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Biomedical subjects

E Viel

Publications and source records attributed to E Viel.

At least 37 records · Page 2Linked to original sources
PubMed1997

[Locoregional anesthesia in digestive surgery].

Many regional anesthetic techniques can be used in the setting of abdominal surgery. Spinal anesthesia has limited indications for lower abdominal surgery (below T10), especially abdominal wall surgery and anal surgery. Indications of epidural anesthesia are quite similar, while epidural analgesia can be extensively used for postoperative analgesia, provided great attention is paid to strict monitoring and safety rules. Finally, peripheral regional anesthetic techniques are discussed, highlighting their advantages in this particular setting.

Anesthesia, Conduction↗
PubMed1997

[Effectiveness of the Palmaz Schatz stent in elderly patients with unstable angina: factors predictive of short-term and long-term events].

INTRODUCTION: To evaluate clinical, procedural and therapeutical predictors of in- and out-hospital events in the elderly, we analyzed 69 consecutive patients (age: 74, range: 70-87) with unstable angina who successfully underwent Palmaz Schatz coronary stenting. METHODS: Between March 1991 and March 1994, after the stenting procedure, a cohort of 38 patients (AC) was treated with iv heparin for 48 hours, warfarin (dosage titrated on INR) and dipiridamole (75 mg tid) for 3 months, aspirin (325 mg a day) chronically; between April 1994 and April 1995, after 48 hours of iv heparin, a second cohort of 31 patients (NO AC) received subcutaneous low molecular weight heparin (4000 U a day) for a week, ticlopidine (250 bid) for 1 month, and aspirin (100 mg a day) chronically. NO AC patients showed, by protocol, a higher postdilatation pressure (14 +/- 2 vs 9 +/- 3 atm, p < 0.0001). RESULTS: The 2 cohorts of patients were similar with respect to baseline clinical and angiographic findings. A shorter hospital stay (5 +/- 2 vs 10 +/- 6 days, p < 0.0001) and a lower incidence of in-hospital events were seen in the NO AC group (3.2 vs 24%, p = 0.028), both by a reduction of ischaemic events (3.2 vs 10.5%, p = ns) and hemorrhagic events (0 vs 13.2%, p = 0.03). During a mean follow-up of 21 +/- 13 months, NO AC patients did not show a significant lower rate of out-hospital events (1 year event-free survival respectively 94.7% in NO AC cohort vs 85.7% in AC cohort, p = ns). At logistic regression model, anticoagulant therapy (OR 10.89, Cl 1.39-85.28, p < 0.05) and refractory angina (Braunwald C3) (OR 5.70, Cl 1.12-29.03, p < 0.05) were significantly related to the incidence of acute events, while refractory angina (OR 5.76, Cl 1.27-26.00, p = 0.02) and multivessel disease (OR 3.31, Cl 0.89-12.20, p = 0.07) to the occurrence of late cardiac events, particularly for a higher risk of non-target site new revascularizations. Stent implantation on saphenous vein graft was also associated to a higher risk of repeating a revascularization of non-treated sites (20 vs 4%, p = 0.021). CONCLUSIONS: In elderly with unstable angina treated with Palmaz Schatz stenting, NO AC patients showed a significant reduction of in-hospital events without a subsequent higher risk of late events. In addition, refractory angina, multivessel disease and stent implantation on saphenous vein graft were the other main clinical variables predictive of out-hospital events particularly for higher risk of non-target site new revascularizations.

Age Factors↗
PubMed1995

[Does neuroplasticity have a role on postoperative pain?].

The neurophysiologic concept of neuroplasticity represents one of the current basis of the pathophysiology of painful post-injury phenomenons (postoperative, post-traumatic...). Deriving directly from these experimental data, the idea of preemptive analgesia has gradually developed in the last five years, the central question being to know if an analgesic intervention preceding surgical intervention is more efficient, as efficient, or less efficient than the same intervention following surgery. The authors bring current data of the literature in favor of the role of neuroplasticity in the genesis and the persistence of painful states in the course of postoperative outcome. A review of the various clinical studies and controversies published is proposed, in the attempt to make the point on current therapeutic implications of the concept of preemptive analgesia.

Analgesia↗
PubMed1995

[Reflex sympathetic algodystrophies. Preventive and therapeutic aspects].

