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Biomedical subjects

M Coggia

Publications and source records attributed to M Coggia.

32 records · Page 2Linked to original sources
PubMed1996

[Rupture to the skin of atheromatous aneurysm on a femoropopliteal venous bypass using an in situ vein].

Atheromatous aneurysmal degeneration of a venous bypass graft is a rare and late event after venous bypass grafting. We report the case of a 49-year-old man in whom a large aneurysm of a saphenous graft implanted 10 years earlier ruptured to the skin. Amputation was required. Graft degeneration can lead to complications which may be life or limb-threatening due to graft rupture, graft thrombosis or distal embolization. Close follow-up after arterial reconstruction using a vein graft is therefore highly warranted for early detection and correction of any abnormalities before onset of complications.

Anastomosis, Surgical↗
PubMed1996

Rifampicin loading of vascular grafts.

Antibiotic-bound arterial prostheses may contribute to the management of prosthetic infections. The in-vitro absorption and release of rifampicin was measured in four different polyester arterial prostheses, including unsealed VP 1200, gelatin-sealed Gelsoft, collagen-impregnated Hemashield and gelatin-sealed Unigraft. Gelsoft grafts bound more rifampicin than unsealed VP 1200. Rifampicin concentrations with the gelatin sealed to Gelsoft grafts reached a threshold when the rifampicin concentrations of the soaking solution were 10 mg/mL or more. Rifampicin adsorption plateaued after 15 min of soaking VP 1200, and peaked after 25 min of soaking Gelsoft. pH variations did not significantly influence antibiotic binding. Prosthesis-bound rifampicin concentrations decreased rapidly after soaking, but a significant portion of the antibiotic remained associated with the material after 7 days. Release was slower with Gelsoft than with VP 1200 during the first 3 h, but after 24 h, the amounts of rifampicin released were similar in the two materials. Other experiments were performed in dogs receiving sealed grafts as infrarenal aortic bypass after soaking the material in a 1 mg/mL solution of rifampicin in normal saline. After 3 days of implantation, the amount of rifampicin in explanted grafts was higher in Gelsoft and Hemashield than in Unigraft. This study confirms that rifampicin bonding to prosthetic material occurs and is enhanced by sealed collagen or gelatin.

Absorption↗
PubMed1996

Are routine preoperative chest radiographs useful in general surgery? A prospective, multicentre study in 3959 patients. Association des Chirurgiens de l'Assistance Publique pour les Evaluations médicales.

OBJECTIVE: To find out which patients about to undergo general or gastrointestinal operations could have the routine preoperative posteroanterior chest radiograph omitted. DESIGN: Prospective open multicentre study. SETTING: 8 Public hospitals, France. SUBJECTS: 3959 consecutive patients about to undergo operations for benign disease were divided into 4 groups depending on the number of risk factors for cardiopulmonary complications (coexisting bronchopulmonary or cardiac conditions, abnormal clinical cardiopulmonary findings): group 1 (n = 2092) had no risk factors, group 2 (n = 946) had 1, group 3 (n = 645) had 2, and group 4 (n = 276) had 3 risk factors or more. INTERVENTIONS: Routine posteroanterior chest radiographs. MAIN OUTCOME MEASURES: Whether the findings on the radiograph (read by the anaesthetist) led to modifications in the type of anaesthesia or operative technique, or both, and whether radiographs were helpful in the postoperative management. RESULTS: 912 (23%) of the radiographs showed some abnormality. Changes were made in anaesthetic or surgical policy in 22 (0.1%), 11 (0.3%), 8 (1%), and 4 (1%) of patients in groups 1-4, respectively. The preoperative films were of some help in the management of about half the patients who developed postoperative cardiopulmonary complications. CONCLUSIONS: Preoperative chest radiographs should be routine for patients about to undergo general and gastrointestinal operations with three or more risk factors, and done selectively for patients with one or two. Routine preoperative films are unnecessary for patients with no risk factors.

Anesthesia↗
PubMed1995

[Introducing an implantable central venous catheter via the right pudendal vein].

