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Biomedical subjects

D Roux

Publications and source records attributed to D Roux.

At least 55 records · Page 3Linked to original sources
PubMed1998

Modified superior approach for repair of supracardiac and mixed total anomalous pulmonary venous drainage.

BACKGROUND: The main goal in the surgical repair of total anomalous pulmonary venous drainage is to reestablish a wide patent connection between the common pulmonary vein and the left atrium. Several techniques have been proposed for achieving this objective, each of which has advantages and disadvantages. The superior approach between the superior vena cava and the ascending aorta was introduced in 1976 for the repair of supracardiac forms of total anomalous pulmonary venous drainage, but it often provides a less than optimum exposure, particularly in tiny infants. We proposed a modification of this approach that includes division of the ascending aorta and offers excellent exposure. METHODS: Seventeen patients (15 neonates and 2 infants) with supracardiac total anomalous pulmonary venous drainage (n = 13) or mixed forms of total anomalous pulmonary venous drainage (n = 4) underwent surgical repair with the use of the modified superior approach. Circulatory arrest was not required in 10 patients and the mean cross-clamp time was 32.5 +/- 13.8 minutes. RESULTS: There was 1 postoperative death resulting from intractable pulmonary hypertension in a compromised infant who was referred to our unit receiving extracorporeal membrane oxygenation. One patient with common hypoplasia underwent reoperation twice at 2 months and then 3 months after the first procedure. All the other patients had a smooth postoperative course, and midterm evaluation showed a widely patent anastomosis between the common vein and the left atrium. CONCLUSIONS: The modified superior approach for the repair of supracardiac total anomalous pulmonary venous drainage can be useful to enhance exposure during surgical repair and may contribute to improved patient outcome.

Anastomosis, Surgical↗
PubMed1998

Management of septate uterus by flexible hysteroscopy and Nd:YAG laser.

OBJECTIVE: To evaluate the efficiency of flexible Nd-YAG laser hysteroscopic metroplasty. METHODS: We present a retrospective study of 17 patients treated for septate uteri between 1990 and 1995. The indication of hysteroscopy was recurrent abortion in nine cases and eight with primary infertility with indication of IVF in another five cases. We did not prescribe any pretreatment. A flexible hysteroscope with a 100-W Nd:YAG laser was used with glycine-controlled flow. The septum was divided by the laser after exploration of the cavity. We proposed a control office hysteroscopy 2 months after surgery to prevent uterine adhesions. RESULTS: There was no complication. Twelve patients conceived with 10 live births at term and two spontaneous abortions. Four are still infertile, two were lost from the study and two no longer desired pregnancy. Resectoscopic studies showed the same results. CONCLUSION: The advantages of this method are the excellent ergonomic properties of the fibroscope and the safety of the laser. We suggest that metroplasty does not improve the pregnancy rate but only the pregnancy outcome of these patients. However, for those with the indication of IVF the procedure seems useful in avoiding abortion.

Adult↗
PubMed1998

[Bartonella endocarditis on native valves. Apropos of 2 cases].

The authors report two cases of Bartonella endocarditis in native valves. The first case was a 15 year old North African Girl who lived in poor social conditions and was admitted to hospital with pyrexia and congestive heart failure. Investigations revealed massive mitral regurgitation due to ruptured chordae tendinae, vegetations on the pulmonary valve with severe pulmonary hypertension due to persistent ductus arteriosus. After antibiotic therapy, the patient underwent surgery for mitral valve replacement, pulmonary valvuloplasty and closure of the patent ductus arteriosus. The second case was a 39 year old man with no fixed abode with a history of alcoholism who presented with a recurrent ischaemic stroke in a context of infection with a murmur of aortic regurgitation. Echocardiography showed a vegetation on the aortic valve with grade III/IV regurgitation requiring aortic valve replacement with a homograft after antibiotic therapy. The aetiological diagnosis was made a posteriori by the finding of high antibody titres and specific genetic amplification of Bartonella. In patients with negative blood cultures, Bartonella infection should be looked for systematically especially in those living under poor social conditions. The practical diagnostic investigation of endocarditis with negative blood cultures is reviewed.

