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Biomedical subjects

X Barral

Publications and source records attributed to X Barral.

At least 37 records · Page 2Linked to original sources
PubMed1994

[Three-and-a-half years' experience with hemodialysis using 37 Permcaths without infection or definitive thrombosis].

34 patients had 37 Quinton Permcath (PKT), surgically implanted in jugular vein (internal: 29, or external: 8). The first 20 were used for a temporary vascular access (mean: 21 weeks). Then, the next 17 were used for permanent vascular access. 8 could be used for more than 1 year and 2 for more than two years. Anti-aggregant (29 cases) or anticoagulant treatment (8 cases) were systematically prescribed. 6 patients died for unrelated causes (mean delay: 35 weeks). 3 catheters were mispositioned. 2 catheters had to be removed because they were damaged (mean 53 and 69 weeks). Complications were: vein thrombosis (internal jugular vein): 2 cases, vein stenosis (inominate vein): 1 case, heparin overdoses: 3 cases. A partial thrombosis of a single lumen was common but always easily cured by local thrombolysis. Nurses were strongly motivated and followed rigorous educations with help of video-movie. This could be why no infectious (local or generalised) complication was observed. Long-term Permcath dialysis is a precious tool for patient without any peripheral vascular access or in elderly and short-live expectancy.

Adult↗
PubMed1994

[Left main coronary artery disease].

There are many causes of left main coronary artery disease, the first of which is atherosclerosis. Other rarer causes may be observed, such as acute and chronic occlusions, spasm and primary and secondary dissection. The prevalence of stenosis of the left main coronary artery at coronary angiography is about 5%. The risk factors are the same as for coronary artery disease. The symptoms are angina, especially unstable angina. The diagnosis is suspected on the finding of an extremely positive exercise stress test, confirmed by coronary angiography. The results of the prospective large scale Veterans Administration trial showed surgery to be the treatment of choice with a 30 months survival of 80% in the surgical group compared with 64% in the medical group. The operative morbidity and mortality is less than 10% at present. Recent studies have reported a medium-term mortality of 4.3 to 10.25% with follow-up periods of 24 and 43 months respectively. The long-term survival and functional improvement are excellent, with values of nearly 80%. Chronic occlusion of the left main stem is rare, 0.01 to 0.7% in coronary angiographic studies. There is no difference in presentation, electrocardiographic or stress test features compared with other severe coronary artery disease. The diagnosis is angiographic and the treatment surgical because of the mediocre natural history with risks of sudden death and severe infarction. Acute occlusion of the left main coronary is rare for generally fatal. The mechanism is acute thrombosis and the clinical presentation is that of extensive infarction usually with cardiogenic shock.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Paradoxical embolism of the aortic arch diagnosed by transesophageal echocardiography. Surgical treatment].

The authors report the case of a woman who presented with a pulmonary embolism followed by systemic embolism. Transoesophageal echocardiography showed a persistent foramen ovale compatible with a possible paradoxical embolism. In addition, a mobile embolism in the aortic arch was demonstrated. This embolism was extracted under cardiopulmonary bypass to avoid a recurrence of embolism. Transoesophageal echocardiography is the only reliable, non-invasive method allowing simultaneous diagnosis of a right to left shunt and visualisation of the thoracic aorta.

Aged↗
PubMed1994

[Aneurysms of branches of the renal artery: surgery ex vivo].

Extra corporeal replacement of the renal artery for the treatment of complex renal artery diseases offers numerous advantages: safe approach for the branches of the renal artery and division of the intra-hilar arteries, easy repair and sutures, excellent quality of intra-operative arteriogram, easy repair of venous damage, excellent renal preservation. These advantages and the excellent long term results justify extra-corporeal surgery as the procedure of choice for the treatment of complex renal artery disease.

Aneurysm↗
PubMed1994

Sequential by-passes for limb salvage.

