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Biomedical subjects

A Leguerrier

Publications and source records attributed to A Leguerrier.

At least 73 records · Page 4Linked to original sources
PubMed1986

[Evaluation of aortocoronary bypass using exercise myocardial thallium 201 scintigraphy].

The surveillance of aortocoronary bypass grafts is a difficult problem. Clinical examination and exercise testing are unable to give a complete evaluation of the operative results and cardiac catheterisation with radiological opacification of the grafts are not without risk and cannot be repeated periodically. Therefore, radioisotopic methods have been proposed as a means of assessing aortocoronary bypass grafts. The aim of this study was to evaluate postoperative myocardial perfusion by Thallium 201 scintigraphy. The authors compared pre and postoperative scintigraphies in 37 patients undergoing aortocoronary bypass surgery (36 men and 1 woman, average age: 53.9 years). Preoperative coronary angiography showed 9 cases of single vessel disease, 11 cases of double vessel diseases and 17 cases of triple vessel disease. Seventy one bypass grafts were performed (average 1.92 grafts/patient): 37 on the LAD, 15 on the circumflex, 10 on the diagonal and 9 on the right coronary. All patients were submitted to the same protocol before surgery and during the third postoperative month; Clinical examination, ECG, exercise stress testing and Thallium 201 myocardial scintigraphy. The results confirm the improvement in myocardial perfusion after coronary bypass surgery. The percentage of pathological scintigraphic segments fell from 42 per cent before surgery to 27 per cent after surgery (p less than 0.01). The total Thallium perfusion index improved significantly after surgery from 9.3 +/- 2 to 7.7 +/- 1.9 (p less than 0.01). Thallium 201 scintigraphy was superior to clinical examination and exercise testing in the assessment of graft patency, identifying 2 postoperative infarctions inapparent on clinical examination, excluding postoperative non-anginal chest pain and evaluating myocardial perfusion in patients who had sub maximal postoperative exercise stress tests. The relatively non traumatic character of Thallium 201 scintigraphy makes it the best non-invasive method of assessing aortocoronary bypass graft patency.

Adult↗
PubMed1986

[Vascular injuries of the limbs. Evaluation of 106 lesions in 76 patients].

A total of 106 lesions due to vascular injuries (noniatrogenic) to limbs were treated in 81 patients at the CHR, Rennes (Cardiovascular and Thoracic Unit) between 1970 and 1983. Analysis of data allowed a profile of arterial lesions (type and location) to be retraced, and demonstrated the high frequency of associated lesions, these varying in distribution according to whether the upper limbs (major seriousness of neurologic sequelae) or lower limbs (very high incidence of osteoarticular lesions) were involved. Among the "immutable" severity factors (related to the injury) emphasis has to be placed on "contending or crush injuries", widely displaced lesions, extensive arterial dilacerations (middle segments of limbs) and multiple vascular lesions. This study focused attention mainly on the tactical and technical factors allowing improvement in the always reserved prognosis of these lesions. Firstly, by maximum reduction in the duration of ischemia by early diagnosis (to avoid referral to a "second hand") and by judicious indication for angiography (conducted preferably in the operation room and if necessary repeated after vascular repair surgery). Secondly, by repair of lesions in conformity with well established rules and principles: bone stabilization initially, formal venous repair surgery for large venous trunks, preferably "conservative" surgery of arterial vessels to ensure a perfect result initially (any recovery operation results in a very high incidence of failures).

Adolescent↗
PubMed1986

[Mural thrombosis of the abdominal aorta. A sometimes unrecognized cause of recurrent embolisms].

A 23 year old patient with an infrarenal abdominal aorta mural thrombosis developed recurrent peripheral emboli. This case underlines the etiologic investigation necessary in cases of peripheral emboli unexplained by the conventional cardiac examinations. Filling of total aorta with contrast is essential (assisted if necessary by oblique projections) to detect possible mural thrombi carrying the risk of recurrent emboli.

Adult↗
PubMed1986

Cancer of the kidney invading the vena cava and heart. Results after 11 years of treatment.

Between October, 1973, and October, 1983, 18 patients with cancer of the kidney or adrenal gland that had invaded the vena cava, and in 11 cases had reached the heart, were operated on by seven surgical teams. The surgical excision in all patients was performed with extracorporeal circulation, circulatory arrest and deep hypothermia. No deaths occurred. If there are no detectable metastases before operation, the 5 year survival rate is 75% as compared to 6 months with medical treatment. This clinical situation is not uncommon, as 3% to 10% of cancers of the kidney invade the inferior vena cava and 40% of them reach the heart. The possibility of curing the cancers with minimal operative risk should prompt a systematic search for venous invasion with any cancer of the kidney.

