References of "Acta Chirurgica Belgica"
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See detailThe Inferior Non Recurrent Laryngeal Nerve: A Major Surgical Risk During Thyroidectomy
Defechereux, Thierry ULg; Albert, V.; Alexandre, j et al

in Acta Chirurgica Belgica (2000), 100(2, Mar-Apr), 62-7

It is now widely established that systematic intraoperative location and diligent dissection of the recurrent inferior laryngeal nerve during thyroidectomy are the keystones to assure its anatomic and ... [more ▼]

It is now widely established that systematic intraoperative location and diligent dissection of the recurrent inferior laryngeal nerve during thyroidectomy are the keystones to assure its anatomic and functional preservation. The possibility of abnormal routes, like a non-recurrent cervical course of the inferior laryngeal nerve is an additional major argument for its systematic identification to avoid surgical damage. In 2517 cervicotomies performed between 1992 and 1997 for at least right thyroid lobe excision or parathyroid glands exploration, 20 cases of non recurrent laryngeal nerve were identified (0.79%). The embryological nature of such a nervous anatomical variation results originally from a vascular disorder, named arteria lusoria in which the fourth right aortic arch is abnormally absorbed, being therefore unable to drag the right recurrent laryngeal nerve down when the heart descends and the neck elongates during embryonic development. The surgeon must be aware of the possibility of a non recurrent laryngeal nerve, which arises directly from the cervical vagus and therefore represents a severe potential pitfall during thyroidectomy. Given the absence of reliable clinical symptoms and signs or investigations indicating preoperatively the possibility of a non recurrent nerve, guidelines are given to prevent intraoperatively this major surgical risk. [less ▲]

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See detailAssessment of Complex Perineal Fistulas
Bruyninx, Luc ULg; Meunier, Paul ULg

in Acta Chirurgica Belgica (2000), 100(3, May-Jun), 115-7

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See detailRenal Artery Occlusion Following Blunt Abdominal Trauma
Elen, Philippe ULg; Ozlu, E.; SakalihasanN, Natzi ULg et al

in Acta Chirurgica Belgica (2000), 100(3, May-Jun), 107-10

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See detailComparison between Open and Closed Repair for Abdominal Aortic Aneurysms: A Word of Caution
Limet, Raymond ULg; CREEMERS, Etienne ULg

in Acta Chirurgica Belgica (2000), 100(1), 12-5

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See detailIschaemic Colitis Following Aortoiliac Surgery
VAN DAMME, Hendrik ULg; CREEMERS, Etienne ULg; Limet, Raymond ULg

in Acta Chirurgica Belgica (2000), 100(1), 21-7

Ischaemic colitis following aortoiliac surgery is a feared complication. Its frequency varies from 7% after repair of ruptured abdominal aortic aneurysm (AAA) to 0.6% after bypass for aortoiliac occlusive ... [more ▼]

Ischaemic colitis following aortoiliac surgery is a feared complication. Its frequency varies from 7% after repair of ruptured abdominal aortic aneurysm (AAA) to 0.6% after bypass for aortoiliac occlusive disease (AOD). In order to analyse predisposing factors and outcome of ischaemic colitis, the authors reviewed their clinical experience from 1988 to 1998. It concerns 28 cases (16 ruptured AAA, 7 elective AAA, 5 OAD) of clinically evident colonic ischaemia. This means an incidence of 7% after repair of ruptured AAA, 0.6% after elective AAA repair, and 0.8% after bypass for AOD. Transmural necrosis (grade 3) was observed in 21 patients, grade 2 ischaemia in 5 patients, and grade 1 ischaemia in 2 patients. Fifteen patients with grade 3 ischaemia underwent colectomy (Hartmann's procedure) with a mortality rate of 66%. All non operated grade 3 patients died. Overall, 16 of the 28 patients died at hospital (57% mortality rate). None of the patients with mild (grade 2 or 1) colonic ischaemia died. Profound hypovolaemic shock and inflammatory AAA were the only significant predisposing factors leading to colonic ischaemia. Associated colon revascularization could not avoid the evolution to colon necrosis in four patients. Reimplantation of a patent inferior mesenteric artery or an internal iliac artery was performed in only 4.8% of all aortoiliac reconstructions, and did not influence the development of ischaemic colitis. The authors conclude that a more liberal use of postoperative sigmoidoscopy could allow detecting colonic ischaemia at an earlier stage and reduce ensuing mortality. A reinforced effort to restore or preserve colonic vascularization could lower the incidence of colonic ischaemia following aortoiliac surgery. [less ▲]

