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Biomedical subjects

J Natali

Publications and source records attributed to J Natali.

At least 127 records · Page 7Linked to original sources
PubMedDate not supplied

[Anatomic pathological aspects of chronic obliterating arteriopathies of the extremities (author's transl)].

It appears that the classical concept of atherosclerosis cannot be applied indiscriminately to all cases and that it is essentially valid for the aorta and its large branches of predominantly elastic structure. When more peripheral arterial trunks are considered, those of muscular type, the lesions are in great part characterized by a dystrophic fibrosis of the media, associated with a diffuse intimal thickening and with stratified fibro-hyaline plaques narrowing the lumen; the latter are responsible for the circulatory insufficiency and gangrene. Comparative analysis of 50 surgical specimens allow us to conclude that those fibro-hyaline plaques represent progressively stratified parietal thrombi that are populated by myocytes, at the contact of which ultrastructural investigation reveals important phenomena of elastogenesis and elastolysis. Most probably, the myocytes originate from the media, through fenestration within the inner elastic membrane. These facts have more than just a purely speculative interest: they express the great plasticity of the arterial walls and their capacity of adaptation to new hemodynamic and biologic conditions. It is interesting to note that this lesion constantly presents signs of metabolic activity and structural remodeling despite its long standing caracter.

Aging↗
PubMedDate not supplied

Incidence of myocardial ischemia during carotid endarterectomy.

Since patients undergoing carotid endarterectomy often suffer from coronary artery disease, the detection, adequate treatment and prevention of intra and postoperative myocardial ischemia are a major concern. Effectively, the deleterious effects of intraoperative ischemic episodes have been largely documented. They may lead to arrhythmia, left ventricular dysfunction lasting several hours or myocardial infarction. Anesthesia induced by fentanyl, flunitrazepam and pancuronium and maintained with N20 and volatile anesthetics when warranted, has the advantage of preventing cardiovascular stimulation during endotracheal intubation and surgery, and of significantly decreasing the incidence of intraoperative myocardial ischemia in patients suffering from mild angina pectoris. However, with this approach, the incidence of intraoperative ischemic episodes remains high in patients suffering from disabling angina pectoris. In such cases, prophylactic i.v. nitroglycerin, administered continuously at the dose of 0.7 microgram/kg-1/min-1, optimizes myocardial oxygenation during surgery and minimizes the risk of intraoperative myocardial ischemia.

Anesthesia, General↗
PubMedDate not supplied

[Lesion of the triceps surae after sclerosing injection in the territory of the external saphenous vein].

Eight cases of injury of the muscle triceps surae after a sclerosing injection in the territory of the external saphenous vein, are reported. In one case, it concerned an extremely severe evolution with necessary amputation of the leg; in the seven other cases, the consequences were less severe but the rate of partial permanent disability increased from 10 to 30 p. cent. The etiology and the mechanism of these accidents are discussed. It seems that the possibility of an accidental injection of the arterial system causing the obstruction of intramuscular arterioli should be remembered. The treatment of sequelae will essentially be of an orthopedic nature with lengthening of the Achilles tendon in case of a severe retraction of the triceps surae.

Adult↗
PubMedDate not supplied

Iatrogenic vascular injuries. A review of 125 cases (excluding angiographic injuries).

From the files of an insurance company and from a number of our own files as expert medical witness to the court we have been able to collect 125 cases of malpractice suits following a iatrogenic vascular injury. An analytic study has revealed the following: --12 vascular injuries occurred after stripping of varicose veins of the lower extremities; --4 accidents occurred during arterial surgery; --35 lesions followed orthopedic surgery; and --2 general surgery. Besides these 53 injuries following surgical procedures, 72 injuries are described following non-surgical diagnostic or therapeutic procedures: --sclerotherapy of varicose veins or angiomas: 34 cases; --injection of anesthesic agents: 20 cases; --injections, infusions, catheterisms: 16 cases; and --endoscopic procedures: 2 cases. Vascular risk exists in almost all medico-surgical procedures and requires constant and careful attention since professional responsibility is easily involved. Early recognition and early correction of the vascular lesion reduce the incidence and the gravity of the complications.

Anesthetics↗
PubMedDate not supplied

[Five year follow-up of 104 cardial artery deobliteration (author's transl)].

From December 1, 1964 to December 31, 1977, 613 patients underwent 699 operations for stenotic lesions of the internal carotid artery. One hundred and four of these cases, operated before December 31, 1972, were reevaluated at 5 years. These include 9 patients stage 0 (asymptomatic), 45 patients stage I (transitory), 8 patients stage II (progressive), 22 stage III mild (mild deficiencies), and 20 stage III severe (severe deficiencies). The overall 5 year mortality is 34% with a survival rate of 65%, steadily decreasing from 87% in the first year. There is a fundamental difference to be made between results in stages 0, I, mild-III and the other, for immediate and for 5 year mortality: 19% versus 67%. The rate of local recurrences is low: 3% of patients operated on the same side. In contrast, 11 subjects underwent a bilateral procedure. Carotidal endarteriectomy improves long term survival only moderately, mainly as a result of coronary disease. However it has an undisputable effect in diminishing neurological accidents.

Adult↗