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Biomedical subjects

D Brodaty

Publications and source records attributed to D Brodaty.

At least 55 records · Page 3Linked to original sources
PubMed1984

[Computerized management of the medical record in cardiac surgery. Experience at Foch Hospital].

Between 1979 and 1983, about 2 000 case reports of patients undergoing cardiac surgery were computerised. The availability of the centralised computer facilities of Hôpital Foch made this experiment possible. The computerised case notes were divided into several chapters in which a certain amount of data was compulsive and provision was made for the addition of further information. The data was introduced in the form of a numerical code out of a possible choice of 700 contained in a dictionary. A terminal located in the department was used to introduce the information or to consult a given case file directly. Statistical analysis of the cases was performed using APL language, the basis of which must be known in order to continue interrogation, the reply being almost immediate. Several examples of the use of the system are given: number of patients, average duration of surgery, characteristics of the ten oldest patients. Other studies include the use of double entry tables to determine the relationship between two variables such as the variation of cardiothoracic index and the degree of postoperative bleeding. Each case takes about 20 minutes to be coded; the number of cases not entered has decreased greatly year by year. The differences in language used in comparison with already existing systems are: the use of syntax, the possibility of dating events, an "open" dictionary. The main drawbacks of the system are: forgetting to code certain data and restrictions of interrogation (easier for fixed than for facultative data). The overall results have been clearly positive.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Surgical Procedures↗
PubMed1983

[4-year clinical experience with gelatin-resorcinol-formol glue in acute dissections of the ascending aorta].

The gelatine-resorcine-formol glue (GRF) was used to reinforce the tissues of 25 patients operated for acute dissection of the ascending aorta, between January 1977 and September 1980. The results were compared with those of a control group of 25 patients operated between 1970 and 1976 by "classical techniques". There were no significant differences between the two groups as regards age, anatomical and preoperative clinical states. The ascending aorta was replaced in all patients; the aortic valve was replaced three times (12 p. 100) in the GRF group and twelve times (48 p. 100) in the control group: the coronary arteries were bypassed or reimplanted in 20 p. 100 of patients in both groups. The average peroperative blood loss was 5,800 ml in the control group and 2,100 ml in the GRF group (p less than 0,01). There were four peroperative deaths (16 p. 100) in the control group and no peroperative deaths in the GRF group. Postoperative complications (renal failure, cerebral ischemia, persistent peripheral ischemia or infection) were much more common in the control group. They were responsible for eight hospital deaths in the control group and two hospital deaths in the GRF group (p less than 0,01). Therefore, global hospital mortality was reduced from 48 p. 100 (control group) to 8 p. 100 (GRF group) (p less than 0,01). Two late deaths occurred in the control group, but there were none in the GRF one, all survivors being in good clinical condition. Sixteen patients in the GRF group underwent 19 angiographic controls, 2 to 36 months after surgery. These investigations showed two moderate aortic regurgitations (8 p. 100), three persistent dissections of the descending aorta but a stable, good quality repair in the other patients. In conclusion, the use of GRF glue significantly reduced: 1) the number of aortic valve replacements, 2) per- and postoperative blood loss, 3) the incidence and severity of postoperative complications. The long-term survival rate (4 years) has improved from 40 to 91 p. 100.

Acute Disease↗
PubMed1983

[Surgery of recurrent aortic dissection. Apropos of 6 cases].

The authors report a series of 6 cases of recurrent dissection, 4 of which were treated surgically, out of a total of 64 acute dissections of the aorta referred to the CMC Foch, between January 1969 and October 1981. Three types of recurrent dissection were identified: --"de novo" recurrent dissection: a new dissection occurring in part of the aorta previously unaffected with a new intimal tear; --recurrent dissection due to extension of the previous dissection; --"in situ" recurrent dissection. Surgery is the treatment of choice because of the poor prognosis. Extensive resection (sometimes carried out in several stages) and deep hypothermia are valuable techniques when part of the aorta giving off arteries to vital organs has to be replaced. The use of GRF biological glue in the treatment of the original acute dissection has been a significant advance in the prophylaxis of recurrent dissection as it ensures better repair of the distal false lumen (27% persistent false lumens). With respect to an extensive replacement of the dissected vessel, the authors advise operation in several stages, especially in young subjects with Marfan's syndrome who are at high risk of recurrent dissection. All cases of acute dissection of the aorta, operated or not, should be followed up indefinitely with clinical and radiological examination, completed, when necessary, by an angioscan and an aortography.

Adult↗
PubMed1983

[Metabolic myocardial modifications following surgical revascularization].

The effects of aorto-coronary bypass surgery on myocardial lactate, free fatty acid and certain amino acid metabolism were studied in 30 coronary patients presenting with unstable, invalidating angina resistant to medical therapy. These patients had electrical signs of anterior wall ischemia without necrosis, significant proximal stenosis of the left anterior descending artery with good distal run-off, and underwent bypass surgery on this artery without signs of postoperative myocardial infarction. This study involved pre- and postoperative hemodynamic investigation with a Swan-Ganz catheter and a metabolic study of the coronary arteriovenous lactate (n = 30), free fatty acid, alanine and glutamate (n = 12) levels under basal conditions and after atrial pacing. These results were compared with those in 10 non-coronary control patients, operated for monovascular replacements. The increase of the pulmonary capillary pressure associated with a fall in systolic index at the 6th postoperative hour showed a reduction in left ventricular performance which tended to correct itself at the 24th hour. In the coronary patients, myocardial lactate production increased, alanine production increased and the uptake of free fatty acids fell during atrial pacing after surgery. These metabolic changes reflect the stimulation of anaerobic glycolysis secondary to myocardial ischemia which disappeared after surgery to compare with the control subjects. Therefore, effective myocardial revascularisation in patients with coronary artery disease is accompanied by the regression of the metabolic stigmata of myocardial ischemia.

