Biomedical subjects
Publications and source records attributed to C Delcour.
Glans hyperemia after penile revascularization is a well known complication normally treated by surgery. However, this reintervention is often difficult due to local fibrosis. We report a case of successful embolization after supra-selective catheterization of the deep dorsal vein through the surgical anastomosis.
Corporeal veno-occlusive dysfunction is an important cause of organic impotence and is characterized by increased flow rates to create and to maintain erection during artificial erection produced by intracavernous saline infusion. Sixty-seven patients with this erectile insufficiency underwent penile ligature-resection of deep dorsal vein between 1982 and 1986, and were evaluated by nocturnal plethysmography, pharmacocavernometry as well as a questionnaire about their sexual life for long-term follow-up. The surgical procedure was controlled in the operating room by reduction of the erectile flow rates. Thirty-one patients were potent postoperatively and were able to have satisfactory intercourse. Results after resection were slightly better than after simple ligation of the deep dorsal vein. Four patients had penile glans insensibility resulting from the surgical dissection. There were 7 relapses several months after the procedure due to leakage through other deeper veins. Eight failures were due to additional psychogenic disorders or to neurologic disease not accurately diagnosed before the treatment because they all developed normal papaverine-induced erection after venous surgery while before it they only developed a slight tumescence. Reduction of the erectile flow rates within normal values was impossible during surgery in 3 patients. Eleven failures were due to concomitant arterial disease. Resection of the deep dorsal vein can restore penile erection in patients with cavernovenous leakage in about 50% of well-selected patients.
This article reports the case of a rapidly severe stenosis of the right renal artery, causing uncontrolled hypertension. After failure of a percutaneous transluminal renal angioplasty, which provoked the thrombosis of the vessel, a surgical revascularization was performed after +/- eighteen hours of renal ischemia. Blood pressure, blood urea nitrogen and serum creatinine returned to normal values. A dramatic improvement of the right renal function was attested at the hippuran scintigraphy after a dose test of captopril. The results of renographic studies obtained in this clinical case underline the role of the captopril radionuclide test in detection and follow-up after treatment of renovascular hypertension.
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One case of renal cortical necrosis is reported. The results of ultrasound and angiographic imaging and the relevant literature are reviewed. The examinations, particularly selective angiography, are of great interest in the diagnostic and in the etiology of this disease.
Two patients presenting a cervical trophoblastic implantation were treated with selective uterine artery embolization associated with dilatation and curettage. This interventional radiological maneuver helped greatly in the management of the bleeding caused by the ectopic pregnancies.
Pseudoaneurysm and arteriovenous fistulae are classical but unusual complications of femoral catheterism. The use of large diameter catheters, heparinotherapy and fibrinolysis constitute risk factors. These local complications are becoming more frequent resulting from an increase in interventional techniques. Therefore, a non invasive management of these lesions becomes necessary. A simple manual percutaneous compression of the puncture site was successful as treatment of 3 arteriovenous fistulae and 4 of 7 pseudoaneurysms. That is the reason why the authors consider that this technique constitutes a good alternative of the surgical treatment.
Vascular lesions are one of the most frequent causes of organic impotence. Dysfunction of the penile veno-occlusive mechanism is studied by cavernography-cavernometry. The major criterion of venous leakage is the maintenance flow which remains less than 25 ml/min after intracavernous injection of papaverine (60 mg). In the erect state cavernography can demonstrate the abnormal venous drainage.
The penile venous outflow is studied by cavernometry-cavernography associated with intrapenile injection of vasoactive drugs. This method allows the detection of patients with cavernovenous leak.
To assess ischemic lesions as a factor in obliterative bronchiolitis after lung transplantation, the authors severed the left bronchial arteries of 15 dogs, together with the left stem bronchus, the latter being immediately reanostomosed. They examined the bronchioles at weekly interfals up to three and a half months. On the week chosen each dog was anesthetized, totally heparinized, and exsanguino-perfused with saline. Just after heart arrest, the thoracic aorta was injected with a barium solution until this white medium appeared in the bronchial arteries. The heart-lung blocs were excised en bloc, submitted to soft-tissue x ray, fixed, and then sliced to 1 cm. Corresponding right and left 5-mm-thick samples of these slices were prepared for contact microradiography followed by histologic 5-to-20-micron-thick, stained, correlated specimens. For two weeks the left bronchial arteries remained empty, but there was no necrosis or edema. Between two and four weeks barium solution appeared in the bronchial arteries, and the bronchiolar epithelium had become multistratified. Later the left bronchiangiogram became similar to the right, but there were more folds of the mucosa and a little submucosal fibrosis. These studies provide proof that no significant ischemic lesions occurred during repermeation of the bronchiolar vascular bed. Ischemia, if existent, is not a significant factor in obliterative bronchiolitis.
