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Biomedical subjects

P Le Bas

Publications and source records attributed to P Le Bas.

At least 37 records · Page 2Linked to original sources
PubMed1990

Human umbilical vein grafts as infrainguinal bypasses: long-term clinical follow-up and pathological investigation of explanted grafts.

This retrospective study examines 105 consecutive infrainguinal bypasses using human umbilical vein (HUV) grafts as blood conduits over a 9 year period. In addition, 39 segments of these grafts were harvested at reoperation and submitted for morphologic, histologic, and scanning electron microscopy examinations. Fifty-two below-knee femoro-popliteal and 53 femoro-distal bypasses were performed in 93 patients. Sixty-seven per cent of these bypasses were performed for either rest pain (18%) or gangrene (49%) and 29% were performed for acute ischemia. Primary and secondary patency rates were not statistically different and were 38% and 29% at 1 and 3 years respectively. Factors found to have a significant effect on patency were site of distal anastomosis, state of distal run-off, and indication for operation. Other complications requiring reoperation included aneurysm formation (8 cases), infection (6 cases), mural thrombus (2 cases), and stenosis (2 cases). Pathologic examination revealed a damaged luminal surface in 22 grafts, deep folds in 8 grafts and delamination of the graft wall in 16 cases. Bacteria were seen in the folds of the grafts and, in addition, the presence of bacteria was documented in 7 out of 26 clinically non-infected grafts. The combination of poor patency rates and pathologic evidence of biodegradative phenomena have led us to discontinue HUV as an arterial substitute.

Adult↗
PubMed1990

Femorodistal bypass using the chemically processed human umbilical vein graft: 9-year experience.

To evaluate patency, limb salvage rates and complications associated with the use of human umbilical vein as an arterial substitute, the authors carried out a retrospective review of 52 femorodistal bypasses performed over 9 years using human umbilical vein. Indications for operation included acute ischemia, rest pain and nonhealing ulceration or gangrene. There were 28 early occlusions, which resulted in a 1-month primary patency rate of 46% and a secondary patency rate of 52%. The primary and secondary patency rates at 1 year were 18% and 19% respectively. The mean limb salvage rate at 1 month was 57% and at 1 year 34%. Three aneurysms occurred (two anastomotic, one graft). Factors found to have a significant effect on patency rates were indication for operation and state of distal runoff. Infection occurred in 6% of grafts and led to amputation in every case. These disappointing results have caused the authors to discontinue use of human umbilical vein as an arterial substitute.

Adult↗
PubMed1989

Traumatic fistula between the aorta and the left renal vein: case report and review of the literature.

This report of an aorto-left renal vein fistula (ALRVF) of traumatic origin is the sixth such case on record. The fistula was successfully repaired, with preservation of the kidney, by autotransfusion. Review of the English language literature revealed the differences between spontaneous and traumatic ALRVF. Spontaneous fistulas were caused by rupture of an abdominal aortic aneurysm into a retroaortic left renal vein. Hematuria was almost constant (93% of cases). The operative mortality rate was 14%. By contrast, traumatic ALRVFs were the result of a penetrating wound to the abdomen. The left renal vein was in a normal position, anterior to the aorta. Hematuria was less common (16% of cases). The diagnosis was delayed because clinical signs were less acute. There were no reports of postoperative deaths.

Abdominal Injuries↗
PubMed1989

[Paraganglioma of the head and neck. Familial forms].

The clinical, epidemiological and genetic aspects of familial paragangliomas of the head and neck are discussed in relation to 6 recent cases from two families which accounted for 2 and 4 patients respectively. Tumors of the carotid body are the most frequent. Bilaterality and association with other paragangliomas are suggestive of a hereditary disorder and should lead to investigation of the family. The establishment of a family tree will define those subjects at risk in whom systemic screening should be performed. The recent advances obtained using new imaging techniques in the diagnosis, evaluation of extension and treatment should enable treatment to be instituted at an earlier stage and thus reduce functional sequelae.

Adult↗
PubMed1988

[Gastric ruptures caused by diving accidents. Apropos of 2 cases. Review of the literature].

Underwater diving was responsible for gastric rupture in two cases seen personally and five cases of total gastric rupture reported in the literature. The various possible mechanisms for onset of this rupture are envisaged, the diagnosis of this rare accident being established from the existence of a large pneumoperitoneum. Emergency laparotomy allows suture of wound and ensures recovery.

Adult↗
PubMed1987

Radiologic anatomy of the anastomotic systems of the internal iliac artery.

On the basis of 200 angiographic studies of atherosclerotic patients affected by aorto-iliac lesions, the authors have investigated the anastomotic collateral systems of the internal iliac artery. After defining the different anastomotic systems of the internal iliac artery, they attempt to assess the functional importance of each anastomotic system in relation to the level of aorto-iliac obstruction. The different anastomotic systems involved are studied in terms of the different types of obliteration of the main arterial axis, and clinical tolerance is assessed for each case. This study emphasizes the important role of the internal iliac artery in the compensatory circulation to the lower limbs, over and above its role as an artery supplying the pelvis. The authors consider that this justifies attaching great importance to revascularization of the internal iliac arteries during reconstructive aorto-femoral procedures.

Aorta, Abdominal↗
PubMed1987

[Are axillo-distal bypasses justified? Apropos of 70 cases over an 8-year period].

