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Biomedical subjects

R Vanmaele

Publications and source records attributed to R Vanmaele.

At least 19 recordsLinked to original sources
PubMed1997

Possible mechanisms of collar-induced intimal thickening.

The positioning of a soft silicone collar around the rabbit carotid artery induces intimal thickening. We investigated to which extent occlusion of the vasa vasorum, damage of the perivascular nerve network, and/or changes in blood flow velocity contribute to intimal thickening. To this end, collars with different bores (diameter of inlet and outlet) were positioned around the carotid artery of male rabbits for 14 days. In another experiment, 75% of the wall of fitting collars was removed (open collar). In the midcollar region, the cross-sectional area of the intima reached a maximum (72 +/- 14 mm2/1000) when the endings of the collar fitted the artery closely. Removal of the side wall of these fitting collars reduced intimal thickening by 90%. Examination of unoperated carotid arteries never showed penetration of the adventitia or the media by vasa vasorum. The perivascular neuronal network in the region surrounded by a closed or an open collar was almost completely lost as compared with the zones outside the collar. Both the closed and open collar slightly bent the artery and increased the peak systolic velocity, measured with pulsed color Doppler after 6 hours, to a similar extent as compared with the proximal zone outside the collar. After 2 weeks, the peak systolic velocity within both the closed and open collar was partly normalized and was statistically not different from the proximal zone outside the collar. In conclusion, the geometry of the collar influenced the extent of intimal thickening, whereby more intimal thickening was obtained with a collar whose endings fit the carotid artery, rather than with a loose collar. Moreover, a closed structure was essential. The results obtained with the open collar exclude occlusion of vasa vasorum, damage of the perivascular neuronal network, kinking of the artery, and changes in blood flow velocity as major factors in the collar-induced intimal thickening. Our findings are consistent with the possibility that intimal thickening is the consequence of the combination of both vascular injury and hindrance of transmural flow by the collar. The obstruction of transmural fluid transport may then lead to retention of toxic metabolites, and/or cytokines within the segment enclosed by the collar.

Animals↗
PubMed1996

Oesophagopleural fistula--a rare sequel of pneumonectomy.

Postpneumonectomy oesophagopleural fistula (OPF) is a devastating situation occurring in 0.2-1.0% of the patients undergoing pneumonectomy. Distinction is made between OPF appearing after pneumonectomy for chronic inflammation and suppuration, and OPF after pneumonectomy for lung cancer. Early and late fistulas (the former appearing within three months of the operation) are found in both groups. We report a case of OPF occurring almost five years after pneumonectomy for malignant lymphoma of the lung. Common signs of OPF are postpneumonectomy empyema and presence of previously ingested food particles in the empyema cavity. Treatment is extremely difficult and prolonged, and often not successful. Amelioration of the nutritional status, drainage of the postpneumonectomy space and closure of the fistula by injecting a sclerosing substance should be attempted. If this fails, the fistula should be closed by direct suture reinforced by a muscular or omental flap.

Aged↗
PubMed1996

Role of thoracoscopy (VATS) in pleural and pulmonary pathology.

Although thoracoscopy is not a new procedure, there was a real revival after the introduction of laparoscopy. VATS (video-assisted thoracic surgery) has potential advantages of reduced pain due to smaller incisions and a shorter hospital stay. Main disadvantages are expensive equipment and a probably less adequate operation, especially for therapy of malignant disorders where long-term results are not known. VATS is very useful for investigation of pleural effusion and malignancy. Spontaneous pneumothorax is a very good indication for thoracoscopic treatment, as well as lung biopsy and diagnostic resection of lung metastases. Therapeutic metastasectomy, however, should not be performed by VATS. Regarding bronchogenic carcinoma, VATS is indicated for staging of lung cancer, facilitating sampling of mediastinal and hilar lymph nodes, investigation of pleural effusion, possible pleural dissemination and suspicion of intrapulmonary metastases. Wedge excision of solitary pulmonary nodules by VATS readily reveals the exact diagnosis, but its role in therapy of lung cancer is very limited at the present time.

Biopsy↗
PubMed1994

Nodular sclerosing Hodgkin's disease of the thymus gland.

An asymptomatic anterior mediastinal mass in a 22-year-old man proved to be nodular sclerosing Hodgkin's disease of the thymus gland. Complete excision was possible via a left posterolateral thoracotomy. Postoperative chemotherapy was given. Follow-up after 1 year showed no residual disease. Nodular sclerosing Hodgkin's disease is an uncommon tumor of the thymus gland and should be incorporated in the differential diagnosis of anterior mediastinal tumors. Multimodality treatment is advocated.

Adult↗
PubMed1994

Combined type B aortic dissection and fusiform abdominal aortic aneurysm. Case reports.

Two patients are described with a combined type B aortic dissection and a fusiform abdominal aortic aneurysm, the dissection not involving the aneurysm. In a seventy-year-old man a type B aortic dissection and a large abdominal aneurysm were found. An infrarenal aortic bifurcation graft was inserted. He died fifteen months later of cardiogenic shock. In a sixty-six-year-old man diagnosis of a primary aortoduodenal fistula was made together with a limited type B dissection. A straight aortic interposition graft was inserted. He died eleven months later of the complications of a secondary aortoduodenal fistula. Although combination of aortic dissection and abdominal aneurysm is a rare occurrence, conservative management of the aortic dissection and interposition graft for the abdominal aneurysm was successful as initial treatment in these 2 patients.

Aged↗
PubMed1993

[Endarterectomy by division of the internal carotid artery].

