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Biomedical subjects

M Batt

Publications and source records attributed to M Batt.

At least 73 records · Page 4Linked to original sources
PubMed1989

Expanded polytetrafluoroethylene prostheses as secondary blood access sites for hemodialysis: pathological findings in 29 excised grafts.

The popularity of expanded polytetrafluoroethylene (PTFE) arteriovenous fistulas for hemodialysis access is increasing. The low infection rate, low thrombogenicity and low body reactivity make it an important blood access for patients on routine hemodialysis. The authors examined 29 PTFE graft fistulas surgically excised from patients on hemodialysis for one or more of the following complications: infection 7, 2 with associated hemorrhage; thrombosis 9; aneurysm 11, 3 with associated thrombosis; stenosis 5, 3 with associated thrombosis; hemorrhage 4 and arterial steal 2. The explanted prostheses were reinforced Gore-tex in 20, Gore-tex thin wall in 1, Impra I in 4, Impra II in 3 and Vitagraft in 1. It was also noted that the implants failed in the short term mainly because of infection, in the medium term mainly because of thrombosis and stenosis, and in the long term usually because of aneurysm.

Adult↗
PubMed1989

Biologic and structural evaluation of 80 surgically excised human umbilical vein grafts.

Human umbilical vein is a valuable alternative to autogenous saphenous vein in lower-limb revascularization. However, the long-term patency is not as good. To understand better the reasons for this, the authors studied the biologic and structural changes occurring in 80 segments of human umbilical vein (HUV) grafts excised from 70 patients. Morphologic, histologic and scanning electron microscopy examinations were performed on each specimen. It was noted that increasing duration of implantation was associated with greater encapsulation and less surrounding inflammatory reaction. Twenty-six percent of clinically noninfected grafts were found to harbour bacteria. Bacteremic colonization was often in the folds of the luminal surface. As a result of these findings, the authors emphasize the need for complete excision of clinically infected grafts. Anastomoses between HUV segments are discouraged because they are associated with a high frequency of infection and a corresponding decrease in duration of implantation. Delamination of the wall was common, and such sites may represent areas at risk for further degradation. Continued surveillance of the biologic and structural changes occurring in excised grafts remains an important method in increasing our understanding of the evolutive complications of HUV grafts.

Adult↗
PubMed1988

Mural thrombus of the aorta.

Twenty-six peripheral arterial emboli complicating 14 cases of mural thrombi of the aorta were diagnosed between January 1978 and December 1986. None of these patients had any cardiovascular history; their mean age was 49 years. Presenting signs were acute ischemia of the lower limbs in 12 cases and chronic ischemia in two. Arteriograms and CT scan were diagnostic. The mural thrombi were infrarenal in 13 cases and suprarenal in one. Treatment of the thrombus was surgical in all but one patient. In four cases, treatment of the underlying cause was simultaneous with embolectomy; in nine patients, treatment was secondary because further workup was needed. In one case, the patient died following embolectomy before definitive treatment could be undertaken. Results were considered good in 11 cases (unlimited walking distance, no recurrent emboli), and poor in three cases (two major amputations and one death). The incidence of mural thrombi is not known. In our experience, they accounted for 3.8% of nonaneurysmal aortoiliac lesions operated upon during a nine-year period and were responsible for 5% of peripheral arterial emboli. Mural thrombosis of the aorta constitutes a dangerous condition with a potentially lethal final outcome. Recurrent emboli are inevitable without surgical treatment of the source.

Adult↗
PubMed1988

[Gastric ruptures caused by diving accidents. Apropos of 2 cases. Review of the literature].

Underwater diving was responsible for gastric rupture in two cases seen personally and five cases of total gastric rupture reported in the literature. The various possible mechanisms for onset of this rupture are envisaged, the diagnosis of this rare accident being established from the existence of a large pneumoperitoneum. Emergency laparotomy allows suture of wound and ensures recovery.

Adult↗
PubMed1987

Radiologic anatomy of the anastomotic systems of the internal iliac artery.

