[Treatment of the tibial shaft fractures by closed intramedullary nailing. Technique, pit falls and complications. A series of 300 similar cases].
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Adolescent↗
Biomedical subjects
Y Glock
Publications and source records attributed to Y Glock.
From Vineberg to bypass: a "second-hand" internal mammary artery.
A patient operated upon 20 years ago for myocardial revascularization with two Vineberg procedures and one coronary artery bypass graft (CABG) on the right coronary artery had a recurrence of unstable angina due to the thrombosis of the left internal mammary artery (IMA) and the right CABG. The right IMA was patent but stenosed distally. Reoperation was performed with a direct end to side anastomosis of the patent right IMA onto the left anterior descending artery and a saphenous vein graft as a CABG on the marginal branch. We comment on the choice of this "second hand" IMA graft and the pathological appearances of the patent IMA.
Aged↗
[20 years of surgical coronary revascularization. The importance of arterial grafts].
Myocardial revascularization surgery by means of a saphenous aortocoronary by-pass is in its third decennial of employment. Also if it has been proved of value in bettering the survival in various kind of anatomical lesions, and in resolving the anginal symptomatology in a majority of patients, it has been granted of a simple palliative surgical procedure in view of the evolutive characteristic of arteriosclerotic disease and of the progressive degenerations of the internal saphenous vein. The wide use of arterial transplants, internal mammary artery and gastroepiploic artery, gives these patients satisfying results. Due to the more technical complexity of its preparation and anastomosis, internal mammary artery was very late adopted by surgeons. Nevertheless it has acquired a title of noblesse demonstrating its long survival, and in the meantime has given an impulse to the use of the gastroepiploic artery. According to our experience 80% of our patients can obtain a complete revascularization using exclusively simple or sequential arterial transplants. Also if this surgery must rightly be considered a palliative one, for its long term results of survival and quality of life it shows a curative value.
Arteries↗
A new device: the quick cannulation system.
We describe a new technique for the placing and fixing of extracorporeal circulation cannulae in the heart. Two devices are involved, the first for an atrial or venous return cannula and the second for an aortic perfusion cannula. These allow quick easy cannulation which is very important in emergency surgery.
Cardiac Catheterization↗
Abdominal aortic aneurysmectomy in octogenarian patients.
The authors report 56 patients. 80 years of age or older who had an abdominal aortic aneurysm (AAA): twenty seven were operated upon as emergencies, 7 with intra-peritoneal (Group I) and 20 with retro-peritoneal rupture (Group II). Twenty nine underwent elective surgery (Group III). Renal pulmonary and cardiac disease are frequent in octogenarian patients. The surgical repair consisted of 40 knitted bifurcated grafts and 16 aorto-aortic woven grafts. The overall in-hospital mortality rate is high (28.5%: 16 patients) essentially in "emergency" surgery: 71% for the seven Group I patients and 45% for the twenty Group II patients. The in-hospital mortality rate of 6.9% for the Group III of "elective" procedure is higher than the mortality rate of patients of all ages operated on for asymptomatic AAA in our institution which is 4.3%. Once a patient has been operated on successfully his life expectancy tends to parallel that of a normal population for his age group. These results can be improved with preventive measures such as elective surgery for asymptomatic AAA with a diameter of 6 cm or more. Operative contraindications are severe congestive heart failure, advanced pulmonary disease or neoplastic disease. The age "per se" is not a contraindication to aneurysmectomy. Physiologic rather than chronologic age should determine the selection for AAA in the over-80 age group. CT scans and MR are safe fast and non-invasive preoperative examinations for AAA.
Aged↗
Isolated aneurysm of the left sinus of Valsalva. Rupture into the left atrium, left ventricle and dynamic coronary constriction.
Aneurysms of the left sinus of Valsalva are exceptional. They may cause aortic regurgitation and may rupture into an extra or intra-cardiac location. We report an aneurysm of the left Sinus of Valsalva associated with 3 unusual complications: rupture into the left atrium, infected rupture into the left ventricle inducing aortic regurgitation and compression of the left circumflex coronary artery. These caused cardiac failure, coronary insufficiency and paroxysmal ventricular fibrillation. A review of the literature on the LASV has been undertaken.
Aged↗
Cardiac damage in nonpenetrating chest injuries. Report of 5 cases.