Deafferentation syndromes have in common the existence of a physical injury and/or of a functional impairment of a nerve, either somatosensory afferent (Phantom Limb Pain) and/or sympathetic efferent (Reflex Sympathetic Dystrophy). These progressively debilitating syndromes are the witness of the absence of self-limitation of neuronal sensitization, which is normally the evolution of any painful stimulation of spinal cord neurons. To some extent deafferentation syndromes could be defined as a maladaptive neuronal plasticity. The lack of complete understanding of underlying pathophysiological mechanisms gives account of the wide variety of proposed treatments and of their unpredictable and variable efficacy. This fact is also due in part to the lack of controlled studies of most of the therapeutic propositions, whose purported efficacy is usually based on anecdotal reports. Finally, the role of prevention must be strongly emphasized, focusing, if those syndromes are likely to occur following surgery, on the importance of pre- and postoperative efficient analgesia, and also, possibly, on the preemptive role of regional anaesthetic techniques.

Anesthesia, Conduction↗
PubMed1994

[Role of analgesia for sedation in intensive care medicine].

Giving a definition of analgesia in ICU needs to answer several questions: Why sedation? Which drugs can we use? How can we deal with sedation? (monitoring, continuous administration, weaning...)? Two different types of sedation must be considered: treatment-sedation (status epilepticus, tetanus, intracranial hypertension...) and comfort-sedation in anxious and/or restless and/or painful patients and in those necessitating mechanical ventilation. Analgesic consumptions vary widely with diseases and their outcome, background diseases and ICU environment. Several studies have shown that pain and analgesia are frequently neglected in ICU. The authors review the different drugs in use, with their advantages and drawbacks. A particular place is reserved to regional techniques, often underused in ICU. Indications are then fully discussed, according to several specific pathological conditions. Monitoring and weaning of sedation are also discussed at the end of the review.

Analgesia↗
PubMed1994

[Locoregional anesthesia for non cardiac surgery in the cardiac patient].

Perioperative cardiovascular morbidity is a common challenge for the anaesthesiologist, who has daily to manage patients with coronary and/or cardiac insufficiency and/or arrhythmias. Regional anaesthesia (RA), especially epidural could reduce morbidity and mortality in the cardiac patient, but the topic remains controversial. The authors propose a review of the cardiovascular effects of RA and of various RA techniques that can be used in the cardiac patient. Finally, they discuss the choice of the anaesthetic technique according to the cardiac disease.

Anesthesia, Epidural↗
PubMed1994

[Neurophysiological bases of preventive analgesia].

The key-question, when dealing with preemptive analgesia, its to know whether an analgesic intervention coming before surgery is as efficient, more efficient or less efficient than the same intervention following surgery. Surgical tissular damaging leads to a dual phenomenon of peripheral and central sensitization. The result is a state of neuronal hyperexcitability, so-called "wind-up phenomenon", which could partially explain postoperative painful states. Peripheral mechanisms involve many factors, especially prostaglandins that could be blocked by NSAIDs. Central mechanisms and neuroplasticity are analyzed, insisting on inter and intracellular biochemical events. The role of excitatory amino-acid is explained, especially of glutamic acid and the NMDA (N-methyl-D-aspartate) receptor at the spinal level.

Analgesia↗
PubMed1994

[Do morphines improve the quality of analgesia with local anesthetics?].

Use of opioids for regional anaesthesia aims to improve the quality and to enhance the duration of local anaesthetics-induced analgesia, and also to reduce the rate of adverse effects due to these agents. Experimental data give evidence for a synergistic effect between local anaesthetic and opiates at the spinal level (dorsal root entry zone). A lot of clinical studies have shown the improvement of analgesia when opioids are added to local anaesthetics, by the subarachnoid as well as by the epidural route. The most frequent associations in use are fentanyl-bupivacaine and morphine-bupivacaine. The efficacy of these associations by peripheral perinervous routes is more controversial. In any cases, one must be aware of the incidence of potential side-effects of opioids and, consequently, of the need for a close clinical monitoring of the patients, at least for the duration of action of the agent injected by the spinal or the epidural route.

Adult↗
PubMed1994

[Headache and low back pain after epidural anesthesia].

Headache and low back pain are common minor complications after epidural anaesthesia. Headache is due to cerebrospinal leakage through the site of accidental dural puncture. Epidural blood patch is considered as the better curative treatment. Acute or long term backache is often reported after epidural anaesthesia. Different mechanisms are suggested: needle trauma, myotoxicity of local anaesthetic and postural problem. Large prospective randomized studies are yet necessary to clarify the role of epidural anaesthesia, the duration of symptoms and the therapeutic.

Adult↗
PubMed1993

[Postdural puncture headache].