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See detailLaparoscopic Live Donor Nephrectomy: Initial Experience
Defechereux, Thierry ULg; Hamoir, Etienne ULg; Detry, Olivier ULg et al

in Acta Chirurgica Belgica (1999), 99(4), 179-81

Transplanting a kidney graft harvested from a live donor has been proposed and used to shorten the waiting time of kidney transplant candidates and to increase the graft pool. Live donor renal transplants ... [more ▼]

Transplanting a kidney graft harvested from a live donor has been proposed and used to shorten the waiting time of kidney transplant candidates and to increase the graft pool. Live donor renal transplants have demonstrated better results in term of graft survival rates, compared to renal transplants harvested from brain dead donor. Recently, laparoscopic live donor nephrectomy has been introduced to reduce the live procurement morbidity. This lower morbidity may result in increased acceptance of the donor operation. We initiated a program of laparoscopic live donor nephrectomy in January 1997 and up until June 1998, three cases were successfully performed in our department. The purpose of this paper was to report the first case of this program and its first year of follow-up. [less ▲]

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See detailTypical Presentation of Intramural Aortic Haemorrhage (Iah) with Evidence of Intimal Tear at Mri and Angiography
RADERMECKER, Marc ULg; LAVIGNE, Jean-Paul ULg; Limet, Raymond ULg

in Acta Chirurgica Belgica (1999), 99(1), 44-6

A typical appearance of IAH was evidenced by CT and TEE in a 56-year-old hypertensive female suspected of developping classical acute aortic dissection (AAD). Further examination with MRI and aortography ... [more ▼]

A typical appearance of IAH was evidenced by CT and TEE in a 56-year-old hypertensive female suspected of developping classical acute aortic dissection (AAD). Further examination with MRI and aortography showed unequivocally the presence of an intimal tear in the aortic arch. This coexistence of intimal tear has never been evidenced preoperatively in patients with IAH. This observation demonstrates at the outset that IAH is part of the spectrum of AAD. [less ▲]

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See detailAnalysis of Factors Influencing Long-Term Survival after Surgical Resection for Oesophageal Squamous Cell Carcinoma
Kolh, Philippe ULg; Honore, Pierre ULg; Gielen, J. L. et al

in Acta Chirurgica Belgica (1999), 99(3, May-Jun), 113-8

OBJECTIVE: We evaluated prognostic factors in 34 patients discharged from hospital after surgical resection for oesophageal squamous cell carcinoma. MATERIAL AND METHODS: There were 22 males and 12 ... [more ▼]

OBJECTIVE: We evaluated prognostic factors in 34 patients discharged from hospital after surgical resection for oesophageal squamous cell carcinoma. MATERIAL AND METHODS: There were 22 males and 12 females; mean age was 59.3 years (range 42-77 years). Preoperative neoadjuvant treatment consisted in chemotherapy alone in three patients and in combined radiochemotherapy in 14. Digestive continuity was restored with a gastric transplant in 26 patients and a colonic graft in 8. Surgery was curative in 28 patients and palliative in 6. There were three stage I, 14 stage II, 13 stage III, and 4 stage IV diseases. In 19 patients the lymph nodes were invaded. The tumour was well differentiated in 17 patients, moderately in 9, and poorly in 8. RESULTS: Follow-up ranged from 2 to 100 months. Overall median postoperative survival was 21 months. By univariate analysis, factors influencing survival were curative surgery (p = 0.04), stage (p = 0.006), and nodal involvement (p = 0.0003). Nodal involvement was an independent prognostic factor by multivariate analysis (p = 0.0002). Patient age and sex, perioperative transfusion, digestive transplant, tumour local extension, grade of differentiation, and distant metastasis did not influence survival. Also, we did not observe any significant benefit of preoperative or postoperative chemotherapy or radiochemotherapy. CONCLUSIONS: Nodal involvement was the most important prognostic factor influencing survival. Therefore, an earlier diagnosis of oesophageal cancer in a less advanced stage is important to improve survival rates. Our study could not confirm the benefit of neoadjuvant therapy in terms of late survival. [less ▲]

