Iatrogenic dissection of the abdominal aorta.
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Aged↗
Biomedical subjects
M Batt
Publications and source records attributed to M Batt.
Lower limb trauma caused by power-driven cultivators: report of 23 cases.
OBJECTIVE: To determine the mechanism and the severity of injuries caused by power-driven cultivators. METHODS: This retrospective study analyzed the clinical records of 20 patients treated from 1984 to 1996 for a total of 23 lower limb injuries caused by power-driven cultivators (three patients had bilateral injuries) in the Nice University Hospital. RESULTS: A total of 90% of the accidents occurred when the machine was put into reverse and the limb was caught by the rotary blades; the cause of the remaining accidents was unknown. Of the 23 patients, 10 patients (43.5%) suffered posterior dislocation of the knee due to forced hyperextension. Injuries were classed in two groups as a function of their prognosis: group I consisted of osteomuscular lesions without vascular or nerve involvement (11 lower limbs, 11 patients). The mortality rate in this group was 9%, the rate of major amputation was 18%, and the prognosis was favorable in 82% of the cases. Group II corresponded to lower limb injuries with neurovascular involvement (12 lower limb injuries in 10 patients: one patient belonged to both group I and group II). Acute lower limb ischemia was constant in group II; the mortality rate was 20% (two of 10 patients), and the rate of major amputation was 41.6% (five of 12 patients; three emergency amputations and two secondary amputations). CONCLUSION: These agricultural machines can cause severe trauma, and the resulting wounds are contaminated by telluric germs in rural areas. Paradoxically, power-driven cultivators are not legally classified as "dangerous machines." Modification of existing legislation in this field would seem advisable.
Adult↗
Abdominal aortic aneurysm and lower-limb occlusive arterial disease.
BACKGROUND: Abdominal aortic aneurysms (AAA) are associated with lower-limb occlusive arterial disease (LLOAD) in 20-40% of patients. Retrospective analysis of 200 elective AAA repairs and comparison with literature data revealed that LLOAD has little influence on standard therapeutic management of AAA. METHODS: In this study, only 2.5% of the patients required femoropopliteal bypass along with aneurysm repair. In contrast, aneurysm repair was associated with lumbar sympathectomy in 30% of cases owing to existence of peripheral arterial disease. RESULTS: Concurrent LLOAD did not significantly increase the operative mortality of AAA, but postoperative peripheral arterial complications were more frequent in patients with both aneurysmal and occlusive disease. CONCLUSIONS: Although concomitant LLOAD did not adversely affect the long-term survival of patients who underwent surgical repair of AAA, this subgroup of patients was at higher risk of aggravation of their lower extremity arterial lesions.
Aged↗
[Carotid angioplasty: review of the literature].
PURPOSE: In order to assess the current knowledge of carotid angioplasty and stenting, we reviewed the pertinent literature distinguishing two types of reports on angioplasty for atherosclerotic stenosis of the internal carotid artery: case reports and series with less than 10 cases, and series reporting more than 10 cases. METHODS: Each series was examined individually followed by a general analysis. RESULTS: The 11 largest series in the literature included a total of 912 patients. The rate of transient ischemic attacks ranged from 6 to 14.8%. Stroke rate varied from 1.5 to 9.1%. Restenosis was reported in 4 to 16% of cases. CONCLUSION: Based on the data available in the literature, we cannot recommend carotid angioplasty. Carotid endarterectomy is recognised as safe and is generally considered to be the gold standard. In order to assess carotid angioplasty and stenting accurately, prospective randomized studies comparing surgery and angioplasty are necessary.
Angioplasty↗
Selectivity of anion exchange chromatography and capillary gel electrophoresis for the analysis of phosphorothioate oligonucleotides.
The complementary nature of anion exchange chromatography and capillary gel electrophoresis for oligonucleotide analysis is demonstrated by evaluating a comprehensive series of authentic deletion sequences and partial phosphodiester analogs of five phosphorothioate oligonucleotides of different base composition and sequence. While anion exchange HPLC is sensitive to differences in backbone length of phosphorothioate oligonucleotides, oligomers with length difference of one base unit are not resolved. Capillary gel electrophoresis, on the other hand, has excellent single-base resolution while being relatively insensitive to phosphate in the phosphorothioate backbone. The data definitively establish the necessity of employing both separation techniques for adequate characterization of lower order process-related impurities potentially found in synthetic phosphorothioate oligonucleotides.