Implantable central venous catheters are routinely introduced in the subclavian or jugular veins. In some cases such as thrombosis or infection, this localization must be avoided. In these circumstances, the inferior vena cava is used. The catheter can be inserted into the inferior vena cava via the right genital vein. Surgery is performed under general or loco-regional anesthesia. The right genital vein is approached using a MacBurney incision. The retroperitoneum is entered and the right genital vein is cannulated. The catheter tip is placed at the limit between the inferior vena cava and the right atrium. The port is placed in a subcutaneous pocket in the lower part of the thorax. In cases where the right genital vein is too narrow to allow catheterization, it is easy to proceed through the same incision and puncture the inferior vena cava.

Catheterization, Central Venous↗
PubMed1995

Anastomosis over a stent for heavily calcified arteries.

In this report we describe the use of an indwelling stent for end-to-end anastomosis of an arterial prosthesis. Designed as an alternative to conventional suturing in patients with heavily calcified arteries harvested from human cadavers. After the prosthesis is introduced into the artery, an angioplasty balloon catheter is inflated to expand the Palmaz stent and press the prosthesis against the calcified wall of the popliteal artery. From January 1993 to February 1994 we used this technique for end-to-end anastomosis of a polytetrafluoroethylene graft on the popliteal artery in six patients with extensive circumferential calcification of the popliteal artery. In all patients surgery was indicated to avoid amputation and no other method was suitable (no available vein graft, poor runoff). Stent anastomosis was successful in all six patients with no postoperative complications. Intraoperative controls using arteriography and angioscopy and postoperative Doppler ultrasound studies were normal in all patients. During follow-up, graft occlusion occurred in two patients at 10 and 14 months, respectively. Three patients died after control studies at 2, 6, and 8 months had shown the grafts to be patent. No false aneurysms were detected by clinical examination or ultrasound imaging. Although our data do not allow assessment of long-term outcome, this study demonstrates the feasibility of stent anastomosis in patients with extensive, circumferential calcification of the popliteal artery.

Aged↗
PubMed1995

[Results of surgical treatment of lung metastases from colorectal cancers].

OBJECTIVE: The aim of this work was to determine the long term results and the prognostic factors after surgical resection of pulmonary metastases from colorectal cancers. METHODS: Clinical status after surgery and survival were studied in 101 consecutive patients undergoing lung resection for pulmonary metastases from colorectal carcinoma between 1970 and 1993. Prognostic factors were evaluated according to surgical design. Mean interval between colon resection and lung resection was 44 months. Fifty-nine patients had a solitary lesion, 17 had multiple unilateral lesions and 25 multiple bilateral lesions. Eighteen patients had undergone previous surgery for localized extrapulmonary metastases. A wedge resection was performed in 47 patients, lobectomy or bilobectomy in 40, pneumonectomy in 11 and biopsy in 3. RESULTS: There was no postoperative mortality and 5-year survival in complete resection was 21%; all patients with incomplete resection or biopsy died within 3 years. Significant prognostic factors were: complete resection, metachronous disease (vs synchronous metastases) and absence of lymph node involvement. The extent of the colorectal disease and the number of resected metastases did not influence prognosis. Survival for patients with resected extrapulmonary disease was not significantly different as compared with patients with only pulmonary metastases. Eleven patients had repeat pulmonary resections, 6 of these patients are currently alive, 3 of them more than 3 years after the second pulmonary resection. CONCLUSIONS: We conclude that resection of colorectal lung metastases is safe and effective, that resectable extrapulmonary disease does not contra-indicate pulmonary resection and that repeat thoracotomy is warranted in selected patients with recurrent lung metastases.

Adult↗
PubMed1994

Lateral approach to femoral bifurcation.

Femoral bifurcation can be approached through a lateral incision in the femoral triangle, passing behind the sartorius muscle and thus leaving undisturbed the femoral lymphatic network. The principal advantage of this route is it limits the local complications that occasionally result in infection of the operative site. This lateral approach is indicated primarily for infrainguinal revascularizations originating from the common femoral artery in patients at high risk for local infection. It should not, however, be used routinely because exposure of the vessels, particularly the medial aspect of the artery and the profundus vessels, is limited. The risks of this route are essentially related to the neural elements encountered during dissection.

