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Biomedical subjects

C A Mestres

Publications and source records attributed to C A Mestres.

At least 55 records · Page 3Linked to original sources
PubMed1991

[An alternative approach in the surgical treatment of infectious endocarditis. The fresh antibiotic-sterilized aortic valve homograft].

Following the pioneering work of Ross and Barratt-Boyes, there is currently a strong evidence based on long-term follow-up data that valve homografts are the best valve substitutes in the aortic position. Currently there exists a renewed interest in the use of fresh and cryopreserved homografts as we know that homografts show a prolonged durability together with the lack of thromboembolic complications. Here we present the case histories of 3 patients undergoing aortic valve replacement by fresh homografts sterilized in antibiotic solution. The underlying pathology was infective endocarditis in all 3 patients, a disease that is considered the ideal indication for homograft implantation. Technical details at the time of implantation, their advantages with regard to other replacements devices and the whole process of procurement, manipulation and preservation are commented on.

Adult↗
PubMed1990

A new technical alternative in the surgery for retroperitoneal fibrosis: the Gore-Tex surgical membrane.

The case of a male patient with retroperitoneal fibrosis secondary to an abdominal aortic aneurysm which was surgically treated with success, is presented herein. What is considered technically new is the management of the ureters after surgical lysis. An expanded polytetrafluoroethylene Gore-Tex surgical membrane, initially developed for pericardial closure after open-heart surgery, was used to isolate the bifurcated aortofemoral graft from the duodenum and the ureters from the vascular prosthesis and surrounding retroperitoneal tissues. This is considered to be a simple and safe technique and a technical alternative when dealing with this complex situation. To date, there has been no other description of such a technique using this material. The potential value of this material to prevent reencasement in retroperitoneal fibrosis from other origins should be kept in mind.

Aorta, Abdominal↗
PubMed1990

AIDS and Salmonella-infected abdominal aortic aneurysm.

The case of a bisexual male patient with acquired immunodeficiency syndrome (AIDS) and an infected abdominal aortic aneurysm requiring surgery is presented. Attention is drawn to the fact that an unpredictable number of operations will be needed in AIDS patients in the next future.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Improvement of renal function in azotaemic hypertensive patients after surgical revascularization.

Between 1974 and 1986, 17 patients (16 men and 1 woman) with renal insufficiency (serum creatinine greater than 1.5 mg/dl, mean 3.75 mg/dl), with a mean age of 51.3 years, underwent surgical renal revascularization. Two of them were on maintenance haemodialysis. All were severely hypertensive in spite of antihypertensive drugs. Atherosclerosis was the cause of renal stenosis in 14 cases and fibromuscular dysplasia in 3. Operative procedures included splenorenal shunt (5), autotransplantation (3), aortorenal bypass (3), hepatorenal bypass (1), bilateral renal endarterectomy (1), renal ostial closure (1) and nephrectomy (3). Mean serum creatinine showed a decrease from 3.76 to 1.65 mg/dl (P less than 0.005). Mean arterial pressure dropped from 161 mmHg to 103 mmHg (P less than 0.001). Systolic and diastolic pressures also showed significant decreases. Two patients died. Four patients required a second operation and the renal function and blood pressure then improved. Renovascular disease must be ruled out in patients with renal insufficiency associated with hypertension, including those patients on haemodialysis. We conclude that renal revascularization surgery is a reliable and efficient form of treatment in selected cases of renal failure of renovascular origin.

Blood Pressure↗
PubMed1988

Hepaticothoracic transdiaphragmatic echinococcosis.

Between 1970 and 1985, seven patients were referred to us for surgical treatment of simultaneous hydatid cysts in the liver and the chest. Their mean age was 45.4 years (age range, 23-73 years), and they represented 46% of patients with hydatid cysts in the liver and thorax. Three patients had hepaticopleural involvement, and 3 patients had symptoms of pulmonary origin. In a single patient, only the diaphragm was involved along with the liver. Liver scintigraphy and ultrasonography were equally helpful in delineating the extent of the disease, but computed tomographic scanning is now the method of choice. The operations were through a thoracolaparotomy in 3 patients and a thoracotomy alone in 3 patients. A single patient had a thoracotomy with a transdiaphragmatic laparotomy. Complete drainage or excision of hydatid cavities was accomplished in all patients. Hydrogen peroxide instilled into the cysts was satisfactory for control of spread potentially secondary to possible intraoperative spillage. There have been no postoperative deaths. Follow-up has ranged from 6 months to 8 years, and 2 patients had relapsing hydatid disease 3 years postoperatively. These results suggest that, when hydatid disease of the liver is complicated by transdiaphragmatic extension and simultaneous pleural or pulmonary cysts, early surgical repair is indicated. Complete drainage and cyst excision are recommended.

Adult↗
PubMed1988

Iatrogenic arteriovenous fistula in infancy.