Chromatography, Ion Exchange↗
Visceral artery aneurysms in Von Recklinghausen's neurofibromatosis.
We report the case of a patient with Von Recklinghausen's neurofibromatosis in whom two visceral artery aneurysms were diagnosed: a 4 cm aneurysm originating from the common hepatic artery and a smaller aneurysm originating from the superior mesenteric artery. The hepatic artery aneurysm underwent successful embolization. Because of the patient's poor general condition, the superior mesenteric aneurysm was considered inoperable and has been kept under surveillance by ultrasonography. Arterial involvement in Von Recklinghausen's neurofibromatosis is a well-known but infrequent occurrence. Stenotic lesions predominate, with the renal arteries being the site of predilection. Aneurysmal defects are less common, and involvement of the visceral arteries is exceptional. Only three reports of superior mesenteric artery aneurysm in patients with Von Recklinghausen's neurofibromatosis were found in the literature, and hepatic artery aneurysm has never previously been described in this disease.
Aneurysm↗
Buttock claudication from isolated stenosis of the gluteal artery.
Buttock claudication is usually caused by proximal arterial obstruction in the aorta or the common iliac artery. We report an unusual case of buttock claudication caused by isolated stenosis of the superior gluteal artery diagnosed by angiography. Both physical examination and noninvasive vascular explorations had been unremarkable. Twenty-six months after undergoing treatment by percutaneous transluminal angioplasty, the patient has no symptoms. Buttock claudication related to unilateral stenosis of the superior gluteal artery as observed in this case can be successfully managed by percutaneous transluminal angioplasty.
Aged↗
Exercise induced leg pain.
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Chronic Disease↗
Shin splints: MR appearance in a preliminary study.
PURPOSE: To investigate the magnetic resonance (MR) imaging appearance of activity-related lower leg pain (shin splints syndrome) and evaluate the relative involvement of bone and soft tissues. MATERIALS AND METHODS: Nineteen patients with activity-related lower leg pain and tenderness on palpation along the posteromedial tibia (shin splints) underwent clinical examination and MR imaging. Five also underwent plain radiography. MR findings were compared with patient demographics, clinical findings, and plain radiographs when available. RESULTS: Four MR patterns were identified: normal appearance (n = 7), periosteal fluid only (n = 5), abnormal marrow signal intensity (n = 5), and stress fracture (n = 2). Increased symptom duration correlated strongly with a normal MR image (P = .002). Plain radiographs appeared normal in all five patients for whom they were available. CONCLUSION: Patients with acute shin splints have a spectrum of MR findings, which suggests this clinical entity is part of a continuum of stress response in bone. The strong association between chronic symptoms and a normal-appearing MR image implies that this modality has less utility in these patients.
Acute Disease↗
Secondary rupture of an iliac artery aneurysm after exclusion-bypass.
We report a case of secondary rupture of a common iliac artery aneurysm into the common iliac vein. Exclusion of the iliac aneurysm had been performed 2 years earlier in association with reconstruction of an aortic aneurysm that had ruptured into the interior vena cava. After closure of the aortocaval fistula by the endoaneurysmal route, aortobifemoral bypass grafting had been performed and a caval clip had been placed. The common iliac arteries had been sutured by the endoaneurysmal route and the right common iliac artery had been excluded by ligation of the right iliac artery. Occlusion of the interior vena cava distal to the caval clip resulted in increased peripheral venous hypertension causing the secondary arteriovenous fistula (rupture of scrotal varices and edema of lower extremities) but prevented right cardiac insufficiency. This observation confirms the possibility of secondary rupture after treatment of an aneurysm by exclusion. Thus the inclusion-graft technique is more reliable.
Aged↗
[Treatment of abdominal aortic aneurysms: importance of the bifurcated prosthesis].