PDPH are not the privilege of spinal anaesthesia, as they can occur in various circumstances including epidural anesthesia, surgical wound of the dura, spinal tap and/or myclography. Diagnosis PDPH can be discussed with four etiologies: cortical vein thrombosis, meningitis, intracranial haematomas (intracerebral, subdural) or migraine. PDPH result from the leakage of CSF via the dural hole, responsible of hypotension of CSF in the subarachnoid compartment. Several etiologies and predisposing factors are discussed. The incidence of PDPH varies with age, maximum from 15 to 50 years-old, the decreasing to reach a very low incidence over 65 PDPH seems to occur more frequently in women, especially during pregnancy. The diameter of the spinal needle is the main factor of PDPH. Using small diameters (25 G and less) allows to reduce the percentage of PDPH, as well as using specially designed needles with a "pinpoint bevel" (Sprîtte, Whitacre). When PDPH occur, no specific treatment is required before the fifth day, as they spontaneously resolve in 80% of the patients, without any intervention. After then, epidural blood patch allows 90% success rate. Other therapeutic proposals are discussed. Finally, prevention of PDPH appears to be the keypoint, paying particular attention to the choice of the needle and of the spinal puncture technique.

Anesthesia, Epidural↗
PubMed1993

[Algodystrophies of the limbs: physiopathology, preventive aspects].

Reflex sympathetic dystrophy is a complex disorder consecutive to trauma, with or without proven nerve lesions, and also following diseases of the central nervous system. Sympathetic nervous system often plays the first part in the genesis of this syndrome (sympathetically-maintained pain). Recent data and theories on the pathophysiology are developed, with special attention to the recent theory of reflex sympathetic dystrophy as a disease of the alpha-adrenoceptor. Finally, the authors tried to define some means of prevention with emphasis on preemptive analgesia and regional anesthesia and analgesia techniques.

Autonomic Nerve Block↗
PubMed1993

[Chemical neurolysis using alcohol (alcoholization) in the treatment of spasticity in the hemiplegic].

Spasticity is a source of disability for the hemiplegic patient. It leads to various disorders influencing the quality of gait: at the lower limb varus equinus foot deformity, toe-claw and/or hip adduction with adductors spasticity. At the upper limb, flexion deformity of the wrist and the hand makes grasp and grip ineffective and spasticity of the Pectoralis Major muscle is considered as a main cause of sympathetic dystrophy. Neurolysis with alcohol injection in the nerve trunk or at the motor point destroys the gamma fibers and reduces spasticity, without impairing motor command. The effects on spasticity, motricity, and deformity of 33 chemical neurolysis with alcohol are analysed with a six months follow-up (27 hemiplegic patients, 28 to 62 years old, mean = 54.5). The authors have used 60% alcohol concentration. Sciatic nerve injection significantly reduces triceps spasticity (7/11), improves the range motion of the ankle, and allows the patient to take off the ankle device. Those fair results are still present at the fourth month after injection. Similar results are reported after injection of the obturator nerve for hip adduction deformity (2/3), median nerve injection for wrist and hand deformity (6/6). Pectoralis Major injection in the motor point is effective for 10 of the 13 cases, preventing sympathetic reflex dystrophy or contributing to its dramatic improvement.

Adult↗
PubMed1992

[The electrocardiogram in epidemiology: the Minnesota code].

A correct methodological approach to electrocardiogram interpretation is an important requirement above all as far as epidemiological studies on large case reports are concerned. The Minnesota code represents a pattern of objective classification of the electrocardiogram and it is fit for application to studies on people and consequent statistical analysis. It consists of a series of items which are assembled in nine principal classes, each of them describing with objectivity a figure of the electrocardiogram; moreover it includes several classes for the codification of the electrocardiogram after effort and in sequenced studies. Multiple applications in this sense confirm the validity of this code which gains, in times of automatisation, a new value.

Electrocardiography↗
PubMed1992

Alcohol: an underscored risk factor for diabetes mellitus.

OBJECTIVE: To investigate the link between alcohol consumption and glycoregulation. PATIENTS AND METHODS: Cross-sectional study during the annual occupational health check-up at the work site, concerning 7402 workers, excluding known diabetic persons and pregnant women. Alcohol consumption was recorded as the number of glasses of alcoholic beverage per day as stated by the subjects. A proxy for the glycoregulation was the level of capillary blood glucose measured with a reflectance meter (Reflolux) at the time of the visit. The association of alcohol consumption with impaired glycoregulation was assessed by multivariate analysis including potential confounders. RESULTS: Mean capillary blood glucose increased with increasing alcohol consumption, in both men and women. This association remained significant (p < 0.001) after adjustment for risk factors (multiple linear regression). Among 366 subjects with a fasting glycaemia or an oral glucose tolerance test, 26 were diabetic. Alcohol consumption was found independently associated by logistic regression with diabetes mellitus. CONCLUSION: Alcohol consumption might be a target for primary and secondary prevention of impaired glycoregulation and diabetes mellitus.

Adult↗