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Biomedical subjects

X Barral

Publications and source records attributed to X Barral.

At least 55 records · Page 3Linked to original sources
PubMed1989

Renal transplantation and Kock pouch: a case report.

We report on a young woman with anuric, terminal renal insufficiency whose bladder could not be used for renal transplantation. A Kock pouch was implanted during stage 1 of treatment and the capacity of the pouch was increased artificially with physiological saline solution. The patient subsequently underwent renal transplantation. Results were excellent with regard to continence and ease of catheterization. No complications due to infection were observed despite immunosuppression and electrolyte disorders were minor.

Adult↗
PubMed1989

Extracorporeal repair of renal artery branch lesions.

Complex renal artery lesions which formerly would have been treated by nephrectomy may now be reconstructed by extracorporeal surgery and autotransplantation. Our experience in 15 patients (17 operations) with renal artery lesions extending into its branches or confined to them is described. Two patients underwent separate operations on both sides. The indications for surgery were severe renovascular hypertension (10 cases), renal artery aneurysm, (5 cases) and deteriorating renal function (2 cases). Overall clinical results after a mean follow up of 3 years were considered excellent in 13 procedures (11 patients). Improvement in 2 patients and failure in the other 2, who ultimately underwent nephrectomy. Discussion is focussed on results, vascular indications, (namely aneurysm, stenosis, dissecting aneurysm and trauma) and surgical techniques. Preservation of functioning renal tissue should be the ultimate goal of renovascular surgery where the ex vivo technique, when indicated, will achieve favorable results in most patients.

Adult↗
PubMed1988

[Evaluation of surgical renal revascularization in renovascular arterial hypertension. Measurement by 99m Tc DTPA scintigraphy].

The effects of surgical renal revascularization on both hypertension and kidney function was assessed in 16 patients with renovascular hypertension (14 unilateral). We have taken a special interest to the split renal function studied with DTPA renogram. The function of the operated kidney was improved in 9 patients and not improved (worsened or unchanged) in 7. Hypertension was cured in 25% and improved in 56% of the patients, without correlation with split renal function outcome.

Adult↗
PubMed1987

[Isolated dissection of the renal artery treated by conservative surgery in 3 patients].

We reported 3 cases of male patients with isolated dissecting aneurysm of the renal artery. The clinical presentation included lumbar pain followed by hypertension (malignant in 2 cases) in the next 3 months. These three patients have underwent surgical renal artery repair. At maximal follow-up (4, 5, 11 years after surgery), the blood pressure was normalized in these 3 patients (with one antihypertensive drug in 2) and the renal function remained stable.

Adult↗
PubMed1986

Anastomotic false aneurysms with aortic Dacron graft after twenty-five years.

One of the early diamond crimped knitted polyester (Dacron) grafts was surgically excised after implantation for 25 years in the aorto-biiliac position because of false aneurysm formation at the three anastomotic sites. The sutures were no longer visible. While the areas around the false aneurysm were poorly incorporated, the graft limbs were well encapsulated with some endothelial-like cells on the luminal surface. The integrity of the graft was well preserved despite mild fraying and the disruption of one stitch.

Adult↗
PubMed1986

Endofibrosis of the external iliac artery in bicycle racers: an unrecognized pathological state.

Since December 1985, we have operated upon seven bicycle racers for endofibrosis of the external iliac artery. In all instances, the athletes had started cycling early in life and were engaged in top level competition by the age of 17. The principal complaint was intermittent claudication of one lower limb at "near-maximal" exercise. Pain could be reproduced by exertional tests on an ergometric bicycle, and in all cases except one, measurement of ankle systolic pressure of that limb compared with the opposite side and brachial pressures showed a marked decrease on the involved side. Arteriography, performed with multiple views and positions, documented a 5 to 6 cm moderately stenotic (less than 40% diameter) segment, associated with arterial lengthening. Surgical treatment consisted of endarterectomy and shortening of the artery. Four patients were able to return to competition. The origin of this pathology is discussed, based on gross and histologic findings. Under certain predisposing anatomic conditions, abnormal hemodynamics, probably due to a high flow arterial state and an aerodynamic position on the bicycle, provoke repeated trauma which eventually produces the lesion. Practically unrecognized until now with only two previous publications on the subject in the literature, this entity is probably not uncommon.

Adult↗
PubMed1986

Infrageniculate thin-walled PTFE bypass: preliminary study of 53 cases.

Between May 1, 1983 and May 1, 1985, 53 patients whose mean age was 75 years, and who presented with rest pain or ischemic changes had infrageniculate insertion of femoropopliteal or femorotibial thin-walled polytetrafluoroethylene (PTFE-TW) bypasses. Occlusive atherosclerotic disease was present in all patients. Postoperative follow-up ranged from 6 to 30 months. One patient died in the immediate post-operative period whereas 15 others died later during follow-up. There was one case of prosthetic sepsis. No anastomotic aneurysms occurred. Actuarial analysis of overall patency rates in significant population samples showed that 88% and 68% of bypasses were functional at one month and two years, respectively. The overall rate of early amputation was 17%. Overall limb salvage was 67% at 30 months. In patients over 75, 85% of bypasses were patent at one year whereas life expectancy for one year in this same group of patients was 49%. Although this is a preliminary study, results obtained with this new material suggest that an average gain of 20% in patency rates can be expected compared to those recorded with standard PTFE prostheses. The PTFE-TW vascular prosthesis may be the material of first choice for the geriatric patient in order to promote early hospital discharge and return to the home environment. Even though long-term patency rates of venous grafts are better, we believe that the use of PTFE-TW prostheses in elderly patients with limited life expectancy may be preferred.

