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Biomedical subjects

E Kieffer

Publications and source records attributed to E Kieffer.

At least 145 records · Page 8Linked to original sources
PubMed1984

[Coronary involvement in Takayasu's disease. Apropos of 3 cases, of which 2 were surgically treated, and review of the literature].

Coronary arteries like other branches of the aorta may be involved in Takayasu's disease. This complication is not rare (7% of cases) but appears to be relatively unappreciated. Three new cases are reported of main coronary artery disease, two of which were treated by coronary bypass surgery. A review of the literature of 1 130 cases of Takayasu's disease revealed 86 cases with coronary involvement, 33 of which were confirmed anatomically and 15 by coronary arteriography. The clinical manifestations, angina and/or myocardial infarction, were present in 5% and 3% respectively, of patients with Takayasu's disease. They may be the first sign of the disease and, in some cases, the only symptomatic arterial localisation. The coronary lesions are either ostial, a direct complication of the aortic disease, or on a main vessel, usually proximal. Histological studies show typical changes of stenosing inflammatory panarteritis involving mainly the media and adventitia. Thrombosis and secondary atheromatous plaques may be observed. Aneurysms are rare. Apart from cases with typical ostial lesions, the coronary angiographic appearances are not specific, but some features are suggestive of the diagnosis; the occurrence in young women; the presence of associated peripheral arterial lesions, their localisation and grouping; their radiological and/or histological characteristics. The spontaneous prognosis of these proximal lesions is usually poor and justifies surgical revascularisation by coronary bypass. Six patients, including two in this series, have been treated surgically. The associated aortic lesions may pose special technical problems which we discussed. The relatively high incidence of coronary involvement in Takayasu's disease and its often unexpected revelation by myocardial infarction or sudden death, suggest that coronary arteriography should be undertaken more often during investigation of the arterial lesions of these patients. Takayasu's disease should figure prominently amongst the causes of coronary artery disease in young women.

Adolescent↗
PubMed1984

[Injuries to abdominal vessels after surgery of disk herniation].

Four cases of major vascular injury after disc surgery have been treated by the authors. In two instances the symptoms were those of an intra peritoneal haemorrhage after injury to the aorta or to the common iliac artery. These two cases were treated by resection-anastomosis of the vessel. In the two other cases, a fistula developed between the common iliac artery and the inferior vena cava or between the common iliac artery and the common iliac vein. Both lesions were also repaired two days and 10 days after disc surgery. A review of the literature has shown that these lesions are more frequent after surgery at L4-L5 level than at L5-S1 level. They are more frequent after repeated operation. They should be looked for when a fall in blood pressure is noted at the end of the surgical procedure. The published mortality is about 80 p. 100 in vessel division and 10 p. 100 after arterio venus fistula. The earlier the diagnosis is made, the higher is the proportion of healing.

Adult↗
PubMed1984

[Persistent sciatic artery. Apropos of a case, review of the literature ].

A case is reported of bilateral persisting sciatic arteries: complete on the right side but incomplete on the left, revealed by the onset of a distal embolism on the right side treated by exclusion and a right femoropopliteal shunt operation. The observation of this further case in France led to a review of the literature which demonstrated the rarity of this congenital anomaly, which usually however represents the only vascular axis to the lower limb, and the frequency of aneurysmal transformations with subsequent complications that are best treated by ligature combined with a femoropopliteal shunt.

Adult↗
PubMed1983

[Arterial injuries in civilian practice].

The authors report their experience of arterial trauma in civilian life in a series of 227 patients (average age 38.2 years) with 233 arterial lesions, treated between 1977 and 1981. Iatrogenic trauma is responsible for 45 p. 100 of cases, the remainder (55 p. 100) being due to road traffic and industrial accidents (29 p. 100), projectiles (16 p. 100) and knife wounds (10 p. 100). 40 p. 100 of patients were seen within 24 h, 30 p. 100 between 24 h and 8 days, and 30 p. 100 over 8 days after the initial trauma. Arteries of the limbs were involved in 61 p. 100 of cases, of the neck in 11 p. 100 of cases and of the trunk in 28 p. 100 of cases. All patients were operated upon, 18 died (7.7 p. 100) and 16 had to undergo amputation (6.8 p. 100). The authors emphasize firstly the serious nature of trauma to the great vessels which is life-threatening and to the popliteal arteries which threatens the functional prognosis, and secondly, the necessity of early diagnosis and treatment.

Accidents↗
PubMed1982

[Leiomyosarcoma of inferior vena cava. A new case. Surgical management (author's transl)].