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See detailMedical aspects of obesity.
Scheen, André ULg; Luyckx, Françoise ULg

in Acta Chirurgica Belgica (1999), 99(3), 135-9

Obesity poses a serious health hazard and its treatment is often disappointing. Major advances have been made during recent years in the understanding of body weight regulation, with the discovery of ... [more ▼]

Obesity poses a serious health hazard and its treatment is often disappointing. Major advances have been made during recent years in the understanding of body weight regulation, with the discovery of leptin, a protein produced by adipocytes and acting on the central nervous system to reduce food intake, and that of beta-3 adrenergic receptors and uncoupling proteins which contribute to stimulate energy expenditure. Numerous metabolic complications are associated with abdominal obesity and most of them, such as diabetes mellitus, dyslipidaemias and arterial hypertension, appear to be linked to insulin resistance and may be part of the socalled metabolic syndrome or syndrome X. While very-low-calorie diets are usually effective in the short-term, they cannot, in the long-term and for most patients, solve the problem of severe obesity. Pharmacological antiobesity treatment may include drugs that reduce food intake, drugs that increase energy expenditure and drugs that affect nutrient partitioning or metabolism. All of these pharmacological approaches have potential efficacy, but unfortunately serious limitations. This is also the case of mechanical means, such as intragastric balloons. Consequently, bariatric surgery may be considered as a valuable alternative therapy in well-selected patients with morbid obesity refractory to classical treatments. In conclusion, obesity is a chronic disease and should be treated as such with reasonable expectations. [less ▲]

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See detailDiverticulosis and Diverticulitis in the Immunocompromised Patients
Detry, Olivier ULg; Honore, Pierre ULg; Meurisse, Michel ULg et al

in Acta Chirurgica Belgica (1999), 99(3, May-Jun), 100-2

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See detailHypnosis with conscious sedation instead of general anaesthesia? Applications in cervical endocrine surgery.
Meurisse, Michel ULg; Defechereux, Thierry ULg; Hamoir, Etienne ULg et al

in Acta Chirurgica Belgica (1999), 99(4), 151-8

Between April 1994 and June 1997, 197 thyroidectomies and 21 cervical explorations for hyperparathyroidism were performed under hypnosedation (HYP) and compared to the operative data and postoperative ... [more ▼]

Between April 1994 and June 1997, 197 thyroidectomies and 21 cervical explorations for hyperparathyroidism were performed under hypnosedation (HYP) and compared to the operative data and postoperative courses of a closely-matched population (n = 121) of patients operated on under general anaesthesia (GA). Conversion from hypnosis to GA was needed in two cases (1%). All surgeons reported better operating conditions for cervicotomy using HYP. All patients having HYP reported a very pleasant experience and had significantly less postoperative pain while analgesic use was significantly reduced in this group. Hospital stay was also significantly shorter, providing a substantial reduction of the medical care costs. The postoperative convalescence was significantly improved after HYP and full return to social or professional activity was significantly shortened. We conclude that HYP is a very efficient technique providing physiological, psychological and economic benefits to the patient. [less ▲]

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See detailFibromuscular dysplasia of the internal carotid artery. Personal experience with 13 cases and literature review.
VAN DAMME, Hendrik ULg; SakalihasanN, Natzi ULg; Limet, Raymond ULg

in Acta Chirurgica Belgica (1999), 99(4), 163-8

From January 1990 to December 1997, the authors observed 13 cases of fibromuscular dysplasia of the internal carotid artery. Four patients presented transient ischemic attacks, one amaurosis fugax, two ... [more ▼]