Adolescent↗
PubMed1997

Abdominal aortic aneurysm and congenital pelvic kidney. A rare association.

We report the case of a 65-year-old man who presented with an infrarenal aortic aneurysm in association with a congenital right pelvic kidney vascularized by 2 aortic arteries, 1 of which arose from the aneurysmal aorta and the other from the common right iliac artery. Successful surgery consisted of excising the aneurysmal aortic segment and replacing it with a Dacron tube graft, then implanting the upper renal artery (supplemented by a short segment of saphenous venous graft) in the Dacron prosthesis. We review 6 other cases of this rare pathologic association, found in our search of the literature, and discuss techniques of renal protection and (when necessary) reimplantation of the anomalous arteries.

Aged↗
PubMed1997

[Long-term results of the surgical treatment of acute type A thoracic aortic dissection].

Out of a population of 110 patients operated as an emergency for acute Stanford type A dissection of the thoracic aorta between 1985 and 1994, there were 84 survivors. Seventy-nine were assessed after a mean follow-up period of 47.3 months. The corrected 1 year, 5 year and 10 year survival rates were 69 +/- 5.1%, 53.1 +/- 6% and 42.1 +/- 7.1% respectively. There were 19 deaths during the study period: in two thirds of cases death was due to cardiovascular complications related to the aortic pathology or hypertension. There were 13 reoperations in 12 patients for complications on the initial site of repair or for progression of the pathological process. The average time to reoperation was 21.5 months with an operative mortality of 3 patients (25%). Predictive factors of reoperation were young age (52 +/- 4.4 years vs 60.1 +/- 1.4 years; p = 0.037), the persistence of a patent false lumen (p = 0.033) and the initial surgical techniques as the incidence of reoperation seemed to be higher after treatment with biological glue alone or resuspension of the aortic valve compared with replacement of the ascending aorta or Bentall's procedure (p = 0.08). The incidence of reoperation also varies with time as it was 1.8 +/- 0.7% at 1 year, 18.5 +/- 6.5% at 5 years and 26% +/- 7.8 at 10 years. In spite of improvements in surgical technique and postoperative care, acute type A dissection of the aorta carries a poor prognosis in both the short and the long-term with a notable number of cardiac or other complications related to repair of the initial aorta. Analysis of these and other reported results suggest that initial surgery should be as complete as possible with extension to the aortic arch when involved: this more aggressive attitude should improve the long-term results by reducing the risk of reoperation responsible for a high mortality rate.

Adolescent↗
PubMed1997

[Fissured leiomyosarcoma of the descending thoracic aorta. Apropos of a case and review of the literature].

The authors report a case of leiomyosarcoma of the descending thoracic aorta presenting with dissection and operated as an emergency. Palliative repair from the oncological point of view comprised the insertion of an aorto-aortic tube. Local radiotherapy was completed by a course of chemotherapy controlling multiple bone and adrenal metastases at 15 months. A review of the literature did not reveal any other cases of haemorrhagic leiomyosarcoma of the descending thoracic aorta. Histological findings were similar to those of the reported case as were the therapeutic attitudes to limit or extinguish disseminated metastases explained by the arterial character of the tumour.

Aorta, Thoracic↗
PubMed1996

A new method for the treatment of fibromas: interstitial laser hyperthermia using the Nd:YAG laser. Preliminary study.

Operative laparoscopy can replace hysterectomy in the treatment of submucous and subserosal uterine fibromyomas. Interstitial myomas are still treated using traditional methods. Using an Nd:YAG laser with a quartz fibre which diffuses the ray, we induced delayed necrosis of myoma secondary to the hyperthermia produced by this method-interstitial laser hyperthermia. We present an experimental study of fibromas from excised tissue. Optimal efficiency is achieved with continuous delivery at 5 W of power for 10 min. The temperature reaches 50 degrees C within a radius of 20 mm around the fibre. A clinical study was undertaken with the approval of the Ethics Committee. Seven patients suffering from symptomatic fibromas were treated by laparoscopy. Preliminary results at 12 months show that their symptoms have disappeared and the size of the fibromas has been reduced. A larger study is in progress.

