Biomedical subjects

M Lacombe

Publications and source records attributed to M Lacombe.

At least 19 recordsLinked to original sources

PubMed2006

[Vascular complications of lumbar disk surgery].

Vascular complications of lumbar disc surgery are rare (about 0,04% of discectomies) but very severe. Great variations of the anatomical lesions and of their clinical aspects may be observed. These lesions are often unrecognised during the operation and they are sometimes identified several years after the injury. The treatment is mainly surgical but percutaneous endovascular treatment has been recently performed successfully in several patients.

Aneurysm, False↗

PubMed2005

[The history of intermittent claudication due to arterial disease].

The clinical description of intermittent claudication due to arterial occlusive disease was made by two French precursors: a veterinary surgeon, Jean-François Bouley, and a neurologist, Jean-Martin Charcot. The subsequent works clarified the aetiology, the investigations and the treatment of this trouble but did not add anything to the initial description.

Arterial Occlusive Diseases↗

PubMed2004

[Aneurism of the subclavian artery associated with Turner's syndrome].

UNLABELLED: Arterial aneurysms associated with Turner's syndrome are rare. CASE REPORT: We report a case of aneurysm of the left subclavian artery in a 16-year-old girl with Turner's syndrome. This patient was operated on: resection of the aneurysm, suture of the aortic arch and reimplantation of the subclavian artery in the left common carotid were performed. At 3-year follow-up, the evolution is favourable. COMMENTS: Cardiovascular anomalies are observed in 50% of subjects with Turner's syndrome. This justifies complementary cardiac investigations in these patients. Congenital malformations (bicuspid aortic valve, aortic coarctation, intracardiac communications, valvular lesions) or acquired anomalies (arterial hypertension, aortic dissection) are frequent. Only one similar case of subclavian artery aneurysm has been reported until now. The risk of rupture justifies the surgical treatment.

Adolescent↗

PubMed2004

[Arteriovenous fistula of the renal vessels due to septic embolism in a patient with bacterial endocarditis].

A 27 year-old woman developed acute pain of the right flank during the course of an infectious endocarditis. A septic arteriovenous fistula of the renal vessels of a solitary functioning kidney was demonstrated. The cardiac valvular lesions required a prosthetic aortic and mitral replacement valves. An attempt to occlude the fistula by embolization with several coils was unsuccessful and led to surgery: extracorporeal repair enabled complete closure of the fistula. During the long-term follow-up, the aortic prosthetic valve had to be changed. Renal function was satisfactory and remained stable over time. Renal arteriovenous fistula is an exceptional complication of bacterial endocarditis despite the frequency of septic emboli during the course of the disease.

Adult↗

PubMed2002

[Renal and aortic localizations in Takayasu's disease].

AIM OF THE STUDY: The aim of this work was to study the localizations of Takayasu's disease to the aorta and the renal arteries, the long-term results of their surgical treatment and the evolution of the disease with time. PATIENTS AND METHODS: From 1972 to 2000, 23 patients (16 females, 7 males) with aortic and/or renal lesions were operated on. Mean age was 19.5 +/- 12.4 years. Despite heavy medical treatment, all had severe and uncontrollable hypertension. Eighteen patients had associated lesions of the aorta and renal arteries, 5 had isolated lesions of the renal artery, 10 had lesions of mesenteric arteries, 6 had lesions of supra-aortic trunks. Percutaneous transluminal angioplasty of the renal artery (ies) was attempted in 4 cases and was unsuccessful in all. Due to bilateral lesions in 12 patients, the surgical treatment consisted of 3 nephrectomies and 32 artery repairs of which 23 were performed by conventional in situ surgery and 9 by extracorporeal repair. An aortic bypass was performed in 7 patients and revascularization of other visceral arteries in 3. The follow-up extends from 1 to 18 years (mean: 5). RESULTS: There was no mortality. Three postoperative thromboses of repairs occurred: 2 of renal artery and 1 of mesenteric artery. Immediate results on blood pressure control were as follows: complete cure in 18 patients (78%), improvement in 3 (13%) and failure in 2 (9%). During the follow-up, evolution of the disease was observed in 10 patients (43%): 4 repeat stenoses of renal arteries due to aggravation of aortic lesions requiring reoperation in 2 patients, 3 aggravation of aortic lesions requiring an aortic bypass in 1 patient, 1 coronary insufficiency requiring a coronary bypass at 8.5 years. During the long-term follow up, due to secondary anatomical deteriorations, the results of surgery on blood pressure control were as follow: complete cure in 14 patients (61%), improvement in 4 (17%), failure in 5 (22%). CONCLUSION: Surgical treatment of reno-aortic lesions in Takayasu's disease must be reserved to patients whose arterial hypertension is uncontrollable despite heavy medical treatment. Results are altered by the evolution of the disease either locally or in other territories and that may require several operations. Due to frequently occurring late degeneration of repairs, surgical therapy must be carefully decided and patients' follow-up must be prolonged.

