Biomedical subjects

R Vanmaele

Publications and source records attributed to R Vanmaele.

26 records · Page 2Linked to original sources

PubMedDate not supplied

Venous homografts in infra-inguinal procedures: an eight years experience.

Autogenous saphenous vein is still the first choice graft material for femoro-distal bypass whenever it is available, but the choice of an alternative is still a challenging problem. Between 1982 and 1989, 100 femoro-distal reconstructions were performed with saphenous vein segment homografts, harvested during varicose vein stripping, they were selected, prepared and stored at 4 degrees C. In 71 cases the distal anastomosis was below the knee. According to the actuarial life table analysis (Kaplan & Meyer) the cumulative graft patency rate after 6 months, 1, 3, 5 and 7 years was 79%, 63%, 46%, 45% and 42% respectively. Twelve cases of aneurysm formation or stenosis requiring reintervention occurred. The patency rate was not influenced by the site of the distal anastomosis, but the condition of the run-off vessels had a significant influence on the early occlusion rate. Varicose vein segments are a readily available source of graft material. The low cost, easy storage and handling of these grafts justify their use in limb salvage procedures.

Adult↗

PubMedDate not supplied

Deep venous thrombosis of the upper extremity: case reports and review of the literature.

The development of a thrombosis of the axillary-subclavian vein has long been an uncommon clinical entity. The more routinely use of central venous lines in modern patient management, however, has increased its incidence. Three cases of deep venous thrombosis of the upper extremity are reported. The different possible etiologic factors, the diagnostic tools, complications and different treatments--both conservative and non-conservative--are reviewed and discussed.

Adult↗

PubMedDate not supplied

Primary intrathoracic goitre.

A right paratracheal mass in a 56-year-old man was found to be a primary intrathoracic goitre. Pathological examination showed nodular hyperplasia with focal lymphocytic thyroiditis. Enlarged mediastinal thyroid tissue may result from extension of a cervical goitre into the chest and is then called secondary or may develop from ectopic thyroid tissue located in the mediastinum and is then called primary. In the latter case blood supply comes from local intrathoracic vessels and no connections with the cervical gland are observed. Differentiation can be made by ultrasonography, CT scanning or radioisotope scanning. Primary goitres are best operated on by way of a thoracotomy as troublesome mediastinal bleeding may occur which is difficult to control from a cervical collar incision.

Goiter, Substernal↗

PubMedDate not supplied

Intrapulmonary lymph nodes in the differential diagnosis of solitary pulmonary nodules: case report and review of the literature.

A 49-year-old man was admitted for further investigation of a coin lesion with a diameter of 1 cm. He was a heavy smoker with no professional exposure. Since the percutaneous needle biopsy did not yield a definitive diagnosis, a thoracoscopy was performed. The solitary pulmonary nodule was found to be an intrapulmonary lymph node with anthracosilicotic pigment and a thoracoscopic wedge resection was performed. A review of the case reports in the period 1961-1993 shows that intrapulmonary lymph nodes could be more frequent than originally thought. All patients were smokers but professional exposure was not a constant finding. The differential diagnosis and management of the indeterminate solitary pulmonary nodule are discussed.

Diagnosis, Differential↗

PubMedDate not supplied

Acute aortic dissection.

Acute aortic dissection is initiated by an intimal tear most often found in the ascending or descending thoracic aorta. A high index of suspicion is necessary to establish diagnosis. In the acute setting, transoesophageal echocardiography is very helpful to confirm the diagnosis, locate the intimal tear and demonstrate the extent of dissection. Acute type A dissection is a surgical emergency contrary to type B dissection which is treated medically unless complications arise. With correct treatment, mortality of these life-threatening disorders has been reduced during the last decade and long-term survival of discharged patients is around 50%. Careful follow-up is necessary to detect late complications, mainly the occurrence of a post-dissection aneurysm.

Aged↗

PubMedDate not supplied

Pulmonary metastasectomy.

Between 1988 and 1994, 24 patients underwent 32 procedures for pulmonary metastases. Primary tumours were gastrointestinal, malignant melanoma, osteogenic sarcoma, renal cell carcinoma, head and neck cancer and finally testicular carcinoma. Age ranged from 16 to 78 years, with a female/male ratio of 7/17. Pulmonary metastasectomy was performed in 9 cases through median sternotomy, in 21 cases through thoracotomy and in 2 cases by thoracoscopy. In 9 cases repeated resection was necessary. Overall mortality was 0% (95% confidence limits are 0.00 +/- 14.25). Computed tomography of the chest in combination with tumour markers, were most important during follow-up to detect recurrent disease. The overall 5-year actuarial survival and disease-free survival were 0.56 +/- 0.17 and 0.30 +/- 0.14 respectively. With regard to testicular carcinoma 5-year actuarial survival was 100%. Pulmonary metastasectomy is a recommended procedure in the treatment of selected patients with metastatic pulmonary disease. Resections should be as conservative as possible and if necessary, repeated. In our study this procedure proved especially effective in case of testicular carcinoma.

Adolescent↗

PubMedDate not supplied

Traumatic type B aortic dissection.

A 37-year-old man was referred with thoracic pain after a deceleration trauma. He also had a cerebral contusion and a wrist fracture. There were no sings of hypovolemic shock. Computerized tomography (CT) of the chest and transoesophageal echocardiography (TEE) demonstrated a type B aortic dissection originating just distal to the left subclavian artery. There was a patent false lumen without rupture or distal ischaemia. Conservative treatment was given. A paralytic ileus developed and abdominal complaints persisted for several months. Angiography showed normal patency of mesenteric vessels. On follow-up, 3 years after the accident a slight aortic dilation was found on CT thorax without development of a post-dissection aneurysm. Blunt thoracic injury to the aorta usually gives rise to aortic rupture in the region of the isthmus, which can be complete or partial. In the latter case a false aneurysm may develop. An intimal tear after blunt trauma leading to type B aortic dissection rarely occurs. General principles regarding treatment of type B dissection also apply to this particular condition.

Adult↗

PubMedDate not supplied

Short-term survival after major pulmonary resections for bronchogenic carcinoma.

From January 27, 1992 to December 12, 1994, 100 consecutive patients (86 men and 14 women) with a mean age of 62.5 years underwent lung resection for a non-small cell lung cancer. Squamous cell carcinoma was predominantly found (52%), followed by adenocarcinoma (23%) and large cell carcinoma (18%). Postoperative staging was Stage 0, 1 patient; Stage I, 57; Stage II, 17; Stage IIIa, 20 and Stage IIIb, 5. Thirty-day mortality was 4% (4 patients) with 10.7% for pneumonectomy and 0% for lobectomy or lesser resection. For the whole group 1-, 2- and 3-year survival rates were 83%, 68% and 65% respectively. Survival rates for N0, N1 and N2 after 3 years were 70%, 59% and 54% respectively. In the univariate analysis, a trend to statistical significance was noted between N0 and N1 (p = 0.08). There was no difference in short-term survival between N0 and N2 which represents a highly selected group of patients with N2 disease. In the multivariate analysis the only two independent variables with impact on survival were number of pack-years and diameter of the tumour (p < 0.05). Ninety-two quality of life questionnaires (EORTC QLQ-C30) were sent to home physicians. We collected 31 questionnaires (34%) after 2.5 months. A clear relationship was not seen between complaints of pain or dyspnea and extent of resection or lung function postoperatively. Instead, the global quality of life seemed to be influenced by the extent of resection to the advantage of a lobectomy and disadvantage of a pneumonectomy. Difficulties related to quality of life analysis are discussed and future directions are given.

Adult↗