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Biomedical subjects

F Koskas

Publications and source records attributed to F Koskas.

70 records · Page 4Linked to original sources
PubMed1991

[Long term results of surgery of aortic aneurysms].

During 10 years, between 01.01.80 and 01.12.89, 838 patients have been operated on consequently for a A.A.A. in the vascular surgery department of the Hospital Pitié-Salpêtrière (Paris). Post-operative death was 7.3% (51 patients) among 692 operated on without emergency and 41.7% (60 patients) among 146 patients operated on emergency. The study was undertaken with the 727 surviving patients (86.8%) for the long term follow-up. Only 25 patients (3.4%) were lost out, so 702 patients (96.6%) had complete recalls even to their late death until the fourth trimester 1990. Total deaths, were 172 patients, (24.5%) out of the 702 patients in the follow-up. 60 patients (34.9%) died from cancer, 52 patients (30.2%) from heart disease, 21 patients (12.2%) from C.V.A. (cerebro-vascular-accident), 8 (4.6%) from rupture of aneurysm, 6 (3.6%) from renal insufficiency, 5 (2.9%) from prosthesis infection, 10 (5.8%) died from known reasons, 10 (5.8%) from unknown reasons. All these results were studied according to the "actuarial method" and the conclusions were as follow. The actual survival rate at 5 years was 72.1% +/- 5.6% and the average annual death rate was 5.8%. The factors which have influenced the late death are: a) Patients age: survival rate at 5 years and average annual death rate were significantly different whether the patients were less or more than 70 at the time of surgery. b) Surgical circonstances: late survival was significatively less with patients operated on emergency. c) Cerebro-vascular insufficiency. The average annual rates from cardio-vascular and cerebro-vascular accident were significatively more important in patients which previously had cerebro-vascular insufficiency. This work shows out that cardiac death are slightly overcame by cancer, but these two factors represent almost 2/3 (65.1%) of late death. So it should be important for prevention of late death to screen for lung and E.N.T. cancers. Some authors have proposed for prevention of coronarian accidents extensive use of coronarography and myocardial revascularisation. We prefer more acute screening than aggressive methods for patients with coronary problem who had surgery for A.A.A. and specially when they are less than 70 at surgical time.

Adult↗
PubMed1991

In situ fresh allograft replacement of an infected aortic prosthetic graft: eighteen months' follow-up.

We report a case in which an allogenic aortic graft was used to treat the last one of a series of infectious graft complications. The original operation was a Dacron aortobifemoral bypass for aortoiliac occlusive disease in an institution other than ours. The patient was referred for the treatment of the infection of the prosthetic implant. We inserted a prosthetic bypass from the left axillary to the left deep femoral artery, as well as a crossover autogenous saphenous vein graft from the prosthesis to the right deep femoral artery; in the same operation the infected intraabdominal prosthesis was removed with closure of the proximal aortic stump. Subsequent stenosis of the vein graft made it necessary to insert a prosthetic bypass between the descending thoracic aorta and the two deep femoral arteries. Infection of the last named prosthesis made it necessary to remove it and replace it with a tailored allogenic arterial allograft between the infrarenal abdominal aorta and both deep femoral arteries. The patient had an uneventful recovery as the infection was controlled and both lower limbs were salvaged. Eighteen months later the allograft was patent without any signs of degeneration. Further clinical experience under appropriate conditions may prove the use of allografts effective in the treatment of selected cases of aortic prosthetic infection.

Aged↗
PubMed1990

[Peri- and postoperative use of low molecular weight heparin in peripheral vascular surgery].

A pilot study has been conducted in ten consecutive patients undergoing femoro-popliteal reconstruction or distal vascular surgery under epidural anaesthesia. Immediately before arterial cross-clamping, enoxaparin (E) (75 anti-Xa IU.kg-1) was injected intravenously (i.v.). During surgery, washing of the saphenous or polytetrafluoroethylene (PTFE) graft has been performed using enoxaparin. Enoxaparin (75 anti-Xa IU.kg-1) was administered subcutaneously (S.C.) 8 hours after the i.v. injection, and then every 12 hours during 10 days. The patency of the vascular reconstruction and the side-effects of E administration were evaluated clinically before and during surgery, then by a daily clinical examination. Echo-Doppler and/or arteriography were also performed preoperatively and on the 10th postoperative day. Haematocrit, platelet count, activated partial thromboplastin time, prothrombin time, thrombin time, fibrinogen and anti-Xa activity were assessed. None of the patients developed venous or arterial thrombosis and all the by-pass grafts remained patient. Only one minor surgical bleeding occurred on the first post operative day, despite anti-Xa levels in the expected range. One patient developed minor haematomas at the injection site. No bleeding was observed. Further randomized studies comparing LMWH and UH are required in order to substantiate these preliminary clinical and biological findings.

