[Surgery of aneurysmal lesions of the coronary arteries].
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Adult↗
Biomedical subjects
L von Segesser
Publications and source records attributed to L von Segesser.
[Aneurysms of the supra-aortic and visceral branches: surgical strategy].
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Adult↗
Ruptured arterial aneurysms in the area of the celiac trunk.
Three cases of ruptured aneurysms of the digestive arteries are reported and the different available radiological methods leading to the diagnosis are discussed. Computed tomography and selective arteriography seem to be the methods of choice in this condition. Since the patients do not usually present typical signs until the aneurysm ruptures, the diagnosis is late. Early management of these patients is necessary in order to decrease the mortality rate.
Aneurysm↗
A new abdominal drain for overflowing lavage in instances of severe pancreatitis with persistent peritoneal contamination.
Eight patients with severe acute necrotizing pancreatitis had a new removable drainage device applied which allowed for massive lavage drainage with water tightness and easy repeated abdominal and retroperitoneal revisions. The lavage clears the enzymes and the toxic products that continuously soil the abdomen and affect all other systems. Simultaneously, it acts as a peritoneal dialysis. There were no complications and the 50 per cent survival rate at three months compares favorably with that of corresponding instances in another study (p less than 0.02).
Abdomen↗
[Long-term improvement of exercise performance in patients with activity-dependent pacemakers].
Exercise performance after implantation of the pacemaker with physical activity dependent pacing rate (Activitrax, Medtronic) was assessed by treadmill tests one month afterwards in 10 patients and a further 6 months later in 6 of them, who had long been VVI pacing dependent (reimplantation subgroup). In the 1 month test exercise performance had improved in 7 of 10 in activity pacing mode compared to VVI mode. After 6 months of physical activity dependent pacing the patients in the reimplantation subgroup showed an improved exercise test in VVI mode compared to the 1 month test in VVI mode. In activity pacing mode there was an additional improvement (increase of exercise duration from 12.1 +/- 2.5 to 14.5 +/- 2.7 min, p less than 0.005, and of accumulated work from 31.1 +/- 15.1%, p less than 0.002) compared to the VVI mode. Since Activitrax PM allows better exercise performance at longterm follow-up, it becomes a pacing mode of choice when double chamber pacing is impossible.
Adolescent↗
[Digestive arterial revascularization: long-term results and modified surgical approach].
In this series 31 patients (21 males and 10 females, median age 57 +/- 13.2 years) underwent surgery between 1970 and 1984 for digestive arterial lesions. Abdominal pain was observed in 84% of these cases and weight loss in 48%, while 8 patients were asymptomatic. In 12 patients (39%) the diagnosis was suspected before arteriography, which was the key to the diagnosis in 61% of cases (19 patients). In group A (elective surgery) 42 digestive arterial revascularizations were performed in 24 patients (mean number of effected by-passes 1.5). In group B (emergency surgery) 4 embolectomies and two by-passes were performed. In group A mortality (both surgery and hospital) was 0%. In group B surgical mortality was 33%. In a mean follow-up of 4.1 years the permeability of the by-pass established in elective surgery (emergency surgery) was 100% (64%) after one year and 92.9% (64%) after three years (life table analysis). Multiple digestive arterial revascularisations should be considered for those patients presenting multiple digestive arterial lesions because of catastrophical evolution of single by-pass occlusion in these patients.
Aged↗
Percutaneous transluminal angioplasty of right and left internal mammary artery grafts.
Four patients with recurrent severe angina and evidence of myocardial ischemia two to six months after surgical coronary revascularization have been submitted to percutaneous transluminal angioplasty of the distal insertion of internal mammary artery grafts or of the recipient vessel distal to it. These cases illustrate the feasibility and safety of transluminal angioplasty of right and left internal mammary artery grafts, using the mammary artery as a way of access.
Adult↗
Right ventricular outflow obstruction after radiation therapy.
A unique case of radiation-induced heart disease associated with acquired right ventricular outflow obstruction is presented. Surgical management of this case is described.
Adult↗
Implantation of antibiotic-releasing carriers for treatment of recurrent prosthetic endocarditis.
A 26-year-old man had early recurrence of aortic prosthetic endocarditis with recurrent prosthetic valve dysfunction. Tertiary valve replacement with implantation of antibiotic-releasing carriers for local treatment of aortic root abscesses was performed successfully in this highly lethal condition.
Adult↗
[Deep accidental hypothermia without cardiorespiratory arrest].
A case is reported of profound accidental hypothermia with spontaneous cardiac activity in a patient presenting several risk factors. The rewarming from 23.5 degrees C to 36.5 degrees C by partial cardio-pulmonary bypass was carried out without complications and in particular without cardiac arrythmia. As far as we are aware this is the twelfth case of profound accidental hypothermia reported in the literature in which rewarming was carried out by this method and the fourth case not involving cardiac arrest. Rapid rewarming by partial cardio-pulmonary bypass could be useful in patients with profound accidental hypothermia without cardiac arrest, the most serious complication being, precisely, cardiac arrest during rewarming.
Adult↗
Non-selective intra-arterial digital subtraction angiography for the assessment of coronary artery bypass grafts.
