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Biomedical subjects

C Laurian

Publications and source records attributed to C Laurian.

At least 91 records · Page 5Linked to original sources
PubMed1989

[Extratemporal Horton's disease: diagnosis using subclavian biopsy. 4 cases].

A histological diagnosis of Horton's disease was made in 4 patients with lesions of the axillary-subclavian arteries by biopsy of these vessels. Unilateral biopsy of the temporal artery, performed initially in 2 of these patients, during surgery in one and immediately after surgery in another, had been negative in 3 cases and insufficient for a diagnosis in 1 case. For temporal biopsy to be valuable, the arterial fragment resected must be long enough and serial histological sections must be performed to avoid false-negative results. It is only when these conditions are fulfilled that negative results may be considered. Horton's disease of the axillary-subclavian arteries is relatively frequent, and histological studies of these vessels have already been used to assert the diagnosis in case of negative or non-performed temporal biopsy, whether or not the arteriographic findings were suggestive of the disease. The indications for subclavian biopsy remain to be determined. It can be carried out for diagnostic purposes in case of clinically atypical suspected Horton's disease revealed by axillary-subclavian lesions and negative temporal biopsy, particularly when revascularization proves necessary.

Aged↗
PubMed1989

Arterial complications of the thoracic outlet syndrome: fifty-five operative cases.

Between January 1, 1969, and December 31, 1984, 55 operative procedures were carried out in 47 patients to correct subclavian-axillary artery lesions resulting from compression at the thoracic outlet. The most common causes of compression were a long cervical rib (27) and an anomalous first rib (15). Presenting features included claudication, vasomotor phenomena, digital gangrene, and acute limb-threatening ischemia. A combined supraclavicular and infraclavicular approach was preferred. Decompression was best achieved by excision of the cervical rib and the first rib and division of all soft tissue elements. The most common methods of arterial repair were resection-anastomosis (23) and replacement of vein graft (11). Embolic occlusions were frequently present (35). Axillary emboli were amenable to direct revascularization at the time of subclavian artery repair. If possible, more-distal embolic occlusions were managed without recourse to embolectomy catheter manipulations. The mean follow-up was 5 years 8 months (range 4 months to 16 years). Patients were assessed clinically, and the arterial repair was monitored by Doppler ultrasonography, B-mode scanning, and digital subtraction angiography. Of the 39 patients available for follow-up, 35 had no symptoms and four had residual claudication. There were no amputations. In the remaining cases the subclavian-axillary artery segment showed no hemodynamic or anatomic abnormality.

Adolescent↗
PubMed1987

Polytetrafluoroethylene bypass for revascularization of the atherosclerotic internal carotid artery: late results.

Between 1979 and 1986, 60 patients underwent a total of 62 revascularizations of the internal carotid artery with an expanded polytetrafluoroethylene (ePTFE) bypass. In 54 cases, the indication for surgery was the presence of extensive lesions in both the internal and common carotid arteries and, in 8 cases, a late complication of a previous surgical procedure. There were no early postoperative deaths (within 30 days). Three patients (5%) experienced postoperative neurologic complications. Two complications resolved completely whereas one left minimal residua. The bypasses remained patent in all three cases. All patients had early postoperative Doppler B-mode ultrasonography. Two early occlusions (3.2%) were disclosed but the patients remained symptom-free. Four neurologic complications were observed over long-term (average 23 months) follow-up. None were related to the operated carotid artery. There were no cases of infection or late occlusion. No hemodynamic or morphologic anomalies were observed on late follow-up ultrasound studies. These favorable results support the use of ePTFE as a reliable substitute when adequate autologous saphenous vein is not available for carotid bypass. Routine utilization might be indicated in cases of long bypasses, especially when it is necessary to implant the bypass on the ascending aorta, or when the proximal site of implantation is made on a thickened arterial wall.

Aged↗
PubMed1987

[Emboli-forming arteriopathies of the limbs].

