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Biomedical subjects

E Bastounis

Publications and source records attributed to E Bastounis.

At least 55 records · Page 3Linked to original sources
PubMed1997

Anomalous inferior vena cava complicating abdominal aortic aneurysmectomy.

Variations in the site and course of the inferior vena cava (IVC), although relatively infrequent, can have important surgical implications, especially during surgery for abdominal aortic aneurysm. We report two cases of left-sided IVC encountered during aneurysmectomy. In both cases, the anomaly was not detected during preoperative ultrasound examination, but was identified by CT scan in one case. Careful mobilization of the IVC and left iliac vein allow retraction of the IVC to the right, after which the aneurysm can be approached in the usual manner.

Aged↗
PubMed1997

Secondary aortoduodenal fistulae.

Secondary aortoenteric fistula (SAF) is a rare but fatal complication of reconstructive aortoiliac surgery. The prevention, diagnosis and treatment of this complication remains a challenging problem in everyday practice. Nine cases of secondary aortoduodenal fistulae during the period of 1980 to 1992 are presented. Their main symptom was bleeding of the upper gastrointestinal tract. The mean time interval since the aortic surgical procedure was 32 months. Removal of the old graft and closure of the duodenal defect was the first stage of the operative procedure. One patient underwent replacement of the old graft, with a new graft, while in the remaining three patients extranatomical bypass was not necessary because of satisfactory circulation in the lower extremities. In five patients extranatomical revascularization of the lower limbs was performed postoperatively at various intervals. Three patients died postoperatively. Follow-up of the remaining patients ranged from one month to 8 years. Bleeding of the upper gastrointestinal tract in patients with a history of intrabdominal reconstructive vascular surgery must raise severe suspicion as to the certainty of existance of SAF unless the diagnostic procedure, mainly exploratory laparotomy, excludes this possibility.

Aged↗
PubMed1997

Benefits of early thymectomy in patients with myasthenia gravis.

OBJECTIVE: To report our experience of early thymectomy in patients with myasthenia gravis. DESIGN: Retrospective study. SETTING: University department of surgery, Greece. SUBJECTS: 76 Patients with myasthenia gravis. INTERVENTIONS: Transcervical thymectomy in all cases, additional left thoracotomy in four cases. MAIN OUTCOME MEASURES: Mortality, morbidity, and early (6 months) and late (mean follow-up 4.8 years) response to thymectomy. RESULTS: 20 Patients had thymomas (26%). There was no postoperative mortality; morbidity was 11% (n = 8). There was complete remission in 19 (25%), improvement in 49 (65%) no change in 7 (9%), and impairment in 1 (1%) of the patients at 6 months. Patients who had had symptoms for less than 5 years (p < 0.001), were in an earlier stage of disease (p = 0.006), and who did not have thymomas (p = 0.006) responded better. 3 Patients died of invasive thymoma at 2 1/2, 3, and 5 1/2 years postoperatively and 25/76 (33%) were lost to follow-up. Of the 51 patients available for late follow-up, 19 (37%) were in remission, in 26 (51%) the symptoms had improved, 3 (6%) were unchanged, and 3 (6%) had died of the disease. CONCLUSIONS: Transcervical thymectomy should be considered in patients with early myasthenia gravis.

Adult↗
PubMed1996

The validity of current vascular imaging methods in the evaluation of aortic anastomotic aneurysms developing after abdominal aortic aneurysm repair.

The aim of this cross-sectional study was to evaluate the validity of current imaging methods for diagnosing anastomotic false aneurysms (AFA) of the aorta. One hundred four patients who had undergone elective abdominal aortic aneurysm repair between January 1, 1985, and May 31, 1991, were studied. All of them were investigated for potential development of an aortic anastomotic aneurysm by B-mode ultrasonography, CT scanning, digital subtraction arteriography, and MRI. These findings were compared with results of color-coded Doppler imaging, which is considered the "gold standard," and were subsequently classified as true positive or true negative. The accuracy of color Doppler ultrasound was independently evaluated by clinical examination of the patients, which was carried out for a mean period of 77.5 months during follow-up. On the basis of the data obtained and observations made during follow-up (mean 36.4 months), the sensitivity and specificity of the preceding imaging methods were estimated. Aortic anastomotic aneurysms were detected in two patients (1.9%). The sensitivity of all methods was 100% and specificity was as follows: 74.2% for ultrasound, 59.8% for nonenhanced CT scans, 85.4% for enhanced CT scans, and 99% for digital subtraction arteriograms. Color Doppler and MRI were 100% specific for ruling out aortic anastomotic aneurysms. In a comparison of the accuracy, estimated cost, safety, and the availability of each method, color Doppler appeared to be the diagnostic method of choice for identifying aortic anastomotic aneurysms after abdominal aortic aneurysm repair.