Direct revascularisation of the foot permits the healing of distal trophic lesions. This is not always possible with a by-pass on a single isolated popliteal segment. When multi-segmental occlusive arterial lesions were found in femoral, popliteal and distal arteries sequential by-pass grafting was used to improve distal runoff. During a 5 year period (1988-1992), 53 sequential by-passes were performed in 52 patients with severe ischemia manifested by rest pain (17) or trophic lesions (36). Autogenous saphenous vein was used in 36 (10 reversed, 26 in-situ), homologous saphenous in 3 and composite (PTFE+saphenous) in 14. Proximal anastomosis was performed on 29 common femoral, 20 superficial femoral and 4 popliteal arteries. Intermediary anastomosis was performed on 6 above-knee and 31 below-knee popliteal arteries and on 16 distal arteries. All distal anastomoses were performed on distal arteries (13 cases on malleolar arteries). The mean follow-up was 18 months. Thirteen patients died during this period (mean 8.5 months after the surgery). Primary and secondary patency were respectively 66 and 79% over one year and 51 and 76% over two years. Limb salvage was obtained in 89% over one year and 86% over 2 years. Sequential by-pass is a useful alternative for limb salvage. This approach offers several hemodynamic advantages and may be the best procedure in patients with poor distal runoff.

Aged↗
PubMed1994

Aortobronchial fistula: report of three cases and review of the literature.

BACKGROUND: Aortobronchial fistula is uniformly fatal if not treated surgically. The aim of this study is to report three new cases and to discuss cause, clinical findings, surgical approaches, and results. METHODS: All three patients with massive hemoptysis underwent operation in emergency situation. The procedure performed were a Bentall operation for a false aneurysm of the ascending aorta 10 years after the correction of an acute dissection, a Dacron graft replacement for a mycotic aneurysm of the descending aorta, and an extraanatomic bypass between ascending and celiac aortas for a false aneurysm 14 years after the correction of an isthmic coarctation. RESULTS: The patient with the mycotic aneurysm died of paraplegia and septicemia after operation. The other two were without symptoms after 2 years of follow-up. CONCLUSIONS: The diagnosis should be considered in any patient with minor or major hemoptysis and prior history of thoracic aortic operation. Aortography and thoracic computed tomographic scan are the main investigations for diagnosis. Direct approach or extraanatomic bypass have the same results with a survival rate of 76% in the recent literature. Early diagnosis and emergency surgery are the two predictive factors for good results.

Adult↗
PubMed1993

Cryopreserved arterial homografts: preliminary study.

The use of arterial or venous allografts for vascular reconstruction was first reported in 1951, but long-term results have been disappointing. Rejection and inappropriate methods of preservation are the main reasons for failure. A successful solution to this problem could be achieved by programmed cryopreservation with cryoprotectant. Our study had two aims: to define the biomechanical properties of cryopreserved arterial allografts and to study their histologic appearance. Arteries were removed as part of a protocol for multiorgan harvesting for transplantation. Cryopreservation was performed within the first 24 hours after harvesting. Programmed cryopreservation with 15% dimethyl sulfoxide (cryoprotectant) was used. Mechanical testing was done immediately after thawing. Two groups were tested: a control group of fresh aortas and a group of cryopreserved aortas. Axial and circumferential strips were tested. High strain modulus and stress and strain characteristics were calculated for each strip. There was no statistically significant difference between the mechanical properties of fresh and cryopreserved human descending thoracic aortas. Biochemical tests were performed in the preservative solution at 1 and 7 days in both groups. There was no statistically significant difference between the two groups at day 1 or day 7 (p > 0.05). Histologic studies before and after arterial cryopreservation included standard and electron microscopy and showed that arteries had normal structure after cryopreservation. These results confirm that programmed cryopreservation with cryoprotectant does not alter the molecular or geometric configuration of collagen or elastic fibers. Endothelial cells were still present, however, their viability and function were not assessed.(ABSTRACT TRUNCATED AT 250 WORDS)

Aorta↗
PubMed1993

Trans-osseous ilio-femoral by-pass. A new extra-anatomical by-pass.

