Search PubMed⌕ Search

Biomedical subjects

R Limet

Publications and source records attributed to R Limet.

At least 379 records · Page 21Linked to original sources
PubMedDate not supplied

[Reoperation for aortocoronary bypass].

Iterative aorto-coronary bypass. From 1978 to 1988, 106 previously revascularized coronary patients were reoperated. This represents 3.01% of all aorta-coronary bypass procedures performed in the same period. Characteristics of this group, risk factors, coronary anatomical data, perioperative morbidity and mortality are analyzed and compared to the data of primary revascularization. The progression of atherosclerotic disease, with an annual 2% attrition rate of bypass grafts after the first year, is evidenced by this study. The success rate of coronary reoperations approaches the results of primary bypass surgery. The causes of recurrent angina and graft failure are discussed. The mean age of individuals requiring reoperation is 58.5 years. The mean interval between the two operations reaches 66 months (5 to 168 months). Angiographic lesions are more extensive, with a three vessel disease in 75% of the reoperated patients and an ejection fraction lowered at 55%. A mean of 2.7 bypass grafts per patient is realized, with in 60% of cases an internal mammary artery graft. Perioperative infarction occurs in 10.5% of the reoperations and in 4.5%, an intraaortic counterpulsation balloon is necessary at the end of the procedure. Symptomatic improvement is obtained in 85% of cases. Operative mortality is 5.7%. These findings suggest that coronary reoperation can be accomplished with low morbidity, low mortality and a therapeutic benefit in the majority of cases. In recent years, cardiac transplantation has been considered for some patients with impaired ventricular function. This procedure is only limited by the insufficient number of donors.

Coronary Artery Bypass↗
PubMedDate not supplied

Surgical management of left heart endocarditis.

Between 1981 and 1987, 29 patients (20 men and 9 women, mean age 46 +/- 15) underwent a valvular replacement for endocarditis (19 aortic and 10 mitral). There were 25 native and 4 prosthetic valves. In 85% of cases, underlying valvular lesions were present. The oropharyngeal and the respiratory tracts were the most common sources of infection. In 81%, the infecting microorganism was gram-positive. In 21% of cases, a gram-negative was detected, always mixed with a gram-positive. One infection was caused by a Candida. Indications for surgery were severe valvular insufficiency or cardiac failure (90%), refractory sepsis (21%), thromboembolic events (11%). In 22%, multiple factors were present. A biologic valve was chosen in 12 cases (40%). Simultaneously with the valvular replacement, 4 ventricular septal perforations were occluded and 3 valvular annulus abscesses debrided. The operative mortality was 10% (3/29). The one-year survival is 96%. Two patients required reoperation at 6 months and 2 years, for partial dehiscence, with good subsequent evolution. The authors concluded that surgical operation is the most suitable treatment for unstable or complicated endocarditis, in case of cardiac failure, iterative thromboembolic events or refractory sepsis.

Adult↗
PubMedDate not supplied

[Intrapericardial rupture of an aneurysm of the right anterior sinus of Valsalva: clinical case and review of the literature].

Intrapericardial ruptured aneurysm of the right anterior sinus of Valsalva. A intrapericardial ruptured aneurysm of the right anterior sinus of Valsalva is presented. An infectious origin was suspected. The aneurysm was treated by plication, which allowed to correct the preoperative insufficiency. Aneurysms of the Valsalva sinus can remain asymptomatic. When they are small, a conservative treatment is conceivable. Many complications can occur: rupture (more often in right cavities), aortic insufficiency, coronary insufficiency, cardiac failure, rhythm disturbances. This complications necessitate a surgical treatment. Aortic valvular replacement is indicated only when the structure of the valve is altered.

Aortic Rupture↗
PubMedDate not supplied

[Combined treatment of carotid and coronary artery insufficiency (author's transl)].

The association of a coronary insufficiency and a significant stenosis of the carotid trunks brings up a difficult problem of operative strategy. In a series of 142 patients operated by an aortocoronary vein graft 5 presented a bilateral carotid stenosis, of which two had a history of transient ischemic accidents. These were operated either in sequence: carotid then coronary, or by a simultaneous procedure. In conclusion it appears the planning of surgical procedures in cases of such combined vascular insufficiencies depends on the relative severity of both lesions, and in a case of unstable angina a simultaneous carotid-coronary operation is warranted.

