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Biomedical subjects

M Fitoussi

Publications and source records attributed to M Fitoussi.

9 recordsLinked to original sources
PubMed1996

Abolition of sympathetic skin responses following endoscopic thoracic sympathectomy.

The recording of sympathetic skin responses (SSRs) is a simple, electrophysiological method to assess sympathetic nerve function. Within the last 10 years, SSRs have mainly been applied to delineate peripheral and central nervous system diseases, although the sympathetic nature of these responses was not fully documented, e.g., by a study of sympathectomy. We therefore recorded SSRs before and after 30 cases of endoscopic thoracic sympathectomy. The main indication was palmar hyperhidrosis, in which we found two types of SSR abnormalities. Most patients exhibited normal SSR waveforms but with increased amplitudes. The other patients exhibited abnormal SSRs which did not occur as single responses but as several consecutive waves. Thoracic sympathectomy always led to significant clinical improvement and to the abolition of ipsilateral palmar SSRs, demonstrating the sympathetic origin of these responses. We suggest that the assessment of sympathetic nerve activity by SSR recordings may be useful in sympathectomy.

Adolescent↗
PubMed1994

Abdominal aortic aneurysmectomy in a renal transplant patient: protection of the kidney without adjunctive measures.

Abdominal aneurysmectomy in kidney transplant recipients can be successfully performed without adjunctive protective measures if the period of renal ischaemia is short. A technique that attains this goal is described here. An aortic aneurysm (5 cm) was removed 2 years after kidney transplantation to the left external iliac vessel. The right common iliac artery was divided first and anastomosed to the right branch of the bifurcated graft. Aortic anastomosis was then performed; the period of renal ischaemia was only 20 min. Arterial flow was re-established in the right common iliac artery, providing profuse collateral flow to the transplanted kidney through the internal iliac arteries during the time necessary to complete the left common iliac artery anastomosis. This procedure is feasible unless the internal iliac artery is severely stenosed, occluded or terminally anastomosed to the transplanted renal artery. In all other cases, this technique may be the optimal procedure to protect the kidney during elective abdominal aorta aneurysmectomy in renal transplant recipients by reducing the period of ischaemia to that of one anastomosis only.

Aortic Aneurysm, Abdominal↗
PubMed1992

[Surgery of aneurysms of the abdominal aorta in 1992. Lessons of a decade].

Perioperative mortality of abdominal aortic aneurysm (AAA) remains at a mean of 3% in asymptomatic cases, 6% when symptomatic and 50% when ruptured while many patients with ruptured AAA die prior to surgery. This has changed little over the last decade. The causes of this stagnation are analyzed, strategic choices as a function of clinical situations, size of aneurysm, and associated lesions exposed, and means explored to improve the prognosis. Since the perioperative mortality rate appears incompressible, an improvement in the prognosis of AAA can be obtained only by a combined medical effort. This requires the more rapid recognition of prodromal symptoms of rupture, the detection of a larger number of asymptomatic AAA and improved postoperative life expectancy, already reasonable, by more rigorous vascular and cardiologic surveillance.

Aortic Aneurysm, Abdominal↗
PubMed1992

[Is it possible to cure various disorders of stability or vertigo by surgical correction of tight stenosis of a supra-aortic artery?].

While the efficacy of vertebral arteries revascularisation on the symptoms of vertebrobasilar insufficiency (VBI = IVB in text) is well established, the effect of correction of stenosis of vessels other than the vertebral arteries on stability disorders and vertigo do not appear to have been studied to any extent. Furthermore, vertigo is not considered as specific to VBI. A retrospective study was therefore carried out to determine the outcome in 33 patients with static disorders or vertigo operated upon for a severe stenosis of a brachiocephalic trunk, a carotid artery or a subclavian artery, with or without associated stenosis of a vertebral artery which in all cases had been neglected. Two patients (6%) died during the early stages of this series. Mean duration of follow up was a little longer than 5 years. One month post-operation 61% of the survivors were asymptomatic, all the others reported marked improvement in their symptoms and all had resumed their social life. At a later stage two patients had a clinical relapse associated with new arterial stenosis. Findings in this small series suggest that it is possible to cure or improve patients with stability disorders or vertigo by the surgical correction of a severe stenosis of a supra-aortic artery other than a vertebral artery.

