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R J Estourgie

Publications and source records attributed to R J Estourgie.

8 recordsLinked to original sources
PubMed2000

Effects of a venous cuff at the venous anastomosis of polytetrafluoroethylene grafts for hemodialysis vascular access.

INTRODUCTION AND METHODS: The most frequent complication of polytetrafluoroethylene (PTFE) arteriovenous grafts for hemodialysis is thrombotic occlusion due to stenosis caused by intimal hyperplasia. This complication is also known for peripheral bypass grafts. Because the use of a venous cuff at the distal anastomosis improves the patency of peripheral bypass grafts, we considered that it might also improve the patency of PTFE arteriovenous grafts. Therefore, a randomized multicenter trial was carried out to study the effect of a venous cuff at the venous anastomosis of PTFE arteriovenous grafts on the development of stenoses and the patency rates. RESULTS: Of the 120 included patients, 59 were randomized for a venous cuff. The incidence of thrombotic occlusion was lower in the cuff group (0.68 per patient-year) than in the no-cuff group (0. 88 per patient-year; P =.0007). However, the primary and secondary patency rates were comparable. The cuff group tended to have fewer stenoses at the venous and arterial anastomoses when examined with duplex scan. Graft failure was higher in patients with an initial anastomosing vein diameter smaller than 4 mm (7 of 18 [39%]) than in those with a vein diameter of 4 mm or larger (16 of 88 [18%]; P =. 052). Local edema, skin atrophy, and obesity yielded a higher risk on graft failure (23% vs 11%). CONCLUSION: A venous cuff at the venous anastomosis of PTFE arteriovenous grafts for hemodialysis reduced the incidence of thrombotic occlusions; stenosis at the venous anastomosis was reduced. However, this did not result in a better patency rate. Therefore, the venous cuff should not be used routinely. Initial vein diameter and local problems (edema, obesity, or skin atrophy) appear to be the most important risk factors for graft failure.

Arteriovenous Shunt, Surgical↗
PubMed1983

The clinical and histopathological effects of pancreatic duct occlusion in experimental acute pancreatitis in dogs.

A continuous production of significant pancreatic enzymes, which are thought to be responsible for the maintenance of the digesting process, is frequently found in fulminant necrotizing pancreatitis. Since the medical therapies known to be effective are based upon the rationale of slowing pancreatic secretion, a simple measure which permits the "burning out" of residual pancreatic tissue might therefore have a therapeutic value. In this study, 2 hr after the induction of acute hemorrhagic pancreatitis, 5 dogs (Group I) were treated with 1.5 ml Ethibloc injected into the pancreatic duct; 5 other animals (Group II) were given 1.5 ml saline; Group III (5 dogs) had no treatment. All animals in Group II and 4 of the 5 animals in Group III expired within 8 days postoperatively. In contrast, 4 of 5 animals from Group I survived. Although some of the biochemical parameters showed significant changes after the induction of acute pancreatitis, no differences were seen between the three groups. In the expired animals, the picture of histological examination was that of a fulminant acute hemorrhagic pancreatitis of the left lobe. In the survival dogs although normal pancreatic tissue was present in the right lobe at necropsy at intervals, there was always a pancreatic atrophy of the left lobe and striking adhesions with the surrounding tissues suggesting the severity of the disease in the acute phase. These findings suggest that pancreatic duct occlusion causing the exocrine secretion to stop may have beneficial effects in the treatment of acute fulminant pancreatitis in the acute phase and may improve the survival rate.

Acute Disease↗
PubMed1982

Treatment of grossly comminuted fractures of the olecranon by excision.

Operative reduction with internal fixation for the fractured olecranon is generally considered to be the treatment of choice whenever there is separation of the fragments. In grossly comminuted fractures, however, anatomical reconstruction often cannot be achieved satisfactorily. In such cases excision of the loose fragments of the olecranon and re-attachment of the triceps tendon to the shaft of the ulna offers a better solution when the fracture is proximal to the coronoid process.

Adult↗
PubMed1981

Mesenteric cysts.

7 new cases of cysts in the mesentery of the small bowel are presented, together with 54 clinically and histologically well documented cases from the literature. Most cysts are found in laparotomy for an acute abdomen. Almost half of the patients are under the age of 11 years. The cysts can be unilocular, multilocular or multiple. Cysts in the mesentery of the jejunum always had a chylous content. Most often the wall consists of an endothelial lining, smooth muscle, lymphatic tissue and lymphatic vessels. Inflammation and/or bleeding destroyed the endothelial lining and added granulation tissue to the histologic picture. With the exception of 7 cases, the cysts are probably of congenital and lymphatic origin. Trauma, infection, bleeding or volvulus can make a silent cyst manifest.

Abdomen, Acute↗