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Biomedical subjects

E Kieffer

Publications and source records attributed to E Kieffer.

At least 199 records · Page 11Linked to original sources
PubMedDate not supplied

[Arterial manifestations of Behçet's disease. 12 cases].

Out of 196 patients with Behçet's disease, 12 (10 men and 2 women, mean age 34 +/- 7 years) had non-coronary arterial lesions. Behçet's disease was complete in 4 patients. The arterial lesions had appeared 8.6 +/- 8 years on average (20 years at most) after the first sign of the disease. Three patients showed evidence of stenosis or occlusion involving one or several arteries. Eight patients had both stenotic and aneurysmal lesions. One patient had an arteriovenous fistula. Another developed a false aneurysm at the site of introduction of a femoral catheter. Yet another patient developed an anastomotic aneurysm one year after implantation of an abdominal aortic graft. In 2 cases histology showed fragmentation of the media associated with vasculitis of the vasa vasorum. Two patients with pulmonary aneurysm died of massive haemoptysis. In 2 patients combined corticosteroid and cyclophosphamide therapy failed to prevent the development of aneurysmal lesions. Phlebitis was associated with arterial involvement in 7 patients. Comparison between patients with or without arterial lesions showed no significant difference in time of onset of Behçet's disease, sex, main clinical features and presence of HLA B5. Aneurysmal lesions respond poorly to medical treatment, and surgery is mandatory. Since recurrence at the site of anastomosis is possible, prolonged monitoring is required.

Adult↗
PubMedDate not supplied

Maternal nativity status and pregnancy outcome among U.S.-born Filipinos.

Using 1979-87 Hawaii vital record data on single live births, this study compares by nativity status of the mother the maternal characteristics and pregnancy outcomes of resident Filipino women. Among ethnic minorities in the United States, the pregnancy outcomes of U.S.-born mothers have been reported to compare unfavorably to their foreign-born counterparts. In this study, unequivocally preferential pregnancy outcome indicators were not observed for foreign-born women. Contrary to expectations, a significant, but modest, increase in the risk of preterm delivery was found for infants of Philippines-born mothers, along with a less favorable mean birth weight and gestational age. As a growing minority population in the United States, the atypical determinants and patterns of pregnancy outcome in this population warrants further investigation.

Adolescent↗
PubMedDate not supplied

Pathophysiologic study of chronic infarcts with I-123 isopropyl iodo-amphetamine (IMP): the importance of periinfarct area.

Seventeen chronic cerebral infarcts were investigated by a highly sensitive, dedicated brain single photon emission computerized tomography system using 123I-isopropyl iodoamphetamine (IMP) and 133Xe. IMP uptake was measured 10 minutes, 2 hours, and 5 hours after injection, and regional cerebral blood flow was measured with 133Xe. In 4 cases a positron emission tomography system was used to measure the rCBF and the regional metabolic rate of oxygen with C15O2 and 15O2. The results obtained allowed us to identify 2 abnormal zones. One, the "central area," was characterized by a severe decrease in IMP uptake and rCBF averaging 34% and 46% respectively and by a hypodense image on the x-ray computerized tomography scan. The second, the periinfarct or "peripheral area" was characterized by a moderate decrease in IMP uptake and regional cerebral blood flow averaging 13 and 19% respectively; this area extended around the central area and had a normal density on computerized tomography scan. The IMP hypofixation of the peripheral area observed at the 10th minute tended to disappear at the 5th hour. The volume of this area was often found to be quite large, covering more than 30% of a hemisphere whereas the central area did not exceed 25%. Volume appeared to be correlated with the neurological status of the patient. The nature of the peripheral area is not established with certainty. It may be caused by deafferentation of areas not directly affected by the ischemic insult and/or selective ischemic neuronal loss. The results stress the important role played by the peripheral area, which may be useful in establishing the prognosis and evaluating the efficacy of therapy in individual stroke cases.

Adult↗
PubMedDate not supplied

Fractures of the clavicle and injuries of the sub-clavian artery. Report of 10 cases.