From January 1990 to December 1997, the authors observed 13 cases of fibromuscular dysplasia of the internal carotid artery. Four patients presented transient ischemic attacks, one amaurosis fugax, two suffered from a minor stroke, four had non-focalized ischemic cerebral symptoms and two were asymptomatic. At angiography, all patients showed a typical image of "string of beads". Seven patients were operated on. Six had endoluminal graduated dilatation, with rigid dilators up to 4.5 mm, associated with thrombendarterectomy of the bifurcation in three and to correction of a kink in one case. In one case a venous interposition graft was done to exclude a saccular microaneurysm of the dysplasic internal carotid artery. In another case, backflow was insufficient after endoluminal dilatation, and a long venous patch allowed to restitute a normal vascular lumen. There was neither postoperative mortality nor stroke. Six patients, asymptomatic or with non focalized symptoms, were treated medically. During a mean follow-up of 47 months, only one of the 13 patients developed a transient ischemic attack; the patient had not been operated on and received only medical treatment. Prevalence, etiopathology, diagnosis and management of fibromuscular dysplasia of the internal carotid artery are discussed. Fibromuscular dysplasia is a rare cause of cerebral ischemia. For asymptomatic lesions, a conservative approach seems appropriate. Surgery is only to be considered for symptomatic lesions. Surgical graduated endoluminal dilatation, where necessary combined with standard endarterectomy of the carotid bifurcation, is a safe, efficient and durable operation. Some complex cases of fibromuscular dysplasia may necessitate patch insertion or excision and graft interposition. [less ▲]

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See detailHypnosedation: a valuable alternative to traditional anaesthetic techniques.
Faymonville, Marie-Elisabeth ULg; Meurisse, Michel ULg; Fissette, Jean ULg

in Acta Chirurgica Belgica (1999), 99(4), 141-6

Hypnosis has become routine practice in our plastic and endocrine surgery services. Revivication of pleasant life experiences has served as the hypnotic substratum in a series of over 1650 patients since ... [more ▼]

Hypnosis has become routine practice in our plastic and endocrine surgery services. Revivication of pleasant life experiences has served as the hypnotic substratum in a series of over 1650 patients since 1992. In retrospective studies, followed by randomised prospective studies, we have confirmed the usefulness of hypnosedation (hypnosis in combination with conscious IV sedation) and local anaesthesia as a valuable alternative to traditional anaesthetic techniques. The credibility of hypnotic techniques and their acceptance by the scientific community will depend on independently-confirmed and reproducible criteria of assessing the hypnotic state. Based on the clinical success of this technique, we were interested in confirming this phenomenon in healthy volunteers. The revivication of pleasant life experiences thus served as the cornerstone of a basic research program developed to objectify the neurophysiological attributes of the hypnotic state. We compared hypnosis to normal alertness with similar thought content. In our experience, the activation profile obtained during the hypnotic state was completely different from simple re-memoration of the same subject matter during normal alertness. This represents an objective and independent criteria by which to assess the hypnotic state. [less ▲]

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See detailManagement of Fulminant Hepatic Failure
Detry, Olivier ULg; Honore, Pierre ULg; Meurisse, Michel ULg et al

in Acta Chirurgica Belgica (1998), 98(6), 235-40

Fulminant hepatic failure is an infrequent but dreadful disease, occurring usually in young patients. Despite fulminant hepatic failure is reversible in most of the cases, some patients develop brain ... [more ▼]

Fulminant hepatic failure is an infrequent but dreadful disease, occurring usually in young patients. Despite fulminant hepatic failure is reversible in most of the cases, some patients develop brain edema and intracranial hypertension, which are the most common cause of death in these patients. Liver transplantation significantly improves the prognosis of selected patients in who precise criteria predict a low chance of survival. This review summarizes the modern standard of care of patients with fulminant hepatic failure, with particular underlining of the management of brain oedema and intracranial hypertension. [less ▲]

