Biomedical subjects
Publications and source records attributed to R Repetto.
A country can cut down its forests, erode its soils, pollute its aquifers and hunt its wildlife and fisheries to extinction, but its measured income is not affected as these assets disappear. Impoverishment is taken for progress.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
We have presented both early and late results in 236 extremities revascularized by aortofemoral, axillofemoral, or femorofemoral bypass grafts for severe atherosclerotic disease. The superficial femoral artery was occluded in all patients and initial outflow was provided solely through the profunda femoris system. Five different categories have been defined based on the procedure utilized to insure patency of the proximal profunda system. Subsequent patency rates are determined for each category. In reviewing our total experience the profunda femoris system was adequate to maintain both graft patency and limb viability in 90.3 percent of extremities in the early postoperative period. This declined to 78.5 percent at 5 year follow-up. Femoropopliteal bypass was required in 16 patients within the first postoperative month to maintain graft patency or relieve persistent ischemia. It is suggested that the addition of femoropopliteal bypass may improve inmediate and long-term patency rates and offer greater assurance that ischemia will be relieved.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Fifteen pediatric patients (ages 5-17 years) with renovascular hypertension (RVH) are reported. The diagnosis was made by arteriogram in all patients as the intravenous pyelogram was not helpful in this group. Five patients had a coarctation of the abdominal aorta. Four of these had associated renal artery stenosis. Renal artery stenosis alone was present in 14 patients, unilateral in 8, and bilateral in 6. Three of the former had a contralateral hypoplastic kidney. A nephrectomy was performed in 2 patients, both of whom continue to be hypertensive. Renal revascularization was performed in 13 patients; one of these died of sepsis. Eight are normotensive, 2 are improved (normotensive with diuretics), and 2 remain hypertensive. The follow-up is from 1 to 15 years.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
We have measured blood flows in 155 limbs with chronic arterial occlusive disease after revascularization procedures. Blood flows were recorded during standard electromagnetic flowmeter techniques. Base line flows after maximal vasodilatation with papaverine were recorded. The most important measurement to determine immediate results was the percentage increase of the basal flow after intraarterial injection of 30 mg papaverine. In aorto-iliac revascularization we found a significant difference according to the outflow tract, whether the superficial femoral was patent or occluded. Grafts in which proximal anastomosis were at the aorta on the axillary artery yielded better flows than those from the opposite femoral artery. A vein graft of inadequate caliber may determine a pressure gradient higher than 10 mm. Hg. In these circumstances the the blood flow is lower. Blood flow measurements may aid in the selection of the adequate surgical procedure in cases of arterial lesions of doubtful significance.
Fibromuscular dysplasia of the internal carotid artery is the most frequent extracranial localization of the disease. It can produce TIA or cerebral infarct through formation of fibrinous thrombi or complete occlusion of the artery. Seven cases are presented with disease localized in the distal segment of the carotid artery, usually considered inaccessible through standard exposure. A surgical approach is described to treat these lesions by performing a mandible osteotomy. This allows a resection of the internal carotid and its replacement with autologous saphenous vein graft as performed in six cases. The distal anastomosis was performed 1 or 2 cm. below the base of the skull. One case could not be corrected due to disease extending into the skull. All patients were operated on for TIA and one had a cerebral infarct. Six patients had an uneventful recovery and no further neurological symptoms. One patient had a postoperative hemiplegia. Pathologic specimens were described as fibromuscular dysplasia in all cases. Three of them had also a dissecting aneurysm, two of these also showed a ruptured intima. Intraluminal dilatation is regarded as a potentially risky procedure; resection and replacement through a mandible osteotomy is recommended for very distal internal carotid lesions.