References of "Acta Chirurgica Belgica"
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See detailThrombolysis of Occluded Infrainguinal Bypass Grafts
VAN DAMME, Hendrik ULg; TROTTEUR, Geneviève ULg; Dongelinger, R.F. et al

in Acta Chirurgica Belgica (1997), 97(4), 177-83

From January 1993 to December 1995, intraarterial catheter guided urokinase infusion was used as an initial approach in the management of 29 episodes of infrainguinal graft thrombosis (12 venous and 17 ... [more ▼]

From January 1993 to December 1995, intraarterial catheter guided urokinase infusion was used as an initial approach in the management of 29 episodes of infrainguinal graft thrombosis (12 venous and 17 prosthetic grafts) in 27 patients. The infusion catheter was embedded inside the occluding clot which was infiltrated by 225.000 U urokinase from distal to proximal. Local low-dose urokinase (1.000 U/kg/hr) was continued for a mean of 39 hours. By this regimen, prompt relief of ischaemia was achieved in 69% (20/29) of cases. Complete recanalization was obtained in 79% of cases. In six cases, the graft remained totally (n = 3) or partially (n = 3) occluded. Two of these patients benefited from secondary surgery, two improved clinically by conservative treatment, and two required amputation. In the 23 successful cases, thrombolysis unmasked an underlying flow-limiting stenosis in 83% (19/23), that was subsequently corrected by percutaneous balloon angioplasty (n = 15), by surgery (n = 3), or by a combination of both (n = 4). One early rethrombosis resulted in an amputation. The immediate limb-salvage rate was 89% (26/29). Surgical intervention was avoided in 17 cases (58%). The main hospital stay was 13 days. The short-term follow-up (mean of 17 months) reveals a high early rethrombosis rate (8/23 or 35%) within one year. Four of these repeated graft failures evolved to amputation. At one year, the overall limb salvage rate dropped to 79%. Thrombolytic management of infrainguinal occluded bypass grafts gives excellent initial technical results (79%), minimizing the need for major surgical revision. It is however characterized by a high procedure-related morbidity (21%). These immediate favourable results are not longstanding. Diffuse graft disease, limited outflow and high recurrence rate of anastomotic stenoses after balloon angioplasty explain poor long-term results after thrombolysis of failed grafts. [less ▲]

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See detailSuccessful Management of Acute Aortic Dissection in a Heart Transplant Recipient
Defraigne, Jean-Olivier ULg; Demoulin, J. C.; Detry, Olivier ULg et al

in Acta Chirurgica Belgica (1997), 97(3), 141-4

A case of type III aortic dissection which occurred fourteen months after heart transplantation is presented. Medical therapy was instituted to achieve controlled hypotension. The evolution was favorable ... [more ▼]

A case of type III aortic dissection which occurred fourteen months after heart transplantation is presented. Medical therapy was instituted to achieve controlled hypotension. The evolution was favorable and the patient could be discharged after one month. Hypertension and increased ejection fraction after transplantation could have been predisposing factors via an increase of the shear stress in the aorta. [less ▲]

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See detailRuptured Aneurysm of the Profunda Femoral Artery Associated with Polyaneurysmal Disease
Defraigne, Jean-Olivier ULg; Vasquez, C.; Limet, Raymond ULg

in Acta Chirurgica Belgica (1997), 97(2), 93-6

A 73-year-old man was admitted for rupture of an atherosclerotic aneurysm of the profunda femoris artery associated to popliteal and bilateral axillary arteries aneurysms. The aneurysm of the profunda ... [more ▼]

A 73-year-old man was admitted for rupture of an atherosclerotic aneurysm of the profunda femoris artery associated to popliteal and bilateral axillary arteries aneurysms. The aneurysm of the profunda femoris artery was developed between the branches of the crural nerves. Considering the patency of the superficial femoral artery and of the leg arterie, and to avoid injury to the crural nerve, no reconstruction of the profunda femoris was attempted. The aneurysm was ligated proximally and buttress sutures were placed on the site of rupture to achieve thrombosis of the aneurysms. Most of the published cases of aneurysm of the profunda femoris artery are false aneurysms developed after various trauma. Atherosclerotic aneurysm of the profunda femoris artery is a rare lesion and rupture is exceptional. [less ▲]