Carotid Artery Diseases↗
PubMedDate not supplied

[Polyvascular patients. Retrospective study of 4200 vascular patients operated on between 1980 and 1986].

Polyvascular patients. Among a consecutive series of 4200 patients submitted to vascular surgery, a group of 292 people operated on, in at least two anatomically and physiologically different sites, is individualized as polyvascular patients. A subgroup is characterized by simultaneous procedures in two separated fields; 32 have benefited in the same time from carotid and coronary procedures, i.e., 0.6% of all coronary patients and 2% of all carotid patients. The carotid-coronary group exhibited a more severe anatomical disease both in the carotid and the coronary vasculatures. Apart from simultaneously operated patients, others were sequentially treated over a 7 years period: people with carotid (25%) or visceral (40%) arterial disease were more prone to become polyvascular. Polyvascular patients differ from monovascular patients in that hypertension is more frequent and more severe, mean cholesterol level higher and incidence of severe hypercholesterolemia more frequent.

Aortic Diseases↗
PubMedDate not supplied

[The value of femoro-femoral extracorporeal circulation in the treatment of isthmic rupture of the thoracic aorta].

Between 1977 and 1987, eleven isthmic ruptures and three chronic posttraumatic pseudoaneurysms of the thoracic aorta have been seen in our cardiovascular surgery service. The hemorrhagic intraabdominal wounds were treated first during the same or a staged procedure. Two patients died prior to the vascular intervention. In the other cases, partial femorofemoral extracorporeal circulation has been used after systemic heparinization (3 mg/kg). The perfusion flow was approximately 2 to 3 l/min. Three patients (25%) died following operation. Only one death caused by decerebration is potentially related to heparinization. No paraplegia occurred. The partial extracorporeal circulation is a reliable method to prevent paraplegia and to diminish the left ventricular post-charge during aortic clamp time.

Adult↗
PubMedDate not supplied

[Selection of candidates for surgery].

The different methods used to select the future surgeons are discussed. In order to improve the Belgian system, the authors suggest the creation of a selection board who would reexamine each candidate having accomplished three years of training.

Belgium↗
PubMedDate not supplied

Tracheal papillomatosis in the adult. Report of one case.

A 48 year old male suffered from localized tracheal papillomatosis. The diseaded trachea was resected but recurrence occurs 6 months later. Tracheal localization and occurrence in the adult age were singular features of this case.

Age Factors↗
PubMedDate not supplied

Paradoxical embolism.

Paradoxical embolization of venous thrombus into the abdominal aortic bifurcation has been diagnosed by means of aortography. Lower limb phlebothrombosis accounting for the embolus formation has been demonstrated by phlebography. Arterial embolectomy and venous thrombectomy were successfully performed. Recovery was complete without sequelae.

Adult↗
PubMedDate not supplied

[Reno-vascular hypertension surgery and renal: systemic renin index (author's transl)].

Thirty-two consecutive hypertensive patients with renal artery stenoses have been operated on. Surgical procedures were aorta-renal artery grafting, renal artery endarteriectomies and resection-anastomosis. Results were analysed with respect to the radiologic type of the stenosis (i.e. arteriosclerosis (AS) or fibromuscular dysplasia (FMD) and to the value of Renal: Systemic Renin Indices (RSRI) available in 30 cases. Out of 15 FMD cases, 14 are completely cured while in 5/15 cases RSRI values were not significant. 1/15 case is a failure, RSRI was here not significant. Out of 16 AS cases, 2 died in the immediate postoperative period. Out of 14 AS survivors, 11 are completely normotensive, 2 are only improved (in 11/13 cases where RSRI were available, they were significant) and 1 is a failure (in that case RSRI was not significant). One case of arteriovenous fistula is reported; reliable RSRI determination can not be obtained in that pathology. It is the author's suggestion that every case of FMD related renovascular hypertension should be operated on irrespectively of RSRI value. Opposingly, in AS case, operative decision is dependent on prior determination of RSRI.

Adolescent↗
PubMedDate not supplied

Traumatic tracheo-bronchial ruptures.