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We studied 15 patients 4 to 8 days after myocardial infarction by using ECG gated MR before and after administration of 0.2 mmol/kg Gd-DOTA. The diagnosis in each patient was confirmed by electrocardiographic criteria, elevated levels of fractionated creatine kinase (CK) isoenzyme, thallium scintigraphy, ventriculography and coronarography. T1-weighted, spin-echo images, were obtained before and immediately after injection of Gd-DOTA and were repeated 15 min later. The site of infarction was visualised in 10 patients as an area of high signal intensity after the injection of Gd-DOTA. Contrast between normal and infarcted myocardium was greatest 15 min after injection. Three patients were excluded because of failure to acquire adequate MR studies. In 2 other patients, the infarct were not detected. Before injection of Gd-DOTA, only 2 infarcts were detected. These results suggest that Gd-DOTA can improve MR visualisation and detection of acute myocardial infarction.
We reviewed the results of percutaneous transluminal coronary angioplasty (PTCA) in 200 consecutive patients from January 1988 to January 1989. The mean age was 55.8 years. Twenty-two per cent had unstable angina, 66% had stable angina and the other 12% had atypical chest pain or were asymptomatic after a myocardial infarction. Five percent had left ventricular function less than 45%. The angioplasty procedure was angiographically successful in 184 patients (92%). There was no significant difference in success rate in the different vessels or indications. Coronary bypass surgery was required in 3% of patients as an emergency procedure; myocardial infarction occurred in 2% less than 24 hours after the procedure. There has been no in-hospital death. The recurrence rate of ischemic symptoms was 26.5%. Considering lesions treatment, the procedure was successful in 71% of the 200 patients over a long-term follow-up period.
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One hundred and seven Hickman catheters for haemodialysis were inserted in 90 end-stage chronic renal failure patients, and were used for 1-448 days (median 45 days). Sixty-nine per cent of the patients were treated without any problem for 1-165 days (median 34 days). Clinically evident complications occurred in 44 catheters inserted in 28 patients, and included outflow obstruction (16.8% of the catheters) and thrombosis (13.1% of the catheters). However, many episodes of clotting or insufficient flow could be corrected by simple manoeuvres. Other less frequent complications were recorded: sepsis, mainly in patients with increased risk factors (4.1% of the catheters), laceration of the catheter (3.7%) and occasional cases of jugular-vein phlebitis, transient palsy of a vocal cord, haematoma of the wound, and bleeding of the cutaneous orifice. No clinical sign of subclavian or innominate-vein thrombosis was observed. Nevertheless, a prospective study conducted in 50 asymptomatic patients demonstrated a 12% rate of anomalies of the venous system, although two-thirds of these alterations were mild and had no consequence. When the present series is compared to the results obtained with currently available percutaneous haemodialysis catheters, it is concluded that the Hickman catheter is a safe, comfortable and efficient vascular access device.
A series of 12 patients with vasculogenic impotence (4 arterial lesions; 8 arterial and venous lesions) underwent deep dorsal vein arterialisation after pre-operative assessment by a multidisciplinary approach. Cumulative graft patency was 58% (7 of 12 patients) up to 21 months but only 4 patients developed almost normal erections. Digital angiography, with and without the intracavernous injection of papaverine, was performed during follow-up to determine the vascular physiological status. At flaccidity, the corpora cavernosa were never opacified in the absence of a venocorporeal shunt. The penile glans was always visualised. Opacification of the deep dorsal vein and the circumflex system decreased with penile rigidity, resulting from their compression between Buck's fascia and the tunica albuginea. Intracavernous pressure recorded before and after the surgical procedure showed a marked increase when a caverno-venous shunt was performed. Hypervascularisation of the glans occurred in 2 cases. The relevance of this new surgical technique and its functional mechanism are discussed.
Percutaneous laser thermal angioplasty with a hot tip fiber was used in 26 patients to recanalize 20 femoropopliteal occlusions, 5 iliac thromboses and one occlusion of the left subclavian artery. Initial angiographic success was achieved in 85% for the femoropopliteal lesions and in 60% for the iliac occlusions. Eight complications did occur, but none necessitated emergency bypass surgery.
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