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Biomedical subjects

E Kieffer

Publications and source records attributed to E Kieffer.

At least 127 records · Page 7Linked to original sources
PubMed1987

Traumatic rupture of the thoracoabdominal aorta.

We report a case of traumatic rupture of the thoracoabdominal aorta that was successfully repaired 3 days following the accident. Associated lesions included rupture of the left renal and celiac arteries. This rare lesion should be suspected in the victims of violent hyperextension of the body with or without a fracture of the dorsolumbar spine. Aortography is diagnostic. Whenever possible preoperative angiographic visualisation of the spinal cord arterial supply should be performed.

Adult↗
PubMed1987

Leiomyosarcoma of the inferior vena cava. Ultrasonographic appearance.

Ultrasonographic features of six leiomyosarcomas of the inferior vena cava are described. In most cases, the presentation is typical enough to strongly suggest the histologic diagnosis. The tumor is usually greater than 10 cm long, hypoechoic, heterogeneous. Cystic components can be found. It is sharply demarcated from neighboring organs which are displaced. The mass is located at the very place of the inferior vena cava, the lumen of which is no longer seen. It is fusiform shaped, surprisingly sparing the aorta. Differential diagnosis along with other radiologic examinations, pathologic findings, and prognosis are discussed.

Adult↗
PubMed1987

[Diffuse disease of elastic tissue and hyperphosphoremia].

Pseudoxanthoma elasticum (PXE) is exceptionally associated with abnormal phosphate-calcium metabolism. On the other hand, significant hyperphosphataemia is present in tumoral calcinosis, with an occasional elastopathy resembling that of PXE. We report here the first case of diffuse elastic tissue disease associated with hyperphosphataemia in the absence of tumoral calcinosis. The patient, a 29-year old Gabonese, had severe arteritis of the lower limbs with linear calcifications of the aorta and major arteries of the limbs. Angioid streaks and calcifications were present in the retinas. The skin appeared to be normal, but histological examination of specimens from flexures showed abnormalities of the elastic tissue with many fibres being broken into small pieces and curled up. In a morphometric study of cutaneous elastic tissue these abnormalities were compared with those observed in a PXE patient and with normal elastic tissue. The abnormalities in our patient and in the PXE patient were similar. Compared to normal elastic tissue, there was a slight decrease in the total number of oxytalan and elaunin fibres. The elastic fibres were distinctly wider, longer and separated from each other by smaller spaces, but not more numerous than normally. The histopathological appearance of an artery removed during bypass surgery was similar to that of a PXE artery. The hyperphosphataemia was due to an increase in tubular absorption of phosphates without abnormalities of parathyroid hormone, or resistance to its phosphaturic effect or any other tubular disorder. It was little altered by aluminium carbonate, and it partially decreased after addition of calcitonin.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

[Takayasu's disease. Value of digital intravenous angiography. 44 cases].

Forty-four patients with Takayasu's arteritis were explored by digital intravenous angiography either for diagnostic purposes and pre-therapeutic assessment (n = 29) or immediately after surgery (n = 15). There were 36 women, 6 men and 2 children; mean age was 31 years. The contrast medium (mean volume 140 ml) was injected into central (74%) or peripheral (26%) veins. No other angiographic exploration was contemplated in 24 patients selected for medical treatment. Among 15 patients destined to surgery or percutaneous angioplasty, 13 were operated upon without further angiography and 2 underwent arteriography since the distal vascular bed beyond the major lesions could not be evaluated adequately. Data obtained from post-operative evaluation (n = 15) were satisfactory, with 1 failure in this group. Digital intravenous angiography seems to be reliable enough to be used as first examination in patients with suspected Takayasu's arteritis. The procedure is well tolerated and can be repeated for optimum determination of the operation date. Arteriography can now be reserved to those rare cases where digital angiography has failed; it can then be limited to the study of a specific territory, the site of puncture being located by digital angiography.

Adolescent↗
PubMed1986

[Hemodynamic effect of the clamping of the carotid in the surgically treated coronary patient].

To determine both the incidence of myocardial ischaemia and haemodynamic response to carotid cross-clamping in coronary artery disease, 30 patients undergoing carotid endarterectomy were studied with a clear history of effort related disabling angina pectoris. Myocardial ischaemia was detected by a recording of lead CM5 of the electrocardiogram. A radial arterial and a thermodilution pulmonary catheter were inserted to obtain haemodynamic measurements before and after carotid cross-clamping and unclamping. Anaesthesia was induced with increments of thiopental, fentanyl 6 micrograms X kg-1 and pancuronium. Additional fentanyl (2 micrograms X kg-1) was injected before skin incision and before carotid cross-clamping. Carotid cross-clamping results in a significant increase in both mean arterial blood pressure and capillary wedge pressure. Two patients experienced myocardial ischaemia with ST segment depression during carotid cross-clamping. Nitroglycerin infusion led to the improvement of ST segment depression. When halothane was additionally administered to patients who developed hypertension in response to carotid cross-clamping, arterial blood pressure returned to normal value. These results indicate that carotid cross-clamping increases determinants of myocardial oxygen demand and may cause myocardial ischaemia in patients suffering from angina pectoris.