The literature reports superior results with patch angioplasty compared to direct suture for the restoration of the carotid artery after endarterectomy through a longitudinal arteriotomy. With the technique presented here access to the arterial lumen is gained through an oblique division of the internal carotid at its origin. After endarterectomy this vessel is reanastomosed to its origin on the common carotid. This oblique suture does not induce any stenosis. This technique is easily reproducible. In a prospective randomized study, comparing its results to saphenous vein angioplasty, no significant difference was found on mortality, morbidity and recurrent stenosis. With this technique, the saphenous vein can be preserved for other vascular reconstructions.

Carotid Artery, Internal↗
PubMed1991

Investigation of Shiga-like toxin binding to chemically synthesized oligosaccharide sequences.

Shiga-like toxin (SLT)-I and SLT-II/IIc bound to Synsorbs containing synthetic alpha Gal(1-4)beta Gal (P1 disaccharide), alpha Gal(1-4)beta GlcNAc (P1 trisaccharide), or alpha Gal(1-4)beta Gal(1-4)beta Glc (Pk trisaccharide) sequences but not to Synsorbs containing alpha Gal(1-3)beta Gal, alpha Gal(1-3)beta Gal(1-4)beta GlcNAc, or the hydrophobic oligosaccharide linkage arm. SLT-I had a preference for Synsorbs containing trisaccharides, whereas SLT-II/IIc binding was less selective. 125I-labeled SLT-I remained bound to Pk trisaccharide Synsorb in the presence of lactose, galactose, or EDTA but was partially released by acetic acid, guanidine HCl, or a 10% solution of SDS. Vero cells coincubated with Pk trisaccharide Synsorb and SLT I extract were protected from this toxin, whereas Pk trisaccharide Synsorb was much less efficient at neutralizing SLT-II/IIc activity in Vero cell coincubation experiments. The SLT-IIc component was not responsible for the inefficient neutralization. Results suggest that synthetic oligosaccharide sequences related to the P blood group antigens coupled to inert matrices could be useful for rapid diagnosis or possibly therapeutic intervention in enterohemorrhagic Escherichia coli infections.

Animals↗
PubMed1990

Closure of the internal carotid artery after endarterectomy: the advantages of patch angioplasty without its disadvantages.

We present an original technique which precludes narrowing of the internal carotid artery after simple closure of a longitudinal arteriotomy for endarterectomy. Derived from the technique used to treat excess length of the internal carotid artery, this procedure includes the following steps: (1) division of the internal carotid artery at its base; (2) slitting the carotid artery until reaching the distal part of the plaque; (3) endarterectomy of the internal carotid and common carotid-external carotid axis; and (4) reimplantation of the internal carotid into its ostium, enlarged to the new size of the divided carotid artery. It has been possible to use this technique in eight consecutive cases. Postoperative arteriograms and duplex scanning have shown that anatomic and functional results were excellent. Presently, this technique has our preference in the surgical treatment of atheromatous stenoses of the internal carotid artery.

Anastomosis, Surgical↗
PubMed1990

Pseudoaneurysm of the posterior tibial artery as an early complication after Fogarty catheter thrombectomy.

After angioplasty of the superficial femoral artery at Hunter's canal in a 65-year-old woman thrombosis developed and femoropopliteal bypass grafting was necessary. Four weeks later the graft occluded, successful thrombectomy was performed with a Fogarty catheter and the patient heparinised. Three days later a pseudoaneurysm developed on the posterior tibial artery which was excised and the artery which was longitudinally torn repaired with a vein graft giving good functional results. Complications after Fogarty balloon catheter thrombectomy are relatively rare but Pseudoaneurysms can occur after perforation or rupture of smaller vessels.

Aged↗
PubMedDate not supplied

Venous homografts in infra-inguinal procedures: an eight years experience.

Autogenous saphenous vein is still the first choice graft material for femoro-distal bypass whenever it is available, but the choice of an alternative is still a challenging problem. Between 1982 and 1989, 100 femoro-distal reconstructions were performed with saphenous vein segment homografts, harvested during varicose vein stripping, they were selected, prepared and stored at 4 degrees C. In 71 cases the distal anastomosis was below the knee. According to the actuarial life table analysis (Kaplan & Meyer) the cumulative graft patency rate after 6 months, 1, 3, 5 and 7 years was 79%, 63%, 46%, 45% and 42% respectively. Twelve cases of aneurysm formation or stenosis requiring reintervention occurred. The patency rate was not influenced by the site of the distal anastomosis, but the condition of the run-off vessels had a significant influence on the early occlusion rate. Varicose vein segments are a readily available source of graft material. The low cost, easy storage and handling of these grafts justify their use in limb salvage procedures.

Adult↗
PubMedDate not supplied

Deep venous thrombosis of the upper extremity: case reports and review of the literature.

The development of a thrombosis of the axillary-subclavian vein has long been an uncommon clinical entity. The more routinely use of central venous lines in modern patient management, however, has increased its incidence. Three cases of deep venous thrombosis of the upper extremity are reported. The different possible etiologic factors, the diagnostic tools, complications and different treatments--both conservative and non-conservative--are reviewed and discussed.

Adult↗
PubMedDate not supplied

Primary intrathoracic goitre.

A right paratracheal mass in a 56-year-old man was found to be a primary intrathoracic goitre. Pathological examination showed nodular hyperplasia with focal lymphocytic thyroiditis. Enlarged mediastinal thyroid tissue may result from extension of a cervical goitre into the chest and is then called secondary or may develop from ectopic thyroid tissue located in the mediastinum and is then called primary. In the latter case blood supply comes from local intrathoracic vessels and no connections with the cervical gland are observed. Differentiation can be made by ultrasonography, CT scanning or radioisotope scanning. Primary goitres are best operated on by way of a thoracotomy as troublesome mediastinal bleeding may occur which is difficult to control from a cervical collar incision.

Goiter, Substernal↗