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Biomedical subjects

Y Glock

Publications and source records attributed to Y Glock.

At least 73 records · Page 4Linked to original sources
PubMed1984

[Role of thrombolytic treatment in thrombosis of valvular prostheses. Apropos of 2 cases and review of the world literature].

The authors report 2 cases of thrombolytic therapy by Urokinase at the dose of 4 500 U/kg/hour, for 24 hours, in patients with thrombosis of a Bjork aortic and Lillehei mitral valve prostheses, and assess the efficacy with a review of the world literature. The first case was a 65 year old woman who received a Bjork No 25 aortic valve prosthesis for aortic regurgitation. Two years later oral anti-vitamin K anticoagulants were replaced by an association of Aspirin-Persantine. She developed acute pulmonary oedema secondary to thrombosis of her valve during the fifth postoperative year. Treatment with Urokinase was successful (4 500 U/kg/hour for 24 hours). The second cases was a 33 year old woman who received a Lillehei No 27 mitral valve prosthesis for mitral regurgitation due to infective endocarditis. Six years later, during a period of apparently ineffective oral anticoagulation, she developed subacute pulmonary oedema due to thrombosis of her prosthesis. Urokinase therapy was successful after 4 hours, but the valve surface area on cardiac catheterisation was decreased and elective reoperation to change the prosthesis was decided upon. Prosthetic valve thrombosis is a serious complication with an operative mortality of 68.6% (35 deaths out of 51 reoperations in the worl literature) whilst the efficacy of thrombolytic therapy would appear to be about 80%. When thrombosis is progressive, the valve has to be changed surgically, but when it is secondary, thrombolytic therapy at least helps the patient survive the acute phase.

Adult↗
PubMed1984

[Aorto-enteric and paraprosthetic fistulas. Apropos of 5 cases].

Five cases of aorto-enteric fistula (AEF) are reported. The first case was a primary AEF from rupture of the infrarenal section of the abdominal aorta treated successfully by an obliteration and graft. The second patient had a primary AEF from rupture of an abdominal aorta aneurysm, complicated after an obliteration and graft of the primary AEF, requiring excision of the graft and an extra-anatomical shunt (EAS): healing following parenteral hypernutrition. The third case, a patient with a primary AEF from rupture of an aortic adventitial cyst in the left colon, died from septic complications. The fourth case died with heart rhythm disorders on the 4th day after resection and EAS for an aortic fistula. The fifth patient had a secondary AEF with cataclysmic digestive hemorrhage: excision of the graft with digestive closure and aortofemoral bypass did not prevent a fatal outcome on the 20 th day. Digestive hemorrhage and septic signs may be combined or occur as isolated complications. The most valid complementary investigation is fibroscopy, bacteriological culture of arterial blood distal to the prosthesis having an orientation value. Ultrasound, computed tomography or Gallium scintigraphy imaging may detect a retroperitoneal abscess. Effective treatment of all aneurysms can prevent primary AEF and avoidance of infection and interpositioning of viable tissue between duodenum and anastomotic line reduce the risk of secondary AEF. Maximum chances of success require aggressive surgery: aortic ligature; excision of all septic material and duodenal closure or segmental digestive resection with discharge of proximal pocket. Lower limb ischemia is treated by insertion of an EAS.

Aged↗
PubMed1984

[Extra-anatomical shunts in the lower limbs. Apropos of a series of 51 consecutive cases].

Indications for extra-anatomical shunts are defined on the basis of results of 51 consecutive operations. Axillo-uni or bi-femoral (AF) shunts (36 cases) and femoro-femoral (FF) shunts (15 cases) were performed in elderly men (74% over 60 years of age). These were patients in whom multiple affections (40 cases) or contraindications to direct local operations existed. The A-F were performed in either patients with chronic arteriopathies (2/3) or acute ischemic (6 cases) or infectious (4 cases) accidents. Immediate mortality (18%) was related to the age-group. Of the 47 limbs to be saved, 36 were preserved up to the 30th day. Long-term 2-year adjusted mortality was high (85%) because of the poor condition of the patients. The adjusted permeability level was 60% in survivors. The F-F were carried out in patients with either chronic arteriopathies or acute ischemic lesions. Immediate postoperative mortality was 13% and the early failure rate 25%. The long-term 4-year adjusted permeability level was 76%. All deaths were related to the atheromatous disease. These shunting operations remain complementary to conventional surgical procedures and should be reserved for cases such as those with obstacles to the direct reconstruction route or with generally very poor condition.