Dermatologic Surgical Procedures↗
PubMed1994

Heparin-related thrombocytopenia and adrenal hemorrhagic necrosis following aortic surgery.

Adrenal hemorrhagic necrosis is one of several possible complications of heparin-related thrombocytopenia. We report a case in which adrenal hemorrhagic necrosis developed after aortofemoral bypass. This serious complication remains difficult to diagnose in the absence of a high index of suspicion. A routine search for this condition in the setting of heparin-related thrombocytopenia is essential since a favorable outcome is dependent on early diagnosis.

Adrenal Glands↗
PubMed1994

Treatment of vascular graft infection by in situ replacement with a rifampin-bonded gelatin-sealed Dacron graft.

PURPOSE: The purpose of this study was to treat an established prosthetic vascular graft infection by in situ replacement with a rifampin-bonded gelatin-sealed Dacron graft in an animal model. METHODS: The infrarenal aorta of 18 dogs was replaced with a gelatin-sealed graft contaminated in vitro by soaking it in a solution with Staphylococcus epidermidis. One week later, animals were randomized into three groups. In group I (control, (n = 6), the dogs did not undergo repeat operations. The dogs in groups II and III underwent repeat operation. In these animals the infected grafts were removed for bacteriologic analysis and replaced in situ with one of two types of grafts: group II (n = 6) received an untreated, gelatin-sealed graft; group III (n = 6) received a rifampin-bonded, gelatin-sealed graft. Antibiotic bonding was obtained by soaking grafts for 15 minutes in a 60 mg/ml saline solution of rifampin at 37 degrees C. All 18 dogs received no systemic adjunct antibiotic therapy. Control grafts and replacement grafts were removed 4 weeks after the initial implantation for bacteriologic analysis. When harvested, all the grafts were cut into two fragments, and quantitative bacterial cultures were obtained from all the fragments. Results were expressed as colony-forming units (CFU)/cm2 of graft material. RESULTS: All 18 initially implanted grafts and all the untreated replacement grafts were grossly infected at the time of removal, whereas all the rifampin-bonded replacement grafts had normal incorporation. None of the rifampin-bonded grafts grew bacteria, whereas all the initially implanted and all the untreated replacement grafts were infected (p < 0.01). Bacterial counts from the infected fragments were similar in control grafts (2.6 +/- 1.9 x 10(6) CFU/cm2), in initially implanted grafts of groups II (9 +/- 1.1 x 10(5) CFU/cm2) and III (1.3 +/- 1.5 x 10(6) CFU/cm2), and in untreated replacement grafts of group II (1.7 +/- 2.5 x 10(6) CFU/cm2). Blood culture results and culture results of liver, spleen, kidney, and lung specimens at the time of sacrifice were negative. CONCLUSION: This study demonstrates that rifampin-bonded gelatin-sealed Dacron grafts are resistant to infection when used for in situ replacement of an infected graft in the dog.

Animals↗
PubMed1992

The place for bilobectomy in bronchogenic carcinoma.

From 1978 to 1988, 148 bilobectomies (21 upper and middle and 127 lower and middle) were performed for bronchogenic carcinoma. A conservative procedure was mandatory in 29 patients in whom a pneumonectomy was not functionally feasible while bilobectomy was deliberately performed in 119 patients with near normal lung function. Overall mortality was 6% compared to 4% and 3%, respectively, following pneumonectomies and lobectomies. Preoperative functional status did not significantly influence mortality. The complication rate was 55%. The incidence of bronchopleural fistula electively observed after lower and middle lobe resection was significantly higher (11%) compared to 4% after pneumonectomy and 1.4% after lobectomy (P less than 0.01). The overall 5-year survival was 43% and was similar to that observed at comparable TNM stage after other pulmonary resections. Residual right pulmonary function demonstrated by perfusion isotopic scan was 24% +/- 10 in 21 long-term survivors. These results indicate that bilobectomy can reasonably be considered in patients requiring more than a lobectomy but in whom lung conservation is mandatory despite a significant increase in morbidity. The risk appears justifiable regarding late survival results and functional benefit of the remaining right lobe.