Despite the increasing use of tube grafts to treat aortic aneurysms, bifurcated prostheses remain the most frequent solution. Advocates of the tube graft emphasize faster positioning and lower operative morbidity and mortality rates. However, the condition of the aortic orifice (where atheromatous lesions are maximal) and the aneurysmal or occlusive iliac disease frequently associated with aortic aneurysms usually require use of a bifurcation prosthesis for complete treatment of aortoiliac lesions.
Aortic Aneurysm, Abdominal↗
[Iliac vein stenosis caused by intrauterine device migration].
There have been no other cases of migration of an intrauterin device reported to have caused venous compression. In the case reported here, the intrauterin device was removed surgically together with a portion of the damaged vein. A venous graft from the internal jugular vein was performed. The mechanisms of perforations, different localizations are discussed and diagnostic and therapeutic approaches are proposed.
Adult↗
[Palmar hyperhidrosis and arteritis of the finger: value of sympathectomy and videothoracoscopy].
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Adult↗
[[Aneurysm of the abdominal aorta and arteritis of the legs].
Twenty to forty percent of patients with aneurysms of the abdominal aorta also have obliterated arteries of the lower limbs. We analyzed retrospectively a series of 200 patients undergoing elective surgery for aneurysm of the abdominal aorta and compared the results with data in the literature. Obliteration of the lower limb arteries had little influence on the technique usually employed for surgery. Femoro-popliteal bypass was associated with cure of the aneurysm in only 2.5% of the cases. We also performed sympathectomy of the lumbar branches in 30% of the cases because of peripheral arterial lesions. The presence of obliterations did not significantly increase operative mortality. Inversely, post-operative peripheral arterial complications were more frequent in patients with an obliterated artery of the lower limb than in those free of distal disease. Long-term survival was not unfavourably affected by the presence of obliterated arteries, but such patients have a greater risk of arterial lesions of the lower limbs.
Aged↗
Quantitative capillary gel electrophoresis assay of phosphorothioate oligonucleotides in pharmaceutical formulations.
Quantitative capillary gel electrophoresis (QCGE) has been developed for the accurate quantitation of a 21-mer phosphorothioate oligonucleotide, ISIS 2922, and its degradation products in an intravitreal formulation. The electrokinetic mode of injection employed by CGE necessitates formulation of the external reference standard in a sample matrix similar to that of the drug product and the use of an internal standard for improved accuracy and precision. The analytical method detailed in this paper has demonstrated the necessary accuracy, precision, linearity, range, selectivity and ruggedness for use in routine drug product analysis and stability monitoring of phosphorothioate oligonucleotides.
Capillary Action↗
Subadventitial rupture of the splanchnic arteries as the result of blunt abdominal trauma presenting with acute gastric dilatation.
Two patients are reported who presented with intestinal ischaemia caused by a subadventitial rupture of the origin of the coeliac trunk and superior and inferior mesenteric arteries after blunt trauma from deceleration injury. In both cases the initial clinical examination revealed a painful abdomen without any 'peritonism'. Abdominal ultrasonographic examination showed no abnormality. Plain abdominal radiography showed gastric dilatation in both patients. In the first, the diagnosis was made by laparatomy but only after 2 days. In the second, diagnosis was made by aortography performed because of the early appearance of gastric dilatation. Both patients died as a result of extensive associated injuries and delay in diagnosis.
Abdominal Injuries↗
Thrombophlebitis of the ovarian vein with free-floating thrombus in the inferior vena cava.
Two cases of thrombophlebitis of the right ovarian vein, one occurring after cesarean section and the other after natural childbirth, are reported. The clinical diagnosis was based on the symptoms of postpartum fever in association with right flank pain and confirmed by abdominal CT scans. In both cases the thrombosis extended into the inferior vena cava and was associated with a free-floating thrombus extending up to the renal veins. Thrombectomy of the inferior vena cava and ligation of the right ovarian vein were performed with good results in both cases, as shown by late follow-up CT scans. This and alternative therapeutic strategies are discussed.
Adult↗