During four years, the authors have observed ten lesions of the sub-clavian artery associated with a fracture of the clavicle. The clinical picture in one case out of two was that of an acute ischemia of the upper limb. The surgical repair has been performed in 8 cases. The thoracic approach was necessary three times. The clavicle was resected in most cases. The prognosis of these lesions depends on the rapidity of their recognition, and of their treatment, and on the fact whether the brachial plexus is involved or not

Accidents, Traffic↗
PubMedDate not supplied

[Chances of avoiding amputation in an arteritis patient with gangrene].

During the period 1970-1974, restorative surgery was carried out 324 times in patients with gangrene or severe ischaemia caused by arteritis of the lower limbs. In 67 percent of the cases major excision surgery, such as amputation at the thigh or of the whole leg, was avoided and the support was retained. In 61 cases (19 percent) amputation was necessary either immediately or within a few weeks or months. Death occurred in 47 patients (14 percent) either in the operative period or in the 3 following years.

Amputation, Surgical↗
PubMedDate not supplied

Area-level predictors of use of prenatal care in diverse populations.

Patterns and predictors of the use of prenatal care in Hawaii were examined by census tract, taking into account summary measures of socioeconomic status, environmental conditions, and aggregated indicators of pregnancy-related risk characteristics of mothers. The objectives of the study were to identify those census tracts with high levels of inadequate use of prenatal care services; to develop a model, based on census tract characteristics, to explain observed geographic variations in the use of prenatal care services; and to identify for further investigation specific localities with unanticipated patterns of use. Data were drawn from 1980 census reports and vital statistics live birth files for the period 1979-87. Regression analysis was used to develop a model that was able to predict 61 percent of the census tract variation in the percentages of inadequate use of prenatal care services. Increased proportions of mothers of Japanese and other Asian-descent and of adults with more than high school education were associated with low levels of inadequate use of prenatal care services. Increased proportions of high parity-for-age risk and Samoan mothers were associated with higher levels of inadequate use. Census tract maps of actual and predicted percentages and studentized residual values were used to identify areas with high and low rates of inadequate use of prenatal care services. The area-level methods used are believed applicable to health care planning in other areas with ethnically or socioculturally diverse populations.

Demography↗
PubMedDate not supplied

"Redo" surgery for late aorto-femoral graft occlusive failures.

Experience of late failures of Dacron aortofemoral grafts is presented; about 70 cases observed during the past eight years on whom 105 subsequent operations were performed. One third of these patients were first operated upon by another surgical team. During the same period, 850 patients were submitted to reconstructive surgery of the abdominal aorta and iliac arteries either for atherosclerotic or for aneurysmal disease. It appears that conservative procedures like thrombectomy of the occluded limb are often insufficient, impossible, inappropriate or dangerous, even after restoration of a good deep femoral outflow. On the other hand, aggressive restoration of limbflow is generally necessary, with other various and ingenious direct or indirect reconstructive techniques for restitution of a good inflow and outflow. These techniques are usually successful (85%) and gain time against the major etiology of these late failures viz the development of atherosclerotic disease.

Aged↗
PubMedDate not supplied

[Leiomyosarcoma of the inferior vena cava (author's transl)].

A further case of leiomyosarcoma of the inferior vena cava is described, bringing the total number reported in the published literature to 63. The tumor was located in the inter-renal segment of the vena cava, and was effectively removed by excision combined with venous reconstruction, enabling conservation of the renal veins. These malignant tumors occur more frequently in women, and their symptomatology varies according to their location in either the upper, middle or lower area of the inferior vena cava. Upper segment tumors are revealed by a Budd-Chiari syndrome or obstruction of the right atrium and are usually rapidly fatal. Middle and lower segment tumors can be treated surgically, if diagnosis is made early enough and cavography is conducted.

Budd-Chiari Syndrome↗
PubMedDate not supplied

[Peroperative vascular accidents during orthopedic surgery. Apropos of 55 cases].

