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Biomedical subjects

J Natali

Publications and source records attributed to J Natali.

143 records · Page 8Linked to original sources
PubMedDate not supplied

Diffuse intimal thickening in chronic obliterating disease of arteries of the lower extremities in humans.

The concept of atherosclerosis is essentially applicable to the arteries of the elastic type. Lesions in the arteries of the muscular type have a different character. They show an association of fibrosis of the media with a diffuse intimal thickening and the presence of stratified fibro-hyaline plaques, representing organized parietal thrombi. Deposition of lipids is weak or moderate and apparently a secondary event. Intimal thickening of peripheral arteries exceeds largely the limits of the thrombotic zone. It is covered by normal endothelium and populated by myocytes with a few fibroblasts. The intercellular substance shows all stages of formation of elastic structures, a process which is probably related to the activity of myocytes. It leads to the formation of one or several fairly distinct elastic membranes. Concomitantly the lamina elastica interna undergoes considerable degradation. We are, thus, confronted with a lesion of considerable age which, nevertheless, remains active and shows continuing structural changes. The origin of cells in intimal thickening and its significance in terms of general pathology are discussed with respect to the experimental results.

Adult↗
PubMedDate not supplied

"Redo" surgery for late aorto-femoral graft occlusive failures.

Experience of late failures of Dacron aortofemoral grafts is presented; about 70 cases observed during the past eight years on whom 105 subsequent operations were performed. One third of these patients were first operated upon by another surgical team. During the same period, 850 patients were submitted to reconstructive surgery of the abdominal aorta and iliac arteries either for atherosclerotic or for aneurysmal disease. It appears that conservative procedures like thrombectomy of the occluded limb are often insufficient, impossible, inappropriate or dangerous, even after restoration of a good deep femoral outflow. On the other hand, aggressive restoration of limbflow is generally necessary, with other various and ingenious direct or indirect reconstructive techniques for restitution of a good inflow and outflow. These techniques are usually successful (85%) and gain time against the major etiology of these late failures viz the development of atherosclerotic disease.

Aged↗
PubMedDate not supplied

[Congenital arterio-venous malformations. Long-term therapeutic effects of arterial ligatures. A plea for their abandon in favour of more recent procedures (author's transl)].

It is well known that proximal arterial ligations have no curative effect on arterio-venous malformations, unfortunately however they are still employed. The immediate and late consequences of such ligatures have been studied by analysing 36 out of 142 cases of arterio-venous malformations. These ligatures interfere with ulterior treatment. At present such a treatment relies on a combination of radio-surgical treatment associated with embolization and complete surgical excision of the malformation, whenever it is possible.

Arteries↗
PubMedDate not supplied

[Peroperative vascular accidents during orthopedic surgery. Apropos of 55 cases].

The functional or vital prognosis may be affected by the rare vascular accidents resulting from orthopedic operations. During a 10 year period (1970-1980), 55 vascular lesions were observed in 40 patients, and were either arterial (40 cases) or venous (15 cases) in type. Vascular injuries in 9 cases were due to spinal operations (cervical, lumbosacral or herniated disc arthrodesis), in 7 cases to shoulder operations (recurrent dislocation, excision of first rib), in 9 cases to hip surgery (prosthesis, plate and screws, fractured acetabulum), and in 15 cases to operations on the lower limbs (osteosynthesis of femur or tibia, meniscus operations, etc.). Emergency operation was necessary in 18 cases because of a hemorrhagic or ischemic syndrome, all other cases except three requiring secondary surgery for false aneurysms, arteriovenous fistulae, or residual ischemia. Four patients (10%) died, three following hip surgery, and 8 developed complications. The frequency, mechanism, diagnostic and therapy of these lesions are discussed.

Adolescent↗
PubMedDate not supplied

Arteriovenous fistulae of the internal iliac vessels.

Seven patients with arteriovenous fistulae of the internal iliac artery are reported. Ages varied from 6 to 50 years (mean 32 years). Cutaneous angiomata , leg oedema and pain was present in 4 cases each, bleeding in 2 cases whilst only one was asymptomatic. Only 1 patient had cardiac insufficiency. In six patients the lesion was a congenital malformation but in one it was posttraumatic. Arteriography both global and selective, intravenous pyelography and cardiac output are routine. Recently, pelvic computerised tomography has been most helpful. Embolization is recommended in all cases with surgery within 24 hours unless the lesion is very extensive and considered to be inoperable. Repeat embolization is used for recurrence or very extensive lesions. Results were good in five patients; in two patients the results were clinically good but control angiograms showed a recurrence.

Adult↗
PubMedDate not supplied

[Axillary-femoral by passes. Technic. Complications. Results (92 patients) (author's transl)].

Between January 1970 and October 1977, 95 operations of revascularisation of 124 lower limbs were carried out using the axillary artery in 92 patients. 84 patients had very severe ischemia, acute or chronic, which threatened the survival of the limb. In all, direct surgery was too dangerous (77 cases) or impossible owing to local or regional problems (7 cases). The results gave a mortality during the first two months of 13% in which infective complications of the technic accounted for 3.5%. The latter were frequent (12%) but a certain number of them could have been prevented (6%). 55 patients (65%) had a good result at two months (weight-bearing conserved) whilst 20%, i.e. 18 patients were amputated, of which five had a permeable by pass which permitted conservation of the knee. We observed the highest percentage of deaths (3/8 i.e. 37%) in bilateral emergency revascularisations for acute ischemia. We observed a very low percentage of early thrombosis (4%) in axillary bifemoral by pass performed for chronic ischemia. The operation is of great value when no other direct surgical technic is possible and only in these cases. 8 patients underwent an axillary by pass to treat infective complications of aorto-iliac surgery. 4 early deaths showed the severity of this complication (50%). Tactical aspects are discussed briefly.