Aged↗
PubMed1984

[Aneurysm of the gluteal artery].

A 90 year old man developed the rare lesion of an aneurysm of the gluteal artery, provoked by an injury in a patient with atheromatous multiple aneurysm disease. The inflammatory and permanent nature of the sciatic pain, the history of a recent increase in size of the buttocks, as well as signs of a deglobulization suggest the need for urgent arteriographic exploration for precise definition of the arteries supplying the aneurysm. Surgical treatment is by primary ligature of the hypogastric artery associated with a direct approach in order to perform endoaneurysmorhaphy.

Aged↗
PubMed1984

[Aneurysm of the infrarenal abdominal aorta in octogenarians. Apropos of a series of 30 consecutive cases].

UNLABELLED: The authors report a series of 30 operated consecutive infrarenal abdominal aneurysms on patients aged of 80 years old or more. The operation is necessary in emergency in 13 cases (43.3%): 10 patients with sudden severe abdominal pain and faintness and 3 with rupture. In 17 cases the indication of surgery is "elective" (56.7%): sole physical finding in 10 cases, one case of ureteral tract compression and 6 cases of recent pain. In 13 cases, the infrarenal aneurysm is associated with arterial occlusive disease. In 20% of the cases, the operation consists on aorto-aortic bypass graft; in the other cases, aorto iliac bypass is necessary; in 3 cases the distal implantation of the graft is on the groin, on the femoral artery. The hospital mortality is 20% of the cases (6 cases); after operation in emergency the mortality is higher (30.6%) than after elective surgery (11.7%). The mean of the late follow up is of 39 months (2 months to 9 years): the late mortality is 16.6% of the cases (5 cases). The actuarial percentage of survival at 4 years is 60%. CONCLUSION: The elderly is not a contraindication for surgical treatment of the infrarenal aortic aneurysm. The late survival rate is good after the operation.

Aged↗
PubMed1983

[Thrombophlebitis on intravenous cardiac stimulator electrodes].

The main feature of venous thrombosis on endocardial pacing electrodes are described with reference to 7 cases: the incidence is relatively low (0.4 to 4 p. 100) and the diagnosis obvious in the typical axillary-subclavian form associated with pain, oedema and collateral circulation. Diagnosis is mainly clinical and rehoplethysmography, rather than venography with its potential complications, is the complementary investigation of choice. Internal jugular, innominate vein, vena cava and intracardiac thrombosis may also occur. The vena cava syndromes are observed mainly in patients with multiple electrodes. Atrial or ventricular endocavitary thrombosis may give rise to hemodynamic signs of cardiac failure or to thromboembolism which may be fatal. Operational technique is an important factor in the etiology of early thrombosis especially when the approach vein is ligatured. In the late period, the loss of venous mobility due to the presence of a foreign body makes the vessel susceptible to compression in the cervico-brachial region. The mainstay of treatment is anticoagulation with intravenous or subcutaneous heparin with mobilisation and elevation of the affected arm. Fibrinolysis may be indicated in superior vena cava syndromes (case no 1), the results being better when therapy is instituted early on. Long term anticoagulation is not indicated (case no 7) and may even be dangerous in elderly patients with multiple electrodes.

Aged↗
PubMed1982

[Partial sternectomy for metastatic tumor with reconstruction using a methylmethacrylate plate].

A case of partial sternectomy for metastatic thyroid carcinoma is reported. En bloc excision was followed by reconstruction using a molded plate of methylmethacrylate. Sternal tumours are rare and operations for cure of metastases are justified only if the general condition of the patient permits and in the patient with a single metastasis whose primary cancer operation was a radical one. Extensive en bloc excision is based on preoperative investigation in which computerized axial tomography has an important place in delineating the extent of the tumour and providing accurate knowledge of the margins of the section. Reconstruction with methyl-methacrylate allows a rigid setting with a material that can be molded, is radiolucent, inert and well tolerated. In the upper sternum it contributes to the stability of the shoulder girdle and protects the underlying mediastinal structures in a cosmetically acceptable way.

