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Biomedical subjects

B Goudot

Publications and source records attributed to B Goudot.

At least 73 records · Page 4Linked to original sources
PubMed1981

[Cold-induced paralysis of the phrenic nerve in open-heart surgery (author's transl)].

Cold-induced injury of the phrenic nerve after pericardial cooling during open-heart surgery has already been reported, but the post-operative consequences and long-term course of this complication have seldom been documented. Fifty cases (6.6%) of phrenic nerve paralysis were observed in a series of 750 patients undergoing open-heart surgery with topical cooling of the pericardium for myocardial protection. As infectious and respiratory complications (including atelectasis, bronchial obstruction, pleural effusion, pneumonia and bacteriaemia) were significantly more frequent (p less than 0.05) in these patients, assisted ventilation and intensive care were significantly more prolonged (p less than 0.01). Long-term follow-up of 42 patients (mean: 14 months; range: 3-42 months) showed inconstant and often incomplete regression of the paralysis. The complication can easily be prevented by using a plastic insulation pad during pericardial cooling and cold cardioplegia.

Cardiac Surgical Procedures↗
PubMed1981

[Circadian rhythms of cortisol in burns (author's transl)].

Circadian rhythms of cortisol were studied in 10 patients. This study was made shortly after the burn and for a short period of one or two days maximum in 9 patients. Blood level measurements of cortisone were made in 4 patients. 7 patients died. The analysis of circadian rhythm was made with a computer (méthode de régression harmonique combinée à une analyse de variance). The results are deceiving: there are qualitative and quantitative disturbances but we could not give a significance to them, each patient reacting differently. In one case, a drop of cortisol to 0 was observed and the patient died, this observation shows the development of corticosurrenal failure. So, one or several measurements do not allow the study of corticosurrenal function which differs in each case. Theoretical appreciations in handbooks on the subject must be tempered.

Adult↗
PubMed1981

[Bacteriologic study of indwelling central venous catheters. Factors influencing the risk of microbial colonization and sepsis (author's transl)].

The mechanism of microbial colonization and sepsis is disputed. For many authors, catheter contamination results from poor aseptic technic during insertion or removal or from the descent of organisms along the catheter from the skin puncture site; we think with Michel that endogenous colonization of the thrombus at the tip of the catheter must be considered: a statistical correlation between infected foci remote from the catheter allows this hypothesis; tracheostomy may be considered as well as a percutaneous contaminant as a deep infected focus. The correlation between non specific immunity and contamination is another finding which allows the ability of endogenous colonization.

Catheterization↗
PubMed1980

[Surgery of the descending thoracic aorta. Partial derivation between the pulmonary and femoral arteries: 29 cases (author's transl)].

The authors report on 29 surgical operations on the descending thoracic aorta, where partial extra-corporal circulation was established between the pulmonary and femoral arteries, using a straight Rigg's cannula inserted into the pulmonary artery. The blood flow rate in the shunt was of the order of 1,5 l/min. Owing to the ease with which the cannula is inserted and removed and to the possibility of switching to total extra-corporeal circulation the authors prefer this technique to all other types of partial derivation.

Aorta, Thoracic↗
PubMed1980

[Replacement of the ascending aorta and aortic valve with re-implantation of the coronary arteries. Long-term results in 20 cases (author's transl)].

Total replacement of the ascending aorta and aortic valve using Bentall's technique was carried out in 20 patients with dystrophic (13 cases), chronic dissecting (4 cases) or acute dissecting (3 cases) aneurysm. Five patients died in the first month following surgery, but all patients operated upon for dystrophic aneurysm survived. The mean follow-up period for the 15 survivors was 39 months, and there was no late death. Thirteen patients are leading a normal life. Nine out of 14 control aortographies were performed 48 months on average after the operation. They showed normal and stable anatomical restoration of the aorta and coronary system. Total replacement of the ascending aorta seems to be the operation of choice for dystrophic aneurysm.

Adult↗
PubMed1980

Aortocoronary bypass with homologous saphenous vein: long-term results.

Between February 1973, and February, 1979, 27 homologous saphenous veins were used in 20 patients (mean age, 54 years). Seven fresh grafts were used less than 24 hours after severance. They were kept at a temperature of 4 degrees C in saline solution containing penicillin. Twenty cryopreserved grafts were used within a period of eight days to 2 months from severance. They were preserved in glycerol at a temperature of -40 degrees C. One patient (5%) died postoperatively. A perioperative myocardial infarction developed in 3 patients (15%). Average follow-up is 27 months. No late mortality was registered. Fifteen patients are free from symptoms, and 3 patients have residual angina with exercise. Control angiograms were made in 13 patients 1 to 68 months after operation; 17 homografts were seen. Early occlusion of 1 graft and late occlusion of 8 grafts were registered. The poor late patency rate does not seem to be related to either histocompatibility or technical conditions. Conversely, microscopic examination of several cryopreserved grafts showed that the mode of preservation resulted in deterioration of intimal and medial tissues of the vein. Therefore, it appears to us that the use of homologous saphenous veins should be avoided for coronary bypass.

Adult↗
PubMed1979

[Dissecting aneursym of the ascending aorta after lateral clamping for aorto-coronary by pass (author's transl)].

Four cases of dissecting aneurysm of the aorta after lateral aortic clamping for aorto-coronary bypass are described. These accidents are rare but very serious. They often occur in hypertensive patients, and sometimes an aortic wall with a low elastic fibre content is found on histology. Surgery is that of dissecting aneurysm of the ascending aorta. However the severity of these accidents should lead to routine preventive measures during all aortocoronary bypass operations, in particular aortic anastomosis of the grafts under extra-corporeal circulation.