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See detailSpinal ischaemia after surgery for abdominal infrarenal aortic aneurysm. Diagnosis with nuclear magnetic resonance.
Defraigne, Jean-Olivier ULg; OTTO, Bernard ULg; SakalihasanN, Natzi ULg et al

in Acta Chirurgica Belgica (1997), 97(5), 250-6

A 76-year-old man underwent surgery for an infrarenal aortic aneurysm reaching 6 cm in maximal transverse diameter. The aorta was crossclamped below the level of the renal arteries. A tube graft was ... [more ▼]

A 76-year-old man underwent surgery for an infrarenal aortic aneurysm reaching 6 cm in maximal transverse diameter. The aorta was crossclamped below the level of the renal arteries. A tube graft was interposed and tend between the infrarenal aorta and the aortic bifurcation. Due to leakage on the suture line two consecutive episodes of crossclamping for a total duration of 40 min. were required. No hypotension was noted during or after the procedure. After operation, the patient complained of difficulties to move both legs and neurologic examination demonstrated paraparesis, with mild sensory deficit. Faecal and urinary incontinences were also noted and urodynamic testing demonstrated sphincterovesical palsy. Nuclear magnetic resonance imaging detected an ischaemic zone in the spinal cord at the level of T11. Faecal incontinence and motor deficit partially resolved but no bladder function recovery was observed. Spinal ischaemia is a rare complication after abdominal aortic surgery. Several risk factors have been suggested which include level and duration of the aortic crossclamping, possible interruption of the spinal cord blood supply via the greater medullary artery (the so-called artery of Adamkiewicz), presence of intra- or postoperative episodes of hypotension, atheromatous embolization, underlying occlusive arteriosclerosis of spinal arteries, and respect or not of the hypogastric circulation. In our case, the duration of the crossclamping and interruption of the blood flow in lumbar arteries probably supplying the distal spinal cord were likely contributive factors. [less ▲]

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See detailUretero-arterial fistula: two observations.
VAN DAMME, Hendrik ULg; KEPPENNE, Véronique ULg; SakalihasanN, Natzi ULg et al

in Acta Chirurgica Belgica (1997), 97(3), 133-6

Two cases of life-threatening haematuria, secondary to an uretero-arterial fistula, are reported. Both cases present predisposing causative factors. One patient had a combination of previous aorto ... [more ▼]

Two cases of life-threatening haematuria, secondary to an uretero-arterial fistula, are reported. Both cases present predisposing causative factors. One patient had a combination of previous aorto-bifemoral bypass grafting, an iliac artery aneurysm (retrogradely perfused), and an indwelling ureteral stent for ureteral compression. The other patient had previous aortoiliac surgery and obstructive uropathy with chronic urinary tract infection. Preoperative diagnosis of uretero-arterial fistula was made in only one patient. He was successfully operated (exclusion of the iliac aneurysm). In the other patient, nephrectomy was attempted to control reno-ureteral bleeding of unknown origin. Fatal recidive of brisk haematuria occurred some days later. Factors contributing to the development of uretero-arterial fistula, their diagnosis and optimal treatment are discussed. [less ▲]

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See detailKinking of the Internal Carotid Artery: Clinical Significance and Surgical Management
Van Damme, Hendrik ULg; Gillain, Daniel ULg; Desiron, Quentin ULg et al

in Acta Chirurgica Belgica (1996), 96(1), 15-22

The authors report on 62 surgical corrections for kinking of the internal carotid artery during a 13-year period (1980-1993). This represents 2.8% of all carotid operative procedures (n = 2188) in the ... [more ▼]