Adenocarcinoma↗
PubMed1981

[Surgical revascularization of infarcted myocardial areas. Its effects on left ventricular function].

The results of twelve patients undergoing revascularisation procedures of infarcted myocardial territory alone were analysed quantitatively by planimetry in the right anterior oblique projection. Patients operated in the acute phase of myocardial infarction (2 cases) were distinguished from those with preinfarction syndromes (8 patients) and those with postinfarction angina (2 patients). Two posterior wall and ten anterior wall revascularisations were carried out by single bypass grafts (8) and double bypass grafts (2) with no operative deaths. The results were assessed 2 months to two years after operation (average: 6 months). Twelve of the fourteen bypass grafts were patent. Only one of the twelve operated patients, an anterior wall revascularisation, was considered a complete surgical failure: global left ventricular function and segmental wall movement progressively deteriorated with reduced contractility and velocity of fibre shortening. Improved contraction of both anterior and posterior walls was observed in the other 11 patients. The ejection fraction of the 9 patients with anterior wall revascularisation rose significantly from 47,1 +/- 10,5% to 56,3 +/- 3,5% and a similar rise was observed in systolic index (29,0 +/- 12,0 to 36,8 +/- 11,0 ml/syst./m2); the average akinetic end diastolic perimeter fell by 17%; segmental wall analysis of mean radial shortening and mean amplitude of excursion on the hemiaxes was improved, especially in the antero apical region: the corrected rates of mean excursion and average systolic work indices (33,2 +/- 15 to 41 +/- 13 gm/syst./m2) also increased. Surgical revascularisation of infarcted zones, made possible by new methods of cardioplagia and reliable circulatory assistance, may lead to improvement in global and segmental left ventricular function with minimal risk to the patient: this is thought to be due to an active mechanism and not to the passive process of scarring. Although a reserved attitude should be adopted in the acute phase of myocardial infarction, preinfarction syndromes and unstable postinfarction angina could well benefit from surgical management.

Adult↗
PubMed1981

[False aneurysms of the subclavian artery].

The authors describe two cases of false aneurysm of the right subclavian artery. One was due to a penetrating cervical injury and the other to blunt thoracic trauma. Both patients were treated surgically. Early diagnosis by aortography and surgical treatment are important. The operation is difficult because of the cervicothoracic course of the subclavian artery. Because of this a wide approach should be made and reconstruction is mandatory.

Adolescent↗
PubMed1980

[Floating thrombus of the left ventricle after recent myocardial infarction, treated by surgery].

The case of a 55 year old man admitted with an uncomplicated anteroseptal myocardial infarction is reported. At the third week this young patient underwent complete assessment. On coronary angiography severe double vessel disease was demonstrated and ventriculography showed a "floating" pediculated thrombus attached to the akinetic anterior wall. The ejection fraction was calculated at 40%. Subacute ischaemia of the right lower limb developed in the hours following catheterisation. In the face of all these findings surgery was proposed; ablation of the "fresh" thrombus was associated with a ventricular resection and an aorto-coronary bypass graft on the left marginal branch, together with disobliteration of the distal ilio-femoral artery of the right leg. The following points are emphasised with respect to this report: - the rarity of such cases in the litterature despite the high incidence of mural thrombi after infarction; - the value of diagnosing this complication by systematic investigation of patients under 60 years of age in full socio-professional activity; - the indications of rational surgery comprising ablation of the thrombus and any necessary prophylactic coronary revascularisation.

Coronary Angiography↗
PubMed1979

[Secondary tamponade following cardiac surgery with reference to 3 cases].

Secondary tamponnade after cardiac surgery occurs after a variable period, generally between the 15th day and the 5th post-operative week. Although this is a rare complication, it occurred three times in a consecutive series of 225 patients (1.3 p. 100). Based on this short experience as compared to the number of cases already published, the authors discuss their opinions on: -- the factors of inflammation and post-operative anticoagulation which predispose to this complication; -- the progress in diagnosis brought about by echocardiography; -- the minimal suggested management of pericardocentesis completed or not by surgical drainage; -- the possibilities of prevention based on prolonged follow-up of patients who present post-operative "pericardial problems". In this way it may be possible to eliminate a not negligeable cause of secondary mortality after cardiac surgery.

Aged↗