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Four patients with Marfan syndrome developed severe aortic insufficiency requiring complete replacement of the ascending aorta with reimplantation of the coronary arteries by the technique of Cabrol. All patients have remained asymptomatic in NYHA class I.
The authors report a case of an infant affected by isolated thrombosis of splenic vein. They stress the necessity of a precious diagnosis in order to prevent the haemorragic consequences of distrectual portal hypertension. Splenectomy, the only therapeutic mean considered in these patients, has been followed, in our patient, by reimplantation of splenic tissue, in order to prevent the septic complicances (mainly due to pneumococcus) frequently occurring in splenectomized patients.
In 6 patients with cystic medial necrosis of the ascending aorta and the aortic root complete elective replacement of these structures with coronary reimplantation was performed. Two patients died from postoperative left ventricular failure, 4 patients survived and were hemodynamically unaffected at follow-up. Also the heart size in these patients decreased postoperatively. Survival seemed mainly related to the degree of preoperative cardiac failure and cardiomegaly.
The advantages of a distal tunnel ureteral reimplantation have been elaborated upon previously. This method offers simplicity of transvesical exposure, rapidity of execution, excellent visibility of the terminal ureteral segments, minimal dissection and trauma in the paravesical space, the opportunity to advance the ureteral orifices to a physiologic position on the trigone and minimal risk of angulation, kinking or obstruction of the terminal ureter. It is now recognized that this method, with the modifications discussed herein, has wide applicability in the management of vesicoureteral reflux of all varieties and etiologies.
Vesicorenal reflux raises specific problems in adults, as regards both the surgical indications and the operative technique. The operative results are discussed in relation to fifty seven ureters reimplanted in thirty six patients, and the indications for surgical management are outlined. Refluxes clinically associated with lumbalgia, fever and pyuria, always require surgery. The most difficult problems arise from "asymptomatic" refluxes revealed by checkups for renal insufficiency, proteinuria or arterial hypertension. In these cases, the characteristics of the ureter (e.g. wide or narrow) and the existence or absence of renal scars must be taken into consideration. Refluxes in narrow ureters should be followed closely, and the advisability of surgery should be carefully weighed in patients with a wide ureter with no visible damage to the parenchyma.
Five cases of acute dissection of the ascending aorta superimposed on a pre-existing aneurysm, including two with propagation of the dissection into the coronary arteries, were treated by total replacement of the ascending aorta utilizing a valve containing tube graft and reimplantation of the coronary arteries. Diverse techniques such as the use of an intermediate tube for reconnecting the coronary arteries, correction of the coronary dissection by reapproximation of the two layers or with bypass grafting, support of the distal aortic suture line with Teflon felt and fistulization of the periprosthetic space to the right atrium, greatly simplified the treatment of these lesions, permitting survival of four out of five patients, who are in excellent health one, four, and seven years respectively after surgery.
Based on a series of 350 thyroidectomies, of which 214 were total or practically total, the risk of postoperative sequelae due to hypoparathyroidism was investigated. The frequency of this complication was particularly high (11.43 p. 100) during the immediate postoperative period, probably due to the amount of thyroid excised in this series. Long-term follow-up showed that only 15 patients (4.29 p. 100) were still being treated with vitamin D derivatives. Parathyroid reimplantation, whether "accidental" during simple thyroidectomy or "as a principle" in jugulocarotid and recurrent nerve gland curettage (25 cases) appears a valid method for avoiding long-term hypoparathyroidal sequelae.
From January 1973 to June 1983, 69 children have been operated on: remodeling of a primary mega-ureter and reimplantation of the tailored ureter with the Cohen technique. 81 ureters have been treated this way. 68 children have been followed and the results of this operation are evaluated on 80 ureters. There are 65 satisfactory results, 5 mediocre and 10 bad (5 stenosis, 5 reflux); another operation has been done for these cases: 3 nephrectomy, 7 conservative treatments have been successful.
A case of revascularization in mesenteric infarction by reimplantation of the superior mesenteric artery combined with intestinal resection is presented. The patient had an acute occlusion of the superior mesenteric artery with coincident blockage of celiac axis and inferior mesenteric artery resulting in gangrene and perforation of the small bowel. The good postoperative recovery suggests the usefulness of this method in selected cases.
