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Biomedical subjects

M A Schepens

Publications and source records attributed to M A Schepens.

50 records · Page 3Linked to original sources
PubMed1996

Management of combined carotid and coronary artery disease.

Although it has been the topic of intense medical and surgical attention for over 20 years, the coexistence of severe carotid artery disease in patients undergoing coronary artery bypass graft continues to be a major cause of perioperative morbidity and mortality. Refinements in diagnostic modalities, mainly by duplex ultrasonography, have improved preoperative assessment. Management possibilities vary from ignoring the carotid problem to simultaneous reconstructions. However, the best surgical option for these high-risk patients has yet to be determined because of the lack of controlled, prospective, randomized trials.

Carotid Artery Diseases↗
PubMed1995

Use of left heart bypass in the surgical repair of thoracoabdominal aortic aneurysms.

The purpose of this study was to assess the usefulness of left heart bypass in thoracoabdominal aortic aneurysm surgery. Data from 50 patients who underwent thoracoabdominal aortic aneurysm repair between July 1987 and October 1993 were retrospectively reviewed. In all of them a left heart bypass (left atrium to left femoral artery) with a centrifugal pump (without systemic heparinization) was used. Patient-, disease-, and operation-related variables were analyzed using univariate methods. There were no intraoperative deaths. The in-hospital mortality rate was 8% (n = 4). Survival rates were 77% (+/- 6.5) at 2 years and 62% (+/- 8.7) at 5 years. Renal failure requiring dialysis occurred in five (10%) patients and paraplegia in five (10%). Sixteen (32%) patients had respiratory insufficiency requiring prolonged (> 8 days) ventilation. After univariate analysis, the risk factors for developing a need for postoperative dialysis were found to be the preoperative creatinine level (p = 0.002) and the presence of preoperative arterial hypertension (p = 0.018). A history of peripheral vascular occlusive disease (p = 0.008) was an important risk factor for predicting late death. No factors retained significance in the univariate analysis of hospital deaths and postoperative paraplegia. Renal and spinal ischemic times were substantially reduced in comparison to the theoretic times calculated if cross-clamping had been used. Bypass-related complications were completely absent. The use of a left heart bypass during thoracoabdominal aortic aneurysm surgery may not reduce the global complication rate; the results were similar to those achieved using simple cross-clamping. However, this technique appears to be the method of choice for protecting organ systems at risk during difficult repairs.

Aged↗
PubMed1995

Is a third mediastinoscopy really useful?

The value of a second remediastinoscopy in the diagnostic assessment of new or recurrent lung cancer have never been evaluated before. We retrospectively reviewed our experience with a third mediastinoscopy in the staging of lung cancer to define its role. In 13 patients a third mediastinoscopy was performed; in all cases the indication was suspected or proven new or recurrent lung cancer. All accessible lymph nodes were sampled. The technical aspects of the procedure are described. Nine patients with a negative third mediastinoscopy underwent subsequent surgery, four patients were not operated on, based on the positive histology and concomitant diseases. There were no major complications. Reremediastinoscopy can be performed safely and has proven to be helpful in defining potential surgical candidates. Mediastinal involvement can be excluded in most.

Aged↗
PubMed1994

Late results of sleeve resection for typical bronchial carcinoids.

The late follow-up was analyzed of 17 patients who underwent a sleeve resection for bronchial carcinoid tumor between 1974 and 1993. The mean age was 38 years (range 22-59). The bronchoplastic resections performed were sleeve lobectomy of the right upper lobe in six patients, sleeve lobectomy of the left lower lobe in three, sleeve resection of the right main bronchus in five and a sleeve resection of the left main bronchus in three patients. Only the pure sleeves are included and all other types of bronchoplastic resections (variant sleeves) for the same type of tumor were excluded. Preoperative laser therapy was applied in eight patients (from 1986 on). On surgical-pathologic staging, ten patients belonged to stage I (8T2N0M0 + 2T1N0M0), one patient belonged to stage II (T2N1M0) and six patients to stage IIIA (T3N0M0). There was no major perioperative morbidity and the hospital mortality was 0%. There were no local tumor recurrences but in one patient a bronchial stenosis at the site of the anastomosis needed a completion pneumonectomy after 16 months. The actuarial survival rate was 100% (+/- 0) at 5, 10 and 15 years. At 5, 10 and 15 years, 94% of the patients were free of major pulmonary events. This large series of bronchial carcinoids from one center treated by pure sleeve resection shows excellent short- and long-term results; therefore it seems to be justified to perform a sleeve resection for bronchial carcinoids when the tumor location and the surgeon's skill permit.

Adult↗
PubMed1994

Risk assessment of acute renal failure after thoracoabdominal aortic aneurysm surgery.

