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Biomedical subjects

J Marzelle

Publications and source records attributed to J Marzelle.

18 recordsLinked to original sources
PubMed1992

[Femoro-distal revascularization for "critical" chronic atheromatous ischemia. 695 cases].

The results of the revascularizations carried out over a 10-year period for "critical" chronic ischaemia, using the femoropopliteal bypass technique, have been retrospectively analyzed. In all, 600 patients underwent femoro-distal revascularization in 644 limbs, and 695 bypasses were performed. The hospital mortality rate was 4.3 percent. Among these 695 bypasses, postoperative occlusion occurred in 16.5 percent of the cases, and major amputations were necessary in 9.8 percent. The probability of 5-year survival was 47 percent. The probabilities of bypass patency and limb salvage were 50 and 76 percent respectively. The failure of revascularization ending in amputation did not significantly increase the postoperative mortality rate (4.1 percent versus 4.6 percent), but the life expectancy of patients who were amputated was significantly lower than that of patients who were not (55 +/- 5 percent versus 63 +/- 3 percent at 3 years; P = 0.03). The factors predictive of successful bypass were examined; they included age, clinical stage, diabetes, bypass material, site of distal implantation, revascularization procedure and reoperation. Femoro-distal revascularization makes it possible to cope with the challenge of limb salvage, even when the receiving vessel is an artery of the foot.

Aged↗
PubMed1992

Acute colorectal ischemia after aortic surgery: pathophysiology and prognostic criteria.

Acute colorectal ischemia is a rare though potentially lethal complication of aortic surgery. We reviewed our recent experience with 16 cases in order to analyze its causative and prognostic factors. The incidence was 2.8%, and the inferior mesenteric artery was occluded in all cases. All patients also had severe occlusive disease of at least two of the hypogastric or deep femoral arteries. Hypoperfusion due to arterial ligation, prosthetic occlusion or embolism was responsible in half the cases. Ischemia and perfusion due to aortic cross-clamping or perioperative hemorrhage were involved in the rest of the cases. Postoperative mortality was 31%. The mortality was lower for partial, nontransmural necrosis, and for elective operations. Recurrent intestinal ischemia, transmural necrosis, surgery for ruptured aneurysm, intestinal hemorrhage and pulmonary edema were associated with a higher mortality rate. All patients with anuria or extrarenal epuration and hepatic cytolysis died. Although reconstruction of the inferior mesenteric artery might lessen the incidence of postoperative colonic ischemia due to hypoperfusion, the role of oxygen free radicals should be investigated in humans, in order to afford colonic protection against the consequences of ischemia-reperfusion.

Acute Disease↗
PubMed1991

[Surgical results in stage 2 arterial diseases].

The results of surgical treatment of peripheral artery disease at the stage of intermittent claudication may now be assessed with a 40 year follow-up. In selected cases the 10 year patency rate of aortoiliac revascularisation is 90% and the 5 year patency rate of femoropopliteal revascularisation is 85%. When the indications are widened to include less favourable lesions giving rise to severe claudication, the patency rate falls to 60% at 5 years. These results should improve with better preoperative assessment by Doppler ultrasonography the use of new material and methods (endovascular) and stricter control of the revascularisation procedure by angioscopy in patients with severe effort ischaemia which is the principal surgical indication; the association of endovascular revascularisation procedures has increased the therapeutic indications and improved the functional result.

Blood Vessel Prosthesis↗
PubMed1990

[Value of superior angiocardiography in the evaluation of the surgical excision of bronchial cancer. Respective role compared to thoracic x-ray computed tomography].

The place of angiography-superior vena cavography in the assessment of the resectability of a lung cancer must be defined in comparison with the data provided by thoracic computed tomography. Sixty-six patients with proximal lung cancers of doubtful resectability were studied by means of angiography and computed tomography and the results of these preoperative investigations were correlated with the operative findings. The sensitivity of these two examinations for the diagnosis of vascular invasion preventing pulmonary resection is poor (53% and 47% respectively). The specificity and positive predictive value of angiography appear to be slightly superior to those of computed tomography (Sp: 96% and 82%, PPV: 78% and 47%, respectively). The diagnostic performance of these two examinations remains poor. Magnetic resonance imaging may replace these two examinations in the future.

Carcinoma, Bronchogenic↗
PubMed1989

Combined ascending aorta rupture and left main bronchus disruption from blunt chest trauma.

After blunt chest trauma, early diagnosis of associated bronchial, vascular, and esophageal injuries must be attempted, as those lesions may be produced by the same mechanism. We report a case of successful management of associated bronchial transection and injury of the ascending aorta. Aortic repair required cardiopulmonary bypass and the use of prosthetic materials, although gross contamination of the mediastinum from the bronchial disruption is a theoretical contraindication to such a procedure. A separate approach to the vascular and airway injuries allowed successful management of both lesions.