Atheromatous embolism disease is a recently defined entity of still to be determined prevalence. This complication can develop during the course of any arterial disease by overload or dystrophy in lower limbs, and is certainly responsible for many cases of worsening of subacute ischemias occurring during arterial disease for which it is not always possible to affirm the embolic origin. It is in no way a rare syndrome and the true frequency of this affection can only be underestimated. If arterial dystrophies are excluded, the primum movens is ulceration of an atherosclerotic plaque. Two types of emboli have been described as originating in these plaques. First, small cholesterol crystal emboli containing fibrino-platelet material that are the cause of very distal arterial occlusion, notably in the foot: the most typical corresponding clinical condition is the so-called blue toe syndrome. Second, larger emboli due to formation and migration of a fibrino-platelet thrombus in contact with the atheromatous ulcer. They consist mainly of fibrino-platelet material with variable quantities of atheromatous debris. They may be of moderate size, occluding a collateral of the deep femoral artery or a leg artery usually in an asymptomatic manner, or larger and provoking occlusion of main trunks. Diagnostic difficulties emphasize the importance of referring all embolectomy products for histopathology. One of the essential problems of this disease is that of diagnostic criteria. When confronted with the previously evoked picture of peripheral ischemia and/or a peripheral arterial occlusive lesion, how can this distal accident be related to a subjacent arterial lesion suspected of possessing an emboli-forming nature?(ABSTRACT TRUNCATED AT 250 WORDS)

Arteriosclerosis↗
PubMed1987

Hypothenar hammer syndrome: seventeen cases with long-term follow-up.

Hypothenar hammer syndrome is a rare and often incorrectly diagnosed form of secondary Raynaud's phenomenon in workers who use their hand as a hammer. We report 17 documented cases with long-term follow-up after diagnosis made on the basis of arteriography. Clinical findings include male sex, unilaterality, sudden onset, and severe Raynaud's phenomenon. Angiography indicated that the 17 patients had either ulnar thrombosis or ulnar aneurysm; most of them also had embolic occlusions of the digital arteries. Main pathologic findings were thrombosis on the intima and fibrosis in the media. We adopted a surgical procedure consisting of resection with end-to-end reconstruction for patent aneurysms to avoid downstream emboli and more conservative treatment when the ulnar artery was thrombosed. No patient required digital amputation and all except one improved and were able to live and work normally with only a moderate disability, consisting of Raynaud's phenomenon during the cold season only.

Adult↗
PubMed1986

[Hemorrhagic vascular complications of pelvic fractures . The role of embolization. 9 cases].

Emergency haemostatic embolization of the branches of the hypogastric artery was performed within 24 hours in 9 patients with fracture of the pelvis and major progressive retroperitoneal haematoma. Eight to 48 units of blood had been transfused. The patient in the worst condition (48 units of blood) died of respiratory failure and myocardial incompetence 2 hours after embolization. In the remaining 8 patients, embolization was effective without any immediate or delayed complication of the angiographic procedure. The usefulness of emergency angiographic exploration and the possible applications of endovascular haemostasis are discussed.

Adolescent↗
PubMed1986

[Exposure of the retro-hepatic inferior vena cava by the left approach].

The suprarenal segment of the inferior cave can be exposed by sterno-laparotomy. By reclining the left and caudate lobes of the liver to the right, the left border of the retro-hepatic segment of the inferior vena cava is displayed. Duodeno-pancreatic separation gives access to its intra-hepatic segment. The entire suprarenal segment of the vein can thus be exposed, its lower portion only being barred by the hepatic vessels. Such wide exposure makes complete hepatic and caval vascular exclusion possible, as well as elective repair surgery of all lesions involving this segment.

Humans↗
PubMed1986

Aorto-femoral bypass with polytetrafluoroethylene prostheses: preliminary results in 363 cases.

From October 1977 to October 1982, 363 unilateral aorto-femoral bypasses using polytetrafluoroethylene (PTFE) prostheses were performed for predominantly unilateral aorto-iliac disease. The distal anastomosis was extended into the deep femoral artery in 57% of the patients. The postoperative mortality was 0.5%. The actuarial patency rate after 6 years was 87% in patients with claudication and 77% in those with critical ischemia. No false aneurysm developed. Thrombosis of the prosthesis was due to progression of distal disease, intimal hyperplasia and postural extrinsic compression. The latter seems to be characteristic of PTFE prostheses and can be treated by thrombectomy. In 21 cases a cross-over femoro-femoral bypass was done during the follow-up period because of contralateral progression of disease.