Aged↗
PubMed1986

Gunshot pellet embolus to the middle cerebral artery.

A 24-year-old man sustained a gunshot wound to the upper right hemithorax and neck, with injury to the subclavian and carotid arteries. A cerebral artery pellet embolus resulted in contralateral hemiplegia. The injured vessels were repaired, but the middle cerebral artery pellet was left undisturbed. Neurologic improvement occurred. Fifteen cases of foreign body embolus to cerebral vessels are reviewed and the management of this unusual injury is discussed.

Adult↗
PubMed1986

Exclusion-bypass for aneurysms of the descending thoracic and thoracoabdominal aorta.

From October 1973 to April 1985, 81 patients with aneurysms of the descending thoracic or thoracoabdominal aorta underwent surgery. Eight (10%) of these patients were treated by exclusion-bypass. The aneurysm was located in the descending aorta alone in five cases, and in the descending thoracic and thoracoabdominal aorta in three cases. In all cases, the proximal anastomosis of the bypass was performed on the ascending aorta. The site of the distal anastomosis was the supraceliac aorta in two cases, the infrarenal aorta in three cases and the iliac arteries in three other cases. Exclusion was bipolar, at each end of the aneurysm, in six cases, and unipolar, ie. proximal interruption only, in two cases. Two patients died during the first postoperative month, one of rupture of the distal portion of the aortic arch, the second, after onset of secondary paraplegia. There were no other spinal, cardiac or cerebral complications. One patient died three months postoperatively of intercurrent pulmonary infection. The five other surviving patients whose mean follow-up period is 48.1 +/- 25 months, are alive and enjoying good health. Resection and grafting as advocated by Crawford, is the usual treatment proposed for aneurysms of the descending thoracic and thoracoabdominal aorta. Exclusion-bypass may however be preferred in the following cases: elderly patients with compromised respiratory status, aneurysms of the descending thoracic aorta, either voluminous, of infectious origin or associated with aneurysm of the infrarenal abdominal aorta.

Adult↗
PubMed1986

[Digitized intravenous angiography in Takayasu's disease. Apropos of 44 cases].

Forty-four patients with Takayasu's disease were investigated by digitised intravenous angiography (DIVA) during a diagnostic and pretherapeutic work up (N = 29) or at surgery (N = 15); the aim of this retrospective study was to assess the role of DIVA in the investigation of this condition. The patients were 36 women, 6 men and 2 children; the average age was 31 years. The intravenous injections were performed in a central vein in 74% and in a peripheral vein in 26% of patients; the average amount of contrast medium injected was 140 ml per investigation (32 g of iodine %). Depending on the site of the lesions, the distribution of the 43 successfully investigated patients was as follows: Type I: 13 (20%), Type II: 6 (14%), Type III: 12 (28%), Type IV: 12 (28%). In the group of patients managed medically (N = 14) no other angiographic investigations were considered. In the group with an indication for surgery or percutaneous angioplasty (N = 15), the procedure was carried out without further angiography in 13 cases; in 2 patients the imaging of the distral vessels was inadequate and complementary angiography was required. All postoperative controls (N = 15) but one were satisfactory. These results show that DIVA is sufficiently reliable for it to be considered as an investigation of first intent in patients with suspected Takayasu's disease. The investigation is well tolerated and can be repeated when necessary to determine the optimal time for surgery. Arterial angiography should seem only to be indicated when the venous approach has failed, which was rare in this series.

Adolescent↗
PubMed1986

Intravenous digital subtraction angiography in Takayasu's disease. A report of 32 cases.

IVDSA appears to be a reliable method and should therefore be considered as a first step examination when Takayasu's disease is suspected. The simplicity and safety of the method provide a rationale for the use of this technique in Takayasu's disease. Therapeutic decisions can usually be obtained without further radiological investigation, and conventional arteriography has to be performed only when data obtained with IVDSA are insufficient. In these rare cases, conventional arteriography aims at the investigation of a particular area. The site of arterial puncture can be precisely guided by IVDSA.