Aortic Dissection↗
PubMed1979

Use of biological glue in acute aortic dissection. Preliminary clinical results with a new surgical technique.

Use of a biological glue (GRF) is common in certain fields such as hepatic or renal surgery, but its use in vascular surgery, especially in acute aortic dissection, has not yet been reported. Our experience has demonstrated many advantages: The glue is very simple and safe to use. The aortic tissues are firmly reinforced and the sutures tighten immediately. The proximal aortic stump is anatomically reconstructed, and generally the aortic valve can be preserved and coronary reimplantation avoided. The preoperative and postoperative bleeding rates are low and the postoperative course generally is simple. The risk of maintenance or recurrence of the dissection process is reduced. Consequently, the hospital mortality rate can be reduced to about 10 percent and the long-term survival rate greatly improved.

Adult↗
PubMed1979

[Surgery of acute aortic dissection by use of a biological glue. Experimental study (author's transl)].

The improvement in surgical technic in the treatment of dissecting aneurysm of the aorta should permit a reduction in mortality and secondary complications. With this object, an attempt to stick together the two parts of the aneurysm with biological glue, was submitted to an experimental study. The operative protocol included on the one hand, creation of a dissecting aneurysm in the thorax of the dog, and secondly, repair of the latter with biological glue of variable composition. 27 dogs were thus operated on : -- 4 dissections were treated by simple suture (control group); -- in 23 cases, the two parts of the dissecting aneurysm were stuck together with gelatin-resorcin glue which was polymerised either by formaldehyde alone, or by a mixture of glutaraldehyde-glycerinaldehyde or by a mixture formaldehyde-glutaraldehyde. The best results of adhesiveness and tissue tolerance were obtained with the latter mixture.

Acute Disease↗
PubMed1979

[Study of two observations of bronchial muco-epidermoid tumour (author's transl)].

This study deals two cases of operated bronchial muco-epidermoid tumours. They were localized in both cases in the segmentary bronchi (apical ones of lower lobes), one mostly endo-bronchial, the other with an endo-exobronchial development. The histological diagnosis was done after the thorough analysis of the surgical specimen revealed the association of two cell types characteristic of these tumours: mucus producing cells and epidermoid cells. Evolution differs in both cases, as the first observation revealed the existence of a potentially benign tumour, while in the second it behaved like a truly malignant one with local recurrence, regional invasion and distant metastases.

Adult↗
PubMed1979

[Segmentary bronchial atresia. One observation (author's transl)].

This study was done on a case of segmentary bronchial atresia of the left upper lobe. It is an exceptional congenital malformation, as only 47 observations have been so far recorded. Diagnosis was essentially radiological. The standard chest X ray and tomographies revealed an area of segmentary and lobar transparency surrounding a para-hilar lump. Diagnosis was confirmed by bronchography revealing the lack of injection into the atretic bronchus. Possible infectious complications and the evolution of bronchiectasis and obstructive emphysema justify the surgical exeresis.

Adult↗
PubMed1978

[Re-operation for myocardial revascularisation. 15 cases (author's transl)].

Among 1110 patients undergoing aorto-coronary bypass procedures, 15 required late re-operation (average interval 28 months) for myocardial revascularisation. This was performed following the recurrence of anginal symptoms, on average 15 months after the first operation. Six resections of localised stenosis of the vein graft and eleven "new" aorto-coronary bypass were performed. One patient died early, 12 hours after surgery, while 2 died 3 and 26 months later. Nine of the 12 survivors had no symptoms 4 to 63 months after the re-operation. Thus in the presence of angina recurring after aorto-coronary bypass, a new follow-up coronary arteriogram should be performed in order to seek lesions which might benefit from further attempted surgical treatment.

Adult↗
PubMed1978

[Congenital arteriovenous fistula of the broad ligament. 1 case].

Following a case report of a congenital arterio-venous fistula of the broad ligament, the authors set out the different types of vascular malformation seen in the pelvic region and they attempt to define the place of treatment. The treatment of these lesions involves embolisation of the vascular pedicle and an attempt at surgical excision, alone or one after another.

Adnexa Uteri↗
PubMed1978

Pulmonary gas exchange during venoarterial bypass with a membrane lung for acute respiratory failure.

In patients with fulminating pulmonary edema not responsive to conventional therapy, venoarterial membrane lung bypass can provide assistance if decreased systemic blood pressure prevents use of high-level positive end-expiratory pressure ventilation. In 10 patients with acute respiratory failure, partial venoarterial bypass provided a rapid and marked improvement of systemic oxygenation. Measurement of pulmonary blood flow (PBF) and intrapulmonary shunting (QS/QP) during bypass via prolonged left heart catheterization showed that left ventricular PaO2 was increased through a rapid and profound reduction of QS/QP. During the first days of bypass, derecruitment of pulmonary vessels is probably the mechanism of improved pulmonary oxygenation. When low pulmonary arterial pressures (PAP) are sustained, resorption of pulmonary edema is favored. Despite the beneficial effects of bypass, death occurred in every case due to diffuse interstitial fibrosis and/or parenchymal damage. The absence of healing, due to prolonged circulatory exclusion, may be detrimental despite immediate improvement. Because of this possibility, venovenous or mixed perfusion should be more extensively explored.

Acute Disease↗