cord protects it from the ischemia that follows double aortic cross-clamping. The extracorporal perfusion system consisted of heat exchanger and a pump, infusing saline solution at 5 degrees C into the subarachnoid space (L-6) and draining it through the cisterna magna. After 30 minutes this system cools a normally perfused spinal cord to a stable temperature gradient of 13 degrees C (inflow) to 18 degrees C (outflow). Proximal and distal intrathecal, proximal and distal aortic, and central venous pressures were continuously recorded. Rectal temperature was maintained between 36.5 degrees C and 38.5 degrees C. Eight control dogs had cross-clamping of the aorta below the left subclavian artery and above the diaphragm without cord hypothermia. Nine experimental dogs had cord hypothermia initiated 50 minutes before systemic heparinization (100 U/kg) and double cross-clamping of the aorta. Cross-clamping was maintained for 45 minutes. The aorta was then unclamped, heparin was reversed, cord cooling was discontinued, and the dura was closed. Hindlimb function of animals was graded by use of Tarlov's scale at recovery and 24 hours later. The dogs were then killed, and the cords were removed and fixed for microscopy. All control animals were paraplegic and had histologic confirmation of spinal cord infarction. All experimental animals had intact hindlimb function and normal appearing cords on histologic examination. A two-tailed Fisher's exact test (chi square) shows this difference to be significant to p = 0.00004. In the dog selective deep hypothermia of the cord avoids the ischemic injury induced by aortic cross-clamping that results in paraplegia. The implications of these findings in thoracoabdominal aortic clamping in humans is discussed.

Animals↗
PubMed1986

Embolization of the mesenteric arteries: surgical treatment in twenty-three consecutive cases.

Twenty-three patients with acute embolization of the superior mesenteric artery are presented. Twenty-one of them presented with sudden abdominal pain but no other remarkable physical findings. One had diffuse abdominal pain while one did not have any abdominal pain. Twenty-two patients underwent direct surgical revascularization and one patient refused operation. The total mortality in this series was 27%. Eighteen patients underwent revascularization without resection and 15 of them (83%) survived. Early diagnosis is the key to improved results in acute mesenteric ischemia. It relies on the aggressive utilization of arteriography to identify patients with superior mesenteric artery embolization before intestinal infarction takes place.

Aged↗
PubMedDate not supplied

Direct surgery on the aorto-iliac area. Prostheses--endarterectomy?

Of the 365 surgical techniques performed on the aorto-iliac area in 354 patients, 448 extremities were revascularized by means of the insertion of a prosthesis as a by-pass, and 165 by thromboendarterectomy (TEA), either global or ilio-femoral. The patency rate at five years was 83% for prostheses, and 72% for TEAs, studied as a whole, or 75% for global TEAs, and 60% for ilio-femoral, once they had been individually analysed. The analysis of these results proves that the patency of the ravascularized aorto-iliac area depends more on the associated pathology in the femoro-popliteal distal area, than on the surgical technique that has been applied. There are no significant differences in relation to the early patency or mortality between the three groups, although as regards age, younger patients with fewer risk factors were selected for global TEA operations.

Aorta, Abdominal↗