Aged↗
PubMed1992

[Is preoperative systematic chest x-ray useful in general surgery? A multicenter prospective study of 3959 patients. ACAPEM. Association des Chirurgiens de l'Assistance Publique pour les Evaluations Médicales].

In order to define which patients may not require a routine preoperative chest X-ray, a prospective multicenter study was carried out. It included 3,959 consecutive fifteen, or more, year-old patients, free from any cancer, scheduled for a general or gastrointestinal surgical procedure other than thoracotomy, and had a plain chest X-ray beforehand. This investigation was prescribed before surgery, either by the surgeon or the anaesthetist. Patients were classified according to selected risk factors: age, smoking, emergency surgery, a past history of lung, heart or vascular disease, abnormal clinical findings related to the cardiovascular and respiratory systems, and a previous chest film made less than one year before. There were 2,092 patients in Group I (no risk factors), 916 in group II (one risk factor), 645 in Group III (two risk factors), and 276 in group IV (three risk factors). Three endpoints were selected: a modification of operative schedule or anaesthetic technique, a change in surgical procedure, and the diagnosis of postoperative complications. A rate of 23.2% of preoperative chest films were considered to be abnormal. This rate increased with age and the number of risk factors: 6.2% in Group I and 72.5% in Group IV. Surgical and anaesthetic procedures were modified as a result of the chest X-ray in only 0.5% of patients: 0.1% in Group I, 0.3% in Group II, 1.2% in Group III and 1.4% in Group IV. When pulmonary or cardiac complications did occur after the surgery, the preoperative chest film was of no help for making this diagnosis in more than 50% of cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Totally laparoscopic tube graft bypass for infrarenal aortic aneurysm: a well-established surgical technique.

Abdominal aortic aneurysm (AAA) repair enters the field of laparoscopic surgery. Main advantage of laparoscopic AAA repair is to perform the gold standard endoaneurysmorraphy with a reduced surgical trauma. Since 2001, the technique has evolved and is now well-established. We describe the standard technique of totally laparoscopic endoaneurysmorraphy with tube graft interposition through a transperitoneal left retrorenal approach. Main technical points are discussed.

Aortic Aneurysm, Abdominal↗
PubMedDate not supplied

[Supracoeliac aortic clamping. Technique and indication in traumatic abdominal pathology].

Supracoeliac occlusion of the aorta was performed in two patients with visceral and vascular lesions due to blunt abdominal trauma. In both cases, aortic occlusion was required due to peroperative hypovolaemic shock. The first case was a 30-year-old man hospitalized for blunt thoracic and abdominal trauma. Haemodynamic parameters were unstable at admission with initial blood pressure at 85/45 mmHg. Physical examination indicated a haemoperitonium which was confirmed echographically. At laparotomy, among other injuries, the right supra-hepatologic vein and two posterior veins draining the segment VII were severed. Despite suture and haemostatic procedures, hypovolaemic shock occurred with systolic pressure at 40 mmHg. In the second case, haemoperitonium was also confirmed echographically in a 28-year-old man hospitalized for blunt frontal abdominal trauma. Blood pressure was 70/45 mmHg at admission and emergency laparotomy revealed major avulsion of the left lobe of the liver and lesions to the sub-renal vena cava and the left renal vein in addition to major injury to the pancreas and the stomach. While the supra-coeliac aorta was being prepared, persistent bleeding led to shock with a systolic pressure of 45 mmHg. In both cases, the supracoeliac artery was clamped, for 30 and 35 minutes respectively, making it possible to re-establish satisfactory haemodynamic conditions and allowing favourable outcome. These observations demonstrate that per-operative occlusion of the supracoeliac aorta performed as a salvage manoeuvre in cases of hypovolaemic shock can be an effective means of re-establishing a precarious haemodynamic situation. The technique is simple and rapid and few complications have been reported.

Abdominal Injuries↗