Seventy axillary/distal artery shunts were carried out in 67 patients between 1978 and 1985. Mean age of patients was 71.5 years; 34% had coronary disease, 39% respiratory insufficiency, 12% diabetes and 12% severe renal impairment. Indications for the operation were sepsis in Scarpa's triangle (5 cases) and to save a limb with major ischemic lesions (65 cases including 14 stage III, 28 stage IV and 23 acute ischemic lesions). One-stage operation was performed in 37 cases and a two-stage procedure in 33. In 80% of cases the distal artery was the upper popliteal (11 cases) or lower popliteal (45 cases) artery. In 14 cases the distal artery was either the fibular (6 cases) anterior tibial (4 cases) or posterior tibial (4 cases) artery. Allowing for the context, the results justify this "maximalist" attitude (16% operative mortality, 43 limbs saved at 6 months, 31 at 1 year, 19 at 2 years). Three factors are determinant for permeability of shunts: severity of initial clinical stage, level of distal anastomosis and type of material used.

Adult↗
PubMed1987

[Internal iliac arteriovenous fistulas following gynecologic surgery. Development of principles of treatment. Apropos of 2 cases].

Pelvic arterio-venous fistulae are rare. They can be congenital or acquired. If the latter they are nearly always iatrogenic following surgery for prolapsed intervertebral discs or following gynaecological or obstetrical surgery. Diagnosis is difficult because the symptoms and signs are not specific ore are deceptive. Clinical examination shows that this "tumour" is vascular in nature. Up till recently treatment was disappointing, consisting as it did of surgery which was often difficult and dangerous and possibly carrying a poor prognosis, and in most cases resulting in recurrences. Since intra-arterial embolisation techniques have been developed, either by themselves or before surgery, the results have been better. They cannot be carried out without a preliminary precise and complete arteriographic assessment.

Abortion, Induced↗
PubMed1986

Aneurysm of the inferior mesenteric artery associated with occlusion of the celiac axis and superior mesenteric artery.

The authors report a case of aneurysm of the inferior mesenteric artery encountered in a 38-year-old man, associated with occlusion of the celiac axis, the superior mesenteric artery and the inferior mesenteric artery distal to the aneurysm. All three arteries were revascularized. In spite of failure in the bypass of the superior mesenteric artery, the patient remained symptom free until his demise four years later, from a probable myocardial infarction. Only 11 cases of aneurysms of the inferior mesenteric artery have been reported in the literature. The causes, diagnosis and treatment of these uncommon lesions are discussed. When occlusion of the celiac axis is associated with that of the superior mesenteric artery, a complete mesenteric revascularization should be attempted whenever possible.

Adult↗
PubMed1986

[Must all ruptured aneurysms of the aorta be operated on?].

Surgery is the only means of saving the life of patients with ruptured aneurysm of aorta, but it is universally accepted that the chance of survival is very low in case of prolonged collapse in patients over 80 years. Definition of pre-operative factors of severity and analysis of their effect on postoperative mortality showed that neither advanced age nor collapse nor anuria on admission allowed exclusion of patients when evaluated singly. When associated, however, the mortality rate becomes very high, but in this case any result of less than 100% mortality implies progress and should incite operation. In contrast, when patients with aneurysms have been excluded on other grounds then the contraindication to surgery should be maintained in case of rupture.

Age Factors↗
PubMed1985

[A frequent malignant tumor of the soft tissues, malignant fibrohistiocytoma. Current interest: apropos of 2 cases disclosed by vascular complications].

Malignant fibrohistiocytoma represents one of the most common malignant tumors of soft tissues. Previously difficult to diagnose with precision, it can now be detected pathologically as a result of recent techniques for investigating cellular development. Treatment is by wide exeresis, prognosis remaining reserved and requiring prolonged postoperative surveillance.

Adult↗
PubMed1985

[Popliteal aneurysms. Our experience apropos of 119 cases].

The authors report their experience of 119 popliteal aneurysms diagnosed in 76 patients. They feel that the prevalence of such aneurysms is underestimated. In 56% of cases there were bilateral aneurysms and in 24% of cases there was an associated aortic aneurysm. In 68% of cases, the popliteal aneurysm presented with complications. Clinical examination of the popliteal fossa gave a diagnosis in 66% of cases. In 1/3 of cases, arteriography failed to provide direct visual evidence of the aneurysm. The arteriographic diagnosis was then that of a femoro-popliteal thrombosis, of stenosis or isolated popliteal thrombosis. In all these difficult cases, echotomography is essential to diagnosis. The authors feel that indications for surgery should be as wide as possible. They consider that there are three types of contraindications: an excessively precarious physical condition, absence of a distal vascular network, an asymptomatic thrombosed popliteal aneurysm.

Adult↗
PubMed1985

[Medical and surgical outcome of thigh amputation for arteritis].

Results of a minimum 4 year follow up of 87 cases of thigh amputation are discussed. Postoperative mortality was 40% and 40% of patients had survived after one year. Early mortality factors were age (mean 75 years) and the coronary lesion responsible for more than a half of postoperative deaths. Amputation stump complications were noted in 13% of cases, their onset being dependent on 3 factors: loss of femoral pulse, failure of vascular re-establishment and early amputation after this failure. The remaining limb required major amputation in 21% of cases before the end of the second year, the final major level of amputation being a factor of the lack of distal revascularization in 77% of patients.

Age Factors↗