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M Reggi

Publications and source records attributed to M Reggi.

At least 19 recordsLinked to original sources
PubMed1992

[Vascular endoprosthesis. A new indication in the surgery of the iliac artery].

We have used endoprosthesis (Palmaz Schatz) after balloon angioplasty of iliac arterial stenoses or thromboses, in order to increase the immediate patency and to prevent the recurrence of stenosis. Our series gathers 24 patients operated with endovascular procedures over a period of 2 years: 22 men, 2 women--extreme ages 42 to 78 years, average age 63.5 years--Clinical stage: 22 at stage I, 1 at stage III, 1 at stage IV. Arteriographic findings: 8 primary iliac lesions (6 stenoses and 2 thromboses), 11 external iliac lesions (stenoses). All these lesions were atheromatous. One of them had recurred after angioplasty. Usual technique: balloon angioplasty of the stenosis, assessment on a fluoroscopic screen and angioscopy of the result, decision to insert the Palmaz Stent if defects are seen on the image. Repatency of impassable lesions with a YAG laser was carried out in 2 cases. The indication of an endoprosthesis was established on the basis of the radiological image in 17 cases, of the angioscopic image in 4 and systematically in 10 cases of recurrence of stenosis, iliac thrombosis or associated surgery. Associated surgery: 2 femoropopiteal bypass grafts, 3 femorofemoral bypass grafts, 1 deep plasty, 1 superficial femoral recanalization with laser, 1 lymbar sympathectomy. Postoperative results: 1 death due to MI (78-year-old diabetic woman), 1 thrombosis treated with femorofemoral bypass. Middle-term results: after 6 to 24 months, average time lapse 13 months. The comparison of the ankle pressure indices and of the pre- and postoperative sonographic findings shows an indisputable hemodynamic improvement.

Adult↗
PubMed1991

Pre- and intraoperative transcranial Doppler: prediction and surveillance of tolerance to carotid clamping.

We report 91 patients (mean age 70 years) operated upon, prospectively for a total of 100 carotid revascularizations (nine bilateral). Eighty-five of these patients had pre-, intra-, and postoperative transcranial Doppler investigations. Preoperatively, these 85 patients (92 procedures) were classified into two groups based on the results of their Doppler examinations: Group A (65 patients, 72 procedures), those who did not require an intraoperative indwelling shunt and Group B (20 patients, 20 procedures), those who did. The shunt was inserted only when the mean stump (back) pressure was less than 50 mmHg after cross-clamping. Group A all had satisfactory collaterality with a functional anterior and one or two posterior communicating arteries. Group B had no communicating arteries (anterior or posterior) identified by transcranial Doppler. In 17 of 20 patients in this group, the stump pressure was less than 50 mmHg and a shunt was placed. The overall prediction based on Doppler examination of whether or not patients would need a shunt during operation for the two groups A and B (i.e., 92 procedures) was correct in 95.6% (88/92) of cases. Moreover, six hemodynamically significant stenoses (four in the cavernous portion, two in the middle cerebral artery) were disclosed. Sensitivity and specificity of transcranial Doppler as correlated with arteriographic findings were 70 and 90%. Preoperative transcranial Doppler can measure the velocities of the principal cerebral arteries and the collateral capacity of the circle of Willis, and can forecast tolerance to carotid cross-clamping. Intraoperatively, the velocity of flow in the middle carotid artery was correlated with stump pressure, which allowed for surveillance of the shunt.

Aged↗
PubMed1988

[Cerebral protection in carotid artery surgery. The role of the intraluminal shunt. Results of a national survey].

Clamping of the carotid artery made necessary by surgery of that vessel produces haemodynamic disturbances which may result in a neurological deficit accident at recovery from anaesthesia. Evaluating the patient's tolerance to carotid clamping and using brain protection methods during clamping increase the safety of the operation. The different methods of protection used in France were examined in an enquiry conducted among members of the French college of vascular surgery, with special attention to measurement of residual pressure in the clamped internal carotid artery (performed by 60 p. 100 of surgeons) and its corollary which is intraluminal shunting in case of hypotension. This type of enquiry concerning controverted technical procedures should provide information on the best way of improving surgical results.