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See detailSuccessful Bridge to Transplantation with Pierce Donachy (Thoratec) Ventricular Assist Device
DEFRAIGNE, Jean ULg; DETRY, Olivier ULg; Demoulin, J.C. et al

in Acta Chirurgica Belgica (1998), 98(2), 90-4

Biventricular assistance with the Thoratec ventricular assist device was performed in a 48-year-old man waiting heart transplantation since 6 months. Indication for circulatory support was considered ... [more ▼]

Biventricular assistance with the Thoratec ventricular assist device was performed in a 48-year-old man waiting heart transplantation since 6 months. Indication for circulatory support was considered because of the development of progressive irreversible right heart failure with deterioration of the hepatic and renal functions. Orthotopic heart transplantation was performed after 13 days of circulatory support. No complications occurred during the assistance and in the posttransplant period. The patient was discharged on day 21 after transplantation. Five months after transplantation he is well and alive. [less ▲]

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See detailAbdominal aortic aneurysms in octogenarians.
VAN DAMME, Hendrik ULg; SakalihasanN, Natzi ULg; Vazquez, C. et al

in Acta Chirurgica Belgica (1998), 98(2), 76-84

The decision on whether to operate or not abdominal aortic aneurysms (AAA) in elderly depends on the relative risk of the operation versus the natural course of the unoperated AAA. From January 1984 to ... [more ▼]

The decision on whether to operate or not abdominal aortic aneurysms (AAA) in elderly depends on the relative risk of the operation versus the natural course of the unoperated AAA. From January 1984 to December 996, 138 patients, aged 80 years and older, were referred to our department for an aneurysm of 40 mm or more (transverse diameter) of the infrarenal abdominal aorta (95 asymptomatic, 15 painful, and 28 ruptured AAA). For 58 patients with asymptomatic AAA, operation was denied at referral because of transverse diameter less than 50 mm (n = 21), patient refusal (n = 10) or unacceptable operative risk or poor general condition (n = 27). Thirty-four of these observed AAA were ultimately operated after a mean delay of 41 months because of aneurysm enlargement (n = 15), aneurysm tenderness (n = 6) or rupture (n = 13). Overall, 52 patients had immediate (n = 37) or delayed (n = 15) elective repair of their AAA, with an in-hospital mortality of 5.7%. Urgent operation was done for 21 patients with a painful AAA. Six patients died at hospital (28% mortality rate). Emergent surgery was applied to 41 patients with ruptured AAA (including 13 AAA who ruptured during surveillance). The operative mortality in this subgroup attained 68%. Follow-up for the 77 survivors and the 24 non-operative patients averaged 43 months. The 5-year survival (operative mortality included) is 47% for electively operated patients, 30% for urgently and 20% for emergently operated patients. For comparison, the 5-year survival of an age and sex matched Belgian population is 63%. For the 24 medically followed AAA, the 5-year survival was 33%. In six cases, the cause of death was rupture of the AAA. Of the 58 patients for whom operation was initially not considered, 19 (33%) presented AAA rupture (13 operated in emergency and 6 who never came to surgery). The operative outcome of AAA repair in octogenarians is less favourable than in the younger age group (3.6% mortality after elective repair, 44% after operation for AAA rupture, according to our institution data). The authors conclude that AAA surgery should not be denied to octogenarians on the basis of advanced age alone. They recommend a straightforward surgery for otherwise healthy octogenarians with AAA of 50 mm diameter, surveillance up to 60 mm for high-risk patients and no surgery for unfit, bedridden or demented patients. [less ▲]

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See detailPathogenesis of abdominal aortic aneurysm (AAA) formation.
Limet, Raymond ULg; Richelle, Betty ULg; VERLOES, Alain ULg et al

in Acta Chirurgica Belgica (1998), 98(5), 195-8

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See detailThrombangiitis Obliterans (Buerger's Disease): Still a Limb Threatening Disease
VAN DAMME, Hendrik ULg; de Leval, Laurence ULg; CREEMERS, Etienne ULg et al

in Acta Chirurgica Belgica (1997), 97(5), 229-36

A series of 29 well-documented and properly analysed patients with thrombangiitis obliterans (Buerger's disease) is presented. The diagnosis of Buerger's disease was based on following criteria: smoking ... [more ▼]

