Biomedical subjects
Publications and source records attributed to M O Bitker.
The role of the left spermatic vein as a replacement in cases of obstruction of the inferior vena cava is discussed in connection with a case of varicocele revealing a thrombosis of the inferior vena cava.
The extension of renal cell cancer into the vena cava is not inaccessible to treatment. In the absence of any other effective treatment, only surgical resection is able to provide a chance of long term survival. The authors report their experience of 40 cases, 24 of which underwent complete resection of their lesions. The survival rates in these cases were 47.6% at 1 year, 28.6% at 2 years, 15% at 3 years and 9.5% at 5 and 7 years. A selective approach to the right auricle was performed in three patients and the technique of this operation is outlined. The global mortality was 8.8%. The various technical possibilities and the prognostic factors are also reviewed.
The authors report the case of a patient with a crush fracture of the pelvis associated with rupture of the urethra, rupture of the bladder and ano-rectal disruption. The emergency and subsequent management of the urinary tract and gastrointestinal lesions is discussed. A review of the literature reveals the rarity of the association of ano-rectal and urinary tract lesions in the context of pelvic fractures and the unique nature of the present case.
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To ensure vascular access, a biological graft was inserted in 44 patients from August 1982 to February 1985 at the Department of Urology, Pitié Hospital, Paris. Forty-nine grafts were used, including 39 saphenous veins and 10 carotid arteries from calves. Four patients free of renal failure had insertion of a graft to allow chemotherapy (3 cases) or plasmapheresis (1 case). Graft patency rate in these four patients is 50%. Among the 40 patients with renal failure, 11 have not yet had dialysis, 26 are currently under dialysis, 2 have been lost to follow up, and 1 died before dialysis. All but one of the patients with renal failure not treated by dialysis have a patent graft. Graft patency rate after one year in the 26 patients under dialysis is 83% for non-reoperated patients and 91% for reoperated and non-reoperated patients as a group. As concerns complications, an interesting fact is that thrombosis of the graft usually required graft replacement, whereas most delayed stenoses were treated by surgery with preservation of the graft. No case of infection or aneurysm was recorded throughout follow up. These results pertain chiefly to saphenous vein grafts as use of carotid arteries from calves is recent. In view of the 95% immediate graft patency rate and of the satisfactory results at one year in these patients usually selected because of the poor condition of accessible arteries and veins, we believe biologic grafts constitute an outstanding material in vascular access surgery for hemodialysis.
The preoperative assessment required for the creation of a vascular access for hemodialysis is reviewed in relation to a series of 104 patients. The immediate or early failure rate works out at 11%, which is in line with the experience reported in the literature for other series. Emphasis is laid on the good results that can be obtained in polycystic disease, an on the difficulty of creating an access in patients under continuous ambulatory peritoneal dialysis. The preoperative management of patients with chronic renal insufficiency is also discussed.
The construction of an arteriovenous fistula is not always immediately feasible. Temporary recourse to a Buselmeier shunt and the subsequent conversion of the shunt into an arteriovenous fistula, using the same vessels, provides an economy of the vascular sites. This technique precludes the need for permanent or frequent recourse to central venous catheters.
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The Döppler ultrasonic examination proposed for the diagnosis of acute painful scrotal syndromes has been used during 4 months. The presence of false negative results in the literature and in the series reported here throws some doubt on the reliability of the method and confirms that systematic surgical exploration remains imperative at the slightest doubt.
The injection of bile under low pressure led in 21 dogs out of 30 to a process of acute pancreatitis and to the reproduction of the different histopathological types of pancreatitis seen in man. This represents a weighty argument in favour of the concept of oedematous pancreatitis, interstitial pancreatitis with sometimes major cytosteatonecrosis and necrosing pancreatitis as different manifestations of the same disease, which is not universally accepted. Our research has once again emphasized the fact that the interstitial phenomena and in particular fatty necrosis precede parenchymatous necrosis. Morphological studies were used to attempt to define the link between fat necrosis and acinar necrosis. Light microscopy showed that there was no topographic evidence of direct involvement of the acinar cell in contact with fat necrosis. By contrast, ultrastructural studies revealed initial involvement of the basal pole of the acinar cell. This would emphasize the responsibility of interstitial phenomena in the maintenance, if not the induction, of acinar necrosis. It cannot be excluded that fat necrosis could indirectly, via the liberation of factors carried by oedema, play a role in these phenomena of acinar necrosis. In addition, it was noted that the apical poles of the acinar cells did not seem to be damaged, the acinar lumina were dilated and there was loss of the intercellular junctions. This would hence indicate the possible passage into the interstitium of a toxic substance (bile salts, enzymes liberated in excess) coming directly from the acinar lumina.
The authors report a case of delayed diagnosis of intraperitoneal rupture of the bladder, and describe the wide variety of signs and symptoms observed in these cases. They emphasize the diagnostic value of biological test results, and discuss a case in which cicatrization without sequelae was obtained without operative intervention.
This report describes the CT and MRI features of rectal malacoplakia in a renal transplant recipient. The lesion appeared strongly hyperdense (105 HU) on unenhanced CT and demonstrated hypointense signal on T1- and T2-weighted MR imaging with slight homogeneous enhancement after gadolinium injection. These characteristics distinguish this lesion from other more common neoplastic, inflammatory rectal lesions that are typically isointense on T1-weighted imaging and enhance variably after gadolinium injection. Characteristic intracytoplasmic siderocalcific spherules in malacoplakia can produce suggestive features on unenhanced CT and MRI.
Nineteen cases of focal infectious lesions of renal parenchyma studied included 10 cases of acute focal bacterial nephritis (AFBN) and 9 of abscess, cases of pyelonephritis without radiological signs being excluded from this report. Each patient had been investigated by intravenous urography (IVU), ultrasound and CT scan imaging. Comparison of value of the different radiological explorations showed that urographic signs were inconstant and only weakly specific, the most valuable examination being CT scan imaging. The latter images show hypodense zones, clearer with contrast, of a rather triangular form and either single or multiple in AFBN, and mainly nodular images in abscess cases. Ultrasound is of intermediate value, being of high performance in cases of abscess but failing to demonstrate AFBN in about half the cases. However, it should not be totally neglected because of its case of access.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
From October 1987 to June 1992, 359 renal transplantations were performed, while, over the same period, 25 patients with a follow-up of more than six months underwent repeat renal transplantation: 23 for a second transplant and 2 for a third transplant. The initial disease was glomerular for 17 patients and interstitial for 6 patients. The mean age of the patients at the time of the repeat transplantation was 36.9 years (range: 20 to 53 years). The mean survival after the first transplantation was 3 years and 10 months (range: 1 week to 10 years). The reasons for loss of the first transplant can be classified as follows: acute rejection (n = 5), chronic rejection (n = 14), surgical failure (n = 5) or sepsis (n = 1). 9 patients received conventional immunosuppressant therapy, while 16 patients (64%) received four-drug therapy including cyclosporin. The actuarial one-year survival of the patients and the transplants was 100% and 92%, respectively. The mean serum creatinine was 136.4 +/- 65 mumol/l (range: 59 to 298 mumol/l). Ten patients developed rejection after a mean of 18.6 days (range: 6 to 30 days) and 2 patients suffered from 2 episodes of rejection within 4 months. These results illustrate the low postoperative surgical and immunological complication rate in this group of patients whose long-term results are at least comparable to those of first transplantations in our group.