OBJECTIVE: The authors sought a statistical model that permits the calculation of the chance of postoperative dialysis in patients undergoing thoracoabdominal aortic aneurysm repair. The preoperative risk of each individual patient was assessed. SUMMARY BACKGROUND DATA: Acute renal failure requiring dialysis after thoracoabdominal aortic aneurysm surgery is a common complication. Despite modern intensive care facilities, it continues to be associated with high morbidity and mortality. METHODS: The authors studied the influence of preoperative and intraoperative variables thought to be important clinically in the development of serious acute renal failure in 88 consecutive patients. Simple cross-clamping was used with the Crawford's graft inclusion technique without shunts or heparin. Statistical methods used include univariate and multivariate analysis (stepwise logistic regression analysis and Cox proportional hazard model). RESULTS: The hospital mortality was 11.4% (n = 10). Long-term survival at 2 years was 78% (+/- 4.4), and at 5 years was 54% (+/- 5.3). A logistic regression model with only two explanatory variables to predict postoperative dialysis showed an almost perfect fit (chi 2 = 4.2, p = 0.84): the risk factors of postoperative dialysis were age (p = 0.003) and the preoperative serum creatinine level (p = 0.04). As determined by stepwise Cox regression analysis, postoperative dialysis also was a significant risk factor for late death (p = 0.002). CONCLUSIONS: Using this statistical model, the chances of postoperative dialysis can be estimated exactly before operation; age and preoperative serum creatinine level are the only variables predictive for postoperative dialysis.

Acute Kidney Injury↗
PubMed1994

Somatosensory evoked potentials during exclusion and reperfusion of critical aortic segments in thoracoabdominal aortic aneurysm surgery.

Forty-three patients undergoing repair of a thoracoabdominal aortic aneurysm were monitored to evaluate spinal cord ischemia, as evidenced by somatosensory evoked potentials (SEPs). All patients were operated on using left heart bypass. In 34 patients (80%), staged clamping was used. Except for cerebrospinal fluid (CSF) drainage in 15 patients (35%), no other protective measures to preserve spinal cord function were used. The overall incidence of immediate onset paraplegia was 7%, and of immediate onset paraparesis was 5%; neither was limited only to those patients in whom potentials were lost. In 18 patients (42%), no change in the evoked potentials occurred; one of these patients (5%) awoke paraplegic after operation, and two others had a delayed onset paraplegia. In 13 patients (30%), evoked potentials were lost despite adequate perfusion; in 12 of them, potentials returned gradually, with one immediate paraplegia (8%), and in one potentials did not return at all, with subsequent immediate paraplegia (100%). In 12 patients (28%), evoked potentials decreased without being lost completely, and then recovered; in this group there were no immediate paraplegias. No relationship could be demonstrated between the extinction time, the recovery time, or the duration of loss of evoked potentials with postoperative neurological outcome. Intraoperative monitoring of SEPs is a good indicator of spinal cord ischemia, although we found a 5% incidence of false negatives. SEP monitoring offers an improvement in surgical strategy, and allows safer operations for thoracoabdominal aneurysms.

Aged↗
PubMed1994

Surgical treatment of thoracoabdominal aortic aneurysms by simple crossclamping. Risk factors and late results.

Between 1981 and 1987, 88 consecutive patients were operated on for a thoracoabdominal aortic aneurysm by simple crossclamping and a graft inclusion technique (without shunts or heparin). This article presents an analysis of the operative outcome and long-term follow-up. Patient- and operation-related variables are age (mean 64.3 years, range 28 to 82 years), sex (82% men), rupture (20.5%), diabetes (2.3%), renal insufficiency (34.1%), chronic obstructive pulmonary disease (27.3%), previous aortic operation (31.8%), arterial hypertension (66%), postdissection (18.2%) versus degenerative (80.7%) origin, preoperative shock (11.4%), ischemic cerebrovascular (12.5%) or ischemic heart (17%) disease, peripheral vascular disease (14.8%), renal (mean 48 minutes, range 0 to 83 minutes) and lower spinal cord (mean 21 minutes, range 0 to 68 minutes) ischemic time, number of reattached intercostals, blood loss, and extent of the aneurysm (Crawford classification: type I, 16 patients [18.2%]; type II, 21 patients [23.8%]; type III, 29 patients [33%]; and type IV, 22 patients [25%]. Intraoperative mortality is 1.1% (n = 1). Thirty-day mortality is 5.9% (n = 5). Hospital mortality is 11.4% (n = 10): 7% for elective cases and 28% for ruptured aneurysms (p = 0.014). The survival at 2 years is 78% +/- (4.4%) and at 5 years 54% +/- (5.3%). Postoperative spinal cord injury occurred in 12 patients (13.8%) (5 had paraplegia and 7 had paraparesis) and postoperative renal dysfunction necessitating dialysis in 12 patients (14.1%). Risk stratification for hospital death, late death, renal failure, and spinal cord dysfunction was performed by means of multivariate logistic regression and Cox proportional hazard regression as appropriate. The best fitting model to predict hospital death includes preoperative shock (p = 0.02), female sex (p = 0.06), preoperative elevated serum creatinine level (p = 0.06), and preoperative myocardial infarction (p = 0.08). Variables predictive for late death are postoperative dialysis (p = 0.002), age (p = 0.008), and rupture (p = 0.04). The risk factors of postoperative dialysis are age (p = 0.003) and preoperative serum creatinine level (p = 0.04). The risk of postoperative spinal cord dysfunction increases with longer lower spinal cord ischemic time (p = 0.02) and with the presence of preoperative shock (p = 0.06).