Blood Pressure↗
PubMed1988

[Reliability and perspectives in peroperative flowmetry. An original computer-assisted ultrasonic technic].

To mitigate the lack of reliability of currently used flowmetry technics, an original method was developed based on a single window 15 MHz Doppler flowmeter and an Apple IIe computer with data acquisition system. Eleven successive measurements of instantaneous rate were made in an arterial section. A mean flow was determined by integration of mean rate in section. The reliability of the method was evaluated by an experimental study on a hydrodynamic bench reproducing physiologic flow conditions with an error always less than 8%. An in vivo study in 30 patients provided 100 measurements of arterial flow before and after surgical arterial reconstruction. The mean error value was less than 10%. Among the risks of error, those due to the probe was reduced by specially conceived probes. The most important factor was that of respiration, this latter factor imposing an integration time of rate of signal of 30 seconds to eliminate errors due to respiration. The conventional measurement time for other configurations is 6 seconds but this leads to a mean error of 25% which can attain 60%. The perspective of miniaturization of the apparatus in the near future with acceleration of measurements using a multi-window Doppler should allow flow measurement in 30 seconds and control of surgical reconstructions (on healthy arteries, vein grafts and prostheses but excluding PTFE). Similarly, it should be possible to improve evaluation of so-called vasoactive drugs.

Arterial Occlusive Diseases↗
PubMed1987

[Has phlebography become useless in the diagnosis of deep venous thrombosis of the lower extremities?].

It is now widely accepted that the clinical diagnosis of deep venous thrombosis (D.V.T.) is unreliable. Many venous thrombi are nonobstructive and not associated with vessel wall inflammation or inflammation of the surrounding tissues and consequently have no detectable clinical manifestations. Moreover, none of the symptoms or signs of venous thrombosis are unique to this condition and all can be caused by non thrombotic disorders. On the other hand, in most of the D.V.T., the calf is the site in the legs where a thrombus starts. This thrombus begins commonly in valve pockets throughout various deep veins of the leg and in saccules of soleal veins. Several non invasive techniques have been developed for diagnosing D.V.T.: 125I, fibrinogen, impedance plethysmography, Doppler ultrasound, Duplex scanning. Many publications document the correlation between venography and these non invasive tests for D.V.T. Unfortunately it appears that, excepted 125I. Fg, these techniques are poorly reliable at the level of the calf. Moreover the diagnosis of D.V.T. may occur in particular and difficult situations such as a recurrent deep vein thrombosis. Considering all above the authors believes that contrast venography remains the standard and that it is less dangerous to do unnecessary venography than not to recognize a deep vein thrombosis.

Humans↗
PubMed1987

[Exploratory hierarchy and surgical indications for carotid surgery in patients with coronary disease].

The major cause of death from carotid artery surgery (1.2% in 1984 in this series) is still coronary disease and myocardial infarct. A series of 50 patients were randomly selected for detailed study of post-operative cardiologic complications and the following sequelae were noted: mortality = 1 myocardial infarct; morbidity = 1 myocardial infarct, 3 documented anginal pains, 8 repolarization disorders, 4 benign ventricular arrhythmias. Analysis of these complications and a literature review demonstrated: the high frequency of combined carotid artery and coronary artery stenosis even in asymptomatic patients (25 to 40% of cases); the elevated percentage of complications in patients with symptomatic coronary disease (mortality risk multiplied by ten), hypertension or arterial disease; the low effect of age taken alone as risk factor. Pre-operative explorations to detect angina, particularly when latent and asymptomatic, should include a questionnaire, strict patient clinical examination and detailed reading of electrocardiogram tracings. An effort test should be performed as a function of results and patients' medical history and when positive should lead to coronarography in patients under 70 in good general condition, and when doubt persists after the effort tests. The indication for surgical treatment is dependent on results of these explorations: Carotid artery surgery (stenosis with high cerebral risk) should be performed under pre- and post-operative myocardial protection in patients with coronary artery disease who are too old or inoperable for cardiac reasons. Simultaneous myocardial and cerebral revascularization in the presence of severe lesions and at equivalent risk of progression. First intention carotid artery surgery for bilateral stable lesions with subsequent simultaneous myocardial and cerebral revascularization. First intention carotid artery surgery in case of cerebral ischemia with coronary artery shunt surgery at a later stage. Improved exploration of patients and close cooperation between cardiologists, anaesthetists and surgeons should allow patients at high risk to be operated upon under improved conditions of safety.