Adult↗
PubMed1996

Endometrial Nd-YAG laser ablation by hysterofibroscopy: long-term results of 137 cases.

OBJECTIVE: In our gynecology department, we have been performing endometrial laser ablation (ELA) under video control using a flexible hysteroscope since 1989. The aim of this study is to evaluate the long term results of our experience. STUDY DESIGN: We went back to the files of 137 patients treated between 1989 and 1993. These women (mean age 42 years) exhibited menorrhagia unamenable to medical treatments which had been developing for 28 months. Mean hysterometry was 9.8 cm. A hysteroscopy with ELA was performed. Our procedure lasts 19 min on average and uses 0.9 1 of glycocol. There were no perforations. Six patients presented a fever above 38 degrees C within the next 48 h; only one developed a true endometritis necessitating antibiotherapy. One patient who had received several GnRH agonist courses had a coagulation of the uterus and had to be hysterectomised. RESULTS: Nine patients were lost to follow-up; for the others, mean follow-up was 32 months. Seventeen women (13.3%) were hysterectomised, including the patient with a coagulation necrosis of the myometrium. In most cases, this was for undetected adenomyosis or fibromas evolving after hysteroscopy. Bleeding recurred in two other patients; they refused hysterectomy but should be counted as failures of this method. Among the 109 patients (85.1%) considered a success, 35 have had menopause since the procedure. CONCLUSION: ELA is a simple quick procedure which significantly reduces the number of hysterectomies. In addition, the economic value of ELA is beginning to be assessed in the literature. This long-term study should allow the indications to be better defined by eliminating patients with a high risk of failure and should lead to improved results.

Adult↗
PubMed1996

Breast cancer and in vitro fertilization. About 32 cases.

Because of the increased risk of breast cancer for infertile nulliparous women, the suspected promoter role of estradiol in mammary carcinogenesis and the high frequency of ovulation inducer treatments, it was interesting to focus on the risk of breast cancer after such a treatment. We reviewed 32 cases during a retrospective survey in Assisted Reproductive Techniques (ART) centers in France. Because of the small sample size and the few cases published so far, no statistical study could be made. However, many observations may have gone unnoticed or were not published. Two hypotheses can be proposed: (1) the facilitating role of stimulation on potential infra-clinical or un-diagnosed cancers; (2) the initiation of new cancers. Consequently, we propose to establish a register for the follow-up of treated women to monitor the advent of new cancers and to increase the follow-up of patients with other associated risk factors.

Adult↗
PubMed1996

Cardiac surgery in the ninth decade of life.

This study considers 96 consecutive patients of more than 80 years of age who were referred for surgery for either valve replacement (n = 51) or myocardial revascularization (n = 45) between 1985 and 1992. The patients having valve surgery consisted chiefly or aortic valve replacements (AVR), with a total of 48 (isolated in 44 and combined with another valve in 4 cases) being performed. Some 70% were in New York Heart Association (NYHA) class III and IV and 21.5% had experienced syncope. Bioprosthetic valves were implanted in all patients with an average aortic cross-clamping time of 58 min. The 1-month mortality rate was 9.8% (5/51, one mitral valve replacement and four aortic valve replacements). Death was caused by perioperative haemorrhage (one), low cardiac output (one), cardiopulmonary failure (two) and multiorgan failure (one). The morbidity rate was 64%. The actuarial survival rate was 76, 67 and 46% at 1, 2 and 4 years, respectively. By 4 years 89% were in NYHA stages I and II, of the 45 patients having coronary artery bypass grafts, 85% were in NYHA class III or IV and 69% had progressive unstable angina. Some 29% had a stenosis of the left main coronary artery and 51% had multivessel disease. Each patient had a mean of two venous grafts. The in-hospital mortality rate was 11% (5/45) and 13% had a postoperative myocardial infarction. The actuarial survival rate was 80, 77, 60 and 58% at 1,2,3 and 5 years, respectively, with 85% in NYHA class I or II. In spite of their chronological age, many octogenarian patients who are in good physical condition can be operated upon for coronary artery bypass grafts or aortic valve replacement with an acceptable operative risk, good surgical outcome with improved quality of life.