Aged↗
PubMedDate not supplied

The role of surgery in the treatment of acute phlebitis in the lower members.

UNLABELLED: Most phlebitis responds favorably to medical treatment. Iliofemoral and iliocaval phlebitis, however, involve considerable risk as they may endanger life (pulmonary embolism), limb (ischemic forms) or the functioning of the limb (severe post-phlebitic syndromes). Because of this triple risk it is important to be able to judge when to opt for surgery. Surgical treatment is called for in cases of certain iliofemoral phlebitis developing in spite of medical treatment. Threat of "blue phlebitis" (acute arterial ischemia); threat of severe post-phlebitis syndrome (the thrombosed iliac veins do not easily recover their permeability); threat to life (iliac thromboses producing mortal embolism). These three risks justify emergency phlebography. The aims, means and limitations of surgery. 1. Aim - to maintain the permeability of the femoro-ilio-caval venous axis and to avoid pulmonary embolism. 2. Methods - Thrombectomy is done at the level of the femoral vein using Fogarty's catheter and Esmarch's bandage; this is carried out at an early stage (5 first days). A De W. clamp may be positioned at the level of the vena cava (in case of preexisting pulmonary embolism or incomplete thrombectomy). 3. INDICATIONS: --Phlebitis with ischemia. --Recent severe phlebitis not responding enough to urgent medical treatment particularly in the cases of young patients. --Clamp used in cases of pulmonary embolism or when threats of embolism are visible on the phlebography (floating clots). 4. MATERIALS: --82 patients were operated between 1970-1978. Phlebography showed: 44 iliofemoral phlebites, 11 femoropopliteal phlebites, 27 iliocaval phlebites. --Arterial affection revealed in the cases of 8 patients, four of which had blue phlebitis. --Pulmonary embolism was the symptom showing iliofemoral phlebitis in 7 cases. 5. OPERATIONS: 42 isolated clamps; 40 thrombectomies (in 15 cases completed by a clamp, in 12 cases by arteriovenous fistula; in 10 cases by treatment of an anomaly of the origin of the left common iliac vein. 6. RESULTS: --Two deaths. --In the long term (average interval = 4 years) the results were excellent in 54% of the cases (no oedema), good in 28% (light compression required), and bad in 8%. Conclusion. Certain iliac phlebites can, we believe, be cured by surgery.

Acute Disease↗
PubMedDate not supplied

Carotid artery surgery in patients over 70 years of age.

Between 1965 and 1979, 934 patients underwent 1,057 operations for extracranial carotid stenosis at this institute, and over a recent 30-month period 463 patients underwent 511 operations of this type. This number is equal to the total of operations performed during the years 1965-1976. The increase in the frequency of carotid artery surgery has been more marked in patients of over 70 years. The percentage of elderly patients has increased from 17.5% to 27% in the recent period. In the latter group of 511 operations, results were good in 93.17% of cases, while there was a mortality rate of 1.95% (1% of which were directly related to the surgery), in 1.95% the neurologic condition deteriorated and in 3.13% there was no change. In the first period the mortality rate for patients over 70 years of age was 7.69%. In the second it was 3.27% (1.63% of which were due to non-neurologic causes), 4.09% deteriorated, in 2.18% there was no change and good results were obtained in 90.46%.

Aged↗
PubMedDate not supplied

[Complications of sclerosing and surgical treatment of leg varices. Apropos of 90 cases].

The authors discuss 90 cases of iatrogenic incidence following either sclerotherapy (46 cases), or surgery (44 cases) performed on varices of the lower members. Some such incidence may be extremely serious (5 deaths, 15 amputations), or much less so. They may be due to the general risk of therapy, or to imperfect technique or professional error. The authors analyse the various aspects of these causes. Everything possible must be done to prevent incidence or, if they occur, to treat them effectively. The authors will have reached their goal if they manage to provide more complete information on the very real risks incurred sometimes by treatment; these are undoubtedly rare, but are occasionally mortal or of major functional importance, whereas the illness itself is common, disabling, but almost always without serious consequences.

Adult↗
PubMedDate not supplied

[Medico-legal consequences of complications of superficial venous surgery of the legs].

67 cases of complications of superficial venous surgery of the lower limbs were reported. They consist in the following troubles: 23 arterious injuries, 10 venous injuries, 28 nervous injuries, 4 instrument forgettings, at last, 2 anaesthesia incidents. All these injuries lead to: 4 deaths, 9 amputations, and in 75% of cases, important functional after-effects. One has to insist on the necessity of per-surgical vigilance with the immediate therapy of injuries that have been observed. It is also necessary to look carefully after the patient during the surgery. The disrespect of these precautions is often followed by the most important complications we had to face.

France↗
PubMedDate not supplied

[Arterial lesions caused by the Fogarty catheter (author's transl)].

The authors report 7 cases of arterial wound consecutive to the use of the Fogarty catheter: 1 rupture, 1 perforation, 2 arteriovenous fistulae. They investigate the mechanism and stress the importance of preoperative angiography to minimize the risk of unknwon anomalies. Also they indicate the ease and efficiency of the surgical correction when needed.

Adult↗
PubMedDate not supplied

Superselective arteriography and therapeutic embolisation for vascular malformations. (Angiodysplasias).

By virtue of superselective arteriography which makes possible the catheterisation of extremely fine arterial branches, the authors were able to embolise vascular malformations (angiodysplasias). Twenty seven cases were treated in this way with satisfactory results for twenty one of them. Seven patients must be operated on after the embolisation. The problem of the future of this technique is considered, and it will perhaps be possible to avoid revascularization by the use of new substances.

Angiography↗