Iatrogenic arteriovenous fistulas (AVF) in infancy are rare and are usually located at the level of femoral and antecubital vessels. They are generally secondary to multiple diagnostic or therapeutic arterial or venous punctures. The diagnosis is usually easy to make on clinical grounds; however, invasive procedures such as digital subtraction angiography (DSA) can be used to locate the fistula. These iatrogenic AVF may present as direct vascular communications or pseudoaneurysms originating in the venous wall. Surgical treatment is the therapy of choice. The case of an infant with an iatrogenic AVF of the femoral vessels is presented.

Arteriovenous Fistula↗
PubMed1987

Traumatic injuries of the diaphragm. Experience in 33 cases.

Between 1978 and 1985, 33 patients were treated because of a traumatic injury of the diaphragm. There were 28 males and 5 females, ages ranging from 19 to 54 years, with a mean of 34.5. There were 19 cases of open trauma and 14 were closed injuries. In 3 cases, the diagnosis was established on a delayed basis. Treatment was always surgical, with the following procedures: Laparotomy and chest drainage tube in 7 cases (21%), thoracotomy in 12 cases (36%) and a combined thoracoabdominal approach in 14 (43%). Surgical findings were 19 perforations, 10 tears and 4 crushes. In 11 cases there was gastric intrathoracic migration, in 9 cases pulmonary lesions and in 4 cases liver injuries. There were 4 cases of hospital mortality (12%) and overall 6 cases (18%). It is concluded that the early establishment of the diagnosis and the prompt initiation of therapeutic measures is a fundamental factor in the outcome of diaphragmatic injuries. The surgical approach must be individualized in every case, however we prefer the abdominal approach in acute and left diaphragmatic injuries and the thoracic approach in the case of chronic and right lesions.

Accidents, Traffic↗
PubMed1987

Endarterectomy of the LAD and internal mammary artery grafting. A reliable association.

Endarterectomy of the left anterior descending (LAD) coronary artery and concomitant myocardial revascularization with the internal mammary artery (IMA) were performed in five men aged 52-62 years. There was no perioperative myocardial infarction and no hospital mortality. Early postoperative angiography was performed in four cases and showed patent IMA grafts. The infrequent association of LAD endarterectomy and IMA grafting in the literature is commented on. The authors recommended myocardial revascularization with the IMA in all cases of LAD atherosclerosis, even though the condition is severe and diffuse, requiring endarterectomy.

Coronary Artery Disease↗
PubMed1986

Severe fibrous epicarditis after microporous polyurethane (Mitrathane) cardiac patch implantation.

Several materials have been used for pericardial closure after open heart surgery. Mitrathane is a recently introduced material designed for use in the cardiovascular system. A case of severe epicarditis after implantation of a Mitrathane cardiac patch for pericardial closure is presented. This epicardial reaction rendered the exposure of the heart at reoperation extremely difficult. This is a complication not reported to date with this new material. Thus, careful evaluation of Mitrathane is needed before extending its use to larger series.

Adult↗
PubMed1986

Atherosclerosis of the internal mammary artery. Histopathological analysis and implications on its results in coronary artery bypass graft surgery.

To evaluate internal mammary artery (IMA) atherosclerosis in our population, 38 segments of IMA obtained at the time of coronary surgery and 20 segments of IMA obtained at postmortem studies were histologically studied. Hematoxilin-eosin, Masson trichromic, elastic fibers and reticulin fibers were the stain methods used. A total of 236 sections were studied. Atherosclerosis was graded from 0 to 4 according to Kay and co-workers. Severe disease, with more than 50% luminal narrowing was found in one necropsy case (5%) and in no surgical case. In the surgical group, only one case (2.36%) showed a degree 3 luminal narrowing (between 25% and 50% luminal reduction). The remaining sections were normal or minimally affected. It is concluded that the IMA shows minimal atherosclerotic changes, being considered a protected vessel.

Adult↗
PubMed1985

Clinical performance of the omniscience prosthetic heart valve with Dacron sewing ring.

The Omniscience prosthetic heart valve has been clinically evaluated in 44 patients operated on between January and July, 1981. There were 23 aortic valve replacements (AVR), 18 mitral valve replacements (MVR) and 3 double valve replacements (DVR). Mean age was 48 +/- 11 years. Preoperatively, 61% patients were in New York Heart Association (NYHA) functional class IV, 36% in class III and 2% in class II. The hospital mortality rate was 4.5%. Actuarial freedom from thromboembolic events was 97.4 +/- 2.6% (3 1/2 years of follow-up). Postoperatively, 93% of the patients were in NYHA class I and 7% in class II. There were 7 cases of periprosthetic leak requiring reoperation (6 AVR, 1 MVR) for an overall incidence of 6.3% per patient year. In all these cases the causative factor was considered to be the Dacron sewing ring. All patients survived the reoperation. The actuarial survival rate was 93.9 +/- 5.9% for AVR and 93.7 +/- 6.1% for MVR. These data would suggest that the Omniscience prosthesis represents an acceptable device for heart valve replacement, except for the high incidence of periprosthetic leakage, related to the Dacron sewing ring. Recent modification of the valve-construction including a Teflon sewing ring may avoid the relatively high rates of periprosthetic leakage following implantation of this mechanical valve.

Acenocoumarol↗