Adolescent↗

PubMed2002

[Renal transplantation, a centenary epic].

The year 2002 marks the centenary of the first attempts of renal transplantations. The steps of this great human enterprise are reminded, from the first animal experiments at the dawn of the century, the attempts of renal grafts in humans with animal and then human kidneys, to the present era during which renal transplantation has become the treatment of choice of chronic end-stage renal insufficiency.

Animals↗

PubMed2001

Isolated spontaneous dissection of the renal artery.

PURPOSE: The aim of this study was to assess the results of surgical treatment in a series of patients who underwent operation for isolated spontaneous dissection of the renal artery. The feasibility of renal artery reconstruction is emphasized. METHODS: During a 21-year period (1978-1998), 22 patients (17 men, 5 women) with spontaneous dissection of the renal artery underwent operation. Their mean age was 41 +/- 8.4 years. All patients were admitted with uncontrollable arterial hypertension and underwent the usual investigations performed in subjects with hypertension. Because of bilateral lesions (3 patients), surgical treatment consisted of eight nephrectomies (6 total, 2 partial) and 17 arterial repairs (in 16 patients) carried out by conventional in situ surgery (6 cases) or by extracorporeal repair (11 cases). RESULTS: There were no postoperative deaths or morbidity in this series. Arterial hypertension was cured in 9 patients (41%), improved in 11 (50%), and unchanged in 2 (9%). Anatomic results of repairs were excellent in 13 patients (81%) and incomplete in three (19%). During long-term follow-up, one late thrombosis of a repaired polar artery and one spontaneous dissection of the contralateral renal artery occurred. In eight patients, late angiographies showed that the results of reconstructions remained stable with time. CONCLUSIONS: Surgical treatment of isolated spontaneous dissection of the renal artery is indicated in patients who have severe uncontrollable hypertension despite extensive medical treatment. Arterial repair is the ideal treatment. It is often possible even when complex lesions are present; in such cases ex vivo surgery affords great safety and ease of repair. Results concerning control of hypertension are satisfactory.

Adult↗

PubMed2001

High concentrations of fluoride and boron in drinking water wells in the Muenster region--results of a preliminary investigation.

In 1998, two cases of severe dental fluorosis in schoolchildren occurred in the Muenster region. These cases took place in one household, where fluoridated toothpaste, fluoridated salt, and fluoride tablets were consumed. Furthermore, the family used drinking water from its private well only. Analyses of the well water ordered by local health officials revealed very high amounts of fluoride, boron, and other electrolytes. This unusual combination of high amounts of fluoride and boron could also be found in the water of a great number of other private wells that are the only source for drinking water in this rural region of the Muensterland. Anthropogenic sources could be excluded. Because of this, the results of the water samples were collated to the specific geological situation in this area. In the Muenster region there are marl layers of the chalk era covered with quarternary sediments. The quarternary sediments are up to 10 to 20 metres thick and they usually conduct the groundwater. The marl contains high concentrations of fluoride and boron. In some places the groundwater has contact with these layers. To check the amount of fluoride and boron in the groundwater, indicator values were sought, which can give a hint of high contents of these trace elements. In this study the conductivity and acidity were identified as possible indicators of a high amount of fluoride and boron in the drinking water in this specific region. To work economically and efficiently, the drinking water should be checked for fluoride and boron on a regular basis only when these values are extraordinarily high. In the case of high concentrations, especially of fluoride, in the drinking water the persons concerned should be informed about their potential health risk, giving them the opportunity to optimise the total daily intake of fluoride.

Boron↗

PubMed2000

[Abdominal aortic aneurysm and autosomal dominant polycystic kidney disease].

