Biomedical subjects

R Rettori

Publications and source records attributed to R Rettori.

At least 19 recordsLinked to original sources

PubMed1992

[Electric stimulation of the spinal cord in arterial diseases of the legs. A multicenter study of 244 patients].

From January 1985 through January 1990, 244 patients (168 males, 76 females, mean age: 69 +/- 14 years) received epidural spinal cord stimulation for the treatment of advanced, nonreconstructable, peripheral vascular disease of the lower limbs due to atherosclerosis in 180 patients, atherosclerosis and/or diabetes in 49, and thromboangiitis obliterans in 15 patients: previous surgery included 101 bypass-grafts in 70 patients, 51% of which below the knee, and 117 sympathectomies in 113 patients as the last resource in face of distal peripheral vascular disease of the lower limbs. Mean ankle-to brachial systolic pressure ratio was .31 +/- .34 on symptomatic limbs; due to pain and advanced disease, walking capacity was assessed in only 151 patients, either on treadmill in 25, or in a metered corridor in 126; angiogram of the lower limbs was performed in every patient unless one not older than three months was readily available; pain at rest was assessed after an analogical scale; partial transcutaneous oxygen tension was measured on the dorsum of the fore-foot of 77 symptomatic limbs (mean: 13.35 +/- 14 mmHg). According to clinical and functional evaluation, 18 patients had exertional ischemia (group I), 87 had permanent ischemia with pain at rest and no tissue loss (group II), and 139 had chronic tissue loss (group III), including 93 ischemic ulcers (mean surface: 3.7 cm2, mean duration: 3.5 months) in 88 patients, 27 limited gangrene, and 24 previous limited non-healing distal amputation. After temporary spinal cord stimulation at T12-L1 level (mean duration: 9 +/- 4 days) with a percutaneous quadripolar electrode lead had allowed for selection of responders, 212 patients received an implantable neurostimulator.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1990

[Popliteal vein entrapment, popliteal cyst, desmoid tumor and fabella syndrome].

The popliteal fossa is a relatively small, muscle-bound strategic anatomical area where is found, on the posterior aspect of the knee, a vasculonervous pedicle and where both vascular and pseudovascular disease may develop, the latter originating from wall-constituting parts. Among non-typical popliteal diseases, the authors have singled out four rare syndromes. The popliteal vein may be trapped due to fibrous strangulation or, more often, to compression by the hypertrophied gastrocnemius muscle. This requires proper diagnosis and surgical management prior to thrombosis onset. Synovial cysts raise no diagnostic problems, unless they mimic an episode of phlebitis; echotomography has now become essential for diagnosis. Desmoid tumors for which predominant extra-abdominal occurrence sites are the popliteal fossa, the leg and thigh, are difficult to excise completely, especially at the popliteal level, and are a major technical challenge because of the inclusion of the vasculonervous pedicle. Lastly, in sports pathology, one must be able to recognize the painful fabella syndrome (osteochondritis of sesamoid fibrocartilage in lateral head of gastrocnemius), so as not to mistakenly implicate vascular disease. New developments in imaging (namely, real time CT-echography) are of major help to clinicists, who should, nonetheless, remain chiefly responsible for detecting these diseases.

Arterial Occlusive Diseases↗

PubMed1989

[Clinical and paraclinical identification by various imaging technics of congenital anomalies of the inferior vena cava (apropos of 4 cases)].

Four cases of anomalies of the inferior vena cava (IVC) were studied by two noninvasive imaging techniques: real-time ultrasonography and computed tomography. These techniques were used alone in 1 case of left IVC to determine the diagnosis. The other 3 cases were studied initially by phlebography: left IVC with iliac phlebitis; double IVC, also with iliac phlebitis, and a special case in which it was not clear whether the diagnosis was agenesis of the IVC or postnatal caval thrombosis. The two patients with recent iliac vein thrombosis were treated by heparin, but the other two received no particular therapy. Concerning these 4 cases, the authors speak of the known complexity of embryogenesis of the IVC which accounts for the great diversity in its anomalies. Left and double IVC are among the most frequent anomalies along with periaortic venous rings and the ureter behind the IVC. These anomalies are most often asymptomatic, but an understanding of them is essential for correct interpretation of the results of different imaging techniques and for effective performance of surgical and medical acts concerning the IVC directly or indirectly. For diagnosis of IVC anomalies, iliac venacavography, when not performed initially, can in certain cases be replaced by routine noninvasive imaging techniques, to which may now be added magnetic resonance imaging.

Adult↗

PubMed1989

[Procedure to follow with a resistant venous ulcer of the ankle].

In this study the authors present details of the clinical and paraclinical examination, in particular, examination of vascular function, which enable identification of the reasons why a venous ulcer on the lower leg fails to heal or recurs despite the usual treatment. Two important possibilities are stressed: 1. Progressive aggravation of the causal venous insufficiency, in which incompetence of calf perforators plays a fundamental role in both varicose veins and phlebitis. 2. Combination of venous insufficiency with a loco-regional or general factor, which contributes to trophic tissue deterioration. It is, thus, at a loco-regional level that ankle stiffness, major sub-ulcer sclerosis with possibility of formation of calcified plaques, lymphatic stasis and exceptionally malignant degeneration should be systematically investigated. It is necessary to act effectively on the various associated factors in order that treatment of the venous insufficiency responsible for the ulcer may succeed in spontaneous healing or allow successful grafting. However, the most important occurrence in the event of resistant ulceration is due to a combination, in patients over 60 years, of arterial insufficiency and venous insufficiency of variable duration. This is the context of mixed ulceration, in which treatment of both etiological factors must be modulated as a function of good identification of concomitant venous and arterial lesions.

Ankle↗

PubMed1989

[Complications of postoperative systematic preventive anticoagulant treatment].

In a series of 887 cases who underwent visceral, orthopedic or vascular surgery and who received systematic post-operative prophylactic anticoagulant treatment (calciparine S.C. or in 4.8% of cases low dose heparin IV), the author reports 31 accidents (3.5%). These included 9 thromboembolic disorders with 2 deaths (0.45%) due to pulmonary embolism, 19 hemorrhagic episodes (2.14%) with 2 deaths, and 3 cases of intolerance to heparin (0.34%): 2 cases of uncomplicated thrombocytopenia and 1 case of white clot successfully treated surgically. In spite of the good results obtained as far as prevention of thromboembolic disease is concerned, this study confirms the significant frequency and severity of iatrogenic accidents. These may be reduced partly by greater care in the prescription and execution of this treatment, but it is impossible to completely avoid them; it is therefore desirable in certain cases to avoid systematic prophylactic treatment by using other first line methods such as early mobilisation, elastic contention, hemodilution or indeed in certain cases the insertion of a vena cava filter. Moreover, in 11 out of 19 patients who presented a hemorrhagic complication of heparin therapy, the insertion of such a filter was judged indispensable in order to avoid possible pulmonary embolism favored by stoppage of anticoagulant treatment.

Aged↗

PubMed1989