Aged↗
PubMed1986

Supraceliac aorta-to-lower extremity arterial bypass.

From 1979 to 1986, ten patients had a revascularization procedure using the supraceliac portion of the aorta. Six patients had aortofemoral or aortoiliac bypasses and four others had additional procedures for revascularization of the lower extremities or of the visceral arteries. The latter included four renal, three superior mesenteric and three hepatic artery revascularizations. There were no postoperative deaths. One patient with chronic renal failure underwent temporary hemodialysis after the operation. The postoperative course was uneventful in the nine remaining patients. Postoperative arteriograms showed all visceral artery revascularizations to be patent. All patients were symptom-free at follow-up (mean 3.8 years, range 1 month to 7 years). One patient had a successful percutaneous balloon angioplasty for a late anastomotic stenosis in a renal artery. The operative technique is described and the specific indications for the technique are discussed in patients with renal and suprarenal aortic disease.

Adolescent↗
PubMed1982

[Infectious aneurysm of the abdominal aorta and Salmonella septicemia. Favorable development over 2 years of a case treated by resection and axillobifemoral bypass].

A 57 years old man had a two months history of chills and fever with abdominal pain. Blood cultures were positive for Salmonella ohio. He suddenly became hypotensive with oedema of lower limbs. Angiographic findings were infrarenal aortic rupture with pseudoaneurysm formation and inferior vena cava compression. After ligation of the aorta and both common iliac arteries, an axillo-bi-femoral graft was constructed to bypass the infection area. Subsequent occurrence of lumbar osteomyelitis required debridement and drainage of retroperitoneum. The patient was discharged on oral amoxicilline given for eleven months. Two years postoperatively he is able to walk without evidence of further infection. With a review of 32 other cases in the literature, emphasis is placed on theories of pathogenesis and on modes of surgical management.

Aged↗
PubMed1982

[Isotope phlebography. Value and limitations. Reliability in recent deep venous thrombosis of the lower limbs (author's transl)].

Isotope phlebography is a reliable examination in the diagnosis of deep venous thrombosis. Too complicated and expensive to be suggested for the purpose of routine detection, it nevertheless is of definite interest in three circumstances: --Suspicion of pulmonary embolism, with visualisation of any possible reservoir of peripheral clot and proof of the embolism. --Postoperatively, for repeated follow up to evaluate permeability after surgical procedures. --Finally, dynamic information by calculation of transit time of the radioactive embolus. Combined with Doppler measurement of peripheral venous pressures, it reflects the emptying capacities of a limb affected by post-phlebitis syndrome and hence plays a role in the decision to stop oral anticoagulants.

Humans↗
PubMed1981

[Progression and severity of arterial hypertension in aged subjects (12 cases].

We analyzed retrospectively 12 patients, aged from 63 to 73 years, with renovascular hypertension due to unilateral or bilateral atheromatous lesions (4 out of 12). Malignant or accelerated hypertension with multiple visceral involvement was frequent (8 out of 12). The proximal lesions (stenosis) of the renal arteries were rapidly progressive, leading to complete thrombosis in 8 cases. Five patients received medical treatment only, but 2 worsened their GFR and 2 had a poor blood pressure control. Of the 5 patients who underwent renal surgery 2 had nephrectomy, 2 had an aorto-renal bypass and 1 a bypass plus nephrectomy; 2 of them recovered a normal GFR, but 2 died in the post-operative period. Three patients had selective embolization of a renal artery, but only one was definitely improved. So far, the treatment of such cases still is very difficult.

Aged↗
PubMed1980

[Contribution of epidural infiltration in the treatment of acute ischemia in the lower inoperable limbs (author's transl)].

Epidural infiltration easily causes without surgical intervention, paralysis of the sympathetic nervous system and analgesia. In this way, spasm and vasoconstriction are inhibited and the use of collateral vessels which are still permeable is facilitated. The antalgesic position of the dropped foot, which is a cause of oedema and hemodynamic disconfort, is eliminated. Out of 17 patients showing an acute ischemia of the lower limbs treated by this method, seven were cured, 3 of whom already having trophic disorders, 7 underwent local amputations and 3 had leg and thigh level amputations. Six months later 10 of these patients were doing well. The best therapeutic conditions of this treatment are non-atheromatous arteritis: angiospasm, toxic or inflammatory acute ischemia and Buerger's disease. On the other hand, the results are mediocre with atheromatous arteritis.

Acute Disease↗
PubMed1980

[Lower limbs deep veinous thrombosis. Diagnostic and therapeutic actualizing (author's transl)].

At the present time, deep veinous thrombosis profit from a recrudescence of interest for we own a better anatomo and physiopathological concept. Likewise, the amelioration of clinical investigations must allow an electric therapeutics where heparine is no more the only one purposed. Surgery and thrombolysis are integrating parts of the therapeutic arsenal and must decrease in an actual way embolism risks and post phlebitic syndrome.

Heparin↗