AIM: The aim of this study was to report a series of patients with autosomal dominant polycystic kidney disease operated for abdominal aortic aneurysm. PATIENTS AND METHODS: From 1986 to 1999, seven patients with this pathologic association were operated for aneurysm by the same surgeon. All were males, 47 to 69 years old (mean: 57.7). All were hypertensive and heavy smokers. Four were treated by hemodialysis. In five patients, the aneurysm was an incidental discovery, while two patients presented signs of obstructive arterial disease of the lower limbs. Ultrasound was the routine screening investigation, completed by aortography in all patients and by computed tomography in 2 patients. Surgical treatment consisted of intrasaccular repair of the aneurysm with a straight aortic tube (n = 5), a bifurcated prosthesis from the aorta to both common iliac arteries (n = 1) and a bifurcated prosthesis from the aorta to both common femoral arteries (n = 1). RESULTS: There was no postoperative mortality or morbidity. Two late deaths (at 5 and 8 years) occurred from myocardial infarction. Only one patient subsequently received a kidney transplant. Repairs were verified by postoperative angiography: anatomical results were satisfactory in all patients. Only nine similar cases have been published in the literature, including two deaths from ruptured aneurysm. CONCLUSIONS: The clinical diagnosis of aortic aneurysm is difficult in patients with polycystic kidneys due to renal volume. Ultrasound scan of the aorta is recommended to screen these patients for aneurysm. The data of our series show that the main cause of aortic aneurysms is atheroma and that a pathogenic link between this lesion and polycystic kidney disease is questionable. Elective aortic repair is recommended in order to avoid rupture of the aneurysm.

Aged↗

PubMed1999

[Mycotic aneurysm after kidney transplantation].

PURPOSE: The study aim was to report six cases of mycotic aneurysms in renal transplant patients and to review the literature on this subject. PATIENTS AND METHODS: Six patients, aged from 13 to 59 years, who had undergone renal transplantation 4 months to 16 years earlier, developed a mycotic aneurysm after bacteremia. The diagnosis was based on morphological investigations (echotomography, arteriography, spiral computed tomography) and bacteriological studies (blood culture, culture of the aneurysmal wall and content). The aneurysm was located in five cases at the anastomosis of the renal artery with the iliac axis, and in one case on the popliteal artery and tibioperoneal trunk. All patients were treated surgically: five reconstructions were performed using two arterial iliac prostheses, three hypogastric artery autografts and one saphenous vein graft (combined with an iliac prosthesis); one repair was impossible because of profuse local suppuration, and endoaneurysmorraphy with multiple ligatures of the popliteal vessels was performed. Postoperative radiological control was performed in all cases of arterial repair. All patients received antibiotic therapy during three to six months after the operation. RESULTS: No postoperative mortality occurred. All kidney transplants were salvaged. Anatomical results of arterial reconstructions were satisfactory in all cases and remained so during the follow-up. CONCLUSIONS: Mycotic aneurysms after renal transplantation are rare since only six observations with a kidney transplant in place have been published in the literature with a single long-lasting kidney salvage. Surgical treatment is mandatory to prevent rupture. Survival of patients occurred exclusively in operated cases.

Adolescent↗

PubMed1999

[Surgical treatment of renal artery lesions in children].

PURPOSE: The aim of this retrospective study was to report the modalities and results of the surgical treatment of renal artery lesions in children. PATIENTS AND METHODS: The series included 78 patients (43 girls, 35 boys), 16 months to 18 years of age, operated on from between 1975 to 1998. Lesions were bilateral in 24 cases. Due to bilateral procedures and to secondary or late re-operations, the number of surgical procedures was 106 (91 repairs and 15 nephrectomies). The repairs were performed by extracorporeal surgery in 22 cases and by in situ surgery in 69 cases. Whenever an arterial substitute was necessary, an arterial autograft was preferred. RESULTS: Fibrodysplasia of the renal artery was the prevailing pathologic finding (63%). Associated lesions were observed in 64% of the patients: coarctation of the abdominal aorta (n = 20), stenoses, obstructions, or aneurysms of splanchnic arteries (n = 15), and pheochromocytoma (n = 2). There was no postoperative death in this series. Seven postoperative thromboses occurred (7.7%). In the long-term follow-up, three recurrent stenoses, two stenoses of the opposite artery, and one aneurysm of a venous autograft were repaired surgically. In two patients, a stenosis of the abdominal aorta worsened and required an aortic bypass at 3 and 12 years. A complete cure of arterial hypertension was observed in 87% of the patients. In young children, growth of the repairs appeared normal when age increased. CONCLUSIONS: Surgery still has a prominent role in the treatment of these lesions. The prognosis is favorable since atheroma, visceral or renal lesions are usually lacking.