Adult↗
PubMed1986

[Interruption of the vena cava inferior. A comparative study of the Adams de Weese clip and the Kimray Greenfield filter].

Efficacy of two methods for interruption of inferior vena cava was compared after insertion of 95 Adams de Weese clips by the sub or trans-peritoneal route and of 72 Greenfield filters usually by a jugular approach. Introducing Greenfield's filter to produce caval interruption did not require modification of operative indications. In contrast, it allowed caval blockade to be performed in more elderly patients, generally in a poorer condition, at the price of higher mortality, due more to the clinical circumstances of the interruption rather than the caval blockade itself. Postoperative follow up showed fewer caval thromboses after Greenfield's filter (15%) than after the pericaval clip (35%).

Adult↗
PubMed1986

[Nonsurgical treatment of cystic lymphangioma].

Capillary lymphangiomas present of birth, and which have very little tendency to regress, must be distinguished from true cystic lymphangiomas developing after birth which are probably due to lymph blockade and are not true congenital malformations. This probably explains why the latter lesions regress either spontaneously or more rapidly after treatment with products such as Ethibloc. In the latter case, the efficacy of Ethibloc therapy appears to be equal to that of surgery without the formation of a scar and should therefore be tried initially before surgery.

Adolescent↗
PubMed1986

[Indications for revascularization of the distal cervical vertebral artery].

Since the development of the technique of revascularizing the vertebral artery in its transversal and suboccipital portions, 22 revascularisation procedures of the distal vertebral artery (above C2) have been carried out in 21 patients. The earliest cases have been followed up for more than 4 years and the technique has proved to be reliable, both from the clinical and anatomical points of view. The indications were based on restoration of the vertebral axis compromised by major lesions (stenosis: 2 cases, occlusion: 14 cases) of both vertebral arteries (13 cases) or of the dominant vertebral artery in symptomatic patients (3 cases). Surgery was also offered to preserve a vascular axis which had to be sacrificed for the treatment of potentially embolic disease (aneurysm or dissection: 3 cases) or hypervascular lesions (arteriovenous malformation, tumour: 2 cases). However, the indications for distal cervical vertebral artery revascularization should be carefully considered as it is impossible to evaluate the long-term tolerance of major vertebral arterial lesions.

Adolescent↗
PubMed1986

[Venous thrombectomy and caval interruptions].

Authors study the role of surgical treatment in the venous thrombo-embolic disease. At the moment, venous thrombectomy can be performed only in post-operative unilateral iliac thrombosis as well as in juxtarenal vena cava thrombosis (so as to enable a sub-nephric cava interruption) and finally to ilio-cava thrombosis. Vena cava interruptions can be performed either through a peri-cava clip, or by an intra-cava filter (the most efficient appears to be the K.R. Greenfield filter). Various advantages are thus studied. Vena cava interruptions are then discussed, according to clinical and angiographic data.

Filtration↗
PubMed1985

[Popliteal artery entrapment. Contribution of ultrasonography].

Ultrasounds contribute significantly to the diagnosis of popliteal artery entrapment. The haemodynamic data obtained by Doppler's velocimetry and the parietal and morphological data obtained by ultrasonography make it possible to proceed beyond a diagnosis of "presumption" based on clinical and arteriographic findings and to reach directly a positive diagnosis of entrapment, even in cases with arterial obstruction. Between December, 1979 and December, 1983, 12 cases of popliteal artery entrapment (5 of type I, 1 of type II and 6 of type III) were diagnosed by ultrasonic methods in 8 patients. In each of these patients the data thus obtained concerning the diagnosis, the type of lesion and the arterial complications were fully confirmed by a subsequent arteriography and at surgery.

Adult↗