The functional or vital prognosis may be affected by the rare vascular accidents resulting from orthopedic operations. During a 10 year period (1970-1980), 55 vascular lesions were observed in 40 patients, and were either arterial (40 cases) or venous (15 cases) in type. Vascular injuries in 9 cases were due to spinal operations (cervical, lumbosacral or herniated disc arthrodesis), in 7 cases to shoulder operations (recurrent dislocation, excision of first rib), in 9 cases to hip surgery (prosthesis, plate and screws, fractured acetabulum), and in 15 cases to operations on the lower limbs (osteosynthesis of femur or tibia, meniscus operations, etc.). Emergency operation was necessary in 18 cases because of a hemorrhagic or ischemic syndrome, all other cases except three requiring secondary surgery for false aneurysms, arteriovenous fistulae, or residual ischemia. Four patients (10%) died, three following hip surgery, and 8 developed complications. The frequency, mechanism, diagnostic and therapy of these lesions are discussed.

Adolescent↗
PubMedDate not supplied

Arteriovenous fistulae of the internal iliac vessels.

Seven patients with arteriovenous fistulae of the internal iliac artery are reported. Ages varied from 6 to 50 years (mean 32 years). Cutaneous angiomata , leg oedema and pain was present in 4 cases each, bleeding in 2 cases whilst only one was asymptomatic. Only 1 patient had cardiac insufficiency. In six patients the lesion was a congenital malformation but in one it was posttraumatic. Arteriography both global and selective, intravenous pyelography and cardiac output are routine. Recently, pelvic computerised tomography has been most helpful. Embolization is recommended in all cases with surgery within 24 hours unless the lesion is very extensive and considered to be inoperable. Repeat embolization is used for recurrence or very extensive lesions. Results were good in five patients; in two patients the results were clinically good but control angiograms showed a recurrence.

Adult↗
PubMedDate not supplied

[Axillary-femoral by passes. Technic. Complications. Results (92 patients) (author's transl)].

Between January 1970 and October 1977, 95 operations of revascularisation of 124 lower limbs were carried out using the axillary artery in 92 patients. 84 patients had very severe ischemia, acute or chronic, which threatened the survival of the limb. In all, direct surgery was too dangerous (77 cases) or impossible owing to local or regional problems (7 cases). The results gave a mortality during the first two months of 13% in which infective complications of the technic accounted for 3.5%. The latter were frequent (12%) but a certain number of them could have been prevented (6%). 55 patients (65%) had a good result at two months (weight-bearing conserved) whilst 20%, i.e. 18 patients were amputated, of which five had a permeable by pass which permitted conservation of the knee. We observed the highest percentage of deaths (3/8 i.e. 37%) in bilateral emergency revascularisations for acute ischemia. We observed a very low percentage of early thrombosis (4%) in axillary bifemoral by pass performed for chronic ischemia. The operation is of great value when no other direct surgical technic is possible and only in these cases. 8 patients underwent an axillary by pass to treat infective complications of aorto-iliac surgery. 4 early deaths showed the severity of this complication (50%). Tactical aspects are discussed briefly.

Aged↗
PubMedDate not supplied

Carotid artery surgery in patients over 70 years of age.

Between 1965 and 1979, 934 patients underwent 1,057 operations for extracranial carotid stenosis at this institute, and over a recent 30-month period 463 patients underwent 511 operations of this type. This number is equal to the total of operations performed during the years 1965-1976. The increase in the frequency of carotid artery surgery has been more marked in patients of over 70 years. The percentage of elderly patients has increased from 17.5% to 27% in the recent period. In the latter group of 511 operations, results were good in 93.17% of cases, while there was a mortality rate of 1.95% (1% of which were directly related to the surgery), in 1.95% the neurologic condition deteriorated and in 3.13% there was no change. In the first period the mortality rate for patients over 70 years of age was 7.69%. In the second it was 3.27% (1.63% of which were due to non-neurologic causes), 4.09% deteriorated, in 2.18% there was no change and good results were obtained in 90.46%.

Aged↗