Adolescent↗
PubMed1986

Roles of fentanyl and nitroglycerin in prevention of myocardial ischemia associated with laryngoscopy and tracheal intubation in patients undergoing operations of short duration.

The purpose of this study was to evaluate intravenous nitroglycerin given during induction of anesthesia as a means for prevention of myocardial ischemia and hemodynamic changes associated with induction, laryngoscopy, and intubation, in patients with stable angina scheduled for vascular operations of moderate duration. Forty-six patients were randomly assigned to receive either fentanyl, 3 micrograms/kg (group 1, n = 6), fentanyl, 8 micrograms/kg (group 2, n = 20), or fentanyl 3 micrograms/kg plus a continuous intravenous nitroglycerin infusion, 0.9 microgram X kg-1 X min-1 (group 3, n = 20), in addition to thiopental-pancuronium anesthetic induction, prior to laryngoscopy and intubation. The criteria for recognizing myocardial ischemia were the following: horizontal or downsloping ST segment depression equal to or greater than 1 mV, and/or ventricular arrhythmia, on CM5 recording. In group 1, myocardial ischemia occurred during laryngoscopy and intubation in four patients, and mean blood pressure (MBP), heart rate, and mean pulmonary wedge pressure (PCWP) increased significantly (P less than 0.05). Despite greater stability in MBP and heart rate in group 2, myocardial ischemia still occurred in four patients (not significantly different from group 1). Nitroglycerin added to low-dose fentanyl (group 3) produced significant reduction in myocardial ischemia (1/20) when compared with group 1 (P less than 0.01), and significantly greater stability in PCWP during laryngoscopy and intubation in comparison to groups 1 and 2. In patients with stable angina undergoing operations of short duration, the use of nitroglycerin infusion and low-dose fentanyl significantly decreases the incidence of myocardial ischemia associated with induction of anesthesia and tracheal intubation.

Aged↗
PubMed1986

[Leiomyosarcomas of the inferior vena cava].

Leiomyosarcoma of the inferior vena cava in a rare tumor which is predominantly seen in women. The symptomatology is non specific and depends mostly of the segment of the vessel which is involved. Radiologic approach for correct preoperative diagnosis is based on ultrasonography, computed tomography and inferior vena cavography. The best treatment is en bloc resection of the mass associated with pre and post-operative chemotherapy. Although the tumor is slow-growing, the prognosis is poor and the average survival is less than two years, due to local recurrence and metastases.

Diagnosis, Differential↗
PubMed1985

[Current status of the surgery of carotid stenoses].

In a series of 472 operations performed in 420 patients between 1981 and 1982, the mortality rate was 1.1% in asymptomatic patients (stage 0) and 2.1% in patients with transient ischaemic attacks (stage I) or with minor neurological sequelae (stage III). The morbidity rate of serious sequelae was 1.05%. The long term mortality is 30% at 5 years and 50% at 10 years, in most of the major statistical studies. The major cause of death (more than 50%) is myocardial infarction. The study of the local evolution of the operated artery reveals that about 10% of the patients who survived between 5 to 10 years had a recurrent carotid artery stenosis. Comparative studies of the course of the atherosclerotic disease operated patients and in patients treated medically are difficult to evaluate. However, most authors agree with Fields that an operation is justified in asymptomatic patients and in those presenting transient ischaemic attacks, provided the mortality and morbidity rate is less than 3%. Finally, recent studies stress the value of non-invasive investigations for determining the prognosis of tight stenoses: in asymptomatic patients with tight stenoses, the risk of a cerebrovascular accident is 5 times greater than in patients with a minor stenosis.

Arteriosclerosis↗
PubMed1984

[Inferior caval syndromes. Apropos of 45 cases].

The authors report their experience with 45 cases of inferior vena cava thrombosis. Diagnosis was delayed for an average of 55 days. One-third of cases were revealed by an embolic complication. Inflammatory diseases were the most common causes (Behcet disease: seven cases, systemic lupus erythematosus: 5 cases). Malignancies accounted for 20% of cases. Abnormalities of coagulation were uncommon: antithrombin III deficiency in one patient and protein C deficiency in another. Estrogen-progestogen combinations could be incriminated in 4 cases. Outcome was fatal in 20% of cases, usually as a result of the underlying disease. Functional status was good in two-thirds of patients without malignancy followed up for an average of 27 months. In 14 patients a clip was inserted to ensure total (3 cases) or partial (11 cases) interruption of vena cava blood flow because of a free thrombus and/or recurrent pulmonary embolism. Three patients had thrombectomy. After clip insertion two embolisms were recorded, one of which occurred in the immediate post-operative period.

Adolescent↗