Adolescent↗
PubMed1985

[Partial interruption of the inferior vena cava by an endovenous filter. Apropos of 98 patients].

94 partial interruptions of the inferior vena cava (PIIVC) were carried out in 98 patients between May 1979 and November 1983 with a Mobin-Uddin umbrella filter (58 cases) or a Kim-Ray Greenfield filter (36 cases); one patient who had a double inferior vena cava underwent double PIIVC with a Greenfield filter. The patients (56 women and 42 men) were between 22 and 84 years old (average 60.6 years). Phlebocavography was performed pre-operatively in 93 patients (95 p. 100) and showed thrombus in the IVC (21 cases), common iliac vein (20 cases), ilio-femoral vein (32 cases), femoral vein (15 cases), popliteal and/or sural vein (4 cases); the investigation was considered normal in 1 patient. The diagnosis of pulmonary embolism (PE) was made in 86 patients (87.7 p. 100) on clinical and/or pulmonary scintigraphy and/or angiography data. The main indications for PIIVC were major PE (56 cases) or a threatening venous thrombosis (27 cases); other indications included recurrent PE despite adequate anticoagulation, patients with contra-indications to anti-coagulant therapy and pulmonary hypertension due to thromboembolism; 4 PIIVC were carried out during pulmonary embolectomy on cardiopulmonary bypass. The operative mortality was 3.06 p. 100 (3/98) with a global early mortality of 10.2 p. 100 (10/98); morbidity was 12.2 p. 100 (12/98); there were 5 failures of PIIVC. The long-term outcome was studied in the first 80 cases with a mean follow-up of 18 months (4 to 48 months).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1985

[Traumatic rupture of the aortic isthmus in a child, revealed by paraplegia].

After a severe polytraumatism, a 14 year-old boy presents paraplegia without vertebral lesion. Angiocardiography showed rupture of aortic isthmus. Surgical treatment resulted in successful outcome. The authors insist on the rarity of traumatic rupture of aorta in children and or the particularity of the diagnosis revealed by paraplegia.

Adolescent↗
PubMed1985

[Associated lesions in closed injuries of the thorax: right bronchial rupture, rupture of the right subclavian artery, and bilateral fracture of the 1st rib].

A patient presented with rupture of right bronchus associated with rupture of the homolateral subclavian artery (diagnosed secondarily at the false aneurysm stage) and bilateral fracture of the 1st rib. Two stage repair operation provided lasting recovery. This case is used as a basis for emphasizing the diagnostic problems raised by combined endothoracic lesions, the need for systematic investigation of possible presence of a lesion of subclavian artery in patients with fracture of 1st rib, and finally various operative tactics (in the framework of false aneurysms of proximal subclavian vessels).

Adolescent↗
PubMed1984

[Surgery of calcified aortic stenosis in patients aged 70 and over. Immediate results. Apropos of a series of 229 cases].

229 patients aged 70 or over with aortic stenosis (AS) underwent surgery between January 1972 and July 1983 (21.8% of 814 cases of AS operated on during the same period). The Björk Shiley prosthesis was used at the beginning of the series (115 cases, 50.2%), until bioprostheses became the treatment of choice in this age group. Overall operative mortality in the series was 10.9% (25/229). Analysis shows a very marked reduction in recent years: from 15.6% between 1972 and 1977, to 5.8% in 1982-3. Improvement can be attributed in part to the technical progress in myocardial protection. Patient age is a very significant factor in the prognosis. Progress in surgery, together with that in anaesthetics and intensive care, justifies operation in these elderly and incapacitated patients whose general and neurological condition is well preserved.

Age Factors↗
PubMed1983

[Compression of the pelvic ureter by a hypogastric aneurysm].

An isolated aneurysm of the right hypogastric artery provoked ureteral compression responsible for renal colic and evidence of uretero-pyelo-caliceal dilatation on I.V.U. Diagnostic features are reviewed and emphasis laid on the severe course of this affection which justifies urgent surgery associating vascular reconstruction, ureterolysis and ureteral reimplantation.

Aged↗
PubMed1982

[Immunological changes following heart surgery under extracorporeal circulation (author's transl)].

Post-operative immunological changes were studied in 40 patients undergoing heart surgery. Tty-five patients were operated upon under extracorporeal circulation (ECC), and 15 without ECC. Immunological investigations were performed before, immediately after the operation and again 7 days later. The post-operative changes recorded were early decrease in IgG and IgM followed by a rise in IgM, transient lymphocytopenia affecting mainly T lymphocytes and delayed increase in complement (CH50, C2, C3). These changes were comparable in both groups of patients and therefore seemed to relate to the operation itself rather than to the ECC. It may be concluded that ECC does not appear to increase the risk of post-operative infection by depressing immune defence mechanisms.

Adolescent↗