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Biomedical subjects

B Girard

Publications and source records attributed to B Girard.

71 records · Page 4Linked to original sources
PubMed1989

Long term results of treatment of Budd-Chiari syndrome by side to side portacaval shunt.

This is a report of a long term prospective study of 13 seriously ill patients with Budd-Chiari syndrome as a result of occlusion of the hepatic veins who were treated by side to side portacaval shunt from four to 78 weeks after the onset of symptoms and who were under observation for three to 16 years. The patient population was young, ranging in age from 19 to 45 years; seven were men and six were women. The presumed cause was the use of oral contraceptives in three, polycythemia rubra vera in two, Behcet disease in one patient and unknown in seven patients. All of the 13 patients had abdominal pain, marked ascites, hepatosplenomegaly, wasting and disturbed liver function. Diagnosis was based on the symptoms and signs: angiographic demonstration of hepatic vein occlusion and a patent inferior vena cava; pressure measurements that showed an inferior vena caval pressure that was normal or within the usual range for patients with massive ascites and an elevated wedged hepatic vein pressure that was much higher than the inferior vena caval pressure, and the results of biopsy of the liver showing centrilobular congestion and necrosis. Side to side portacaval shunt was very effective in decompressing the liver, reducing the mean corrected portal pressure from 240 millimeters of saline solution before to 7 millimeters of saline solution after the shunt. Operative survival rate was 92 per cent, and the long term survival rate for three to 16 years is 85 per cent. All of the survivors are free of ascites without requiring diuretic therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Comparison of the metabolic control of diabetes achieved by whole pancreas transplantation and pancreatic islet transplantation in rats.

To compare the long-term effectiveness of whole pancreas transplantation and pancreatic islet transplantation in controlling the metabolic disorders of alloxan diabetes, metabolic studies were performed monthly for 2 years in 4 groups of highly inbred rats: (1) NC-116 nondiabetic controls; (2) DC-273 untreated alloxan-diabetic controls; (3) PDT-182 rats that received syngeneic pancreaticoduodenal transplants shortly after induction of diabetes with alloxan; and (4) IT-92 rats that received an intraportal injection of at least 1500, but usually 2000, syngeneic pancreatic islets shortly after induction of diabetes with alloxan. Whole pancreas transplantation maintained strict metabolic control throughout the 2 years of study. In group PDT, hyperglycemia was abolished; plasma glucose concentration was maintained tightly within the normal range; markedly depressed plasma insulin levels were raised to above normal; glucose tolerance tests had insulin levels above normal and glucose levels that increased less and declined more rapidly than normal; and body weight gain and growth approached normal. In contrast, pancreatic islet transplantation failed to maintain precise metabolic control. In group IT, plasma glucose concentration initially fell to normal but then was elevated significantly above normal beginning with the 3rd posttransplant month; plasma insulin level declined progressively after the 6th posttransplant month; glucose tolerance tests had a diabetic glucose tolerance curve as a result of a markedly deficient plasma insulin response; and body weight gain and growth were significantly less than in group PDT. The results of these long-term metabolic studies may explain the effectiveness of whole pancreas transplantation and the ineffectiveness of pancreatic islet transplantation in preventing diabetic nephropathy.

Animals↗
PubMed1988

[Treatment of sequelae of basedowian exophthalmos].

Treatment of sequelae of ophthalmopathy of Basedow's disease, essentially exophthalmos, oculomotor disorders and upper eyelid retraction, is of particular importance because of the functional and esthetic problems presented. Improvement in the different symptoms can be obtained by surgical treatment, but patients must have been perfectly stable with respect to both the thyroid and ophthalmologic plan for at least 6 months. It marked exophthalmos exists this is treated initially by orbital enlargement. Oculomotor problems are then resolved and finally treatment is terminated by surgery to eyelids. Very satisfactory functional and esthetic results are obtained.

Exophthalmos↗
PubMed1986

Lifelong reversal of the metabolic abnormalities of advanced diabetes in rats by whole-pancreas transplantation.

Evidence suggests that metabolic abnormalities are responsible for the widespread microvascular complications of insulin-dependent diabetes mellitus (IDDM). Interest in endocrine pancreas replacement therapy, including pancreas transplantation, is based on the hope that such treatment will reverse the complications of IDDM by providing more precise metabolic control than conventional therapy. To determine if whole pancreas transplantation is capable of reversing well-established metabolic abnormalities of diabetes mellitus (DM) and maintaining strict metabolic control for life, we performed monthly metabolic studies for 2 years in 141 nondiabetic control rats, 273 diabetic control rats with alloxan-induced DM, and 267 diabetic rats that received syngeneic whole pancreaticoduodenal transplants 6, 9, 12, 15, 18, and 21 months after induction of DM with alloxan. Whole-pancreas transplantation in rats with long-standing DM permanently reversed the metabolic disorders. Elevated plasma glucose concentrations were permanently reduced to normal, depressed plasma insulin levels were permanently increased to normal, elevations of BUN and serum creatinine were permanently normalized, and there was a striking gain in body weight. Hyperglycemia during glucose tolerance tests was of lesser magnitude and shorter duration than normal, as a result of greater-than-normal plasma insulin levels. The only abnormality that persisted was hyperglucagonemia, but it did not interfere with control of hyperglycemia and is of unknown significance. These results indicate that whole-pancreas transplantation produces the most complete and sustained correction of the metabolic abnormalities of experimental DM of any available therapeutic modality.

