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Biomedical subjects

S Declemy

Publications and source records attributed to S Declemy.

33 records · Page 2Linked to original sources
PubMed1995

[[Aneurysm of the abdominal aorta and arteritis of the legs].

Twenty to forty percent of patients with aneurysms of the abdominal aorta also have obliterated arteries of the lower limbs. We analyzed retrospectively a series of 200 patients undergoing elective surgery for aneurysm of the abdominal aorta and compared the results with data in the literature. Obliteration of the lower limb arteries had little influence on the technique usually employed for surgery. Femoro-popliteal bypass was associated with cure of the aneurysm in only 2.5% of the cases. We also performed sympathectomy of the lumbar branches in 30% of the cases because of peripheral arterial lesions. The presence of obliterations did not significantly increase operative mortality. Inversely, post-operative peripheral arterial complications were more frequent in patients with an obliterated artery of the lower limb than in those free of distal disease. Long-term survival was not unfavourably affected by the presence of obliterated arteries, but such patients have a greater risk of arterial lesions of the lower limbs.

Aged↗
PubMed1994

Subadventitial rupture of the splanchnic arteries as the result of blunt abdominal trauma presenting with acute gastric dilatation.

Two patients are reported who presented with intestinal ischaemia caused by a subadventitial rupture of the origin of the coeliac trunk and superior and inferior mesenteric arteries after blunt trauma from deceleration injury. In both cases the initial clinical examination revealed a painful abdomen without any 'peritonism'. Abdominal ultrasonographic examination showed no abnormality. Plain abdominal radiography showed gastric dilatation in both patients. In the first, the diagnosis was made by laparatomy but only after 2 days. In the second, diagnosis was made by aortography performed because of the early appearance of gastric dilatation. Both patients died as a result of extensive associated injuries and delay in diagnosis.

Abdominal Injuries↗
PubMed1993

Thrombophlebitis of the ovarian vein with free-floating thrombus in the inferior vena cava.

Two cases of thrombophlebitis of the right ovarian vein, one occurring after cesarean section and the other after natural childbirth, are reported. The clinical diagnosis was based on the symptoms of postpartum fever in association with right flank pain and confirmed by abdominal CT scans. In both cases the thrombosis extended into the inferior vena cava and was associated with a free-floating thrombus extending up to the renal veins. Thrombectomy of the inferior vena cava and ligation of the right ovarian vein were performed with good results in both cases, as shown by late follow-up CT scans. This and alternative therapeutic strategies are discussed.

Adult↗
PubMed1993

[Atheromatous pseudo-occlusive stenosis of the internal carotid].

Pseudo-occlusion of the internal carotid artery is defined as an angiographically occluded but anatomically patent artery. Between january 1980 and december 1990, 14 cases were diagnosed in our institution. Preoperative Doppler examination of the internal carotid artery suggested almost complete thrombosis in 11 patients and occlusion in 3. The angiographic appearance suggested internal carotid occlusion in all but the presence of the slim sign was in favor of a patent artery. All 14 patients underwent surgery. There were no postoperative deaths; one patient presented an ipsilateral TIA post operatively; 3 others presented an ipsilateral TIA after 2, 16 and 30 months respectively. All carotid arteries were found to be patent. The frequency of pseudo-occlusion of the internal carotid artery is probably underestimated. It must be kept in mind whenever an apparently occluded internal carotid continues to be symptomatic. Diagnosis is based on comparative analysis of Doppler examination and angiographic findings. Surgery is indicated whenever doubt persists.

Arteriosclerosis↗
PubMed1992

[Postoperative acute aortic dissection. Apropos of two cases].

Aortic dissection after cardiac surgery is a rare complication. The prognosis is often poor: 33-78% of mortality. The study of two cases out of 2100 patients operated upon during the last three years, and the review of the literature, allows to recall the mechanism, the anatomic origin and the different surgical techniques. Early diagnosis is essential. Some preventive techniques may reduce the incidence of the iatrogenic dissections.

Aged↗
PubMed1991

Spontaneous dissecting aneurysm of the common iliac artery.

A 52-year-old man sought medical advice for sudden onset of intermittent claudication of the left lower limb after 50 meters walking. Aortography documented a dissecting aneurysm limited to the left common iliac artery. After resection, a prosthetic graft was inserted. Pathology showed that the cause of the dissection was atheroma. Spontaneous dissecting aneurysm of the common iliac artery is rare. Rupture represents the principal hazard. A high index of suspicion should lead to diagnosis as soon as signs of lower limb ischemia, occasionally transient, appear.

Aortic Dissection↗
PubMed1991

[Behçet's disease with multiple arterial lesions and voluminous hemangioma of the brain].

A case of a 43-years-old patient with a 9-year history of Behçet's disease is reported. The diagnosis was based on the past of bilateral hypopion iritis, oral aphthous ulceration and venous thrombosis. A right lower limb monoparesia occurred. CT scan and angiography showed a voluminous intracerebral angiodysplasia and an aneurysm of the left anterior communicating artery. Careful angiographic examination of visceral and peripheral arteries showed bilateral thrombosis of subclavian arteries, thrombosis of superior and inferior mesenteric arteries and an aneurysm of the coeliac trunk. Large arterial involvement is an unusual complication of Behçet's disease. A through review of the literature showed only 2 reported cases of intracranial arterial aneurysms. This case report was the first case of Behçet's disease with an intracerebral angiodysplasia.

Adult↗
PubMed1991

[Value of axillofemoral bypass in the elderly].

