Operative balloon dilatation of fibromuscular dysplasia of the internal carotid artery: two case reports.

Two cases of symptomatic fibromuscular dysplasia of the internal carotid artery treated with intraoperative balloon-dilatation and semi-rigid metal dilators are presented. Fibromuscular dysplasia (FMD) is a segmental, non atheromatous disease of small and medium sized arteries. Mainly the renal arteries are affected. Involvement of the internal carotid artery is more frequently, than generally appreciated, associated with definite cerebrovascular symptomatology. Symptomatic FMD of the internal carotid artery requires surgical treatment. Histological findings, pathogenesis, clinical manifestations, diagnosis and therapeutic modalities are discussed.

A. carotis thrombosis with ocular ischemic syndrome: acute glaucoma postendarterectomy: a case report.

A patient develops neovascular glaucoma a few weeks after endarterectomy for carotid artery occlusion. The ocular tension is normalised after retinal photocoagulation, followed by trabeculectomy.

[Computer hardware for a surgical service]. / Over de hardware bij computing in een heelkundige dienst.

While the bulk of all medical information is text, we think that the hardware needed to collect this information and to store it in a databank, must be essentially a first class work processor, working in a multi-user system with terminals where this information is gathered: the nursing stations, operating theatres, outpatient clinics and a working and archiving station centrally placed and capable to link those different terminals and those from other services as well.

Pilonidal sinus. Excision--marsupialization--phenolization?

Too often still this disease is called sacrococcygeal cyst, pointing into the direction of congenital etiology. With this paper (and a review of the literature) we try to proof that the theory of acquired origin of pilonidal sinus is the only one logically to be accepted. We indicate that extensive surgical procedures such as Z-plasty rotated flap or broad excision--are really unnecessary and that a simple and accurate technique--marsupialization--gives excellent results with a minimum of recurrences. The last few years phenolization of the pilonidal sinus has become a popular, and eventually a worthwhile alternative.

[Implantation of a cardiac pacemaker in the octogenarian]. / Implantation de stimulateur cardiaque chez l'octogénaire.

Thirteen centres, specialized in pacemakers and studying the implantation, brought together their material. Consequently, 785 patients living with a pacemaker (PM) were grouped. The average age at the time of the first implantation is 83,5 years old. The mortality of 7.5% as well as the morbidity of 16% lie very low. Nevertheless, their causes are discussed and compared to those resulting from other types of surgical pathologies on the octogenarian. It seems that the implantation of a PM, even on a person of 80 or older, is an efficient therapeutic gesture, benign and capable of normalizing the chances and quality of life on a long term basis.

[Arterial thrombosis of the lower limb in patients over 80 years of age. Belgian multicentric experience concerning 802 patients]. / Arteriële thrombose van het onderste lidmaat boven de 80 jaar. Belgische multicentrische ervaring betreffende 802 patiënten.

This report concerns a joint study of fourteen centres about the treatment of arterial occlusion of the low extremity. Eight hundred and two patients older than 80 years have been studied during a period from 1 to 27 years. The operative mortality was 25.2%. There was no significant difference in mortality between emergency cases and those patients who were operated under elective conditions. Leg amputations are followed by a significant higher mortality than more conservative surgery such as arterial by-pass, sympathectomy or embolectomy. The most frequent cause of death was from cardiopulmonar origin (57%). The postoperative morbidity of cardiac, pulmonary, urinary or infectious origin was frequent (50%). Surgical complications in the true sence of the word are quite rare and their frequency is limited to 7%. The conclusion of this study is that conservative surgery such as reascularisation or sympathectomy is, whenever possible, to be preferred over amputation not only because of their lower mortality (13 to 19%) but also since they permit better revalidation of these elderly patients.

[Revascularization of the extracranial carotid-, vertebral- and subclavian arteries in a small peripheral hospital (author's transl)]. / Extra-craniële arteria carotis-, vertebralis- en subclavia revascularizatie in een perifeer ziekenhuis.

A total of 21 procedures were performed on a group of 17 patients, 13 of them more than 65 years old, for mixed intra- and extracranial vessel disease. Ten had recovered from a frank stroke. Thirteen of them underwent one procedure, three two procedures and one a total of three revascularizations. Eighteen carotid endarterectomies, without patch angioplasty were performed. The determinant factor whether or not to use an intraluminal shunt was the peroperatory encephalographic monitoring by a neurologist. The shunt was used any time significant EEG changes occurred during a test clamping period of five minutes. The other procedures included a vertebral artery endarterectomy with patch angioplasty, a subclavian- subclavian vein by-pass, as well as a common carotid artery resection for elongation and kinking of the internal carotid artery combined with marked stenosis. The mortality was nihil. Postoperatively all patients did well with an improved mental and neurological status.

[Iatrogene aorto-enteric fistula. Report of two cases (author's transl)]. / Iatrogene aorto-enterische fistula. Voorstelling en bespreking van twee gevallen.

Two cases of treated iatrogenic aorto-enteric fistula are presented: one completely successfull, the other less, with exitus after five months due to aortic wall disruption. The late occurrence, operative findings, anatomo-pathological examination of the specimens, as well as the sterile (aerobic) cultures in both cases, rather favour mechanical etiological forces associated with the healing complications of aortic synthetic grafts, with or without secundary infection. Emphasis is placed on familiarity with the symptom-complex and the fact that in general the commonly available objective diagnostic tools are not a great deal more helpful in arriving at the correct diagnosis than the history and physical examination. They may even be time-consuming and lead to the demise of the patient. The importance of prevention is stressed as well as the aspects of early aggressive surgical therapy for this dismal complication.

[Ruptured aneurysm of the inferior pancreatic-duodenal artery (author's transl)]. / Geruptureerd aneurysma van de arteria pancreatico-duodenalis inferior

The authors stress the insidious onset of the lesion, which first presented as a hepatic or a gallbladder disease. Diagnosis was established later by an arteriography after the occurrence of a state of shock. Evacuation of the hematoma surrounding the aneurysm appeared satisfactory to re-establish the circulation; this was confirmed by an arteriogram. A review of the literature reveales 18 such cases, with a high mortality rate, up to 100% where surgery was not performed.

[On frozen vena saphena magna as an allograft in peripheral vascular surgery. Report of a case]. / De bevroren vena saphena magna als allogreffe bij perifere vaatheelkunde. Voorstelling van een geval

The case of a 75 year old white male, with severe ischemia of the left lower limb and gangrene of its fifth digit, is presented. Because of early post-operative thrombosis after insertion of an autogenous composite femoro-popliteal venous by-pass graft and recurrence of symptoms, a fresh frozen human varicose vein allograft procedure was performed. A pseudo-aneurism which occurred along the graft on the 13th postoperative day was successfully treated by segmental excision with "end-to-end" reconstruction of the allograft itself. This was followed by plastic reconstruction of his foot with primary healing and complete disappearance of symptoms. The patient is now eight months post- op with excellent functional result. Only twenty two similar cases were gathered from the literature. All problems associated with allograft transplantation of fresh and frozen veins are discussed. This case further supports the facts that bloodgroup incompatibility is not a major problem and that reinterventions on such grafts are feasable.