Aged↗
PubMed1989

[Carotid surgery for ophthalmic manifestations. Early and late results].

Two hundred and twelve cases of carotid surgery performed on patients presenting ipsilateral ischemic monophthalmic symptoms were retrospectively studied (OPH group). Among these, 125 had presented isolated ophthalmic pre-operative symptoms (OPHEX group) and 87 both ophthalmic and encephalic ischemic symptoms (OPHNEX group). During the same period, 702 cases of isolated carotid surgery were performed upon atherosclerotic patients without ipsilateral ischemic monophthalmic pre-operative symptoms (NOPH group). Among the cases of this latter group, 147 were performed upon asymptomatic patients (ASY group). 514 had presented isolated encephalic pre-operative symptoms (ENC group) and 41 had presented contralateral ischemic symptoms. The OPHNEX group presented a significantly increased peri-operative mortality and morbidity rate compared to the OPHNEX group (peri-operative deaths, lethal strokes, cardiac peri-operative morbidity) and compared to the ENC group than in the ASY group. The OPHNEX group presented a significantly increased long term mortality and morbidity rate compared to the OPHEX group (lethal strokes, all deaths). In the follow up, the OPH group presented, compared to the NOPH group, lower rates of non lethal stroke but higher rates of ophthalmic ischemic events (ipsi or contralateral) and higher rates of cardiac deaths. OPHEX, OPHNEX, ASY, ENC and NOPH groups presented significant differences as regards the general cardio-vascular and metabolic context, the macroscopy of carotid lesions operated upon, the topography and diffusion of other atherosclerotic lesions.

Aged↗
PubMed1987

[Prevalence of gastric or duodenal ulcer in patients with arteritis. 100 systematic fibroscopies].

A 19% prevalence rate of gastric or duodenal ulcer was found by systematic fibroscopy in a population of 100 patients with lower limb arteritis hospitalized in a vascular surgery unit. This morbid association raises pathogenic problems which remain unsolved, but peptic ulcers were unevenly distributed throughout this population. Their prevalence was higher in patients under 50 years of age (P less than 0.05) and in those who had trophic disorders and occlusive lesions of digestive tract arteries or progressive coronary disease. Systematic fibroscopy may be justified in these categories of patients, since 7% of those with ulcer were asymptomatic.

Adult↗
PubMed1987

[Intersubclavian bypass. Technic. Indications. Remote results].

Between 1974 and 1984, 34 patients were treated by inter-subclavian bypass operation for occlusive lesions of proximal subclavian artery or brachiocephalic trunk. Patients treated in this way were those in whom other methods were inapplicable. Results showed it to be a valid procedure: absence of morbidity or mortality related to the operation itself (one postoperative death from myocardial infarction); excellent early and late permeability if the need for absence of parietal or stenosing lesions in the arteries of origin and supply is respected. Doppler ultrasound imaging showed satisfactory hemodynamic results.

Adult↗
PubMed1986

[Thoracic outlet syndrome. Value of non-invasive arterial studies].

The value of non-invasive clinical evaluation of arterial compression at thoracic outlet was evaluated in 150 normal subjects and in 103 patients operated upon (127 sides). The specificity of arm abduction manoeuvres was good for angles of 90 degrees or less. Their sensitivity was poor in forms with neurological symptoms and better in forms with vascular symptoms. In these two forms, their predictive value was excellent (congruent 90%) with angles of less than 90 degrees. Their negative predictive value was mediocre in forms with neurological symptoms. It is concluded that a positive response to manoeuvres at an angle of less than 90 degrees is a strong argument in favour of arterial compression in the thoracic outlet, but that a negative response should not rule out a diagnosis of thoracic outlet syndrome, especially when neurological symptoms are present.

Adolescent↗
PubMed1986

[Fibrovascular polyp of the esophagus].

A case of large intraluminal tumour located in the cervical portion of the oesophagus and removed by thoracotomy is presented. Detailed histological study was necessary, since hypervascularization and hypercellularity made it difficult to diagnose a fibrovascular polyp and to establish its histopathological prognosis. The patient has now been followed up for 7 years and remains cured. Intraluminal tumours are reviewed. Whether fibrovascular polyps should be removed surgically or endoscopically depends on their site and on their size.

Esophageal Neoplasms↗
PubMed1986

Aortic stump closure: a new technique.

The usual closure of the aortic stump results in a cul-de-sac which favors secondary rupture. A new procedure utilizing an anterior-posterior suture line in two layers is described which creates a median strut. It allows a secure suture line in a short aortic stump, and may enhance the splitting of blood flow between the renal arteries.