A 14-year-old boy with tricuspid atresia, transposition of the great arteries, and previous pulmonary artery banding underwent repair by arterial switch procedure with coronary arterial reimplantation, plus connection of the right atrium and ventricle with a valved conduit. Pre- and postoperative hemodynamic and angiographic investigations are presented with comments on operative technique and the rationale for this unique operation.
A case of traumatic amputation of the left testicle with complete avulsion of the spermatic cord in a three year old boy is presented. A successful reimplantation was performed using microsurgical technique. We believe this is the first case reported in the world Literature.
Thirty patients had total replacement of the ascending aorta with reimplantation of the coronary arteries, 20 for a fusiform aneurysm of the ascending aorta and 10 because of a dissection of the ascending aorta, of which there were acute. All had associated aortic insufficiency. The technique consists of implantation, within the aneurysmal sac, of a Dacron prosthesis containing a Björk-Shiley aortic valve. The coronary orifices are anastomosed to the tubular Dacron prosthesis by means of a second smaller Dacron tube. The aneurysmal pouch is then closed over the entire appliance and a fistula between the aneurysmal sac and the right atrial appendage is created to drain oozing from the prosthesis. The operative mortality was 10% (three deaths) and the late mortality has been 14.8% (four deaths). The deaths, early and late, have been confined to the first 10 cases, during which time the technique was being developed. There has been no mortality among the last 20 patients. The 23 survivors followed for an average of 19 1/2 months (range 6 months to 5 1/2 years) are in NYHA Functional Class I (21) or II (two). The technical modifications utilized in this series have simplified the operation and permit the proposal of this technique for aneurysm involving the entire ascending aorta.
Since its inception in 1988 the Cochlear Implant Programme in Manchester has successfully implanted 69 adults and 23 children. Of these 92 procedures, three patients have undergone revision surgery with the insertion of either a new implant or re-positioning of the existing device. We examine the circumstances that lead to the need for reimplantation in these patients, discuss the technical aspects of revision surgery together with the functional results of such procedures.
It is difficult to establish on the basis of rigorous criteria when a prosthetic implant must be considered loosened, but it is even more difficult to define with certainty whether a loosened prosthesis must be reimplanted, and particularly when it is necessary to act. The authors emphasize the need to act quickly every time there is loss of periprosthetic bone substance that progresses in time, and that may make anatomical reconstruction difficult.
The authors report the method used and long-term results for 61 acetabular reimplantations involving screwed truncated-conical acetabula and bone grafts. Mean follow-up was 6.3 years. From a clinical point of view the cases classified as excellent were 14 (24.1%), good 26 (44.8%), fair 12 (20.7%), and poor 6 (10.4%). As for radiographic evaluation, the acetabulum appeared to be stable in 37 cases (63.8%), there was fibrous stability in 13 cases (22.4%), the radiographic findings had shown uncertain stability in 5 cases (8.6%), and the acetabulum was unstable in 3 cases (5.2%). Long-term results show that the biological stabilization and, in particular, the implantation of screwed acetabula, when technically correct, may constitute a valid solution in revision surgery for the acetabular component.
Indications for the surgical treatment of septic loosening of hip arthroplasty vary depending on different parameters. Explantation is indicated when patients are elderly, in generally poor condition, when there are veterate infections, particularly if these were caused by gram negative bacteria, and when there is severe skeletal injury. Reimplantation is instead indicated in patients whose general conditions are good, and who are young and motivated.
Herein we describe our preliminary experience in ureteral reimplantation by fixation of the ureter with a single suture directly onto a detubularized ileal chimney in 12 cases with infiltrating bladder carcinoma who underwent a Studer enterocystoplasty procedure. Follow up ranged from 3 to 24 months. Patient control evaluation included urography and CUMS 3 months postoperatively and ultrasonography every 6 months. The following complications were observed: ureteral fistula above the site of anastomosis (1 case, 4.16%), ureteroenteric stricture (1 case, 4.16%) and grade 2 reflux (2 cases, 9.08%) with no effects on renal morphology or function. The foregoing results show the usefulness of this simple procedure which prevents reflux and carries a low complication rate.
The authors report their experience relative to 8 patients who underwent IMA revascularization during infrarenal AAA repair. The Carrel patch technique was employed in all cases operated. With this procedure no ischemic intestinal complication occurred. Two cases of ischemic colitis were observed in a second group of 40 patients operated for AAA in whom the IMA wasn't reimplanted into the aortic graft. The overall incidence of acute intestinal ischemia was 4%.