Aged↗
PubMed1996

Truncus arteriosus repair: influence of techniques of right ventricular outflow tract reconstruction.

Fifty-six consecutive patients underwent total correction of truncus arteriosus. Median age at repair was 41 days, with a range of 2 days to 8 months. In 71% the operation was done in the first 2 months of life. Nine patients had complex forms of truncus and 11 patients had aortic insufficiency. The truncal aortic root was transected, which provides a clear exposure of the coronary ostia. The aorta was reconstructed by direct end-to-end anastomosis, and the truncal valve was preserved in every case. Several different techniques were used for pulmonary reconstruction, including three types of anatomic reconstruction of the pulmonary valve with a trisigmoid leaflet system and two types of nonanatomic reconstruction. The anatomic techniques included use of 33 Dacron valved conduits, eight homograft valved conduits, and one porcine aortic root bioprosthesis. The nonanatomic reconstructions included direct anastomosis to the right ventricle in nine patients and insertion of autologous pericardial valved conduits in five. The hospital mortality was 16% (9/56; 95% confidence limits, 2% to 30%). Multivariate analysis outlines two independent incremental risk factors for hospital death: nonanatomic pulmonary valve reconstruction techniques and age younger than 1 month. The hospital mortality was 7.1% in the group with anatomic pulmonary valve reconstruction versus 43% in the group with nonanatomic pulmonary valve reconstruction (p = 0.015). The hospital mortality was 5.7% in those older than 1 month versus 33% in those younger than 1 month of age (p = 0.04). There were two late deaths. The actuarial freedom from reoperation and angioplasty at 7 years was 100% for patients receiving pericardial conduits, 80% for those undergoing direct anastomosis, 77% for those receiving Dacron conduits, and only 43% for those receiving homografts (p = 0.02). In conclusion, anatomic reconstruction of the pulmonary valve seems important at the time of the operation, age younger than 1 month remains an incremental risk factor, and the truncal valve can be preserved.

Age Factors↗
PubMed1996

Differential localization of Na+/H+ exchanger isoforms (NHE1 and NHE3) in polarized epithelial cell lines.

Na+/H+ exchangers (NHEs) are transporters that exchange sodium and proton ions across the plasma membrane at the expense of their chemical gradient. In higher eukaryotes these transporters exist as multiple specialized isoforms. For example, NHE1, the ubiquitously expressed form is a major pH-regulating system whereas the epithelial NHE3 isoform is specialized in transepithelial Na+ transport. NHE1 and NHE3 can be very well distinguished pharmacologically with the HOE694 specific inhibitor and immunologically with specific polyclonal and monoclonal antibodies. With these molecular tools we investigated the specific steady state expression of the two NHE isoforms in polarized epithelial cells in culture. Endogenous NHE3 in OK cells or NHE3-VSVG transfected in either OK or MDCK cells showed an exclusive expression of the transporter at the apical membrane. Overexpression of NHE3 did not result in any spill over on the basal lateral side. These results obtained by functional measurement of NHE3 activity were fully consistent with its detection only at the apical side by immunofluorescence and confocal microscopy. By contrast, using the same cells, the same culture conditions and the same detection methods, we clearly detected NHE1 at both specialized membranes of four different polarized epithelial cell lines. Furthermore, biotinylation of cell surface proteins of MDCK, OK and HT-29 cells followed by immunoprecipitation of NHE1 revealed expression of the transporter at both sides of the polarized epithelial cells. Interestingly, the cell surface expression correlated well with the corresponding NHE1 activities. In addition, immunodetection by fluorescence microscopy was found to be qualitatively consistent with the above-reported results. We therefore conclude that the epithelial and more specialized NHE3 isoform is exclusively restricted to the apical side of epithelial cells. In marked contrast, both endogenous or ectopically expressed NHE1 isoform, have the capacity to be expressed in both the apical and basal lateral membranes of polarized cells in cultures.