Aged↗
PubMed1985

Anatomical study of digital compression of the vertebral artery at its origin and at the suboccipital triangle.

Manual compression of the vertebral artery is used in routine clinical practice for diagnosis of positional hemodynamic vertebro-basilar insufficiency (VBI). The supraclavicular and suboccipital areas were carefully dissected in 20 cadavers. Anatomical variations observed on dissection were compared to angiographic data from 150 patients and data from the literature. Objective results of manual compression of the vertebral artery can be obtained by sonography. In patients with VBI, such compression induces signs of reversible cerebellar or brain stem ischemia, whereas no signs are observed in patients without VBI.

Cadaver↗
PubMed1985

Anatomical study of retrosternal gastric esophagoplasties.

Five currently used procedures of gastric esophagoplasty were done in 5 groups of 14 embalmed human cadavers. These procedures were: whole gastric intrathoracic transposition (Kirschner's procedure) isoperistaltic gastric cone (Akiyama's procedure) isoperistaltic gastric tube (Rutkowski's or Lortat-Jacob's procedure); isoperistaltic gastric tube with resection of the lesser curvature; anisoperistaltic gastric tube with intrahilar splenectomy (Gavriliu's, Heimlich's procedure). Gastric morphometry and ascinding vascularization ability and quality of the vascular network were assessed. Injection of plastic dye was used to evaluate the vascularization of the grafts. In 13 out of 14 grafts, whole gastric transposition extended above the sternal notch, for a mean distance of 7.7 +/- 4.9 cm. This basic performance was significantly correlated to the dimensions of the greater and lesser curvatures and to the cardioxiphoid, sternal and hyosternal distances. Absent or poor injection of the distal arterial network, over a mean distance of 3.6 +/- 0.8 cm, was seen in all 14 grafts. Study of the isoperistaltic gastric cone demonstrated that the graft extended above the sternal notch in all 14 cases. The mean distance of the graft segment above the sternal notch was 5.0 +/- 3.0 cm. This basic performance showed a significant correlation only with the dimensions of the greater and lesser curvatures. Absent or poor injection of the distal arterial network of the gastric cones was seen in 9/14 cases, the mean length of the devascularized segment being 1.3 +/- 1.3 cm. Subsequent to resection of the distal zone showing poor vascularization, 13 out of the 14 isoperistaltic cones still extended above the sternal notch. The mean length of the segment above the sternal notch was 3.7 +/- 2.6 cm. All 14 isoperistaltic gastric tubes (without resection of the lesser curvature) extended above the sternal notch. The mean length of the segment above the notch was 15.1 +/- 7.1 cm. This basic performance showed a statistically significant correlation only with the minimum pylorodiaphragmatic distance subsequent to extensive Kocher's manoeuver. Of these 14 gastric tubes, 9 showed poor or no vascularization of their distal arterial network. The mean length of the poorly injected segment was 8.0 +/- 1.8 cm. Subsequent to resection of the poorly vascularized territory, 12/14 grafts were still found to extend above the sternal notch. The mean length of the segment above the sternal notch was 7.1 +/- 6.9 cm.(ABSTRACT TRUNCATED AT 400 WORDS)

Esophagoplasty↗
PubMed1984

Blunt thorax oesophageal stripping: an emergency procedure for caustic ingestion.

We report our experience with an original procedure which we have applied to the management of acute necrotic caustic burns of the upper gastro-intestinal tract. Blunt thorax oesophageal stripping is performed through a cervicotomy and a laparotomy, thus avoiding a wide pleural exposure and the frequent and often fatal respiratory complications of a thoracotomy. The stripping method permitted survival of 13 of 17 patients and is thus considered to be a safer and more successful technique than open thoracic oesophagectomy.

Adult↗
PubMedDate not supplied

[Variations in the origin of the artery of Adamkiewicz].

Variations of the origin of the medullary artery. The purpose of this study was to define the origin of the medullary artery through medullary angiography in order to prevent paraplegia during surgery of the thoraco-abdominal aorta. Twenty-eight patients, candidate to thoracoabdominal aorta operations, have been studied for the study of the origin of the medullary artery and its eventual reimplantation during surgery. The artery has been localized in 24 of the 28 patients. In 22 cases (78.6%) it originated from an intercostal artery between D8 and D12, while in 6 cases (21.4%) it originated from a lumbar artery between L1 and L2. In 23 (82.1%) cases it originated from the left side, while only in 5 (17.9) from the right side. Although medullary artery originates more frequently at the thoracic level, particularly from the left D9 and D10, its variability is important, and its localization before thoraco-abdominal aortic surgery is often desirable.

Adult↗