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Biomedical subjects

A Grignon

Publications and source records attributed to A Grignon.

At least 55 records · Page 3Linked to original sources
PubMed1989

Disrupted coronary artery caused by angioplasty: supportive and surgical considerations.

Of 2,859 patients having percutaneous transluminal coronary angioplasty, 201 (7%) underwent emergency coronary artery bypass grafting. Two categories of patients were reviewed. Group 1 consisted of 126 patients of 2,304 who had immediate coronary artery bypass grafting after failed elective percutaneous transluminal coronary angioplasty. Ninety-eight of these patients had angiographic evidence of occlusion of a coronary artery, and 28 had angiographic evidence of coronary artery dissection. Epicardial hemorrhage was observed at operation in 20% (25 patients). Three deaths (2.4%) occurred in group 1, and an average of 3.3 grafts was performed per patient. Group 2 comprised 75 of 555 patients who had unsuccessful attempted percutaneous transluminal coronary angioplasty during an evolving myocardial infarction and required immediate coronary artery bypass grafting. Angiography revealed coronary artery occlusion in 61 patients with dissection in 14. All group 2 patients had evidence of myocardial injury by electrocardiographic and enzymatic (myocardial-specific isoenzyme of creatine kinase) criteria. Three deaths (4%) occurred in this group, and there was an average of 3.4 grafts per patient. Percutaneous transluminal coronary angioplasty is routinely performed without surgical consultation, although an operating room and team are usually available. Supportive techniques include the intraaortic balloon pump and percutaneous cardiopulmonary bypass. In those patients with coronary artery dissection, care must be taken to reestablish the true lumen of the coronary artery. Hemopericardium should be surgically explored and broken guidewires or other foreign bodies or debris removed. From 1979 through 1986, the number of patients requiring emergency coronary artery bypass grafting after percutaneous transluminal coronary angioplasty steadily declined to less than 5%.

Angioplasty, Balloon↗
PubMed1989

Percutaneous cardiopulmonary bypass: application and indication for use.

Percutaneous cardiopulmonary bypass (CPB) was used in 22 patients: 7 patients with cardiac arrest due to acute myocardial infarction; 4 patients in cardiac arrest because of failed angioplasty; 1 patient for high-risk elective angioplasty; 1 patient with massive pulmonary emboli; 2 patients with hypothermia; 2 pediatric patients (1 with sepsis and 1 in combination with extracorporeal membrane oxygenator support); 1 patient with refractory arrhythmia; and 4 patients with trauma. Percutaneous CPB involves a modified Seldinger technique that is easily applied. All patients except those with massive trauma were resuscitated with the use of percutaneous CPB. One patient requiring a very difficult proposed angioplasty received percutaneous CPB support while triple-vessel angioplasty was performed. Percutaneous CPB appears to be beneficial in resuscitating patients with refractory cardiac arrest or other forms of circulatory collapse except trauma. Limited use for brief periods in high-risk patients having elective angioplasty might be applicable.

Angioplasty, Balloon↗
PubMed1989

Permanent left ventricular assistance for outpatients through surgical implantation of a modified intra-aortic balloon pump.

There is a large population of patients in end-stage congestive heart failure who cannot be treated by means of conventional cardiac surgery, cardiac transplantation, or chronic catecholamine infusions. In 2 such patients, we provided permanent left ventricular assistance on an outpatient basis by surgically implanting a modified intra-aortic balloon pump. A Dacron-velour graft to the common iliac artery served as a covering for the extravascular portion of the balloon's pneumatic tubing, which was stabilized by routing it through the iliac crest. The tubing was then carried ventrally to exit through a stoma just above the inguinal ligament. Before hospital discharge, each patient underwent a 5-day regimen of alternate pumping and ambulation. The patient was then permitted to go home, but returned daily as an outpatient in accordance with individual need, for approximately 6 hours of hemodynamic support. The 1st patient lived 3 months after pump insertion, and the 2nd patient for 38 days. Although the 1st patient developed a fever of unknown origin that prompted us to remove the intra-aortic balloon pump unnecessarily, there was no evidence of infection upon surgical exploration and subsequent tissue culturing; she died, rather, of intractable ventricular fibrillation, apparently consequent to her 36-hour loss of hemodynamic support. The 2nd patient also died of a cause unrelated to the presence of the pump, and on autopsy showed good evidence of healing and absence of infection. On the evidence of this pilot study, we conclude that intermittent left ventricular assistance, through periodic activation of a permanently implanted intra-aortic balloon pump during outpatient visits, warrants further study as an alternative for selected patients with end-stage heart disease, when medical and other surgical options have been exhausted.