Amino Acid Sequence↗
PubMed1996

[Assessment of pharmacokinetic parameters of amikacin in a group of neutropenic patients in onco-hematology].

The pharmacokinetics of Amikacin were studied in 56 febrile episodes for 45 patients with severe neutropenia while using the USC*Pack PC Clinical Programs for adaptive control of their dosage regimens [223 drug levels]. The purpose of this study are: i] to estimate the pharmacokinetic parameters in this neutropenic population [56 episodes, I], ii] to evaluate the effect of the dosage regimen: once-a-day [22 episodes, II] versus bid or tid [34 episodes, III]. Patients [mean age 53.3 +/- 17.9], 23 men and 22 women, received amikacin [17.7 +/- 3.6 mg/kg/d at day 1] in a 30 minutes infusion. The mean estimated creatinine clearance [CCr] was 76 +/- 22.5 ml/min/1.73 m2 at day 1. The method used for the population modeling was the Non Parametric EM algorithm [NPEM2] which computes the complete probability density function for a 1 or a 2 compartment model. The parametrizations studied are: Clearance/Volume [CL/VOL], Elimination rate constant/Volume [Kel/VOL] and KS/VS with Kel = KS * CCr + 0.00693, VS = VOL/Weight for a 1 compartment pharmacokinetic model. The main results concerned CL and VS with: CL[I] = 4.94 +/- 2.71, CL[II] = 4.74 +/- 2.65, CL[III] = 5.14 +/- 2.75 l/h and VS[I] = 0.31 +/- 0.11, VS[II] = 0.34 +/- 0.10, VS[III] = 0.30 +/- 0.11 l/kg. Volume of distribution VS is not so large as expected and a slight difference appears between II and III. The pharmacokinetic parameters obtained for this population of neutropenic patients will be used thereafter for the daily adaptive control of Amikacine therapy in our haematologic/oncologic patients. The variability observed remains important and requires an individualization of the dosage regimen for each patient.

Adult↗
PubMed1996

[Traumatic rupture of the thoracic aorta].

This is a retrospective analysis of 50 postraumatic aortic rupture (1968-1996, 39 males, mean age: 34.5). Group A is composed of 35 patients with an acute aortic rupture and a prompt diagnosis. Group B includes 13 patients with a chronic rupture. All patients from group A had a severe politraumatism with abdominal, cranial, extremities or hip fractures. Mediastinal thickening with or without hemothorax indicated an angiography or a transesophageal echocardiography lately. In group A, 36 patients have been operated on urgently (12-24 hours); cardiopulmonary bypass was performed on 20 patients; an aorto-aortical bypass was done in 27 cases and a direct suture in the remaining 9. In group B, cardiopulmonary bypass was performed on 9 patients; a aorto-aortical bypass was done in 11 cases and a direct suture in 2. Overall hospital mortality was 16%; 19% in group A and 7.6% in group B. Ischemic paraplejia appeared in 5 patients (10%), all from group A. No false aneurysm developed after 4.5 years of follow-up (3-135 months) in the 38 survivors. The usefulness of transesophageal echocardiography, the importance of medular protection and the utility of several interventionist radiologic techniques are discussed.

Adolescent↗
PubMed1995

Prenatal diagnosis of trisomy 9. Six cases and a review of the literature.

Six prenatally diagnosed cases of trisomy 9 are reported and 22 previously reported cases are reviewed; the difficulty of genetic counselling for such cases and the variation in the percentage of trisomic cells in different tissues, thus making accurate diagnosis of trisomy 9 difficult, are emphasized. In addition to karyotyping results, ultrasound findings are important in achieving diagnoses. Finally, a course of action when prenatal trisomy 9 is detected is proposed.

Adult↗