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Biomedical subjects

J Natali

Publications and source records attributed to J Natali.

At least 37 records · Page 2Linked to original sources
PubMed1989

Training of vascular surgeons in France: ten years of the French College of Vascular Surgery.

The French College of Vascular Surgeons serves several functions including the organization of vascular surgery training nationwide, overseeing the practical aspects of institutional training, providing motivation for trainees by creating final exams, and bringing surgeons together to update their knowledge. This article details the results of their programs, the demographic changes in vascular surgical practice over the last ten years, and the problems to be solved in the near future. These challenges include: maintenance of autonomy in the surgical world, enlargement of the fields of action, clarification of indications for vascular procedures, demographic control, and recognition of training programs on the wider, European level.

Certification↗
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↗
PubMed1989

[Iatrogenic vascular lesions].

We have observed during a period of 24 years, 277 vascular iatrogenic injuries. An analytic study has revealed the prominent following etiologies; Injections, perfusions, catheterisms and arteriographies: 121 cas; Orthopedic surgery: 69 cas; General surgery: 14 cas; Surgery and sclerosis of varicose veins: 71 cas. The author analyse the various aspects of these lesions, most of them are due to imperfect technique or professional error. A special attention is given to the 82 very serious cases, seen in emergency with more of 50% of bad results. Vascular risk is not frequent, but it exist in very numerous medico-surgical procedures. Early recognition and early correction of the vascular lesions reduce the incidence and the gravity of complications.

Adolescent↗
PubMed1989

[Throbbing buttocks syndrome].

The authors define the "throbbing buttocks syndrome" which can in fact correspond to different pathological entities: aneurysm of the persistent sciatic artery and/or congenital or traumatic arteriovenous fistula of the hypogastric and gluteal vessels. Seven cases are reported: 1 case of aneurysm of the persistent sciatic artery complicated by truncal embolism and fissuring which was treated successfully by occlusive endoaneurysmorrhaphy; and 6 cases of arteriovenous fistulas (1 traumatic and 5 congenital). In all cases of arteriovenous fistula the technique used involved initial embolization which was complicated by anterior ligature of the hypogastric artery and then by excision of the malformation which was extremely hemorrhagic in some cases. Out of these 6 cases, results have been satisfactory for 5 and incomplete for the remaining one.

Adult↗
PubMed1986

[Embolization of arteriovenous malformations using compression. Apropos of 11 cases].

External compression of both arterial feeder and venous return of an MAV allows embolization material to be stabilized into the area of the shunts. 11 patients were treated according to this method, either by an external compression method (4 cases) or by tourniquets (4 cases) or by a balloon compressing the vena cava (3 cases). The material of embolization was in all cases Isobutyl-2-Cyano-Acrylate. 5 patients were successfully operated after the procedure and 7 patients had considerable improvement after embolization, 2 of them being considered as cured.

Adolescent↗
PubMed1985

Post-operative angiographic control. A. Cerebrovascular disease. Main surgical techniques.

Carotid endarterectomy is the procedure most commonly used for the treatment of lesions in the internal carotid artery. It is occasionally also necessary to insert an internal shunt. After surgery, the patient should be kept in intensive care for 24 h. The most serious complication that can occur is a neurological deficit. Endarterectomy of the origin of the vertebral artery is also the most common procedure used at this location. The techniques for treatment of lesions in the supra-aortic trunks are also discussed, as are the procedures used in cerebral revascularization by extra-intracranial anastomosis.

Blood Vessel Prosthesis↗
PubMed1985

[Value of arteriography in the exploration of subungual glomus tumors. Apropos of a case].

Difficulties in the diagnosis of subungual glomus tumors are increased when clinical examination and standard radiographic images are normal. In these cases arteriography is a useful procedure, opacification in the arterial phase of a small vascular lake confirming the diagnosis and localizing the lesion. A case is described that illustrates the interest of this examination, although it is indispensable only in patients with glomus tumors of atypical clinical expression or when symptoms recur after excision.

Adult↗
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↗
PubMed1985

[Asymptomatic carotid lesions].

The appropriate management of cases of asymptomatic stenosis of the carotid artery is still very much a matter of controversy. There are those who decline intervention of any kind since they argue that patients exhibiting such a syndrome are particularly exposed to the general complications of atheroma, and essentially to myocardial infarction. At present, when additional tests are available which allow the severity of the stenosis to be assessed, this attitude does not seem logical since patients with a severe or very severe stenosis run a serious risk of TIA and CVA. This view emerges from a number of recent studies, some of which are prospective and confirm the gravity of the spontaneous progression of a severe stenosis of the internal carotid artery. Moreover, study of the statistics shows that, after intervention, mortality lies at about 1 percent with a morbidity of less than 3 percent. Thus, if it is out of the question to suggest prophylactic intervention for all patients exhibiting an asymptomatic stenosis of the carotid artery, such an intervention should be considered in the case of severe stenosis, equal to or higher than 70 percent.

Brain Ischemia↗
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↗