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Biomedical subjects

R Limet

Publications and source records attributed to R Limet.

At least 19 recordsLinked to original sources
PubMed2006

[Chronic intestinal angina and bypass revascularization: a case report].

Intestinal angina is a rare affection with a high morbidity-mortality rate if not diagnosed. It is characterized by abdominal pain and postprandial vomiting, weight loss and anorexia. Arteriography allows confirmation of the diagnosis. The following case is a typical example of its clinical presentation and surgical treatment. Different techniques of revascularisation in case of a stenosis of the main digestive arteries are discussed.

Arterial Occlusive Diseases↗
PubMed2006

[Surgical left ventricular remodelling via endoventriculoplasty: clinical observation].

A case of dilated ischemic cardiomyopathy, with severely impaired left ventricular systolic function, treated by endoventriculoplasty and CABG, is reported. The authors discuss the modern concepts regarding the surgical treatment of large anterior asynergic scars following occlusion of the LAD. Since there are more similarities between akinesia and dyskinesia than previously thought, the endoventriculoplasty of DOR may constitute a new way to surgically remodel the left ventricle in dilated cardiomyopathies with large anterior akinesia. This surgery significantly improves the ventricular function and the overall patients' prognosis at short and mid term follow up.

Cardiomyopathy, Dilated↗
PubMed2006

[Surgical treatment of chest wall tumors].

The observation of a primary chest wall desmoid tumor discovered incidentally in a young patient is an opportunity to review the nosology, diagnosis and treatment of this uncommon pathology. Surgical intervention should aim at resecting completely the lesion with sufficient margins. Subsequent reconstruction of the bony thorax uses synthetic materials and muscle or myocutaneous flaps.

Adult↗
PubMed2006

[Aortoaesophageal fistula caused by a thoracic aortic aneurysm].

Primary aorto-oesophageal fistula, secondary to an aneurysm of the thoracic aorta, are almost fatal. In the literature, only twenty six successfully operated cases have been reported. We report the case of a 78-year-old man with a thoracic aortic aneurysm eroded into the mid oesophagus. Prompt diagnosis of an aorto-oesophageal fistula resulted from clinical history, CT-imaging and oesophagoscopy. The patient was successfully operated by exclusion of the thoracic aneurysm (insertion of a straight cryopreserved arterial allograft), oesophagectomy and cervical oesophagostomy and jejunostomy. The continuity of the digestive tube was later restored after preliminary aortic valve remplacement (stenosis of 0.8 cm2). This case report is the second in which a cryopreserved allograft was successfully implanted in the management of a primary aorto-oesophageal fistula.

Aged↗
PubMed2006

[Carotid stenting revisited].

Recent publications about carotid-stenting are submitted to a critical analysis. The fact that an interventional approach in asymptomatic carotid lesions generates only marginal benefit being universally admitted, it is disturbing to see that modern series devoted to carotid artery stenting include a lot of asymptomatic patients and many symptomatic patients with a degree of stenosis well below the optimal range defined in NASCET (70 to 99%). Moreover, the degree of stenosis is often calculated from an inappropriate method that overestimates the degree of stenosis. Two objections have been made about an "hyper-sélection" of the patients enrolled in the NASCET study and the production of ideal not realistic results, not attainable in community hospitals; both objections have been overruled. The rate of acute perioperative myocardial infarction is mentioned, both in NASCET and ECST, it is around 0.9% vs 7.5% in SAPPHIRE study. Moreover, carotid artery stenting with an embolic protection device has resulted in the production of infra-clinical cerebral micro-infarcts in 40% of the patients. Significantly, the independent study EVA-3S, devoted to symptomatic patients had to be stopped because of the high cerebral morbidity in the dilatation-stenting group. Carotid artery stenting of asymptomatic lesions is futile (and potentially harmful because of microinfarcts) while carotid artery stenting of symptomatic lesions generate emboli.

Aged↗
PubMed2005

Primary sarcoma of an abdominal aortic aneurysm.

Primary tumors of the aorta are extremely rare and the diagnosis is made most often after surgery or autopsy. Because clinical symptoms of abdominal sarcoma are similar to those of occlusive or aneurysmal disease, aortic sarcomas are frequently mistaken for these lesions. The imaging findings are frequently nonspecific and therefore do not allow a definitive preoperative diagnosis. We report a case of an epithelioid angiosarcoma in the vessel wall of an abdominal aortic aneurysm.

Aortic Aneurysm, Abdominal↗
PubMed2005

[Clinical case of the month. Lower limb revascularization from descending thoracic aorta in occluded axillobifemoral bypass].

We report the case of a patient who had lower limb revascularization by a bypass graft originating from the decending thoracic aorta, after total thrombosis of an axillobifemoral bypass graft. The latter had been performed for surgical repair of a secondary aorto-enteric fistula. We successively discuss the three particular apects of this observation: the secondary aortodigestive fistula, the axillobifemoral bypass and the bypass between the descending thoracic aorta and the femoral arteries.