A series of 18 ruptures of trachea or bronchi is reported. Gaseous semiology is predominant (pneumomediastinum and subcutaneous emphysema 72%, pneumothorax 67%). Haemoptysis is present in 28%. Assessment of the diagnosis and localization of the rupture was obtained through rigid bronchoscopy, early in the series, and then via fiberoptic endoscopy. Ignored cases in the early phase manifested themselves lately by atelectatic phenomena. Tracheal ruptures (5) were treated by direct repair (1/5) or tracheostomy (3/5) ; 1 died before surgery. Bronchial ruptures (13) were submitted to bronchoplastic procedures (7/13) or pulmonary resection (4/13). In 2 cases, no surgery was necessary or possible. Mortality (7/18) is linked with the importance of associated lesions, especially neurological ones.

Adolescent↗
PubMedDate not supplied

Surgery for occlusive renal artery disease: immediate and long-term results.

A retrospective study is presented concerning 115 patients submitted to renal artery surgery from 1978 to 1990, and observed during 2 to 15 years. Included are 69 men and 46 women, aged 14 to 84 years (mean: 58.8 years). The underlying occlusive arterial disease was atherosclerosis in 87 patients, fibromuscular dysplasia in 21, and miscellaneous causes in 7 cases. One hundred and one patients (88%) were hypertensive. Some degree of impaired renal excretory function (serum creatinine level above 16 mg/l) was present in 30% (n = 42) of the patients, whereas 11 patients had severe renal insufficiency (creatinemia above 30 mg/l). Primary nephrectomy was performed in 11 patients as sole procedure and was associated with contralateral revascularization in another 9 patients. A variety of types of arterial reconstruction was performed, although more than half of the procedures were aortorenal bypass grafts. Bilateral procedures were performed in 19 cases. Simultaneous extrarenal operations included aortic reconstruction (n = 43), mesenteric arterial repair (n = 8), and carotid endarterectomy (n = 5). Operative mortality (9/115, 7.8%) varied considerably between the subgroups: 4% for group I (hypertension alone, n = 73), 15% for group II (renal impairment with or without hypertension, n = 34), and 12.5% for group III (acute renal failure, n = 8). There were 3 late non procedure-related in-hospital deaths. Preoperative renal insufficiency was the only independent predictive risk factor for operative death. The procedure was curative or led to improved blood pressure control in 79% (80/101) of hypertensive patients. The response rate was better for recent onset hypertension, compared to long-standing hypertension. Of the 42 azotemic patients, 78% had a benefit (improvement in 50%, stabilization in 28%) of renal revascularization. Associated longstanding hypertension had a negative prognostic value. Sequential clinical and functional follow-up evaluations are available on 99 of the 103 surviving patients. Cumulative 5-year survival is 87%. Cardiovascular causes account for most (11/15) of the late deaths.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMedDate not supplied

Venous allografts for critical limb ischaemia.

In as many as 25% of the patients with critical lower limb ischaemia, a suitable autogenous vein graft is not available. Patency rate of prosthetic grafts is disappointing at the infrageniculate level. Recently, there is renewed interest in the use of preserved venous allografts as an alternate conduit in patients with threatened ischaemic limbs. From 1991 to 1993, the authors revascularized 12 ischaemic limbs with venous allografts (10 preserved at 4 degrees C, 2 Varivas grafts). The indication for operation was rest pain in five patients and tissue necrosis in seven. Nine patients had one or more previous ipsilateral revascularizations. The at 4 degrees C preserved venous allografts were conserved for a near period of 2 months. In only half (5/10) of the cases ABO isocompatibility could be respected. Distal anastomosis was always below the knee. In 6 patients, the anastomosis was at tibial level. There was one rupture of a Varivas graft on the fifth postoperative day, necessitating ligation of the graft and subsequent amputation. All other grafts remained patent for a mean period of 10.6 months. Actually, 6 grafts are still open. Most patients were given aspirin. Only three patients were under oral coumarin anticoagulation in an effort to prevent early graft failure. The limb salvage rate is 67% (8/12) (mean follow-up of 13 months). The authors discuss the clinical experience with venous allografts as published in recent literature. Use of venous allografts for arterial reconstruction in humans was met with limited success so far. The one year patency approximates 50%. Venous allografts progress in an ineluctable way to a fibrous conduit.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