Adult↗
PubMed1989

Surgical management of acquired post-intubation tracheo-oesophageal fistulas: 27 patients.

From 1962 to 1987, 27 patients with tracheo-oesophageal fistulae (TOF) were treated at our institution. Mean age was 43 years. The indications for respiratory support were blunt chest trauma (11), neurological dysfunction (8), and acute pulmonary distress syndrome (8). TOF symptoms occurred 12-200 days (mean 43) after initiation of ventilatory support and was caused by tracheostomy tube cuff (17), intubation tube cuff (8), or injury at the site of tracheostomy (2). The size of the fistula ranged from 0.3 to 5 cm (mean 2 cm). Seventeen of the 27 patients were operated upon. A simple repair of the TOF was performed via a cervical approach in 10 patients; tracheal resection and reconstruction was done in 4 patients presenting with tracheal stenosis, while 2 patients with slight tracheal stenosis had a simple repair of the TOF without the need for further tracheal surgery. Three patients underwent primary oesophagostomy, followed later by colon interposition. Five patients died. Ten cases were not operated upon: the TOF closed spontaneously in 1 patient, 1 patient was lost to follow-up and 8 died. In our series, significant tracheal stenosis occurred in only 6 patients (22%), only 4 of whom had tracheal resection. Simple repair of TOF provides excellent results with a low mortality (10%) considering the poor condition of the patients, and should be considered the procedure of choice. Surgical oesophageal diversion (i.e. cervical oesophagostomy and suture of distal oesophagus) is usually unnecessary.

Adolescent↗
PubMed1989

[Polyaneurysmal dystrophy].

Polyaneurysmal dystrophy (PAD) is a strange disease. It is also an uncommon disease if only strict, arteriographic and pathological criteria, are considered. True varicose disease of the arteries, this disease develops slowly and its clinical manifestations, often severe, only occur in patients over 50. The frequent association with dolichomega arteries (DMA), especially at the aorto-iliac level, is certainly not accidental. A continuous dystrophy of the media would result in the occurrence of DAM; a segmental dystrophy these diseases under a single entity: ectatic mediadystrophy. Our small personal series of 9 cases is presented to analyse the course of this disease and specify its treatment.

Aged↗
PubMed1989

[Value of nuclear magnetic resonance in the detection of false aneurysm of the abdominal aorta].

Among the long-term complications that jeopardize bilateral aorto-femoral prostheses, the development of a false aneurysm on the aortic suture line, is indeed one of the most severe. Its frequency, approximately 1 p. cent of cases, is probably underestimated, since its diagnosis, with usual exploration methods, is difficult. The nuclear magnetic resonance (NMR) examination is here particularly indicated and, when in doubt, must be systematically requested, especially in the presence of a false aneurysm of the femoral suture line.

Aorta, Abdominal↗
PubMed1989

[Antibiotic and antiseptic prophylaxis in thoracic surgery. Controlled study].

The aim of this report was to evaluate perioperative antibiotherapy and antiseptic irrigation of the operative site in the prevention of post-pneumonectomy empyema. From 1984 to 1986, 171 patients undergoing pneumonectomy at our institution for bronchogenic carcinoma were randomly selected in 2 groups: group I (85 patients) received a "classical" prophylaxis: irrigation of the operative site with saline, plus a 7-day antibiotherapy (minocycline 200 mg/24 h) started the evening following surgery; group II (86 patients): irrigation of the operative site was performed with Povidone iodine (dilution 5%); antibiotherapy (cefotiam was given for a short period (2 g intraoperatively, 2 g 12 hours and 24 hours following surgery). We used a "pragmatic" approach in order to choose, whatever the results would be, a type of perioperative antibiotherapy. We thus accepted the choice, without the help of statistical tests, of the therapy that would best prevent infection, and, if both regimens would demonstrate the same efficacy, to leave the choice at random. The only statistical test was to calculate the "gamma-risk" that we choose the worst among the 2 regimens. Although no significant difference in the overall infection rate was observed between the 2 groups, there were 9 empyemas (5 of those with bronchial fistula) in group I and 3 empyemas (2 of those with bronchial fistula) in group II. The cefotiam-povidone iodine regimen is thus better than the minocycline-saline regimen in the prevention of post-pneumonectomy empyema (3.5% v.s. 10.5%). The "gamma-risk", ie the probability that the minocycline-saline regimen is the best, calculated from these percentages, is 0.03.