Journal Article↗
PubMed1988

Blunt pancreatic injuries in children: the role of percutaneous external drainage in the treatment of pancreatic pseudocysts.

During the past 10 years, 26 cases of blunt pancreatic trauma were diagnosed in our institution. In 42.3% (11/26) the accident was bicycle-related. Seventy-three percent of patients were seen within 48 hours of injury. The most frequent clinical presentations included abdominal pain, tenderness and vomiting. Diagnosis of pancreatic injury was suggested by hypermylasemia in most cases. Associated trauma was seen in seven patients (26.9%) and it was intraabdominal in four (15.3%). Computerized tomography (CT) scan is the single most useful radiologic investigation in evaluating pancreatic trauma. Ultrasound, although less accurate than CT scan in determining the severity of the initial injury, is useful in the evaluation and treatment of pancreatic pseudocysts. Pancreatic pseudocysts developed in ten patients. Spontaneous resolution occurred in five (50%). In three patients, percutaneous external drainage (PED) was successful in treating pancreatic pseudocysts without complications or recurrence at 11, 19, and 31 months. PED is a suitable form of treatment in selected cases of pancreatic pseudocysts. Results in children are better than in the adult population, probably due to the absence of primary pancreatic pathology. We believe that PED should be considered the primary therapeutic procedure for traumatic pancreatic collections prior to more invasive surgical treatment, when there is no evidence of pancreatic duct transection on CT scan.

Adolescent↗
PubMed1987

Investigation of childhood blunt abdominal trauma: a practical approach using ultrasound as the initial diagnostic modality.

During a 5.5-year retrospective study (1979-84) 170 children with blunt abdominal trauma were investigated with intravenous urography (IVU), ultrasound (US) and scintigraphy. For the investigation of the last 71 children (after 1982) a 4th generation CT scanner was available in the same department. The results of radiologic investigations were compared with clinical outcome in 157 and results at laparotomy in 13 children. During the study period, real time US became the first line screening tool, and was combined with IVU in suspected renal trauma. In spite of permanent accessibility of CT since November 1982, the latter was used only in complex diagnostic problems or in children with multiple injuries (8% of the series). There were no deaths resulting from abdominal trauma. During the study, the incidence of splenectomy and exploratory laparotomy decreased, and no diagnostic peritoneal lavage were performed after 1980.

Abdominal Injuries↗
PubMed1987

Percutaneous cholecystography in children.

Percutaneous cholecystography was performed on 13 children who had biliary system abnormalities: two had biliary hypoplasia, five had sclerosing cholangitis, three had cirrhosis, two had distal choledochal obstruction, and one had an obstructed portoenterostomy. In 12 patients transcholecystic cholangiography showed, without significant complications, the intra-and extrahepatic bile ducts. In one patient with primary sclerosing cholangitis, the intrahepatic bile ducts were not opacified satisfactorily; dilatation of the gallbladder required surgical drainage. The transcholecystic technique is indicated when the intrahepatic bile ducts are either mildly dilated or not dilated.

Adolescent↗
PubMed1986

Reperfusion protocol and results in 738 patients with evolving myocardial infarction.

Reperfusion is an accepted therapy for evolving myocardial infarction (MI), as successful reperfusion reduces morbidity and mortality. A team approach between the cardiologists and cardiac surgeons must be applied to achieve reperfusion within a finite time from the onset of coronary thrombosis. Analysis of 738 patients grouped them by successful reperfusion in the catheterization laboratory versus the operating room. Factors that predict wall motion recovery related to the onset of clinical symptoms, time to reperfusion, coronary anatomy, and collateral network were reviewed. Comparisons were made between patients with stable versus unstable hemodynamics and successful or unsuccessful reperfusion. Of the 738 patients, the initial attempt at reperfusion was made in the catheterization laboratory with success in 331. These patients all had primarily single-vessel disease. With multiple-vessel disease identified at catheterization, 189 patients were immediately treated by surgical reperfusion. This method also was used for an additional 72 patients in whom reperfusion could not be achieved in the catheterization laboratory. Of the entire group of 738 patients, 146 (20%) could not be reperfused. Overall mortality for the 592 patients reperfused was 4.9% compared with 17% for those who could not be reperfused. Time was critical for wall motion recovery if no collaterals were demonstrated on angiography. If collaterals were present, time to reperfusion was not critical. Wall motion recovered in 90% of the patients if the endocardial anatomy on the initial angiogram was smooth. However, if the endocardial anatomy looked mottled and irregular, less than 10% of patients had recovery of wall motion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Partial splenectomy for benign cystic lesions of the spleen.