Animals↗
PubMed1981

[Orthopaedic examination of 1 500 infants in maternity (author's transl)].

1 500 infants have been examined by two orthopaedic surgeons within forty eight hours. The examination of the feet has showed that the usual position in utero was the dorsiflexion. A new classification of deformities of the feet is proposed. The examination of the knees has permitted to discover a rotatory instability between the femur and the tibia in 2% of the infants. Some of them were actual dislocations. During the examination of the hips, it has been researched an instability; the passive abduction, the tension of the adductors and an abduction contracture have been analysed. Some instable hips are easy to detect because there is a jerk (ressaut) but others are very difficult because there is no snapping sign but only a telescoping displacement (piston). The rate of unstable hips was 1.7%. As the combination of an unstable hip and an adductor hypertonicity is usual it is very important to detect a pelvic obliquity and a bilateral adductor-hypertonicity. The various forms of normal birth postures and the relation to orthopaedic deformities of the inferior limbs are studied.

Fetus↗
PubMed1978

Repeat surgery after disc excision.

Sixty patients requiring repeat surgery after lumbar disc excision are reviewed. Thirty-one had had their initial surgery performed by the authors and represent a 5.9% frequency of repeat surgery after initial laminectomy for sciatica. Of the 60 patients, 49 suffered recurrent radicular pain, 20 suffered from back pain, and 8 had other problems (infection, extradural cysts, etc.). In patients with recurrent sciatica, perineural fibrosis and recurrent herniation were the most common problems; those patients with the latter pathologic condition responded most favorably to repeat surgery. Of 520 patients who had undergone disc excision, only 9 required secondary fusion.

Adult↗
PubMed1975

Autonomic nervous system and adaptation to cold in man.

The responses to cold hand test (blood pressure increase and tachycardia) and to a cold face test (blood pressure increase and bradycardia) were used to study the role of the autonomic nevrous system in cold adaptation in humans. The Eskimos (men, women, children) were shown to have a very weak sympathetic response to cold but the vagal response (bradycardia) was identical to that of white people. A group of mailmen from Quebec city living outdoors approximately 30 h/wk throughout the year was also studied. A significant decline in the cold pressor response and an enhanced bradycardia (cold face test) were observed at the end of the winter. Similarly the fall in skin temperature of the cheek was not as pronounced when the measurements were made in May compared to those made in October. A group of soldiers was also studied before and after an Arctic expedition. It was found that the bradycardia of the cold face test was also more pronounced after sojourning in the cold. These results indicate that repeated exposures to severe cold in men activate some adaptive mechanisms characterized by a diminution of the sympathetic response and a concomitant enhancement of the vagal activation normally observed when the extremities and the face are exposed to cold.

Adaptation, Physiological↗
PubMedDate not supplied

Portal vein thrombosis in cirrhosis with variceal hemorrhage.

Organized thrombus in the main trunk of the portal vein was encountered in 85 (6.5%) of 1300 patients with cirrhosis and variceal hemorrhage who underwent direct portacaval shunt (PCS). The thrombus was successfully removed with restoration of portal blood flow in all patients by phlebothrombectomy and balloon catheter extraction. Of the 85 patients, 65 were among 400 unselected patients who underwent emergency PCS (16%), and 20 were among 900 selected patients who underwent elective PCS (2%). All patients were closely followed for at least 5 years. Patients with portal vein thrombosis (PVT) had more advanced liver disease than those without PVT, reflected preoperatively in significantly higher (P < 0.01) incidences of ascites (75%), severe muscle wasting (52%), varices of very large size (94%), the hyperdynamic state (94%), severe hypersplenism with a platelet count of less than 50,000/mm3 (92%), and placement in Child's class C (52%). Side-to-side PCS reduced the portal vein-inferior vena cava pressure gradient to a mean of 23 mm saline solution in patients with PVT, similar to the marked pressure reduction obtained in patients without PVT. PCS promptly stopped variceal bleeding in all patients in the emergency PCS group. Permanent prevention of recurrent variceal bleeding was successful in 95% of patients with PVT and more than 99% of patients without PVT. Survival rates were similar in patients with and without PVT. In patients with PVT, survival rates at 30 days and 1, 5, 10, and 15 years following emergency PCS were 69%, 66%, 65%, 55%, and 51%, respectively, and following elective PCS were 95%, 90%, 70%, 65%, and 60%, respectively. Quality of life was similar in patients with and without PVT. Long-term PCS patency was demonstrated yearly in 93% of patients in the group with PVT and in 99.7% of patients without PVT. Other similarities after 5 years between patients with and without PVT, respectively, were the incidences of recurrent encephalopathy (9% vs. 8%), alcohol abstinence (61% vs. 64%), improved liver function (68% vs. 62% to 75%), and return to work (52% vs. 56% to 64%). It was concluded that in patients with cirrhosis and variceal hemorrhage it is almost always possible to remove portal vein thrombus by means of phlebothrombectomy and then perform a direct PCS with results similar to those achieved in the absence of PVT.

Adult↗