Anastomosis, Surgical↗
PubMed2005

Factors promoting rupture of abdominal aortic aneurysms.

The risk for rupture of an abdominal aortic aneurysm is widely believed to be related to its maximum diameter. Rupture occurs at the site of maximum wall stress, when it exceeds the tensile strength of the aortic wall. Basic research confirmed that peak wall stress and aortic wall biodegradation contribute to the mechanism of aneurysm rupture. In order to highlight the role of loss in wall strength and increase in focal peak stress, the authors reviewed recent literature. The clinical relevance of these recent insights in the etiopathogenesis of aneurysm rupture is analysed.

Aorta, Abdominal↗
PubMed2005

[Replacement of the descending aorta sparing the aortic valve: the David's operation].

We report the case of an ascending aortic aneurysm involving the aortic root, with a functionally competent bicuspid aortic valve, treated by the David's operation. This operation allows to fix the aortic root pathology, whilst preserving the native aortic valve. The technical aspects, surgical indications, and potential benefits of this operation are reviewed.

Adult↗
PubMed2005

[Acute limb ischemia: clinical, diagnostic and therapeutic aspects].

Acute lower limb ischemia, with sudden interruption of tissue perfusion, is a medico-surgical emergency. An early diagnosis is a prerequisite for optimal management. Diagnosis is mainly based on clinical data. Complementary investigations have a limited place, and should not unnecessarily delay the treatment. There are two categories of acute arterial, non-traumatic occlusion: embolism and thrombosis of an atherosclerotic vessel. The distinction between these two entities is not always evident, since ischemia can be the consequence of an arterial embolism in a diseased atherosclerotic artery. We discuss the clinical aspects and the causes of acute lower limb ischemia. The prognosis, outcome and therapeutic management are determined by the cause of the acute arterial obliteration.

Decision Trees↗
PubMed2005

[Analysis of pooled data from the randomized controlled trials of endarterectomy for symptomatic carotid stenosis].

It is important to establish clear definitions concerning carotid artery disease, a topic that recently regained widespread interest in medical literature. Therefore, we summarize a paper of Rothwell and Barnett, recently published in the Lancet 2003 (1). In their analysis, the data of three randomized trials, comparing carotid endarterectomy to optimal medical therapy alone for a symptomatic internal carotid artery stenosis, were pooled after standardization of the measurement of the degree of stenosis and redefinition of the outcome events, to achieve comparability of the results of each trial. This analysis concerns 6092 patients with 35,000 patient-years of follow-up. Surgery offers a marginal benefit for patients with a moderate (50-69%) symptomatic carotid artery stenosis (absolute risk reduction of 4.6% for subsequent ipsilateral stroke at 5 years). Surgery is highly beneficial for patients with a symptomatic 70-99% stenosis (absolute risk reduction of 16% for ipsilateral stroke at 5 years). The benefit is uncertain for a symptomatic "near occlusion" (99% with retarded opacification of the distal internal carotid artery): absolute risk reduction of -1.7% for ipsilateral stroke at 5 years).

Carotid Artery, Internal↗
PubMed2005

[Analysis of the results of the main randomized trials on carotid endarterectomy for asymptomatic internal carotid stenosis].

The authors analyse the ACAS (1997-93) and ACST (1993-2003) trials, comparing the best medical therapy vs endarterectomy of an asymptomatic 60 % or more stenosis of the internal carotid artery. The ACAS trial does not reveal any benefit of surgery in preventing major stroke during follow-up (stroke rate 3.4% vs 6.02% in medical group, N.S.). Only by considering minor and major strokes together, a beneficial effect of carotid endarterectomy could be evidenced (5.9% stroke reduction at 5 years: 5.1% ipsilateral stroke at 5 years after surgery vs 11% stroke at 5 years under medical treatment). Indeed, following surgery, the stroke risk (ipsilateral) at 5 years attained 5,1% vs 11% following medical treatment of an asymptomatic internal carotid artery stenosis of 60-99%. The ACST trial, set up in 1993, aimed to assess the long-term result of carotid endarterectomy for asymptomatic 60-99% stenosis. Patients randomized for immediate surgery had a slightly more favorable outcome than those allocated to medical treatment. Absolute risk reduction of major stroke at 5 years was 2.5%. Overall, the benefit of operating an asymptomatic carotid artery stenosis is rather low (1% less stroke per year and less than 0.5% major stroke reduction per year). This positive result is obtained only if the operative stroke-death rate remains extremely low (<2.8%). The indication for operating asymptomatic carotid stenosis must be cautiously taken; age of the patient, degree of stenosis and surgeon's experience and results are to be considered.

Aged↗