On the basis of 200 angiographic studies of atherosclerotic patients affected by aorto-iliac lesions, the authors have investigated the anastomotic collateral systems of the internal iliac artery. After defining the different anastomotic systems of the internal iliac artery, they attempt to assess the functional importance of each anastomotic system in relation to the level of aorto-iliac obstruction. The different anastomotic systems involved are studied in terms of the different types of obliteration of the main arterial axis, and clinical tolerance is assessed for each case. This study emphasizes the important role of the internal iliac artery in the compensatory circulation to the lower limbs, over and above its role as an artery supplying the pelvis. The authors consider that this justifies attaching great importance to revascularization of the internal iliac arteries during reconstructive aorto-femoral procedures.

Aorta, Abdominal↗
PubMed1987

[Are axillo-distal bypasses justified? Apropos of 70 cases over an 8-year period].

Seventy axillary/distal artery shunts were carried out in 67 patients between 1978 and 1985. Mean age of patients was 71.5 years; 34% had coronary disease, 39% respiratory insufficiency, 12% diabetes and 12% severe renal impairment. Indications for the operation were sepsis in Scarpa's triangle (5 cases) and to save a limb with major ischemic lesions (65 cases including 14 stage III, 28 stage IV and 23 acute ischemic lesions). One-stage operation was performed in 37 cases and a two-stage procedure in 33. In 80% of cases the distal artery was the upper popliteal (11 cases) or lower popliteal (45 cases) artery. In 14 cases the distal artery was either the fibular (6 cases) anterior tibial (4 cases) or posterior tibial (4 cases) artery. Allowing for the context, the results justify this "maximalist" attitude (16% operative mortality, 43 limbs saved at 6 months, 31 at 1 year, 19 at 2 years). Three factors are determinant for permeability of shunts: severity of initial clinical stage, level of distal anastomosis and type of material used.

Adult↗
PubMed1987

[Internal iliac arteriovenous fistulas following gynecologic surgery. Development of principles of treatment. Apropos of 2 cases].

Pelvic arterio-venous fistulae are rare. They can be congenital or acquired. If the latter they are nearly always iatrogenic following surgery for prolapsed intervertebral discs or following gynaecological or obstetrical surgery. Diagnosis is difficult because the symptoms and signs are not specific ore are deceptive. Clinical examination shows that this "tumour" is vascular in nature. Up till recently treatment was disappointing, consisting as it did of surgery which was often difficult and dangerous and possibly carrying a poor prognosis, and in most cases resulting in recurrences. Since intra-arterial embolisation techniques have been developed, either by themselves or before surgery, the results have been better. They cannot be carried out without a preliminary precise and complete arteriographic assessment.

Abortion, Induced↗
PubMed1986

Aneurysm of the inferior mesenteric artery associated with occlusion of the celiac axis and superior mesenteric artery.

The authors report a case of aneurysm of the inferior mesenteric artery encountered in a 38-year-old man, associated with occlusion of the celiac axis, the superior mesenteric artery and the inferior mesenteric artery distal to the aneurysm. All three arteries were revascularized. In spite of failure in the bypass of the superior mesenteric artery, the patient remained symptom free until his demise four years later, from a probable myocardial infarction. Only 11 cases of aneurysms of the inferior mesenteric artery have been reported in the literature. The causes, diagnosis and treatment of these uncommon lesions are discussed. When occlusion of the celiac axis is associated with that of the superior mesenteric artery, a complete mesenteric revascularization should be attempted whenever possible.

Adult↗
PubMed1986

[Must all ruptured aneurysms of the aorta be operated on?].

Surgery is the only means of saving the life of patients with ruptured aneurysm of aorta, but it is universally accepted that the chance of survival is very low in case of prolonged collapse in patients over 80 years. Definition of pre-operative factors of severity and analysis of their effect on postoperative mortality showed that neither advanced age nor collapse nor anuria on admission allowed exclusion of patients when evaluated singly. When associated, however, the mortality rate becomes very high, but in this case any result of less than 100% mortality implies progress and should incite operation. In contrast, when patients with aneurysms have been excluded on other grounds then the contraindication to surgery should be maintained in case of rupture.