Aged↗
PubMed1986

Routine intraoperative carotid angiography: its impact on operative morbidity and carotid restenosis.

The impact of routine intraoperative carotid angiography was evaluated by comparing 206 procedures without such angiograms with our last consecutive 100 endarterectomies with completion angiography. No significant age or sex differences were observed between the two groups. Exploratory surgery was repeated in five cases for a stenosis greater than 40% or for an intimal flap. This protocol reduced operative mortality (2.9% to 1%), the permanent stroke rate (1.9% to 1%), and the temporary stroke rate (6.3% to 1%). Furthermore, a second angiogram was performed in these 100 cases (at a mean interval of 19.2 months later) and the incidence and evolution of both residual and recurrent carotid lesions were analyzed. Five internal carotid artery lesions that had been immediately repaired because of intraoperative angiographic defects remained normal. Of 58 normal internal carotid arteries at the completion of surgery, two became stenotic during the next year. In addition, three spastic internal carotid arteries became normal. Of 20 internal carotid arteries with modest irregularities, 16 became normal and four were stenosed. Of three internal carotid arteries with intimal flaps, two became normal and one was stenosed. Among 13 internal carotid arteries with modest stenosis (40%), eight became normal, two became severely stenotic, and three became thrombosed. Among 21 instances of a proximal common carotid artery "shelf," 17 resolved and four progressed to less than 50% stenosis. Of 67 normal external carotid arteries, late stenosis was seen in one case. Of 33 external carotid arteries with residual stenosis, 17 became normal, 14 remained unchanged, and two were thrombosed.(ABSTRACT TRUNCATED AT 250 WORDS)

Carotid Arteries↗
PubMed1986

[Computerized records in vascular pathology. II. Computer-assisted management of records in cerebrovascular pathology].

Computerized processing of data from patients with cerebro-vascular disease should improve interpretation of results of complementary examinations by allowing their comparison with arteriography and operative findings. It should also allow comparison of postoperative clinical and angiographic findings in order to analyse results obtained in an identical manner, and to provide a basis for discussion of therapeutic indications. Spontaneous evolution of atheromatous lesions can finally be compared with the course after surgery.

Cerebral Angiography↗
PubMed1986

[Computerized records in vascular pathology. III. Computer-assisted management in chronic arteriopathies of lower limbs].

Computerized processing of data from patients with chronic arterial disease of lower limbs has been an unsuccessful venture in many cases. This is due essentially to the complexity of the case-reports to be analyzed. In addition, the objectives are not the same if it concerns an angiologist or a vascular surgeon, or relates to an outpatient or hospital sector. Certain exploratory procedures such as Doppler and arteriography have not yet been the object of an agreement with respect to their results. An approach to the problem is proposed with respect to the polyvalent basic elements and then the more specific features as a function of the specific activity of the doctor concerned.

Angiography↗
PubMed1986

[Computerized records in vascular pathology. IV. Computer-assisted management in Raynaud's phenomenon].

The "dead finger" was first introduced into medical language in 1862 during the inaugural thesis of Maurice Raynaud: "of local asphyxia and symmetrical gangrene of the extremities". It has never ceased to stimulate interest since that date and to excite passionate speeches. Numerous reports of studies have been published since 1862 and "Raynaud's disease" has become a "syndrome", "phenomenon" or even "idiopathic disease" as a function of the author and the prevailing fashion, thus increasing the original confusion. However, it is now recognized that vasomotor disorders are not due to a single cause: apart from the primary forms of apparently purely spasmodic etiology, numerous affections accompanying these anomalies have been discovered.

Computers↗
PubMed1986

[Computerized records in vascular pathology. V. Computer-assisted management of records in venous pathology].

Computerized processing of data from patients with venous disease concerns mainly those with chronic venous insufficiency and venous thromboembolic disease. It is of particular interest for epidemiologic studies of venous disease, explorations (functional, phlebographic) and proposed therapies. Progress in these 3 sectors requires computerized processing of data from case-reports and standardization of the noting of these data.