The aim of this retrospective study was to assess the merits of axillofemoral bypass in elderly patients. 69 axillofemoral grafts were laid from 1981 to 1985 in 56 patients, all older than 70. They always were aimed at limb salvage due to aortoiliac obliterating lesions (the indications of sepsis of aorto-bifemoral prostheses have been excluded). 13 patients have had an axillo-bifemoral graft and 43 an unilateral axillofemoral graft. The lower anastomosis involved the common femoral artery in 30 cases, the deep femoral artery in 39. The patients were followed up for 1 to 74 months, with an average of 24 months. The operative mortality was of 10 cases (17%). During the first postoperative month, 3 major amputations were required. The cumulated survival rate at 60 months was of 18%, with the primary and secondary patency rates at 60 months being of 46% and 71%, respectively. We conclude that axillofemoral bypass is perfectly adapted to this population of elderly subjects, in whom a direct aortic approach is counterindicated.

Aged↗
PubMed1990

Neurologic complications of axillary and brachial catheter arteriography in atherosclerotic patients: predictive factors.

Catheter arteriography by the axillary or brachial route can be responsible for central neurologic complications. The objectives of this prospective study were to define the predictive factors of these complications and determine their incidence. This report is based on 288 consecutive arteriography sessions performed between January 1985 and June 1987. All patients had arterial atheromatous pathology. Ten central neurologic complications (3.5%) occurred, two of which (0.7%) were permanent. Four factors were significantly associated with increased incidence of central neurologic complications: antecedent transient ischemic attack (p less than 0.001); tight (greater than 80%) stenosis of at least one internal carotid artery (p less than 0.02); angina pectoris (p less than 0.05); age over 80 years old (p less than 0.001). Seldinger's or Dos Santos' techniques are preferable to axillary or brachial catheter techniques for investigation of the lower limbs and the abdominal aorta. The former obviates the need to catheterize the aortic arch and reduces the risk of embolism to the supraaortic arteries. Digital venous arteriography is an alternative to aortic arch catheterization when investigating the supraaortic arteries in the presence of risk factors.

Age Factors↗
PubMed1990

[Prognosis of acute ischemia of the lower limbs in patients over 80 years of age. A prospective study].

To demonstrate the importance of age in the prognosis of acute lower limb ischemia, a prospective study was performed in 137 patients over 24 months. Group I contained 75 patients aged under 80 years and group II 62 patients aged over 80 years. Risk factors and previous history were equally distributed in the two groups. The level of arterial blockage and the treatment were comparable in the two groups. Mortality was higher in group II than in group I (p less than 0.01). In both groups deaths were principally due to cardiac causes and a revascularisation syndrome. Amputation at thigh level was more common in group II (p less than 0.01). Mortality was higher in group II for combined thigh level amputation and cardiac or coronary insufficiency (p less than 0.05). This study demonstrated that, in terms of prognosis of acute lower limb ischemia, the critical threshold is 80 years.

Actuarial Analysis↗
PubMedDate not supplied

Persistent hypoglossal artery.

During embryological development, the hypoglossal artery serves as a transient anastomosis between the internal carotid artery and the vertebro-basilar system. This artery occasionally persists into adult life. Two cases of persistent hypoglossal artery we have recently encountered are reported here. The embryology, diagnosis and potential problems for carotid surgery are discussed.

Aged↗
PubMedDate not supplied

Synchronous reconstruction for combined aortoiliac and femoropopliteal occlusive lesions. The role of proximal bypass.

Between January 1984 and December 1986, 31 patients underwent synchronous revascularization (SR) because of the serious clinical condition of a lower limb and presence of arteriographically visible lesions. Average follow-up was 30 months. Operative mortality was 10%. Two patient populations were identified: Group I (N = 13): patients who underwent ilio-femoral or aorto-femoral proximal revascularization (PR); Group II (N = 18): patients who had axillo-femoral PR. Group I patients were younger than those in Group II (64 yr versus 72 yr; p less than 0.01). An association of pre-operative risk factors (arterial hypertension; coronary, renal or respiratory insufficiency) was twice as frequent in Group II as in Group I (p less than 0.02). The rate of SR compared to PR alone was 15%. However, there was no statistically significant difference between Groups I and II. Comparison of the actuarial survival curves for patients ahd the patency rates of SR in Groups I and II failed to reveal any statistically significant differences. Axillo-femoral bypass can be used for PR when SR is necessary in high risk patients.

Aged↗
PubMedDate not supplied

[Encapsulating peritonitis. Apropos of a new case].

The physiopathology of the rare affection encapsulating peritonitis is poorly elucidated, but its etiologies are now more clearly defined. Diagnosis is usually at operation, as in the present case, a 65 year old man with known alcoholism and wearing a LeVeen type peritoneo-jugular valve, probably the cause of the peritonitis.

Aged↗
PubMedDate not supplied

[Thrombophlebitis of the ovarian vein with a floating clot in the inferior vena cava].

The authors report two recent observations of thrombophlebitis of the right ovarian vein. The first occurred after a cesarotomy, due to a bigeminal pregnancy, and the second, after a breech delivery. The diagnosis was given when faced to a febrile syndrome and pains of the right flank and confirmed in both cases by an abdominal tomodensimetric examination. In both cases, an enlargement of the lower vena cava thrombosis was observed with a floating clot that reached the renal veins. Both patients underwent a surgery. The latter consisted in both cases in a thrombectomy of the lower vena cava as well as a ligature of the right ovarian vein. In both cases, the evolution was positive, thanks to a remote-control of the lower vena cava via tomodensimetry. This therapeutic procedure and other potential therapies were discussed.

Adult↗