Adult↗
PubMed1983

[Aortocoronary bypass with 10 years' follow-up. Apropos of 183 cases].

Between 1970 and 1972, 183 patients were admitted to the CMC Foch (Pr D. Guilmet) for saphenous vein aorto-coronary bypass surgery. Ten years later a questionnaire was sent to the patient and his cardiologist and the two replies were analysed. Before surgery, all patients had invalidating angina: 12 p. 100 had unstable angina, 61 p. 100 had previous myocardial infarction. Preoperative coronary angiography showed triple vessel disease in 64,5 p. 100, double vessel disease in 18,6 p. 100 and single vessel disease in 14,2 p. 100. There hundred and thirty two grafts were performed (average 1,8 per patient); 42 endarteriectomies were also carried out, 35 on the right coronary artery. Complete revascularisation was achieved in 95 cases (52 p. 100). The incidence of perioperative infarction was 17,5 p. 100 and operative mortality was 7,6 p. 100. Thirty two patients (19 p. 100) died during the 10 year study period; 11 deaths were of cardiovascular origin. The 10 year actuarial survival rate was 66 p. 100. Half the patients are asymptomatic and nearly two thirds take no anti-anginal therapy. The patency of the grafts was chacked in about half the cases and was found to be 72,8 p. 100 at one year. From the professional point of view, two thirds of patients returned to full time working one year after surgery. The degree of activity at 10 years is only known in 87 cases; half these patients are working and a quarter have retired normally. This study shows that: --coronary bypass surgery has excellent long-term effects on symptoms; --the incidence of infarction and survival are comparable to other reported studies; --patients with triple or double vessel disease may have lived longer after surgery than had they been treated medically.

Adult↗
PubMed1982

[First human case of Drechslera longirostrata mycosis. Spondylodiscitis complicating prosthesis endocarditis. Treatment with combined ketoconazole and amphotericin B].

In a patient with spondylodiscitis secondary to cardiac valve prosthesis infection with endocarditis the fungus Drechslera longirostrata, which had not yet been known to cause mycoses, was isolated from cultures of prosthetic material and an intervertebral disc. The cardiac prosthesis had to be replaced and the vertebral lesion, which extended along 3 lumbar segments and was destructive enough to produce neurological disorders, required surgical immobilization of the spine. The disc infection was cured after combined administration of amphotericin B and ketoconazole, both drugs having proved unsuccessful when given alone. Infections caused by rare opportunistic fungi are becoming increasingly common and are difficult to diagnose since immunological methods are inapplicable. In some resistant or extremely severe fungal infections antifungal agents can be used in combinations for their synergistic effects, with subsequent reduction of dosage and potential side-effects. Combinations must be based on in vitro sensitivity tests.

Adult↗
PubMed1982

[Coarctation and dystrophic aneurysm of the thoracic aorta (author's transl)].

Coarctation and dystrophic aneurysm of the thoracic aorta are seldom associated. In this series of 6 patients the aneurysm, often voluminous, was located on the ascending aorta in 1 case, on the distal part of the aortic arch in 3 cases and on the descending aorta in 2 cases. Surgical treatment consisted of resection and prosthetic replacement of the coarcted and aneurysmal segment under extracorporeal circulation. In a 13-years old patient, however, the coarctation was repaired but the aneurysm of the descending aorta below it was deliberately left in situ. All six patients are now asymptomatic. Post-operative angiography was performed in 4 cases with satisfactory results. In all cases the dystrophic aneurysm resulted from lesions of the elastic fibers of the tunica media and was therefore different from other aneurysms associated with coarctations.

Adolescent↗
PubMed1982

[Rupture of post-infarction left ventricular aneurysm. Apropos of 2 cases treated surgically successfully].

Two cases of post-infarction anterior left ventricular aneurysm complicated by localised rupture into the pericardium are reported. The clinical features of these cases were severe cardiac failure, 10 days or more after initial necrosis posing the problem of myocardial failure due to extension of the infarct. The surgical indications were brought by left ventricular angiography performed under intra-aortic balloon pumping: in the first case the diagnosis had already been suggested by the detection of a hemopericardium on echocardiography. In both cases, the surgical procedure comprised aneurysmectomy with reinforcement of the ventricular wall with bands of Teflon. The postoperative period was complicated due to the very precarious hemodynamics at the time of surgery. The functional status of both patients is now very satisfactory.

Echocardiography↗
PubMed1982

[Calcifying obstructive disease of the descending thoracic aorta].

The authors present the first surgically treated case of calcifying obstructive disease of the descending thoracic aorta. The diagnosis was based upon the coexistence of an aortic isthmus coarctation syndrome together with massive calcifications seen by chest X-ray. The aetiology remains uncertain but the authors tend in favour of an atheromatous aetiology. Cure was obtained by simple surgical treatment.

Aorta, Thoracic↗
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↗
PubMed1979

[Conduction disorders after aortic valve replacement. Apropos of 200 cases].

The following points become apparent after the study of 200 cases of aortic valve replacement:--Conduction defects are very common after this type of surgery, affecting one in three patients in this series;--Above all, the frequency of conduction defects of the left bundle branch (2/3 cases) must be underlined. They are much more common than complete atrioventricular block, bifascicular block or isolated right bundle branch block;--Diagnosed immediately after operation in almost all cases, regression is common (50%) especially of left anterior hemiblock;--The long term prognosis is good. There was no long or short term mortality due to this cause in this series;--Apart from traumatic lesions which are difficult to avoid when the aortic orifice is calcified, ischaemia of the conduction pathways due to insufficient myocardial protection probably plays a role in the aetiology of these conduction defects.

Aortic Valve↗