Biomedical subjects
Publications and source records attributed to C Christides.
Explore the source record for details and available documents.
The authors describe a case of high venous thrombosis with floating clots at the 37th week of pregnancy. The problem of diagnosis was solved by urgent Doppler examination and by phlebograms of the legs. It is necessary to have a team of many disciplines that can be brought together at any time. These consist of: -an anaesthesist who can resuscitate with heparin and give obstetrical anaesthesia, -an obstetrician who can carry out caesarean sections, -a vascular surgeon who can carry out a partial block of the inferior vena cava. This would appear only to be possible in a special centre.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The authors, having had a case of deep pelvic phlebitis occurring in a young primiparous woman who was treated prophylactically against the occurrence of a pulmonary embolus by placing a clip on the inferior vena cava discuss: the etiology of the condition: the difficulties of the diagnosis. They point out the value of phlebo-cavography which is an essential investigation in which no more than 4 films are taken, because it is on this that the indication for surgery rests. They point out the value of anticoagulant treatment, especially that using Calciparine which permits the patient to lead a more or less normal life at home. As far as the surgical procedure is concerned, a median approach seems to them the best way to carry out the operation.
The authors present a series of 10 cases of OCM which were treated by replacement of the mitral valve. Mitral incompetence was present in all patients, and was major or massive in 7 of them. Direct surgery to the mitral valve area has demonstrated pathological lesions in the mitral valve mechanism in 7 patients. A formal indication for mitral valve replacement in the surgical treatment of cases of OCM therefore exists when there is major mitral incompetence, intraventricular conduction defect, cardiac failure, or failure of previous myotomy.
Assisted circulation (AC) by intra-aortic counterpressure (IACP) has been used in 60 patients either pre- and postoperatively after a complication of acute myocardial infarction (25 patients: group A), or for a low-output syndrome after extracorporeal circulation (ECC) occurring in the operating theatre (20 patients: group B), or secondarily (15 patients: group C). In group A cases, the IACP stabilised a the myocardial ischaemia, and permitted coronary arteriography and subsequent surgery with little risk. Out of the 8 patients in this group who had cardiogenic shock only 4 survived, whereas out of the 17 patients without shock, only one died. Of the group B and C patients, 58% responded favourably to IACP, and 75% of group B cases survived as against 33% of group C. The postoperative low-output syndrome is related not to the ECC itself but to ischaemia of the subendocardial vasculature during surgery. The incidence of this syndrome can be reduced by the use of improved techniques of myocardial protection. AC by means of IACP becomes an effective therapeutic weapon if it is used early, or even systematically when the ejection fraction is below 0.03 and/or the EVR is less than 0.80.
Surgery of the elderly arteritic raises the problem of operative risk due to pre-existing defects at an advanced stage of the arterial disease and the danger of tiring investigations, anesthetics and repeated operations. Out of 271 arteritics operated on during 1975, half (135) were aged over 70 years. 92, i.e. two thirds were operated on at the terminal stage of their arteritis. The operative indications depended on the clinical, arteriographic, psychological and sociological data. The past history in many cases of heart attacks and cerebro-vascular accidents made the utility and necessity of the operation debatable. The technical choice, sympathectomy or plastic operation, depended on which presented the less risk. Although amputation is still necessary for massive gangrene (50 p. cent survival) one should always attempt to save the leg. Lumbar sympathectomy seems less aggressive; reconstructive surgery is, with greater risk, more effective at stage IV. The final result of the year showed 72.6 p. cent survivors including 56.3 p. cent successes and 16.3 p. cent amputations and a mortality of 27.4 p. cent. But all the failures were situated at stage IV of the arteritis, and the disturbances are increased by the patients' age. We can thus say that it is possible to render survival comfortable for three quarters of our operated patients.
Explore the source record for details and available documents.
The usual distribution of the coronary arteries of the heart as its appears from the study of 60 casts of these vessels is the following:--the right coronary artery gives three right atrial branches, the superior (sinus node artery) medium and inferior branches and three kinds of right ventricular branches : anterior, marginal and inferior. It divides into the posterior descending branch and the posterior left ventricular branch. Its territory is postero-septal.--the left coronary artery divides into 2 branches. The anterior descending artery gives right ventricular, left ventricular (diagonal) and septal branches for the antero-septal territory. The left circumflex gives three left atrial branches, the superior, medium and inferior branches and 1 or 2 left ventricular (lateral) branches for the corresponding lateral territory of the left ventricule.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Out of 350 cases of tricuspid regurgitation operated between 1968 and 1975, a serie of 53 prosthetic replacements (3 of them isolated) was analysed, with specification of operative indications, pre-operative condition, operative findings, procedure used and results. Operative death rate was high (28 per cent) and remote results (6 months to 7 years) were not all satisfactory. This is because functional "tricuspid regurgitation", secondary to advanced mitral lesions, expresses in fact considerable myocardial weakening with severe polyvisceral implications. This picture, where tricuspid patency is in fact contingent, is not always improved by mitral correction and reestablishment of a satisfactory tricuspid function, whatever the procedure used. Thus in very advanced mitral lesions, tricuspid repair should be done only if regurgitation is real and severe. Tricuspid prosthetic replacement should be reserved to valvular destruction; semi-circular annulo-plasty, which is efficient and not very traumatising, is applicable to all the other cases. The best treatment of this syndrome is preventive: as aortic lestions, mitral lesions should be operated early to permit a low risk operation and complete functional recuperation.
The favourable clinical results of cardiac transplantation merit wider application of this therapeutic measure in the management of non-obstructive primary cardiomyopathies and diffuse myocardial fibrosis secondary to coronary artery disease and in its terminal phase, in the absence of any absolute contraindication (pulmonary resistance too high, diabetes, gastrointestinal disorder, infection, patient too old.). Close cooperation between departments of cardiology and surgical transplantation centres, with systematic study of the patients pre-operatively and the setting up of a waiting list of recipients, will make possible in the future the improvement of the already encouraging results of cardiac transplantation.
Explore the source record for details and available documents.