Computers↗
PubMed1986

[Computerized records in vascular pathology. I. Basic elements].

Computerized processing of medical case-report data in angiologic practice should be conceived in two parts: the basic elements which define patients during their identification, and the specific disease-related elements. The basic file raises the problem of coding of data and of who does what. The choice of objectives and of coding is the responsibility of the doctor in charge of the project. Data processed should not be in his language only and cannot substitute for him when a decision has to be made. Collection and storage of data also fall within the medical field, apart from certain sections: identification of patients, intensive care, vascular explorations, the person directly concerned being either the secretary, the nurse or the doctor.

Computers↗
PubMed1986

[The brain scan and cervical artery lesions. Correlations: clinical-arteriographic-scanning].

Cerebral angiography and CT brain scan are performed on a group of 174 patients (28 asymptomatic patients; 109 patients with symptoms of stroke in relation with a clinically defined vascular territory; 37 patients with symptoms in relation with a clinically uncertain vascular territory). Angiographic findings are: cervical artery lesions in 143 patients, brain artery lesions in 6 patients, both extra and intra cranial artery lesions in 22 patients, and non atheromatous artery lesions in 3 patients. CT brain scan shows: hypodensity in 19 cases, hyperdensity in 1 case, cortical and/or sub cortical atrophy in 141 cases. Only 13 patients have normal CT brain scan. Authors also note: 4 infarction areas in asymptomatic patients and only 4 hypodensities out of 21 cases of internal carotid artery occlusion. Ulcerated cervical artery lesions seem to be the main cause (73%) of cerebral infarction.

Arterial Occlusive Diseases↗
PubMed1986

[Arteriography in Raynaud's phenomenon].

Bilateral angiographic examination of the upper limbs is performed under general anesthesia in 64 patients of a group of 138 Raynaud's phenomenons. Clinical severity of the Raynaud's phenomenon is evaluated according to the 3 grades of Porter's classification but including a grade 4 corresponding to digital gangrene. Aetiology of Raynaud's phenomenon is in relation with connective tissue diseases in 11 cases and with other aetiologies in 22 cases. Aetiology is not defined in 31 cases. Angiographic findings are: Arterial lesions are present in all 64 patients, including 11 cases of "Raynaud's disease" defined by clinical and capillaroscopic signs. Frequency of the forearm artery lesions (31% of patients), a majority concerning ulnar artery. Absence of palmar anastomosis in 55% of the cases. Frequency and severity of digital (mean 1.4/hand) and collateral digital (mean: 7.4/hand) artery lesions. Arterial lesions are in relation with the clinical severity of the Raynaud's phenomenon but generally not with its aetiology. Authors consider that angiographic examination may be indicated in Raynaud's phenomenons in relation with defined aetiology but generally not in the other cases.

Adolescent↗
PubMed1985

[Exploration of the cervical arteries. Choice and place of a non-invasive technic in relation to the Doppler test].

An analytic study of the different techniques for non-invasive vascular exploration, used to examine cervical arteries, distinguished between hemodynamic tests (continuous and pulsed Doppler, spectral analysis of frequencies, oculoplethysmography) and imaging methods (ultrasound and real time echotomographic imaging). Best performances at the present time are obtained by combined frequency spectral analysis + real time echotomography or Doppler + real time echotomography. Selection of appropriate techniques is based on clinical findings of a symptomatic or asymptomatic patient. The decision as to the need for angiography and therapy can be made either immediately after the examination by Doppler alone or after a complete investigation, depending upon the circumstances.

Carotid Arteries↗
PubMed1985

[Late postoperative evolution of juvenile arteritis].

Investigation of 102 patients with arteriopathy and aged under 40 years show two groups as a function of course of disease: inflammatory and stasis arteriopathies. The course of the former disease is practically unaffected by surgery and repair is impossible, the common denominator in this group being amputation. Prognosis is better in patients with high lesions of stasis arteriopathy, but comparison with patients operated upon at "typical" age (58-62 years) showed increased progression of juvenile arteritis as seen by reduced permeability of repair procedures after 5 years. These findings suggest the need for extreme caution before conducting repair operations in this age group, and for maximum use of medical treatment.

Adult↗