Aged↗
PubMed1996

Hydatid disease: a rare cause of adrenal cyst.

A case of hydatid cyst in the adrenal gland is presented. Eight cases have been previously reported. The diagnosis of an adrenal cyst is usually incidental, and the diagnosis of hydatid cyst is seldom made preoperatively. Surgical excision of the gland including the cyst is the treatment of choice.

Adrenal Gland Diseases↗
PubMed1996

Three-dimensional time-of-flight MR angiography and MR imaging versus conventional angiography in carotid artery dissections.

A retrospective analysis comparing the three-dimensional time-of-flight MR angiography, MR imaging and transfemoral digital substraction angiography (DSA) in cases of carotid artery dissection was made. During a 2-year period, 12 cases (11 males and 1 female), aged between 16 and 60 years, were submitted to our Hospital with the symptoms of TIA, stroke or cranial nerve palsies and the suspicion of carotid dissection. Transfemoral angiograms were done in other Institutions, while the MRI and MRA were performed in our diagnostic center. Blind interpretation of MR and angiography images was made by two independent radiologists. MR angiography in combination with MR imaging was more accurate than conventional angiography in the diagnosis of carotid artery dissection. Respective sensitivity and specificity were 100% and 100% for MRI with MRA and 91.6% and 100% for conventional angiography. From the analysis of this small series, we can conclude that MR angiography in combination with MR imaging is a reliable noninvasive method for use in diagnosis of extracranial internal carotid artery dissection.

Adolescent↗
PubMed1996

Acute arterial thrombosis of the lower extremities due to prolonged intestinal obstruction.

A case of a female patient who was admitted urgently with intestinal obstruction, peripheral shock, hypovolemia and acute ischemia of the lower extremities is presented. The ischemia of the lower extremities had developed due to low cardiac output following extensive dehydration caused by a prolonged intestinal obstruction from a cholelith. Although this pathogenetic mechanism of acute ischemia of the lower extremities is well known, this characteristic case is, nevertheless, presented to alert the clinician of this situation.

Acute Disease↗
PubMed1995

Abdominal aortic aneurysm and left sided inferior vena cava. A case report.

The co-existence of abnormalities of the inferior vena cava (IVC) and abdominal aortic aneurysm (AAA) is a rare condition but with surgical significance. With the development of various imaging technics and the routine use of computerized tomography for the examination of the abdomen and/or the investigation of AAA these venous abnormalities can be disclosed. A male patient with AAA and left sided IVC is presented.

Aged↗
PubMed1995

Mesenteric venous thrombosis due to coagulation deficiencies - a case report.

Mesenteric venous thrombosis is a rather rare condition posing diagnostic problems and very often with an obscure etiology. Recently, various coagulation deficiencies were found as the main etiologic factor. A case of a 75-year-old man with acute abdomen is presented. Exploratory laparotomy revealed a 250 cm necrosis of the small intestine. Patient was successfully treated by resecting the entire involved segment of the bowel. After a complete coagulation profile examination, deficiencies of protein C and anti-thrombin III were found and were considered as the main cause of the disease. In cases with known coagulation deficiencies the presence of an acute abdomen should raise suspicion of mesenteric venous thrombosis.

Abdomen, Acute↗
PubMed1994

Free radical related myocardial mitochondrial damage following limb ischaemia-reperfusion.

OBJECTIVE: The aim was to define the following: (1) if reperfusion of ischaemic limbs could cause myocardial damage; (2) if reactive oxygen metabolites are involved in such possible damage. METHODS: Ten rats underwent ischaemia-reperfusion of the lower limbs (group A) and 10 underwent the same procedure following treatment with ascorbic acid (group B). Ten rats were used as a control group (group C). RESULTS: The incidence of severe myocardial mitochondrial damage and serum malondialdehyde concentrations 30 min after reperfusion were both higher in group A than in groups B and C [8/10, 2/10, and 0/10, p < 0.05 and 7.25 (SEM 0.33), 5.30(0.26), and 4.89(0.23) mumol.litre-1, p < 0.05, respectively]. CONCLUSIONS: Ischaemia-reperfusion of the lower limbs may cause mitochondrial damage in the myocardium and reactive oxygen metabolites could mediate this damage.

Animals↗
PubMed1994

Obstructive uropathy, following redo aortobifemoral by-pass surgery.

A rare case of obstruction of the right ureter due to encagement between the right iliofemoral and right limb of an aorto-bilateral femoral Dacron graft is described. Patient was managed successfully by ureterolysis, removal of the occluded right iliofemoral graft, omentoplasty and placement of a pig tail catheter along the right ureter.