Adolescent↗

PubMed1998

[Extracorporeal surgery of the renal artery].

PURPOSE: The aim of the study was to assess the short- and long-term results of ex situ renal artery repair in a homogeneous series of patients operated on for complex lesions of this artery. MATERIAL AND METHODS: Seventy-seven patients (38 males and 39 females) underwent 80 extracorporeal repairs of the renal artery. The operated lesions were: aneurysms of the artery and/or of its branches with or without associated dysplasia (30 cases), extensive fibrodysplasia extending to distal branches (31 cases), spontaneous dissection of the artery with extension to the branches (nine cases), reoperation on the renal artery (six cases), miscellaneous (four cases). In all cases, the kidney was exteriorized after transsection of its vessels and cooled by perfusion of cold Collin's solution. After repair, it was reimplanted in the lumbar (36 cases) or iliac fossa (44 cases). An arterial substitute was used in 59 cases. RESULT: No mortality was observed in this series. Five postoperative thromboses occurred leading to kidney loss (6.25%). Segmental thrombosis leading to partial atrophy of the kidney occurred in three cases (3.75%). During the long-term follow-up, one repeat stenosis and four fusiform dilations of venous autografts were observed. All other repairs were successful (89.3%). Results on blood pressure control were favourable in 88.7% of the cases. CONCLUSIONS: Ex situ repair must be reserved to lesions involving several branches of the artery whose repair requires prolonged circulatory arrest and lesions profoundly situated in the renal sinus whose repair is difficult by conventional in situ surgery.

Adolescent↗

PubMed1998

[Treatment of abdominal aortic aneurysms in chronic hemodialysis].

PURPOSE: The aims of the study were 1. To describe the special features of the surgical treatment of abdominal aortic aneurysms in hemodialysis patients and of the perioperative care and 2. To study the results of this treatment and the long-term survival of these patients. PATIENTS AND METHODS: A retrospective study of the author's series was undertaken. Thirty-three patients were operated on for abdominal aortic aneurysms. The 30 male and three female patients ranged in age from 39 to 78 years (mean: 55.3). Eighty percent of the patients were operated on during the first five years following the beginning of maintenance hemodialysis. Preoperative assessment of patients' condition was usual. All patients were operated on from six to 18 hours after a dialysis. The surgical repairs consisted of short prostheses, whenever possible, so as not to make subsequent renal transplantation more difficult. Hemodialysis was resumed on the day of surgery in a few patients or later, according to the level of kaliemia. RESULTS: Postoperative mortality was 9% and morbidity 18%. Secondary or late vascular operations were required in 10 patients (30%). Only eight patients (24%) underwent secondary renal transplantation. The long-term survival rate was 43% at five years and 11% at ten years. Late deaths were due to coronary artery disease or to worsening of arterial lesions in the lower limbs. CONCLUSIONS: The vascular risks are increased in dialysis patients and their arterial lesions are especially severe. The surgical treatment is not different from that performed in non dialysed patients. Mortality and morbidity are acceptable. The long-term prognosis is poor.

Adult↗

PubMed1997

Vascular rupture complicating transluminal angioplasty applied on a failed dialysis vascular access in a patient under chronic steroid therapy.

We report a case of venous rupture complicating percutaneous transluminal angioplasty (PTA) applied on a failed dialysis vascular access (VA) in a patient on chronic steroid therapy. This complication resulted in a rapidly growing hematoma which was successfully controlled by a prolonged reinflation of the balloon catheter at the angioplasty site. The absence of oversizing of the balloon catheter and the low inflation pressure at which the perforation occurred suggest a vessel fragility which was probably induced by a long-standing steroid therapy. In dialysis patients in whom steroid therapy does not represent an infrequent therapeutic modality, this potential risk of vascular rupture should be carefully weighted while treating VA stenoses with the use of PTA.