The authors report on 62 surgical corrections for kinking of the internal carotid artery during a 13-year period (1980-1993). This represents 2.8% of all carotid operative procedures (n = 2188) in the same period. It always concerned a significant (< 60 degrees) angulation of a redundant internal carotid artery, that in all but 3 cases was associated with atherosclerotic involvement of the carotid bifurcation. The indication to surgery included transient hemispheric or ocular ischaemia in 25.5% of cases, a regressive neurologic deficit in 8%, a minor stroke in 3%, a stroke in evolution in 11%, and non-lateralized cerebral ischaemia in 21%. In 19 patients (31%) it concerned an asymptomatic high degree stenosis. The surgical technique consisted in carotid transposition-reimplantation after eversion endarterectomy in 37 cases, in posterior transverse plication with patch angioplasty in 20 cases, and in segmental excision with venous interposition graft in 5 cases. There was one postoperative death. The morbidity include one ipsilateral non-fatal stroke and 3 transient ischaemic attacks. A complete long-term follow-up (mean duration 3.4 years) is available for 57 patients. The late incidence of stroke is 1.5% per year. The 5-year survival attains 67%. These long-term results are comparable to the outcome of standard endarterectomy in the same institution. The authors discuss the indication, techniques, and outcome of surgical correction of kinked internal carotid artery. They recommend a shortening procedure, often associated with endarterectomy for severely kinked vessels (angulation 60 degrees or less), symptomatic or not. [less ▲]

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See detailSuccessful Tricuspid Valve Replacement and Pulmonary Valvulotomy for Carcinoid Heart Disease
DEFRAIGNE, Jean ULg; Jerusalem, O.; Soyeur, Daniel ULg et al

in Acta Chirurgica Belgica (1996), 96(4), 170-6

A case of successful tricuspid valve replacement with a mechanical prosthesis and pulmonary valvulotomy for carcinoid heart disease is reported. The patient was a 61 years old women. The primary tumor was ... [more ▼]

A case of successful tricuspid valve replacement with a mechanical prosthesis and pulmonary valvulotomy for carcinoid heart disease is reported. The patient was a 61 years old women. The primary tumor was in the terminal ileum. Liver metastasis and carcinoid syndrome were present since 8 years. After cardiac surgery, the patient survived 38 months and late death was related to disseminated metastasis. Even in case of metastasis, carcinoid tumor is slow growing. Without cardiac operation for correction of valvular lesions, terminal symptoms and death may often be related to cardiac operation for correction of valvular lesions, terminal symptoms and death may often be related to cardiac failure rather than to tumoral growth. Thus, even in presence of metastasis, cardiac surgery may be mandatory to improve both quality of life and survival. [less ▲]

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See detailCarotid Surgery in Octogenarians: Is It Worthwhile?
VAN DAMME, Hendrik ULg; Lacroix; Desiron, Quentin ULg et al

in Acta Chirurgica Belgica (1996), 96(2), 71-7

Controversy surrounds the role of carotid endarterectomy in octogenarians. Although the prognosis of severe degree carotid stenosis is more ominous in the elderly, operative risk seems more important in ... [more ▼]

Controversy surrounds the role of carotid endarterectomy in octogenarians. Although the prognosis of severe degree carotid stenosis is more ominous in the elderly, operative risk seems more important in the aged. To evaluate the presumed detrimental effect of advanced age on the mortality-morbidity of carotid endarterectomy, the authors reviewed their common experience with carotid surgery in patients aged 80 years or more. From 1980 to 1994, 129 octogenarians were operated on for occlusive carotid artery disease in two university hospitals. The data for these patients, 80 years of age and older (group 1) are compared to these for a large middle age group (less than 80 years) (group 2) operated by the same surgeons during that period. The baseline characteristics of both groups were similar, except for smoking, diabetes and previous myocardial revascularization, more prevalent in the younger age group. In the elderly group prophylactic surgery for asymptomatic stenosis was done in 36%, versus 40% of the middle aged patients, and for stroke in evolution in 8% versus 4% (p < 0.05). The perioperative stroke rate was 0.8% in the group older than 80 years, compared to 1.2% for non octogenarians (NS). The operative mortality was similar for both age groups (2.3 and 1.5 respectively). The long-term results gave a similar outlook for both age groups. The 5-year stroke-free rate reached 89% for group 1 versus 91% for group 2. The 5-year survival rate, however, was less for the elderly patients (47% versus 77%, mean follow-up periods of 30 and 49 months). These results suggest that carotid endarterectomy can be safely done in elderly patients, with a similar risk/benefit ratio as for the younger patients. Advanced age, by itself, is not to be considered as contraindication to carotid surgery. [less ▲]