Age Factors↗
PubMed1986

Pathologic features of surgically excised human umbilical vein grafts.

This article describes the pathologic changes in 31 human umbilical vein grafts excised from 23 patients after implantations ranging from 24 hours to 5 years. Gross morphologic examination, light microscopy, and scanning electron microscopy demonstrated that the umbilical vein grafts appeared to be fragile and easily delaminated. Bacteremic colonization on the luminal surface was present in the grafts removed because of infections but in two instances had extended into the wall. The presence of lipid on the surface and in the subintimal layer was observed in five grafts, three of which had been implanted for less than 1 month. We concluded that human umbilical vein grafts pathologically exhibit fragility, biodegradation, lipid accumulation, and bacterial colonization in infected cases, and these characteristics may adversely affect the durability and long-term success of the prosthesis.

Adult↗
PubMed1985

[A frequent malignant tumor of the soft tissues, malignant fibrohistiocytoma. Current interest: apropos of 2 cases disclosed by vascular complications].

Malignant fibrohistiocytoma represents one of the most common malignant tumors of soft tissues. Previously difficult to diagnose with precision, it can now be detected pathologically as a result of recent techniques for investigating cellular development. Treatment is by wide exeresis, prognosis remaining reserved and requiring prolonged postoperative surveillance.

Adult↗
PubMed1985

[Popliteal aneurysms. Our experience apropos of 119 cases].

The authors report their experience of 119 popliteal aneurysms diagnosed in 76 patients. They feel that the prevalence of such aneurysms is underestimated. In 56% of cases there were bilateral aneurysms and in 24% of cases there was an associated aortic aneurysm. In 68% of cases, the popliteal aneurysm presented with complications. Clinical examination of the popliteal fossa gave a diagnosis in 66% of cases. In 1/3 of cases, arteriography failed to provide direct visual evidence of the aneurysm. The arteriographic diagnosis was then that of a femoro-popliteal thrombosis, of stenosis or isolated popliteal thrombosis. In all these difficult cases, echotomography is essential to diagnosis. The authors feel that indications for surgery should be as wide as possible. They consider that there are three types of contraindications: an excessively precarious physical condition, absence of a distal vascular network, an asymptomatic thrombosed popliteal aneurysm.

Adult↗
PubMed1985

[Medical and surgical outcome of thigh amputation for arteritis].

Results of a minimum 4 year follow up of 87 cases of thigh amputation are discussed. Postoperative mortality was 40% and 40% of patients had survived after one year. Early mortality factors were age (mean 75 years) and the coronary lesion responsible for more than a half of postoperative deaths. Amputation stump complications were noted in 13% of cases, their onset being dependent on 3 factors: loss of femoral pulse, failure of vascular re-establishment and early amputation after this failure. The remaining limb required major amputation in 21% of cases before the end of the second year, the final major level of amputation being a factor of the lack of distal revascularization in 77% of patients.

Age Factors↗
PubMed1984

[Mechanical fatigue of an arterial prosthesis].

This case study reports the analysis of a knitted polyester arterial prosthesis that was implanted in an 18-year old patient for five years following a bicycle accident which injured the left external iliac artery. In spite of the prosthesis, the patient continued to participate in competitive cycling. The graft became dilated and stretched by tension from the hypertrophic psoas muscle, and because the patient presented with pain and claudication, a second surgical operation was performed. The central region of the prosthesis was badly kinked. A segment was resected and analyzed in terms of pathological, textile and chemical properties. The analysis showed a poorly healed graft that had suffered from mechanical and chemical degradation. The findings point to the wisdom of implanting woven rather than knitted grafts in young patients and also suggest that in this particular case, where mechanical deterioration was accompanied by chemical degradation, it would have been preferable to remove the whole prosthesis.

Adolescent↗