The authors report on a new case of leiomyosarcoma of the inferior vena cava, to add to the sixty five cases already mentioned in the literature. The patient had been suffering from subcostal pains for 12 years, and an adenomyoma of the gall bladder was diagnosed. The tumor was discovered in the course of a cholecystectomy. The vena cava was resected and ligated below the renal veins. After describing the case, the authors go on to review the literature and stress the fact that the prognosis, which is often severe, could be improved by earlier diagnosis.

Diagnosis, Differential↗
PubMed1982

[Myocardial ischemia and carotid surgery. Holter study of 21 severe coronary patients. Preventive effect of intravenous trinitrin].

Cervical carotid artery surgery is increasingly being performed in elderly, polyvascular, high risk patients, some of whom have severe coronary artery disease. Is this right? The effects of this almost routine surgical procedure from the technical point of view were analysed with respect to the coronary lesions. 1. A retrospective study of coronary events occurring in the peroperative or immediate postoperative period and at short term was carried out in 367 patients aged over 70 years old (average 73,4 years) undergoing 424 cervical carotid artery procedures with a particularly high coronary risk. 2. A prospective study of ischemic ECG changes occurring in the period between induction of anaesthesia and the 4th postoperative day was performed by Holter monitoring in 21 patients with severe coronary artery disease. The mortality and morbidity observed were very low and could be further reduced by certain anaesthetic and pre-and postoperative techniques. In particular, prophylactic intravenous trinitrin (0,5 to 1,5 gamma kg/min) was most effective in protecting the myocardium in 15 patients with severe angina (classes III and IV of the NYHA classification). The authors conclude that the surgical result depends mainly on the neurological status of the patients, the best results being obtained in asymptomatic patients (stage 0) or those having suffered transient ischemic attacks (stage 1). The global mortality and morbidity rate was less than 2 p. 100 in those groups. On the other hand, long-term survival depends mainly on the severity of the coronary artery disease.

Aged↗
PubMed1982

[Cardiac manifestations of Takayasu's disease (excluding hypertensive heart disease) (author's transl)].

The literature is reviewed in the light of 6 cases of Takayasu's disease with cardiac manifestations. Whilst the cardiac manifestations of Takayasu's disease are most often due to the effects of hypertension, there nevertheless exist specifically cardiac lesions: coronary, valvular and myocardial. Coronary lesions, typically ostial, a veritable extension of aortic disease, may also effect the vessels themselves. The course is generally grave but surgery has been performed in a number of cases. Aortic insufficiency is usually moderate and without haemodynamic consequences and is the most frequent valve lesion, others being rare. Direct myocardial involvement with the possibility of arrhythmias or conduction disturbances is also rare, as are pericardial and endocardial lesions.

Adolescent↗
PubMed1981

[Superior vena cava syndrome: a rare complication of endocavitary cardiac pacing].

The superior vena cava syndrome is an exceptionally rare complication of endocavitary cardiac pacing, asymptomatic venous thrombosis being much more common. Two cases wee observed as late complications of pacemaker implantation. In the first case the clinical signs regressed with the development of a collateral circulation under heparin therapy after failure of fibrinolytic drugs. In the second one, the severity of the superior vena cava syndrome and the poor quality of the collateral circulation led to the implantation of a Gore-Tex prosthesis. This surgical bypass led to a rapid and complete regression of the clinical signs. It would seem to be a valuable alternative when anticoagulant therapy fails.

Cardiac Pacing, Artificial↗
PubMed1981

[Subclavian steal syndrome from congenital atresia of the left subclavian artery (author's transl)].

Obstruction of the left subclavian artery is one of the rarest causes of the cogenital subclavian steal syndrome with a right-sided aorta. Radiological diagnosis can be made from a standard film which shows the aorta on the right, and a barium examination of the esophagus which demonstrates the absence of any compression posteriorly. Angiographic exploration (aortography, pulmonary angiography) is essential for positive confirmation of diagnosis and to exclude other types of congenital subclavian steal with a right-sided aorta. Certain cardiac malformations may be associated, but forms have been described without any other anomalies as in the case reported, which only became apparent when neurological symptoms developed in adult age.

Adult↗
PubMed1981

[Celiac artery aneurysms: ultrasonographic appearances in two cases (author's transl)].

Two patients were treated surgically for an aneurysm of the celiac artery, one of atheromatous and the other of dysplasic origin. Diagnosis was established by mode B ultrasonography, and confirmed by arteriography and operative findings. Emphasis is placed on the possibility of detecting such lesions, when confronted with an atypical epigastric symptomatology, by means of ultrasonography, particularly by the use of an apparatus in real time. This should enable a more rapid and probably more precise approach to the aorta and large abdominal vessels.

Aneurysm↗