Aorta, Abdominal↗
PubMed1994

Arterial aneurysms in Behçet's disease.

Six cases of arterial aneurysms, due to "Behçet's disease" located in various arteries are presented. Surgical reconstruction included: Resection of the lesions and replacement with corresponding grafts with satisfactory results. In spite of the macroscopic similarity of the aneurysms found in "Behçet's disease" as compared to those of mycotic origin, the presence of any microorganism could not be detected in various cultures or pathological specimens. Meticulous diagnosis on the nature of the aneurysm, close follow-up and careful postoperative anticoagulant treatment, is imperative for satisfactory immediate and late results.

Adult↗
PubMed1993

Axillodistal bypass on critical limb ischaemia.

The axillodistal extra anatomic bypass is not an operation commonly performed and the only reason for performing it is to attempt limb salvage for a reasonable period of time or until death in patients with critical ischaemia. During the period 1983-1991 we performed 67 such bypasses where no other form of reconstructive arterial surgery was feasible. There were 27 axillopopliteal (15 below and 12 above the knee), five crossover, seven bilateral, 11 axillotibial and 17 jump (sequential bypasses). The first 34 procedures (1983-1987, early period) had a 5-year cumulative secondary graft patency of 20%, which increased to 33% for the 33 bypasses performed during the second period (1987-1991). The primary graft patency of the 67 bypasses was 13%. Our clinical results show that even in these patients with diffuse occlusive arterial lesions, limb salvage is possible in a reasonable number even when axillodistal bypass is used. Improvements in the technique, better selection of patients, the performance of jump grafts and the aggressive treatment of early and late graft occlusions have led to much better results being achieved.

Adult↗
PubMed1993

Acute abdominal aorta embolism caused by primary cardiac echinococcus cyst.

Embolism of the abdominal aorta by an echinococcus cyst is extremely rare and is due to rupture of an intracardiac hydatid cyst. We report a case of abdominal aortic embolism by a primary intracardiac echinococcus cyst which was treated successfully with bilateral femoral embolectomy followed by direct aortotomy. We found only 16 previous cases reported and only one caused by a primary cyst.

Acute Disease↗
PubMed1993

Acute type A dissecting aortic aneurysm requiring emergency arch replacement.

The intimal disruption is located or extends to the aortic arch in 10-20% of acute type A aortic dissections. Multiple tears are extremely rare. The reported mortality rate of emergency arch replacement varies from 25% to 40%, and therefore many surgeons elect to perform ascending aortic replacement only in these cases. However, with such an approach, the operative mortality rate of 10% is followed by a late mortality rate of up to 30% from residual aneurysm formation. Emergency arch replacement was carried out in five of 14 patients with an acute type A aortic dissection in whom the intimal tear either originated or extended into the arch, or in whom multiple tears existed. The ascending dissections were resected under moderate hypothermia, whereas the arch was explored under profound hypothermia, surface cooling and circulatory arrest. None of these five patients died; one developed slight hemiparesis, but no patient developed recurrent aneurysm in the follow-up period. These results appear to justify this aggressive approach, if it can be performed with an acceptable mortality rate < 25%, by avoiding the late deaths associated with more conservative surgical treatment.

Adolescent↗
PubMed1992

Unresolved pulmonary embolism: the value of surgical management with extensive thrombo-endarterectomy.

In a small but definite number of patients with pulmonary embolism, either gradual resolution of the embolus does not occur or recurrent showers of emboli follow the acute onset, leading to a state of chronic pulmonary hypertension. Two new cases treated surgically without the use of cardiopulmonary bypass are described. The results were excellent in both cases with relief of the dyspnoea and an improvement in the PO2, a result that has been documented in the follow-up of 2-6 years. The only definite treatment of this chronic obstructive pulmonary hypertension is pulmonary thrombo-endarterectomy.

Chronic Disease↗
PubMed1990

[Reconstruction of the femoro-popliteal vessels: indications and late results].

The authors analyse the existing indications for forming a femoropopliteal shunt and its late-term results. Critical ischemia with pains at rest or trophic changes, e.g. ulcers or gangrene, are absolute indications. The nature of the graft as such is the most important factor influencing the late-term results. The indications, the arteriographic findings, the region of the anastomosis, and operations performed on the femoropopliteal vessels earlier have a marked effect on the late-term results, particularly if synthetic prostheses are applied. The results obtained show that further investigations are necessary with careful recording of the variants for better understanding of the role of femoropopliteal shunting as palliative treatment of atherosclerotic occluding lesions of the inferior inguinal region.

Arterial Occlusive Diseases↗