Non-selective intra-arterial digital subtraction angiography (DSA) was performed immediately before selective coronary and bypass angiography in 33 consecutive symptomatic patients 48 +/- 30 months after coronary surgery, for the assessment of 75 coronary bypass grafts. Forty ml of non-ionic, low-iodine content contrast medium (iohexol) were injected into the ascending aorta at 10-20 ml/sec through a 7 or 8 F femoral pigtail catheter. Electrocardiogram-triggered images were acquired on a Siemens Digitron II apparatus in multiple projections in 24 patients and in a single projection in 9 patients. The results of this technique were compared by two independent angiographers with those of selective graft angiography in the same patients. Patency was shown by DSA in 45 of 54 grafts confirmed to be open by selective angiography (sensitivity 83%). Of 21 occluded grafts, stumps were clearly visible at selective angiography in 18 and at DSA in 9 (sensitivity for graft stumps = 50%, p less than 0.01). Of 54 patent grafts with selective angiography, the distal anastomosis could be visualized by DSA in 28 (52%), but the resolution was comparable to selective angiography in 20 grafts (37%) only. A non-significant difference in the sensitivity of DSA was observed between patent saphenous grafts to the left anterior descending coronary artery versus all other coronary arteries (95 vs 85%, respectively), while only 1 of 5 patent left internal mammary artery grafts to the left anterior descending coronary artery was visualized. In 16 of 50 grafts (32%) visualized in a second projection substantial additional diagnostic information was obtained. In conclusion, non-selective intra-arterial electrocardiogram-triggered DSA can visualize patent saphenous grafts with a high sensitivity and may be a useful screening tool for bypass grafts patency; false negatives, however, and poor visualization of distal anastomoses limit its routine clinical use.
Adult↗
[Vascular rings. Apropos of 15 surgical case reports].
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Aorta, Thoracic↗
[Surgery of non-malignant disorders of the cecum].
In a total series of 207 complete or partial cecal resections during the last 6 years, 132 cecal lesions were found. 64 of the lesions were malignant and 68 benign. In the same period 2657 appendicectomies were performed. Histological analysis of the resected nonmalignant cecal lesions (partial cecectomy , ileocecectomy , right hemicolectomy and total colectomy) revealed ulcerative colitis in 25%, Crohn's disease in 20%, inflammatory pseudotumor in 15%, familial polyposis in 11%, benign tumors in 15% and various rare affections in 15%. From the topographical point of view one third of the lesions mainly involved the cecum, one third all of the colon, 20% the ileocecal area and 10% originated from the appendix vermiformis. The fact that the benign cecal lesions are probably as frequent as malignant cecal lesions shows that importance of good preoperative investigations in order to establish optimum surgical tactics and to prevent functional sequelae as a result of too generous resections. Therefore, histological analysis before or during surgery is of prime importance.
Adult↗
Pancreatic cystadenoma and cystadenocarcinoma.
Cystadenomas and cystadenocarcinomas are rare but not exceptional tumours of the pancreas. In this report six cases are added to the more than 300 cystadenomas and over 100 cystadenocarcinomas reported in the literature. We present here the case histories of four cystadenomas and two cystadenocarcinomas with complete follow-up. There is no evidence of recurrence after a maximum of 22 years in cystadenoma and 4 years in cystadenocarcinoma following resection. We have the impression that cystic lesions of the pancreas are nowadays more often detected than in former years. This might be due to abdominal investigation by computerized tomography and ultrasound on a large scale. Pathological features of proliferative cystic lesions of the pancreas permit distinction of three different tumours: serous cystadenoma, mucinous cystadenoma and cystadenocarcinoma. The serous cystadenoma is benign. The mucinous cystadenoma has to be considered as potentially malignant. The cystadenocarcinoma is malignant by definition. As benign and malignant elements can be found in the same cyst biopsy cannot exclude cystadenocarcinoma. Therefore all cystadenomas and cystadenocarcinomas should be totally excised, especially as prognosis after resection of cystadenocarcinoma is much better than after resection of adenocarcinoma of the pancreas.
Adult↗
Arthropump with peristaltic effect and pulsatile flow.
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.
Biomedical Engineering↗
Symptomatic aberrant retro-esophageal subclavian artery: considerations about the surgical approach, management and results.
Ten case histories of patients with symptomatic aberrant retro-esophageal subclavian artery are presented. The diagnosis was made on a clinical basis in 8 cases because of symptoms of tracheo-esophageal obstruction, and confirmed by barium meal. All patients were investigated by angiography. Six patients with right abnormal retro-esophageal subclavian artery (arteria lusoria) and its mirror image were treated by transection of the aberrant subclavian artery and reimplantation into the common carotid artery through a single midline sternal splitting incision which gave ample access. Three patients with left abnormal subclavian artery (right aortic arch) were operated by transection of the patent ductus arteriosus or ligamentum arteriosum through a left lateral thoracotomy. After a follow-up of from one to 10 years (mean 6.4 years), 9 patients are free of symptoms like dysphagia, dyspnea or subclavian steal and normal pulses are present on both upper extremities in 8 cases.
Adolescent↗
[Abdomino-perineal amputation: socio-occupational reintegration and late postoperative complications].
The major social, professional and organic sequelae of abdomino-peritoneal amputation are underestimated. A study covering 274 abdomino-perineal amputations performed between 1965 and 1981 served to determine the degree of social and professional reintegration in 64 patients who underwent surgery at age below 60. No patient was without sequelae. The leading complications are genital (87%) and urinary (30%). 65% of patients who had undergone surgery resumed work, but 26% were unable to work and are on national insurance. Specific "stoma care consultation" can help to reintegrate the patients who have undergone surgery and lessen their handicap by means, for example, of stoma irrigation.
Colonic Neoplasms↗