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See detailGuidelines for authors of medical scientific manuscripts.
Detry, Olivier ULg; Van Damme, Hendrik ULg; Van de Stadt, J.

in Acta Chirurgica Belgica (1996), 96(4), 140-3

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See detailVenous Allografts for Critical Limb Ischaemia
VAN DAMME, Hendrik ULg; CREEMERS, Etienne ULg; Limet, Raymond ULg

in Acta Chirurgica Belgica (1995), 95(1, Jan-Feb), 14-20

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 ... [more ▼]

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) [less ▲]

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See detailSurgical Technique for Reinforcement Cardiomyoplasty
RADERMECKER, Marc ULg; Chachques, J.C.; Fourny, J. et al

in Acta Chirurgica Belgica (1995), 95(6), 271-4

The current technique for reinforcement cardiomyoplasty in man is detailed. The authors emphasize the critical points that determine the perfect execution of this operation. This innovative surgical ... [more ▼]

The current technique for reinforcement cardiomyoplasty in man is detailed. The authors emphasize the critical points that determine the perfect execution of this operation. This innovative surgical approach to heart failure is continuously evolving and, therefore, may be subject to improvement. The major principles however remain valuable. [less ▲]

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See detailPacemaker Implantation for Early Sinus Node Dysfunction after Orthotopic Heart Transplantation
RADERMECKER, Marc ULg; Defraigne, Jean-Olivier ULg; Fourny, J. et al

in Acta Chirurgica Belgica (1995), 95(1), 31-4

Among 60 patients who received OHT at our institution between November 1986 and January 1990, 4 actually needed implantation of a permanent pacemaker. Three patients with symptomatic early sinus node ... [more ▼]

Among 60 patients who received OHT at our institution between November 1986 and January 1990, 4 actually needed implantation of a permanent pacemaker. Three patients with symptomatic early sinus node dysfunction were identified and were satisfactorily paced on the VVIR mode. All three showed sinus recovery within three months following implantation and had their pacemaker switched from the VVIR mode to a simple ventricular demand pacing. Interestingly, administration of beta-blocking drugs quickly reinstituted pace dependence. The patients' outcome is excellent (18 to 48 months follow-up). No difference with the global cohort of our OHT recipients was noticed, apart from an apparent high incidence of infections (3/3) with (2/3) CMV and severe rejection (3/3) during the first month postoperatively. This data suggests that sinus dysfunction may be the result of a multifactorial (rejection, CMV, ...) injury to the conduction system, and is only clinically relevant beyond a threshold level. Denervation hypersensitivity, together with correction of these factors, may account for the restoration of a sufficient reserve of conduction system, and therefore appropriate sinus node function in basal conditions. [less ▲]

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See detailAttitude of a Young Surgeon toward Experimental Surgery. Roles and Limits of Experimental Surgery
Defraigne, Jean-Olivier ULg

in Acta Chirurgica Belgica (1995), 95(2, Mar-Apr), 113-7

At the moment, the place of experimental surgery within the clinical surgical cores is questioned. However, its role in the progresses of surgical practice and training of surgeons is undisputable. It is ... [more ▼]

At the moment, the place of experimental surgery within the clinical surgical cores is questioned. However, its role in the progresses of surgical practice and training of surgeons is undisputable. It is through research that surgeons can keep some critical mind, essential in their daily activities. However, too often actually, the surgeons abandon research. Two essential reasons explain the phenomenon: on the one hand, the weight of the clinical tasks and on the other hand the complexity of research founded on more and more specialized basic notions. In fact, the part of a surgical investigator must be to form a link between basic research and clinical activities. As such, work in collaboration with motivated basic investigators is cardinal. Also, the success of research depends upon the will of the departments to maintain a research activity, but it meets often with the difficulty in obtaining sufficient research credits. Finally, research can play an essential part in the education of the trainees and partly fill some gaps in their clinical training. [less ▲]

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See detailSurgery for Occlusive Renal Artery Disease: Immediate and Long-Term Results
Van Damme, Hendrik ULg; Lombet, P.; Creemers, Etienne ULg et al

in Acta Chirurgica Belgica (1995), 95(1, Jan-Feb), 1-10

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 ... [more ▼]