A new extra-anatomical by-pass is described as an alternative procedure to solve complicated vascular problems in the groin. This trans-osseous ilio-femoral by-pass can be use in spite of classical extra-anatomical by-passes (obturator, perineal, supra-pubic, axillo-femoral). The proximal anastomosis can be performed on aorto-iliac homolateral axis by a retro-peritoneal approach. The by-pass is going externally on the psoas-iliac muscle, through the iliac aisle and then between the sartorius and gluteus medius muscle. Distal anastomosis can be performed on the profunda femoral artery or, with sequential by-pass, on multiple arteries of the leg. We have performed such a by-pass in 5 patients for femoral triangle infection (4 cases) or radiotherapeutic complication. One patient died after cardiac surgery, another has had a major amputation. Three by-passes are patent with a follow-up period of 2 years. This by-pass is easy to do, its route is short, deep (without neurological, bleeding or compressive risk) and far from an eventual infected common femoral artery.

Blood Vessel Prosthesis↗
PubMed1992

Dysplastic lesions of renal artery branches: late results of ex vivo repair.

Between November 1980 and July 1989, 29 ex vivo reconstructions were performed in 12 women and five men (mean age: 42 years) for dysplastic lesions of renal artery branches. Fifteen patients had hypertension, associated with advanced renal failure in one case. The internal iliac artery was used routinely for reconstruction. The saphenous vein was used on one side where bilateral repairs were necessary. A total of 52 distal anastomoses were performed, an average of 2.6 per revascularized kidney. Mean follow-up was four years and 10 months. No patients were lost to follow-up. There were no early or late deaths. At least one follow-up arteriogram and technetium99 diethylene triamine pentacetic acid scintiscan was obtained for all patients. Forty-five (86%) of 52 anastomoses remained patent. Eleven of 15 hypertensive patients completely recovered while four were improved. Systolic arterial blood pressure decreased by an average of 42 mmHg (p less than 0.001), and results remained stable with time. For fibromuscular dysplasia occurring in young patients whose life expectancy is usually long, this type of surgery provides excellent long-term clinical and anatomical results.

Adolescent↗
PubMed1992

Late results of palmar arch bypass in the treatment of digital trophic disorders.

This study reports the late results of eight palmar bypass procedures performed between 1983 and 1988 in eight men patients with a mean age of 43 years old, who presented with unilateral digital trophic disorders. The origin of the arterial lesions was post-traumatic in four cases, embolic in three cases, and aneurysmal in one. The procedures performed included four radiopalmar bypasses, two ulnar-palmar bypasses, one distal radial bypass and one palmopalmar bypass. In all cases, the replacement conduit used was the superficial radial vein retrieved from the wrist. There were no complications observed in this short series. All fingers healed within three weeks' time after excision of necrotic lesions. During a mean follow-up of 66 months, two bypasses became thrombosed, leading to amputation of the distal phalanx of a thumb in one patient while the remaining six bypasses remained patent, three of them for more than seven years. In the presence of trophic changes of the fingers, palmar arch bypasses, whenever feasible, are more effective at long-term and less aggressive than the usually proposed thoracic sympathectomy.

Adult↗
PubMed1992

Rehabilitation of patients with thoracic outlet syndrome.

A series of physical therapy protocols is proposed for patients with thoracic outlet syndrome. The anatomic findings dictating certain physical therapeutic approaches are outlined. General principles of physical therapy that stem from these findings are suggested, and a specific protocol for the physical therapy regimen is given. An appropriate physical therapy program for thoracic outlet syndrome patients with symptoms of mild-to-moderate severity can avoid early surgery. Degradation of symptoms or invalidating functional compromise indicates a referral to surgery. Physical therapy cannot replace surgery in severe or complicated forms of thoracic outlet syndrome with vascular or neurologic compromise.

Humans↗
PubMed1991

[Takayasu's disease and post-traumatic scalp necrosis].