Cystic lesions of the spleen are uncommon, about 600 cases being reported in the world literature. This report concerns three pediatric patients treated by partial splenectomy for benign cyst. In the world literature most of the cystic lesions of the spleen are treated by splenectomy and more recently by partial splenectomy. The infected lesions are treated by splenectomy or by incision and drainage only. Partial splenectomy has evident advantage over splenectomy. Although in the world literature we have not found a single case of infected splenic benign cyst treated by partial splenectomy, we believe that this procedure also has an advantage over drainage as the infected and necrotic part of the cyst is removed, thereby reducing morbidity and further possible complications.

Adolescent↗
PubMed1986

Urinary tract dilatation in utero: classification and clinical applications.

A morphologic classification of in utero urinary tract dilatation is presented. Ninety-two hydronephrotic fetal kidneys diagnosed with ultrasound were graded according to the proposed classification. The findings suggest that grade I dilatation (anteroposterior diameter of the renal pelvis less than 10 mm) should be considered normal. Grades II and III constitute an intermediate hydronephrosis, requiring postnatal urologic surgery in nearly half the cases. Grade IV (moderate dilatation of the calyces, with easily identified residual renal cortex) and grade V (severe dilatation of the calyces with atrophic cortex) are clearly pathologic and require neonatal corrective surgery. It is hoped that use of this simple and practical classification will facilitate communication and comparison of results in the literature.

Dilatation, Pathologic↗
PubMed1986

Ureteropelvic junction stenosis: antenatal ultrasonographic diagnosis, postnatal investigation, and follow-up.

Between January 1981 and October 1984, the diagnosis of ureteropelvic junction (UPJ) stenosis was suspected in 39 fetuses after routine obstetrical ultrasound (US) examination. Postnatal investigation revealed that the initial diagnosis had been accurate in 30 cases (77%). There were 35 UPJ stenoses in 30 patients. The degree of dilatation of the renal pelvis (grades III, IV, or V) observed postnatally with sonography as well as the obstructive excretory pattern noted by renal isotope scanning were used as criteria to determine the need for early postnatal pyeloplasty (performed in 25 patients), which relieved the obstruction and, in the majority of patients, improved renal structure and function.

Diuresis↗
PubMed1986

[Radiologic and echographic aspect of the disease of Kawasaki: experience with 75 cases at the Hospital Sainte-Justine of Montreal].

Seventy-five patients with Kawasaki disease were studied in Hôpital Sainte-Justine between June 1979 and December 1984. Echography (abdominal and cardiac) proved to be a useful tool in the detection of the complications of this syndrome. Coronary aneurysms were present in 9% of our patients; two-dimensional echocardiography easily identified the proximal ones. In all patients, aortography allowed us to identify the extension of the lesions more distally. The left coronary artery was affected in all patients while in five both coronary arteries were involved. In all 75 patients chest radiographs were normal. Abdominal echography permitted diagnosis of a hydrocholecyst in three patients.

Adolescent↗
PubMed1985

Lesser omental thickness in normal children: baseline for detection of portal hypertension.

The lesser omentum between the left lobe of the liver and the aorta at the level of the celiac axis harbors the left gastric vein and artery, lymphatics, nerves, and some fatty tissue. In one study, it was found to be thickened in most of 50 children with portal hypertension, but normal values were not established. Lesser omental thickness was measured in 150 children without systemic, liver, or renal disease, and it was found that it did not exceed 1.7 times the diameter of the aorta at the same level. Increased measurements were obtained in children with portal hypertension, obesity, or systemic steroid therapy (by fatty infiltration), preaortic lymphadenopathy, or with transient interposition of the gastric antrum or pancreas between the liver and aorta. In the absence of obesity or lymphadenopathy, a lesser omentum measuring more than 1.7 times the aortic diameter should raise the possibility of portal hypertension.

Adolescent↗