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) [less ▲]

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See detailTechnique for Ventricular Wrapping in Experimental Dynamic Cardiomyoplasty
Radermecker, Marc ULg; Bonnet, Pierre ULg; Philippart, C. et al

in Acta Chirurgica Belgica (1994), 94(5, Sep-Oct), 266-71

Cardiomyoplasty is a wrapping of an electrostimulated latissimus dorsi muscle flap around the heart for substitution and/or reinforcement. The surgical technique for reproducible cardiomyoplasties in the ... [more ▼]

Cardiomyoplasty is a wrapping of an electrostimulated latissimus dorsi muscle flap around the heart for substitution and/or reinforcement. The surgical technique for reproducible cardiomyoplasties in the goat model is presented. The methods combine the direction of wrapping (clockwise, counter-clockwise) and the orientation of muscle fibers. A cardiomyoplasty model using right and left latissimus dorsi or left latissimus dorsi and pectoralis major as well as a split muscle technique are illustrated. [less ▲]

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See detailLaparoscopic adrenalectomy in pheochromocytoma and Cushing's syndrome. Reflections about two case reports.
Meurisse, Michel ULg; Joris, Jean ULg; Hamoir, Etienne ULg et al

in Acta Chirurgica Belgica (1994), 94(6), 301-6

Laparoscopic adrenalectomy is possible as well on the left as on the right side using a percutaneous transabdominal approach. The exposure of the glands seems better than it could be achieved with an open ... [more ▼]

Laparoscopic adrenalectomy is possible as well on the left as on the right side using a percutaneous transabdominal approach. The exposure of the glands seems better than it could be achieved with an open method. In combination with intraoperative infusion of nicardipine, a calcium-channel blocker, the laparoscopic removal of a pheochromocytoma was performed safely and under stable conditions. In case of Cushing's syndrome, the laparoscopic approach reduces the problems related to poor healing. In all cases of laparoscopic adrenalectomy, this approach could offer the clear advantages of smaller incisions, reduced postoperative pain and incisional discomfort as well as complications related to large and invasive procedure and finally allows quicker recovery. Moreover, conversion to open surgery remains always possible, if needed. [less ▲]

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See detailThe treatment of amiodarone-induced hyperthyroidism. Is there a place for surgery?
Meurisse, Michel ULg; Detroz, Bernard ULg; Messens, D. et al

in Acta Chirurgica Belgica (1994), 94(1), 36-41

In many instances amiodarone-induced hyperthyroidism has been reported as mild, thyroid functions returning to normal after discontinuation of the drug. Nevertheless, life-threatening amiodarone-induced ... [more ▼]

In many instances amiodarone-induced hyperthyroidism has been reported as mild, thyroid functions returning to normal after discontinuation of the drug. Nevertheless, life-threatening amiodarone-induced thyrotoxicosis has also been described. Conventional treatments such as with antithyroid drugs (Thionamide) and corticosteroids are essentially ineffective or fail to stop the dramatic course of the thyroid crisis. This limited efficacy of medical therapy, particularly in patients with previously--neglected or unknown--thyroid disease, prompted us to intervene surgically. We report a series of six patients who underwent total or nearly total thyroidectomy as first line therapy for four of them. Surgery resulted in rapid resolution of thyrotoxicosis with an uneventful postoperative course. This approach has the advantage of immediate and safe efficacy, low risk of relapse and finally, appears to be the only antithyroid treatment that permits continued therapy with amiodarone. [less ▲]

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See detailEchographic Characterization of Carotid Plaques
VAN DAMME, Hendrik ULg; TROTTEUR, Geneviève ULg; Vivario, M. et al

in Acta Chirurgica Belgica (1993), 93(5), 233-8

The histology of the endarterectomy specimen was compared with the preoperative echopattern of 154 plaques. Thirty-four ultrasound images were of poor quality. The 120 adequate echographies revealed 22 ... [more ▼]