Angioplasty, Balloon↗

PubMed1997

[Stenoses of the abdominal aorta in young patients].

Twenty-five patients with stenosis of the abdominal aorta were observed during the last twenty years. The etiology was a congenital malformation in 20 patients (80%) and an inflammatory aortitis in five (20%). All patients had associated lesions of the renal artery(ies) and 10 had lesions of the digestive arteries, especially of the superior mesenteric artery. All patients had arterial hypertension but none complained of circulatory impairment in the lower limbs or in the digestive area. Aorto-aortic by-pass was performed in six patients. The lesions of the renal artery(ies) (37 kidneys at risk) were treated by nephrectomy in three cases and vascular repair in 34 cases. Four reconstructions of the superior mesenteric artery were carried out simultaneously. There was no postoperative mortality in the current series. After surgery, arterial hypertension was cured in 83.3% of the patients and improved in 12.5%; only one patient was unchanged. In three patients, deterioration of the repair of the renal artery led to repeat surgery. Aortic repair is to be performed in tight stenoses only (pressure gradient > 30 mmHg) and as near to the puberty age as possible.

Adolescent↗

PubMed1997

[Aortoiliac surgery in chronic hemodialysed patients].

Thirty eight patients on chronic hemodialysis were operated on for treatment of complicated aortoiliac atherosclerosis: 31 had aneurysms and 7 had stenotic or obstructive lesions. The 35 male and three female patients ranged in age from 39 to 78 years (mean: 55.3). The duration of hemodialysis treatment before the operation ranged from one month to 22 years but 80% of the patients were operated on during the first five years following the beginning of maintenance hemodialysis. The surgical repairs consisted of long aorta to femoral artery prosthesis in obstructive lesions and of short prostheses in cases of aneurysms so as not to make more difficult subsequent renal transplantation. All patients were operated on from 6 to 18 hours after a dialysis. Hemodialysis was resumed on the day of surgery in few patients or later according to the level of kalemia. Postoperative mortality rate was 10.5% and morbidity 13.5%. Only seven patients underwent secondary renal transplantation. The long-term survival rate was 43% at five years and 11% at ten years. Late deaths were due to coronary artery disease or to worsening of arterial lesions in the lower limbs.

Adult↗

PubMed1996

[Arteriopathies of the lower limbs and lesions of the renal arteries].

Thirty-two patients underwent simultaneous reconstruction of aortoiliac vessels and of renal artery(ies). Two groups of patients were defined: groupe I (N = 22), with lesions of the artery(ies) of their native kidney(s), had renal artery repair on one or both sides for a total of 29 repairs; groupe II (N = 10) had repair after previous renal homotransplantation. There was no postoperative mortality in the current series. Late deaths were due to myocardial infarcts in most cases. Blood pressure control was obtained in 76% of the patients but only 26% of complete cure of hypertension without medical treatment were observed, the remaining patients requiring the administration of antihypertensive drugs; 24% of the operated patients were unchanged as to their hypertensive state and required a heavy medical treatment. In patients with renal failure, improvement of renal function was observed only when the functional impairment was slight or moderate. In the particular case of aortoiliac surgery in renal transplant patients, no special measure was used to protect the kidney during the arterial clamping; the organ resumed its function immediately after its revascularization; chronic rejection led to hemodialysis in two patients after 1 and 2 years. Results obtained in this series show that surgical repair of aorta and renal artery(ies) may be undertaken with low operative risk. It appears to be a safe procedure and gives satisfactory results.

Adult↗

PubMed1995

[Hypoplasia of abdominal aorta, rare cause of hypertension in childhood].

BACKGROUND: The majority of children with secondary hypertension have a renal abnormality or renovascular lesions. Coarctation of the aorta is also a classical cause, rarely located to the abdominal aorta. CASE REPORTS: Two girls, 11 and 12 years-old, were suspected of having recent sustained hypertension. Pulsed-wave doppler ultrasonography and angiography showed abdominal aortic hypoplasia associated with renal artery stenosis, unilateral in one patient and bilateral in the other. Both patients became normotensive 10 and 18 months, respectively, after corrective vascular surgery. CONCLUSION: Examination of the abdominal part of the aorta is mandatory in all patients with hypertension.

Aorta, Abdominal↗