Aged↗
PubMed1988

Tracheal sleeve pneumonectomy for bronchogenic carcinoma: report of 55 cases.

From 1966 to 1986, a total of 55 patients underwent a tracheal sleeve pneumonectomy (53 right and 2 left) for bronchogenic carcinoma. Preoperative radiotherapy was given in only 5 patients. The overall operative death rate was 10.9%, but no patient has died since 1975 (32 survivors). Seven patients had a postoperative empyema (12.7%); 4 of these patients had a bronchopleural fistula. Twenty-five patients had postoperative radiotherapy, 5 of whom also had chemotherapy. The actuarial survival rate, after exclusion of the 6 operative deaths, was 38% at 3 years and 23% at 5 years. Survival was correlated to regional lymph node involvement. The actuarial survival rate among patients with tumoral spread to bronchial lymph nodes was 43% at 3 years. Among the 13 patients with only subcarinal involvement, the actuarial survival rate was 34% at 3 years. None of the 8 patients with paratracheal lymph node involvement survived more than 30 months. These results indicate that tracheal sleeve pneumonectomy for bronchogenic carcinoma with extension to the carina is now fully justified considering the low operative mortality and the good results observed when lateral tracheal lymph nodes were not involved.

Adult↗
PubMed1988

[Arterial thrombolysis. Review and future prospects].

After describing the mechanism of action, results and local and general complications of classical thrombolytic agents (streptokinase and urokinase) administered systemically, locally and peroperatively, then of modern thrombolytic agents (acyl enzyme, tPA and scuPA), the future perspectives of arterial fibrinolysis are discussed. These are based upon: analysis of the comparative efficacy of the different thrombolytic agents in the light of results seen, not only in peripheral arterial pathology but also in other indications, as in coronary pathology; discussion of the methods of administration of the thrombolytic agent in such a way as to obtain an optimal local concentration and at the same time reduced systemic fibrinolysis. better definition of the indications of thrombolysis in acute ischemia of the limbs in comparison with other therapeutic approaches, in particular surgery, taking into account the degree of ischemia, of etiological mechanism and the site of the arterial obstruction.

Enzyme Precursors↗
PubMed1988

[Current role of partial interruption of the inferior vena cava. Apropos of 100 cases].

In reference to a personal series of 100 partial interruptions of the inferior vena cava (74 clips, 11 Mobin-Uddin umbrellas, 15 Greenfiled's filters), the authors analyze the criteria of choice in various procedures where the mortality, morbidity and sequellae remain low. In light of these results, the current place of surgery in the prevention of pulmonary embolism is discussed, in cases where anticoagulant therapy is contraindicated, inadequate or has failed.

Constriction↗
PubMed1988

[Aneurysm of the inferior mesenteric artery].

Aneurysm of the inferior mesenteric artery is rare. Often unrecognized unless complicated, it is, today, demonstrated by sonography or tomodensitometry and confirmed by angiography. Usually observed in patients with atheroma, it presents a mechanical origin secondary to a "jet disorder" phenomenon occurring in an artery with a hyper-output, responsible for almost the entire gastro-intestinal vascularization. The prevention of its dangerous complications (rupture or thrombosis) justifies a systematic procedure usually requiring, in addition to the excision of the aneurysm, a revascularization of the digestive arteries, as in the case presented here.

Aneurysm↗
PubMedDate not supplied

[Isolated dissecting aneurysm of the superior mesenteric artery. Dysplasia, a rare cause of mesenteric ischemia. Report of a case].

We report a case of successful surgical revascularization of the superior mesenteric artery in a patient presenting with intestinal ischaemia due to fibrodysplasia. This is a rare pathology, with 5 cases operated in our institution and only 16 cases reported in the literature. Angiography may show other sites of arterial dysplasia. In such cases, success depends on early surgical revascularization.

Aortic Dissection↗
PubMedDate not supplied

Results of thrombolysis in the treatment of arterial ischemia of the limbs according to mode of administration.

After reviewing the principles, results and complications of thrombolytic therapy with "classical" agents (Streptokinase and Urokinase) used via intravenous, intraarterial route, or intraoperatively, and with more "modern" agents (APSAC, scuPA, tPA), we discuss the future of thrombolysis in the treatment of arterial ischemia of the limbs. Several items need to be clarified: --indication of thrombolysis among other treatments, mainly surgery, of arterial ischemia depends on the clinical staging of ischemia, its causes and the site of arterial obstruction; --method of delivery of the thrombolytic agent must provide the highest local concentration and the lowest systemic side effects; --efficacy of each thrombolytic agent must be analyzed when used in peripheral arterial ischemia, but also in other diseases such as myocardial infarction.

Fibrinolytic Agents↗