The Authors report 5 cases of cardiac injury after blunt chest trauma: (a) one right atrial disruption with acute tamponade treated successfully; (b) two left ventricular perforations with rib fractures: one patient was exsanguinated and died, the other one presented a late subacute cardiac tamponade with successful operative repair; (c) one isolated traumatic tricuspid insufficiency which was well tolerated; (d) one atrio-inferior caval disruption with acute tamponade. Cardiac damage secondary to nonpenetrating chest trauma is uncommon but with the present modes of high speed transportation they are occurring with increasing frequency; correct management of cardiac ruptures depends upon rapid recognition of the injury and expeditious surgical repair. The occurrence of tricuspid valvular lesions alone as a result of nonpenetrating trauma is not common. Echocardiographic examination after blunt chest trauma is a useful diagnosis procedure.
Accidents, Traffic↗
Cardiovascular surgery and heparin induced thrombocytopenia.
The Authors report a series of 21 cases of heparin induced thrombocytopenia (HIT) observed in a Department of Cardiovascular Surgery. The indication for heparin treatment was a cardiac procedure in 12 cases, peripheral arterial reconstructive surgery in 3 cases and in 6 cases a prevention of embolism. Two routes were used for heparin administration: subcutaneous and intravenous injections. The diagnosis was biological on low platelet counts (p.c.) in 4 cases, in 7 cases a deep venous thrombophlebitis and in 9 cases an acute arterial ischemia complicated the heparin treatment. From the 7th to 15th day after heparin treatment the p.c. had risen to the average value of 46,857/mm3. The diagnosis was clinical in 3 cases, biological with a positive aggregation test in the presence of heparin in 11 cases out of 14 biological tests performed and pathological with observation of white clots in 11 cases. The related mortality rate to HIT was 28.5% of the cases (6 cases). HIT is a rare but severe complication often associated with thrombo-embolic complications. The routine check of p.c. before and after the first week of heparin treatment is reasonable. The negative aggregation test in the presence of heparin does not permit to confirm this diagnosis. The drop in the p.c. between the 6th to 10th day after heparin treatment required an immediate arrest of this type of anticoagulation and replacement with Coumadin. The low molecular weight Heparin may induce cross matching reactions with heparin and therefore is not used as treatment for HIT. In emergency, cardiac surgery with the use of the extra-corporeal circulation device can be performed with success with heparin (2 cases).
Adult↗
[Effects of intravenous electrodes of cardiac pacemakers. Clinical and plethysmographic approach].
The authors study the haemodynamics of the endovenous electrodes of cardiac stimulators (EE) in the light of clinical and plethysmographic investigations. Seven venous thromboses were observed out of 2,000 implantations of stimulators (0.35%). The risk increases with age 7th decade) and the presence of multiple EEs. The comparative plethysmography of a series of 22 normal young subjects and 28 old patients equipped with EEs demonstrates that the deep venous return in the upper limbs of a normal subject is better in a young person and in a dominant limb. In the subject equipped with an EE, distensibility is reduced. Temporary coagulation has its place in the treatment of these phlebites (heparin, followed by calciparin). Surgery to disobstruct or excise EE or fibrinolytics are only required exceptionally.
Adult↗
Aortic valve replacement in elderly patients.
The results for 62 consecutive patients aged 70 or more given aortic valve replacement (A.V.R.) between 1970 and 1982 are reported. All the patients were in the New York Heart Association (N.Y.H.A.) functional class III (29%) or IV (71%); 54.8% had angina and 30.6% had experienced syncope. Forty patients had aortic stenosis (A.S.), 10 had aortic regurgitation and 12 had mixed aortic valve disease. The operative myocardial infarction rate was 6.4%. Tilting disk valves were used. Eighty percent of the patients were anticoagulated with Warfarin whilst twenty percent received only antiplatelet drugs. All the patients were followed up for a mean period of 26 months; late mortality was 22.6% with 4.8% cardiac deaths. The thromboembolic rate was 1.6% and the disinsertion rate was 3.2%. Cerebral stroke was fatal in 3 cases in anticoagulated patients but the mechanism of the accident was not known. At the termination of the study 93% of surviving patients were in N.Y.H.A. class I or II. No patient was in class IV. The probability of five year survival is 71% for the entire group.
Age Factors↗
[Aneurysms of the popliteal artery. Intravascular bypass using the internal saphenous vein].
We used the internal saphenous vein to create an intravascular bypass for the treatment of aneurysms of the popliteal artery. The saphenous vein was positioned within the lumen of the aneurysmal popliteal artery and in the superficial femoral artery at its origin. Two end-to-end anastomoses were made including the venous wall within the suture. This new surgical technique is based on 3 criteria. i) anatomic: the venous bypass follows the exact path as the artery since it is situated within the lumen; ii) haemodynamic: end-to-end anastomoses are used to avoid turbulence created with end-to-side sutures; iii) histologic: the venous endothelium protects better against thrombus formation ensuring good long-term permeability.
Aneurysm↗