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Biomedical subjects

P Kauffman

Publications and source records attributed to P Kauffman.

At least 37 records · Page 2Linked to original sources
PubMedDate not supplied

[Evaluation of middle cerebral artery blood flow velocity with transcranial Doppler in carotid endarterectomy].

Thirty patients, submitted to 34 carotid endarterectomies, from September, 1992 to April, 1996, on Hospital Albert Einstein, São Paulo, have been studied. In these surgeries, Middle Cerebral Artery (MCA) was miniaturized with Transcranial Doppler (TCD). The purpose of this study were to verify the relationship between MCA blood flow velocity with postoperative neurologic complications: studying the velocity variations with risk of cerebral low perfusion and carotid stump back pressure, during carotid clamping; confirming that the TCD information, could show when it is necessary to use shunting, and its efficiency; and to know whether the method could detect intraoperative embolization. The equipment used was a Transpect TCD-EME 2000. During surgery, when carotid stump back pressure was bellow of 54.4 mmHg, Pruitt-Inahara shunt was applied. The flow velocity value observed with TCD was divided in 3 parts: phase 1, basal, since anesthesy induction until carotid clamping; phase 2, clamping, during the period when the carotid artery was occluded; phase 3, post-declamping, from the time the carotid artery was declamping until the end of surgery. The MCA flow velocity was available on three phases, in cm/s and percentually on phases 2 and 3, in relation to basal phase. The embolizations, detected by TCD, were classified in: a) a few embolizations in less than 10 second period, b) many embolizations in more than 10 second period. Based on the results obtained, its possible to conclude that the MCA flow velocity is related to the risk of cerebral low perfusion during carotid clamping; it was not possible to stablish any relation of MCA flow velocity to carotid stump back pressure; the TCD informs when the use of shunt is necessary and its efficiency; the postoperative neurologic complications were caused by embolizations. The conclusion is that the TCD is useful and easily applicated on carotid endarterectomy.

Aged↗
PubMedDate not supplied

[Unusual complication of surgery of popliteal artery aneurysm: report of a case and considerations on the surgical technique].

A popliteal artery aneurysm was submitted to an exclusion surgery and autologous reversed saphenous vein bypass. The proximal ligation of the popliteal artery was performed 3cm above the aneurysm. A large branch of the artery below this point remained patent maintaining a communication with a branch of deep femoral artery. Due to this fact residual circulation inside the aneurysm was observed. The patient was reoperated in order to ligate the collateral branch and resect part of the aneurysm. This kind of complication of the technique proposed by Edwards is not common and does not invalidate this technique preferred by most surgeons.

Aneurysm↗
PubMedDate not supplied

[Diagnosis of deep venous thrombosis of the lower limbs by computed tomography].

In the CT scan of a patient with knee tumor and deep vein thrombosis confirmed by phlebography, the casual observation of a thrombus image in the vein was made, characterized by wall contrastation in opposition to a lack of luminar contrastation. Then, CT scans of the lower limbs and the pelvic region were performed in 14 patients with suspected DVT, who were followed consecutively. Diagnosis of ruptured Baker cyst was made in one patient and DVT in 13 patients. DVT was demonstrated in both lower limbs of three patients. Diagnosis of DVT was confirmed in six of seven exams involving the legs. CT scan could detect thrombi in muscular veins and in deep femoral and internal iliac veins. In six patients with suspected pulmonary embolism, CT scan was also made of the thoracic region and showed pleuropulmonary involvement concomitant with lower limb DVT. The characteristic image of DVT in CT is that of a contrasted ring. Its brightness may be due to contrastation of the venous wall through its vasa vasorum, whereas the thrombus obstructs the luminar flow of the contrast medium. Reproducibility of the characteristic image of thrombus presence in the vein at different levels of the lower limbs and pelvic region gives CT the status of alternative diagnosis means for DVT. False negatives and false positives should be evaluated.

Adult↗
PubMedDate not supplied

[Arterial reconstruction of the iliofemoral segment by eversion endarterectomy].

From October 1985 to December 1988, 31 iliofemoral eversion endarterectomies were performed in 29 patients with arteriosclerosis. The surgical procedure was carried out for trophic lesions in 74% of the patients and for ischemic rest pain in the remaining 26%. In 11 operations the endarterectomy was associated with profundoplasty, and in eight with saphenous vein femoropopliteal bypass. There were six immediate failures, four of them submitted to successful reoperations, and two to above knee amputations. In cases with good immediate patency no complications occurred during the follow-up periods which ranged from one to 34 months. With one post-operative death the mortality rate was 3.2%. Two patients displayed later severe ischemic manifestations in the opposite limbs and were both submitted to the same type of operation with good result. It may be concluded that iliofemoral eversion endarterectomy is an appropriate alternative procedure to the aortoiliofemoral reconstruction surgery in patients with severe ischemia of the lower limbs.

Actuarial Analysis↗