Adult↗
PubMed1992

[Aorto-bifemoral bypass. Evaluation of Milliknit prosthesis].

Since there is no consensus as to the choice of an optimal prosthesis for aortobifemoral bypass, we have retrospectively evaluated the outcome with 162 Milliknit prostheses laid in cases of obliterating atherosclerosis. Such prostheses were preferentially used when the distal anastomosis were to be located on the deep femoral arteries. Intraoperatively, we noted the absence of fraying and the easy manipulation, owing to the flexibility and thinness of the wall, which are similar to those of the deep femoral artery: however, the blood loss before achieving complete tightness was greater than with most other knitted prostheses, and in 7.4% of the operated patients, defribination on clamp removal caused an additional bleeding averaging 1 litre. There was no graft sepsis during the postoperative period, may be because of the excellent healing of this prosthesis. One prosthesis only presented with excess dilatation accounting for thrombosis. The average length of follow-up was 3.6 years, the primary actuarial patency at 1, 5 and 10 years respectively was 98.7, 93.9 and 92.8%. Secondary patency at the same times was 99, 97.5 and 95.9%. These patency rates are among the best published in the literature. As a conclusion, this prosthesis is perfectly appropriate when the shunts must be located on thin femoral arteries, but a reduction of the intraoperative blood loss through an impregnation process would be desirable.

Actuarial Analysis↗
PubMed1987

Detection of diastolic mitral regurgitation using pulsed Doppler and its implications.

Diastolic mitral regurgitation has been angiographically demonstrated in some patients with severe aortic regurgitation and/or nonobstructive cardiomyopathy. The purpose of this paper was two-fold: to study the feasibility of pulsed Doppler noninvasive detection of this unusually timed regurgitation on the basis of angiographic correlations in a group of 21 patients with such conditions and sinus rhythm with normal PR interval in 81% of the cases, and when diastolic mitral regurgitation was present, to study if it had clinical implications. Doppler detection was feasible in all cases and there were no false positive diagnoses. Comparison of haemodynamic data in patients without (group A) and with (group B) diastolic mitral regurgitation showed a significant increase in the mean values of pressures, particularly for the mean pulmonary artery and capillary wedge pressures (P less than 0.01 to 0.001), in group B. This study suggests that the recording of mitral flow velocity should be routinely performed in patients with such pathological conditions, since the finding of diastolic mitral regurgitation may have clinical significance.

Angiocardiography↗
PubMedDate not supplied

Atherosclerotic disease of the innominate artery: current management and results.

Arterial repair through a sternotomy has long been considered the procedure of choice for innominate artery atherosclerotic disease. Of 22 patients presenting with 21 occlusive lesions and one aneurysm, 17 patients underwent a bypass procedure, and two, an endarterectomy through a sternotomy, whereas three patients underwent cervical procedures. Their postoperative course was uneventful. Early and late results were satisfactory. We conclude that in patients with innominate artery atherosclerotic disease, the procedure employed depends on both the type of lesion and the clinical status of the patient. In most cases, a bypass graft via a sternotomy is the best option, since endarterectomy is not always possible and risks an aortic tear or dissection. In selected cases, balloon angioplasty performed either percutaneously, combined with cerebral protection by an occlusive balloon in the carotid artery or through a carotid arteriotomy in order to flush out embolic material may be sufficient. A by-pass graft from the right to the left common carotid artery is the best procedure in patients with neurological symptoms when angioplasty seems inappropriate, and when sternotomy is contraindicated for either reasons of poor health or a prior mediastinal operation.

Adult↗
PubMedDate not supplied

[All venous obstructions is not necessarily due to phlebitis. Case report of an ilio-femoral venous leiomyosarcoma].

Venous leiomyosarcoma are rare malignant tumours that are usually revealed by an oedema of the lower limb, a sign of deep phlebitis. As the development is not linked with radiotherapy and chemotherapy, the prognosis depends mainly on a early diagnosis, which brings the best opportunities of complete surgical exeresis before the apparition of metastasis. The case reported below as well as ten other cases taken in the literature show the necessity to mention this diagnosis when confronted to any phlebitis appeared in the absence of usual precipitating factors. It is all the more necessary when mass is found by palpation, a small tumour is revealed by echography or when phlebography shows a lateral or circumferencial stricture that is different from usual pictures of phlebitis.

Diagnosis, Differential↗