Adult↗
PubMed1993

Reappraisal of Ekehorn's rectopexy in the management of rectal prolapse in children.

An old and simple operative technique for the treatment of rectal prolapse in children, first described by Ekehorn in 1909, has been reviewed. The technique consists of the insertion of a mattress suture (nonabsorbable and multifilament material) in the rectal ampulla through the lowermost part of the sacrum: the strands of the mattress suture are tied firmly over a piece of dry gauze at the level of the sacrococcygeal junction. By leaving the suture in place for 10 days, the local inflammation and infection causes firm adhesions between the rectal wall and the perirectal tissue so that the anorectal wall is bound to the surroundings (sacrorectopexy). The results of this retrospective study on 22 patients proves that this form of transsacral rectopexy in the management of rectal prolapse in children is effective (100%), simple and without complications compared to other techniques. There were no recurrences and no major morbidity. The overall surgical treatment of rectal prolapse in children is briefly reviewed.

Causality↗
PubMed1992

Long-term clinical and duplex follow-up after proximal vertebral artery reconstruction.

From 1977 to 1989, 28 patients, 18 men and 10 women, underwent 29 proximal vertebral artery reconstructions. Indications were vertebrobasilar insufficiency in 17 patients and TIA or stroke in 6. Five were asymptomatic. Procedures performed were endarterectomy in 20, reimplantation in 5, venous bypass in 3, and decompression in 1 case. Concomitant procedures were coronary artery bypass grafting (6) and carotid, subclavian, or innominate artery revascularization (14). There was no operative mortality. There were 3 early reoperations for occlusion, bleeding, and lymph fistula, respectively. Except for 1 foreign patient recent clinical follow-up was complete. Mean follow-up was 85.6 months (range 17-146). During follow-up 10 patients died. Causes were mainly cardiac (3), carcinoma (3), and stroke (2). Seventeen patients were alive, 13 had no cerebrovascular symptoms, 2 sustained a hemispherical stroke, 1 was only slightly improved, and 1 had a drop attack 131 months after operation. Five and ten-year actuarial survival rates were 85% and 51% respectively. Follow-up with duplex scan was available in 26 patients and was complete in 24. Mean duplex follow-up was 78.6 months (range 3-146). Significant abnormalities were noted in 6 but with symptoms in only 1 patient. Mean time to restenosis was 77.3 months. Late angiographic control in 10 patients correlated well with duplex findings. Proximal vertebral artery reconstruction yields good clinical long-term results, and duplex scan is a useful tool in the follow-up of these patients.

Adult↗
PubMed1989

Herniation of the small intestine through an incised rectal prolapse. Case report.

Spontaneous rupture of protruding rectal wall with evisceration is a rare complication of rectal prolapse. We hereby present the case of a woman with a large prolapse of the rectum into which small intestine descended and strangulated. The evisceration became clear after incision of the prolapse taken for a large anal haematoma.

Aged↗
PubMedDate not supplied

Acute traumatic disruption of the thoracic aorta.

Rapid diagnosis of traumatic aortic rupture is life saving. Initial findings are often misleading and multiple organ injuries add to the diagnostic complexity. Increasing awareness of the diagnosis and rapid performing of aortography together with improved surgical techniques will improve the outcome of these patients.

Adult↗
PubMedDate not supplied

Surgical thromboendarterectomy for chronic thromboembolic pulmonary hypertension using circulatory arrest with selective antegrade cerebral perfusion.

The use of circulatory arrest with selective antegrade cerebral perfusion is described in a 59-year-old man who underwent thrombendarterectomy for chronic thromboembolic pulmonary hypertension. The postoperative course was uneventful. The described surgical technique may prevent the patient from cerebral sequelae especially in more complex cases.

Cerebrovascular Circulation↗
PubMedDate not supplied

Acute cardiac herniation following intrapericardial pneumonectomy.

Cardiac herniation is a rare but potentially fatal complication of intrapericardial pneumonectomy. It usually occurs within the first 24 hours postoperatively. Symptoms are side-related. It has a sudden onset and invariably evolves to cardio-vascular collapse. Clinical suspicion combined with plain chest X-ray and electrocardiographic changes must lead to a quick diagnosis. Definitive treatment requires prompt surgical action. Closure of the pericardial defect during initial operation does not exclude the possibility of cardiac herniation. We present a patient with a right-sided cardiac herniation after intrapericardial pneumonectomy. Patient was treated surgically and survived.

Adenocarcinoma↗