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Biomedical subjects

D Loisance

Publications and source records attributed to D Loisance.

At least 217 records · Page 12Linked to original sources
PubMed1976

[Protection of the myocardium by hypothermia during extracorporeal circulation. Experimental and clinical study].

Hypothermic protection of myocardia during E.C.C. has been estimated on a 35 dogs experimental series and on a clinical series of 700 acquired cardiopathies of adult, including 400 valvular replacements and 300 aorto-coronary by-pass. Experimental results have been estimated by biochemic and morphologic controls done on myocardic samples took up by drillbiopsy. The biochemical study includes among others a dosing of the high-energy phosphorus compounds (P.C. and A.T.P.). Morphological study was done by optic and electronic microscopy. Results made clear the superiority of the hypothermic ischemia at 10 degrees C on the continued perfusion at 32 degrees C with fibrillative heart. An hypothermic protection method with successively cold perfusion of the coronary system and a heart immersion in a salted solution at 4 degrees C has been utilized during valvular and coronary surgery on human in 700 cases. The total mortality was of 5,8 p. 100. The rate of post-operative infarcts was 2,4 p. 100. Incidence of intra-ventricular conduction troubles has been 1,1 p. 100. There was no relation between mortality and morbidity of myocardic origin and the lasting of the ischemic clamp, which were of 21 mn up to 165 mn. The low incidence of complications of myocardic origin is due to the hypothermic protection of the myocardia.

Cardiac Surgical Procedures↗
PubMed1976

[Neuroplegia and extracorporeal circulation. Comparison between combinations of droperidol-phenoperidine and chlorprothixene-dextromoramide in cardiac surgery].

After a quick review of the physiopathology of extra-corporeal circulation, the value of the use of neuroplegic drugs in cardiac surgery is recalled by means of pharmacological arguments. The experimental differences existing between the combinations droperidol - phenoperidine and chlorportixene - dextromoramide, on the rate of flow and on the pressure of the perfusion, and on the esophago-rectal thermic gradients during E.C.C. is then demonstrated. Statistic calculation confirmed the superiority of chlorprotixene in the realm of tissue perfusion during E.C.C. under hypothermia.

Adult↗
PubMed1976

[Congenital arteriovenous fistula between the left subclavian artery and Pirogoff's venous junction. Surgical closure].

The authors report a case of arterio-venous fistula between the left sub-clavian artery and Pirogoff's venous junction. There was no past history of trauma, and no associated cardiovascular abnormality. The hemodynamic effects were moderate. Catheterisation and supra-sigmoid aortography permitted us to localise precisely the site of the fistula. Surgical cure was simple and carried out be cervico-sternotomy. This route of approach is broad and safe, providing satisfactory control of all the vascular structures.

Adult↗
PubMed1976

Biosynthesis of elastin and other matrix-macromolecules in veinous arterial prosthesis.

Homologous saphenous veins where implanted in the arterial circilation (femoral artery) of dogs for various times (1 to 9 months, most data given for 3 months). After this period, the in vitro biosynthesis of intercullar matrix macromolecules was studied by incubating the veins in organ culture conditions in the presence of 14C-lysine for 3 days. A fractional extraction procedure was used to obtain representative macromolecular extracts for the determination of chemical composition (hydroxyproline, hexosamines) and radioactivity. Neosynthesis of elastin was considered as valid criteria for the adaptation of the veinous wall to the new (arterial circulatory) conditions. The chemical composition of the grafted veins was different from that of the nongrafted, controlateral saphenous veins suggesting a molecular remodeling of the grafted veinous wall. Radioactive lysine was incorporated in all macromolecular fractions of grafted and control veins. The specific radioactivity of the extracts obtained from grafted veins was higher than that obtained from the control veins. The only exception was the collagenase extract (containing mainly the polymeric collagen) which had a somewhat lower radioactivity in the grafted vein. The incorporation of lysine in the elastin fraction increased by a factor 10 in the grafted vein as compared to the non-grafted veins. Radioactive desmosine could be demonstrated in the elastin fraction. It appears therefore that the veinous wall could adapt its biosynthetic capacity to the new circulatory conditions by increasing considerably the biosynthesis of elastin. This is accompanied by an increase of the synthesis of other macromolecules and a significant remodeling of the macromolecular structure of the vessel wall.

Animals↗
PubMed1976

[Postoperative myocardial infarct after aorto-coronary bypass].

The incidence (4.3%) of myocardial infarction after aorto-coronary bypass vein graft procedures, and the mechanisms by which they occur, have been analysed in a series of 300 postoperative patients. Very careful case selection for surgery, extreme care in preserving the myocardium throughout the operation, and especially while the coronary anastomoses are being carried out, and attention to detail as they are done all contribute in varying degrees to the prevention of this complication. The particular clinical features and the natural history of this condition of post-operative infarction are recalled.

