Biomedical subjects
Publications and source records attributed to P Patra.
A tuberculous pseudo-aneurysm of the thoracic descending aorta was found in a 57 year-old female with haemoptysis three months after successful chemotherapy for a miliary tuberculosis. After aortic angiography, the aneurysm was resected and the aorta was repaired with a Dacron prosthetic graft. The patient is doing well one year after the operation.
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Tuberculous aneurysm of the descending thoracic aorta is a rare entity. To our knowledge the present case is the sixth on record to have been successfully treated surgically. These aneurysms present the usual difficulties of surgical therapy of the thoracic aorta: spinal cord and renal circulatory protection and the choice between distant or in situ revascularization. This case is of particular interest for its evolution and its treatment: resection of the aneurysm without shunting and insertion of a graft in situ covered by a flap of omentum.
A 40 year old man presented fibromuscular hyperplasia of posterior tibial artery media, a rare lesion, and only exceptionally reported in the calves since a total of 3 cases were found in the literature.
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Twelve cases of mycotic aneurysm are reported. These rare lesions (2 to 3% of all aneurysms) may affect all arteries. Primary aneurysm is currently the most frequent type observed in France, with onset being related to a bacteremia or septicemia with development on an atheromatous lesion (8 of the 12 cases in this series). Manifestations are often misleading or diagnosis delayed in relation to the infectious process, apart from in rupture, which is the commonest cause of detection of aneurysm (half of the present series). Ideal surgical treatment is exclusion with extra-anatomic revascularization: but revascularization in situ has been reported by many authors (6 of the 12 cases in this series). Localization of aneurysm determines surgical procedure and also very variable mortality rate: 4 of the 12 patients in this series.
The amputation proposed by R. Gritti in 1857 involves a supracondylar operation with repair surgery to the patella, which is attached to the femur, allowing a long stump to be maintained. Principal criticisms were related to the apparatus used, until be availability of a prosthetic knee occupying minimal spaces and allowing alignment with the healthy knee. Weight bearing is terminal with a light prosthesis that locks in without difficulty. It can therefore be substituted for conventional lower third of thigh amputations in certain cases.
Two cases of obstructive calcification of the aorta treated by surgery are reported. The disease is extremely rare, notably in the aortic segments involved in these two cases. Its clinical features were similar to those of coarctation. Intraluminal proliferative calcifications were present in the descending thoracic aorta of the first patient who underwent aortic resection with Dacron replacement prosthesis and in the suprarenal segment of the abdominal aorta of the second patient for whom an extra-anatomical bypass between the ascending aorta and the upper abdominal aorta was performed. The first patients remains with moderate arterial hypertension after 4 years; arterial pressure returned to normal in the second patient and is still normal after 15 months.
This study of 41 cases of young patients with obliterative arterial disease treated surgically, with follow-up for 6 and a half years, used the standard classification. Collection of the patients from a department of treatment falsified their true distribution. Atheroma was present in 90% of cases. Sixty eight per cent of patients were initially at stage II and 44% had a good long term result, essentially following the insertion of an aorto-bifemoral bypass. The mortality was 12%. The choice of surgical technique and ideal timing remain difficult to define. It would seem necessary to delay the date of the first operation for as long as possible, stressing the gravity of the first decision to operate.
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The authors have observed one case of injury to the axillary artery complicating anterior dislocation of the shoulder. It produced a marked haematoma of the axilla and ischaemia of the upper limb. At operation, avulsion of a posterior branch was associated with thrombosis of the trunk of the axillary artery. The result was good after saphenous vein grafting. This complication is very rare. Similar complications could arise from an excessively forceful reduction.
This study reports incidence of thromboembolic episodes in a series of 349 patients where the St. Jude Medical (SJM) valve was implanted in the mitral position (252 isolated mitral, 91 mitral and aortic, 4 triple valve and 2 mitral and tricuspid valve replacements). The mean follow up was 28 months (range 6 to 57 months) which represents 784 patient-years. Overall operative mortality was 15 patients (4.3%). There were no valve-related deaths. Late post-operative prosthetic thrombosis occurred in 3 poorly anticoagulated patients (0.4% patient-years). A further 4 patients had a thromboembolic episode (0.5% patient-years). The overall frequency of thromboembolic episodes was 0.9 events per 100 patient-years. Per- and post-operative anticoagulation methods are described. The frequency of thromboembolism was studied with respect to the performance of SJM valve analyzed by echocardiography regardless the positioning of the prosthesis in the mitral ring. Our experience indicates that the SJM valve offers an excellent alternative in the choice of mechanical valve.
In 1956, LIEBOW and HUBBEL defined pulmonary fibrosing haemangioma as a marked vascular proliferation with a marked tendency to fibrosis, papillary vegetations, extensive histiocytic infiltration and haemorrhages at various stages of organisation. More than 70 cases have been reported since. This lesion occurs most often in the middle aged woman. It is usually asymptomatic or may present as haemoptysis. Radiologically, it takes the form of a well-limited round homogeneous opacity and the prognosis is excellent after excision. The case reported here fell fully within this context and had the special feature of intrascissural tumour development resulting in an unusual radiological appearance which initially suggested a diagnosis of encysted pleural effusion. However the solid nature of the opacity being confirmed by CT scan, it was excised surgically. Its nature was revealed by histological examination. A detailed review of the literature is undertaken and changes in the histopathological concept of this type of lesion discussed. Previously classified amongst inflammatory pseudo-tumours, it is now considered to be a tumour proliferation which, on the basis of current data from electron microscopy and histochemistry, is felt by some to be of vascular origin but by the majority to be of epithelial origin, apparently developing from immature type II pneumocytes. The name "benign fibrosing pneumocytoma" suggested by CHAN would seem now more appropriate.
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