A series of 29 well-documented and properly analysed patients with thrombangiitis obliterans (Buerger's disease) is presented. The diagnosis of Buerger's disease was based on following criteria: smoking history, onset before the age of 50 years, infrapopliteal arterial occlusive disease, either upper limb involvement or phlebitis migrans, absence of atherosclerotic risk factors other than smoking. In the last 10 years (1986-1996), we identified 29 patients who met these rigid criteria. There were 24 men and 5 women, aged 32.4 years at the moment of the disease first clinical symptom. The cumulative tobacco use averaged 16 pack-years for each patient. The initial symptom was limited gangrene of a toe (n = 9) or a finger (n = 2), foot claudication (n = 6), calf claudication (n = 3), rest pain (n = 3), migratory superficial phlebitis (n = 4), and Raynaud phenomenon (n = 2). Angiography and/or Doppler ultrasound revealed digital, pedal and calf artery involvement in all patients, with proximal extension in ten patients (femoropopliteal in ten, including three cases with external iliac artery involvement). Seven patients had also evidence of upper limb involvement. Histologic proof was available in only seven patients. Only nine patients completely stopped smoking. Treatment was exclusively medical in five cases. Twenty-four underwent sympathectomy (20 at lumbar, and four at thoracic level), with good immediate result in 16. In 11 patients a vascular reconstruction was done (eight femorocrural and three iliofemoral bypasses), with a patency rate of only 36% at two years. Amputation was required in 16 patients (a mean of 2.7 amputations per patient) at one or more levels: toe (n = 19), forefoot (n = 5), below knee (n = 8), above knee (n = 2), finger (n = 3). Two patients ended up with bilateral leg amputation. Overall, 23% (7/30) of the patients required major leg amputation during the course of the disease. Disease progression was moderately related to continued tobacco use. Buerger's disease still entails considerable risk of major amputation. Complete abstinence from tobacco use is crucial to expect stabilization of the process. However, in advanced stages of the disease and despite cessation of smoking recurrent episodes of ischaemia or tissue loss are not excluded. [less ▲]

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See detailCarotid Chemodectomas. Experience with Nine Cases with Reference to Preoperative Embolization and Malignancy
Defraigne, Jean-Olivier ULg; Sakalihasan, Natzi ULg; Antoine, Paul ULg et al

in Acta Chirurgica Belgica (1997), 97(5), 220-8

The medical records of nine patients (five female and four male, mean age 58 +/- 5 years) presenting with a carotid chemodectoma between 1983 and 1995 were reviewed. In two cases (22%) the diagnostic was ... [more ▼]

The medical records of nine patients (five female and four male, mean age 58 +/- 5 years) presenting with a carotid chemodectoma between 1983 and 1995 were reviewed. In two cases (22%) the diagnostic was not suspected at the time of initial presentation. The most common complaint was a swelling in the anterolateral region of the neck. One patient (11%) presented with a preoperative peripheral nerves deficits (vagus and hypoglossal palsies and Horner's syndrome). Two tumours were embolized preoperatively with polyvinyl alcohol particles. Complete surgical excision was possible in each patient and the plane of resection was adventitial. In three cases, early ligation of the external carotid artery facilitated the resection. In two patients, the vagus nerve was sacrificed because of tumour involvement. No operative mortality was observed and no vascular complication occurred. In addition to the patient with preoperative neurologic symptoms, three patients developed peripheral nerve deficits (vagus and hypoglossal nerves) postoperatively. Two of these deficits were transient. These peripheral neurologic complications were observed with the largest tumour sizes. Two cases were malignant (lymph nodes and bony metastases). These two patients received postoperative radiotherapy. The mean follow-up period 63 +/- 19 months. No patient developed local recurrence during the follow-up. Two patients died during the follow-up, one for condition unrelated to their disease and the second from metastatic dissemination. In conclusion, carotid chemodectomas may be safely resected. The best way to minimize the rate of complications is to operate them at an early stage of evolution. [less ▲]

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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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