The histology of the endarterectomy specimen was compared with the preoperative echopattern of 154 plaques. Thirty-four ultrasound images were of poor quality. The 120 adequate echographies revealed 22 dense hyperechogenic homogeneous plaques, 28 soft hypoechogenic homogeneous plaques, 53 inhomogeneous plaques, and 13 mixed plaques. According to the surface, lesions were subdivided as smooth (n = 63) or irregular (n = 57). Echography recognized fibrous plaques (dense homogeneous hyperechogeneous lesions), with a specificity of 87% and a sensitivity of 56%. Recent intraplaque haemorrhage is echographically apparent as a hypoechogenic area in 88% of cases, what corresponds to a specificity of 79% and a sensitivity of 75%. Echography proved to be more accurate than angiography in determining the presence or absence of ulceration. The ability to characterize the pathology of carotid atheroma by duplex scan make the clinicopathologic correlation of carotid plaques of practical importance. [less ▲]

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See detailAssociation of Aortic Stenosis and Gastrointestinal Bleeding (Heyde's Syndrome). Report of Two Cases
Natowitz, L.; DEFRAIGNE, Jean ULg; Limet, Raymond ULg

in Acta Chirurgica Belgica (1993), 93(1), 31-3

The association between aortic stenosis and digestive angiodysplasia has been described for the first time by Heyde in 1958. This entity is thus known as Heyde's syndrome. In many instances, the recurrent ... [more ▼]

The association between aortic stenosis and digestive angiodysplasia has been described for the first time by Heyde in 1958. This entity is thus known as Heyde's syndrome. In many instances, the recurrent small intestinal bleeding originating from angiodysplasia stopped after aortic valve replacement. We report two cases of patients presenting with a recurrent small intestinal bleeding originating from digestive angiodysplasia and suffering from aortic stenosis. Diagnosis of both pathologies is well documented in both cases. The replacement of the aortic valve by a biologic prosthesis stopped the bleeding. Prior to aortic valve replacement, the two patients suffered severe recurrent blood loss from intestinal angiodysplasia. The treatment of aortic stenosis greatly favored both cardiac and general status. We recommend aortic valve replacement with a biologic prosthesis prior to intestinal resection in patients presenting with Heyde's syndrome. We stress on the fact that anticoagulants must be stopped in order to minimize the risk of further bleeding. [less ▲]

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See detailBrachiocephalic Arterial Reconstruction
VAN DAMME, Hendrik ULg; Caudron, D.; Defraigne, Jean-Olivier ULg et al

in Acta Chirurgica Belgica (1992), 92(1), 37-45

From 1980 to 1990, 18 patients underwent trans-sternal repair for occlusive disease of the brachiocephalic artery. The mean age was 57 years (43-72). Most of the patients were women (n = 10). All but two ... [more ▼]

From 1980 to 1990, 18 patients underwent trans-sternal repair for occlusive disease of the brachiocephalic artery. The mean age was 57 years (43-72). Most of the patients were women (n = 10). All but two patients had one or more symptoms related to the stenosis of the brachiocephalic trunk: right-sided upper limb ischemia (n = 7), transient ischemic attacks (n = 8), vertebrobasilar insufficiency (n = 6), left sided minor stroke (n = 1). Only two patients were asymptomatic before operation. Angiography revealed a tight stenosis (n = 14) or an occlusion (n = 3); in one patient it concerned an ulcerated non-stenotic plaque of the brachiocephalic artery. Eleven patients had coexistent involvement of other supraaortic vessels. Angiographically, clinically and intraoperatively, there was evidence of Takayasu arteritis in three female patients. All patients had direct repair by trans-sternal approach. Six patients with short lesions had thromboendarterectomy with patch angioplasty of the innominate artery. In eleven cases, aorto-brachiocephalic bypass grafting was performed. In one patient, aortic calcification precluded proximal anastomosis, and a carotid-to-carotid bypass was done. In five patients, simultaneous revascularization of subclavian (n = 3), left common carotid (n = 2) or internal carotid artery (n = 2) completed the procedure. In one patient, concomitant coronary revascularization was done. There was no operative mortality. Postoperative morbidity was limited to pulmonary infection (n = 2), transient neurologic deficit (n = 1) and renal insufficiency (n = 1). All patients had relief of symptoms. Duplex echo scan confirmed patency of all reconstructions at a mean follow-up of 46 months.(ABSTRACT TRUNCATED AT 250 WORDS) [less ▲]

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