Coronary Artery Bypass↗
PubMed1976

[Technic for an inflatable and releasable balloon in neurology. Experimental study. Application in man].

We consider our method with an inflatable and releasable balloon to be trustworthy and now applicable to the treatment of carotido-cavernous fistulas; it may not be possible in all cases to pass the ballon on through the fistula and inflate it in the cavernous sinus, but it seems to us so very important to preserve the carotid flow that we think that this should be achieved whenever possible. Certain arterial aneurysms could profit from this technique. We have purposely omitted all diagnostic application of the method which serbinenko has described in his article: selective opacifcation of certain branches of the internal carotid, deliberate temporary occlusion of certain branches to enable the amount of tolerance to be assessed. All these exploratory methods which we are beginning to carry out will form the subject of a later paper.

Adult↗
PubMed1975

[Treatment of arteriovenous fistulas and of aneurysms using an inflatable and releasable balloon. Experimental principles. Application to man].

The authors have perfected a technique making possible the percutaneous introduction of a balloon filled with hydrosoluble iodine and releasable, either in an arteriovenous fistula or in an aneurysm. Experimental jugulo-carotid fistulae and experimental aneurysms in the dog were treated in this way. The technique has been used in two human patients - one with a traumatic caverno-carotid fistula and the other with a complicated vertebral fistula.

Adult↗
PubMed1975

[Factors influencing the results of aortocoronary bypass in a homogeneous series of 125 surgical patients].

A group of 125 patients having undergone aortocoronary bypass by saphenous graft was studied from the point of view of short and medium term results. The following emerged as factors likely to influence these results: --the technique used in the anastamoses and the quality of peroperative myocardial protection; --the presence of hyperlipidaemia; --the restrictive choice of indications in relation to the results of coronary arteriography; --the presence of cardiac insufficiency or an associated valvular lesion. Overall operative mortality was 8 p. cent. Routine ECG's and enzyme studies were carried out to detect postoperative myocardial necrosis. 4 postoperative infarctions without clinical symptoms or signs were detected (2.4 p. cent). 26 patients underwent surgery as an emergency with simultaneous coronary arteriography and surgery in 24. The mortality in this group was not greater (7.6 p. cent) than in the group as a whole. By contrast, mortality was greater in the presence of cardiac insufficiency (25 p. cent) or an associated valvular lesion (16.5 p. cent).

Adult↗
PubMed1975

[Evaluation of 2 years' experience with assisted circulation by diastolic counterpulsation].

The authors report their two years' experience of circulatory assistance by diastolic counter-pulsation with an intra-aortic balloon. This technique was used in 23 patients: 9 cases of cardiogenic shock due to acute myocardial infarction, 9 septal ruptures, 1 rupture of the papillary muscle of the mitral valve, 1 acute ventricular aneurysm, 2 high risk coronary arteriographies and 1 case of early post-infarction recurrent ischemia. It confirms the gravity of cardiogenic shock as, in spite of the frequent improvement in hemodynamic parameters under counter-pulsation, there was only one survivor. The efficacy is greater in cases of septal rupture, where the author obtained 3 survivors out of 6 operated cases. The security of the method and its innocuity permit one to carry out high risk coronary arteriography and extend the indications for circulatory assistance, to certain cases of unstable angina or early recurrent anginal following acute infarction.

Adult↗
PubMed1975

[Diastolic reinforecement by intra-aortic balloon. Critical review of temorary mechanical ventricular assistance technic].

The treatment of the cardiogenic shock complicating acute myocardial infarction has been drastically improved by the progress in temporary mechanical cardiovascular support. The improvement of the synchronous assist device, such as the intra aortic balloon, associated with the progress in the monitoring of the patients, in the surgical treatment of myocardial insufficiency and ventricular abnormalities such as ventricular septal defect and mitral insufficiency, has changed the seroius prognosis in patients. A review of some theretical, physiological and clinical problems are discussed in this paper.

Aorta, Thoracic↗
PubMed1975

[Emergency aorto-coronary bypass. Indications and results in a homogenous series of 50 patients].

Emergency myocardial vascularization through an aorta-to-coronary by-pass has been extended recently to acute evolutive accidents of coronary artery disease: either to its minor forms, as the menace syndrome, or its more severe forms, such as complicated myocardial infarction. This study aimed at a retrospective analysis of 50 patients, all operated upon as an emergency, by the same surgical team. The problems peculiar to any group of indications, and the practical and theoretical problems posed by extension of this type of emergency surgery were discussed.

Adult↗