This relates the case of a 19-years old female suffering from Takayasu's disease, who sustained injury with extradural hematoma formation calling for emergent evacuation thereof. The immediate postoperative period in this neurosurgical patient was characterized by extended necrosis of the scalp and underlying bone, due to low blood supply to the head in connection with her disease. The authors review the main characteristics of this rare inflammatory arteriopathy, and point out to the multidisciplinary collaboration which prompted healing of the patient's loss of substance.

Adult↗
PubMed1990

Primary closure of below-knee amputation stumps: a prospective study of sixty-two cases.

Between January 1, 1985, and December 31, 1988, we prospectively studied the outcome of 62 consecutive below-knee amputations with primary closure in 56 patients. There were 35 men and 21 women; mean age was 70 years. Above-knee amputation was performed for occlusion of the profunda femoris artery, acute thrombosis of a popliteal aneurysm with inadequate sural artery vascularity, intractable knee flexion contracture, suspended ischemia, and occasionally, when ischemia was found intraoperatively to extend proximally during below-knee amputation. Bedridden patients deemed unfit for prosthetic devices were also candidates for above-knee amputation. Fifty-four lower extremities (87%) were gangrenous and rest pain was present in eight patients (13%). Twenty-nine limbs (47%) were amputated primarily, 33 (53%) after failure of one or more revascularization procedures. Six patients had bilateral amputation. Forty patients (71%) were diabetic. Mean hospital stay was five days. Fifteen patients (27%) died during a mean follow-up period of 29 months. Eleven stumps (17.5%) required reoperation; five for postoperative infection, four for wound breakdown after a fall, and two for secondary abscess. Three secondary above-knee amputations (5%) were necessary. Of 44 below-knee amputations in diabetic patients, one had to be revised at the level of the thigh. Of 33 amputations after revascularization failure, one secondary above-knee amputation was necessary. Restoration of preischemic status was achieved after a mean of 58 days. Upon patient discharge from a rehabilitation center, 44 stumps (81%) were suitable to be fitted with prostheses.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Ureteral stenosis in kidney transplantation].

The authors report 13 cases of ureteral or periureteral sclerosis in a series of 330 cases of renal transplantation (3.9%): they occurred early, were asymptomatic (except for anuria); the renal cavities were always dilated, the renal function always deteriorated; the treatment was essentially surgical without mortality and with a low complication rate but 23% of the transplants were lost because of urological complications at 18 months. The authors compare their series with the literature.

Adult↗
PubMed1990

[Urinary fistula after renal transplantation].

Among 336 consecutive renal transplantations performed in our centre from March 1979 to December 1988, we have observed 26 cases of urinary leak in 25 patients. We have separated the ischemic and non-ischemic urinary leaks. The former (11 episodes) would have been prevented in most cases with better graft removal. The latter (15 episodes) were predominantly secondary to an anastomotic leak. We have treated surgically these urological complications. Only one patient died. The one-year graft survival rate was 67% in the 25 kidneys but the graft loss was directly due to the urinary leak in three cases.

Actuarial Analysis↗
PubMed1990

The embolic type of popliteal entrapment syndrome.

The authors describe their experience with two patients who presented with clinical extremes of popliteal entrapment syndrome. One patient presented with acute ischemia and the second patient presented with a chronic Buergerian-like syndrome. The common denominator for both of them was embolic phenomena originating at the site of entrapment. Discussion is centered on pathogenesis of the embolic phenomenon, prevalence of distal arterial degradation and its clinical manifestation. The clue for differentiation from true Buerger disease is the angiographic pattern demonstrating apparently healthy distal arterial segments, confirmed by mandatory arterial biopsy. It is emphasized that in cases having acute embolic presentation the primary pathology should be treated concomitantly to revascularization.

Adolescent↗
PubMed1990

[Colonic perforation after renal transplantation].

Among surgical complications following kidney transplantation, the colonic perforation should be known. We reported a fatal case of perforation occurring on a colonic diverticulosis in the first month week post-transplantation. We emphasized on the difficulty to assess the diagnosis.

Aged↗