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Biomedical subjects

R Kieny

Publications and source records attributed to R Kieny.

At least 145 records · Page 8Linked to original sources
PubMedDate not supplied

What is the place of pulmonary embolectomy today?

From 1.1970 to 31.12.1989, 134 patients with pulmonary embolism were treated by pulmonary embolectomy (74 women and 60 men) of mean age 55 years (23-78 years); 93 (69%) of these patients developed embolism during the postoperative period following surgery for another condition. In 12 cases the embolectomy was performed without circulatory assistance by a modified Trendelenburg operation after an average delay time of 2 hours. In 122 cases, extracorporeal circulation (ECC) was used, preceded in 64 cases, by a femoral-femoral bypass (the average delay interval of operation being 16.9 hours). At operation, 23 patients were in complete circulatory failure needing external cardiac massage, 34 were in cardiogenic shock with systolic arterial pressures (SAP) less than 60 mmHg, 42 maintained their arterial pressure between 60 and 100 mmHg, and only 35 were seen with SAP higher than 100 mmHg under vasopressive drugs. No haemodynamic and angiographic investigations could be undertaken in 31 patients because of their dramatic clinical state. In the other 103 patients who had invasive angiographic investigations performed the pulmonary bed was obstructed from 65% to 90% (mean 79.4%) according to Miller's index. The mean arterial pulmonary pressure was 51.2 mmHg. The survival rate at the 30th postoperative day showed 113 patients were alive (84.3%) with 7 among the 12 operated by the Trendelenburg's modified method and 106 among the 122 operated under ECC. The main causes of the 21 deaths were: peroperative 8, neurological 4, cardiac 4, respiratory 1, recurrent embolism 1, acute thrombosis of the IVC 1. Our results of pulmonary embolectomy can be compared favorably to those obtained by thrombolysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Traumatic lesions of the thoracic aorta. A report of 73 cases.

In a 24 year period we treated 73 traumatic lesions of the thoracic aorta; 36 of these were acute ruptures and 37 post traumatic pseudo-aneurysms. All these cases were associated with violent, sudden deceleration and in 68 instances the cause of this was a traffic accident. Fifty two patients (70%) had severe associated lesions involving the cranium, abdomen, thorax or leg fractures and dislocations but in 5 patients the aortic rupture was the only injury observed. Thirty four patients with acute aortic lesions were operated upon; 30 with extracorporeal circulatory assistance (CA) and 4 with aortic cross clamping alone. Twenty one were repaired by direct suture, 13 by prosthetic graft interposition and there were 8 deaths (23.5%) and one case of post-operative paraplegia. Thirty six traumatic aneurysms were operated upon; 34 with CA and 2 with cross clamping. Only two were repaired by direct suture, 5 by prosthetic angioplasty and 29 required prosthetic interposition grafts; there were no deaths or paraplegias in this group. Aortic rupture demands early diagnosis and immediate surgery. Associated abdominal injuries are easily missed and therefore exploratory laparotomy should be considered after every acute aortic repair.

Accidents, Traffic↗
PubMedDate not supplied

Acute post-infarction left ventricle rupture. Five operations with three long-term survivals.

Cardiac rupture is cause of death in myocardial infarction. Surprisingly only seventeen successful attempts at operative treatment have been published, with a rather good long term survival. The authors report five cases of cardiac rupture operated upon with two deaths and three long term survivals. Frequency, clinical features and surgical possibilities are discussed with particular insistance on a rather aggressive surgical attitude when considering this complication.

Aged↗