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Biomedical subjects

F Bacourt

Publications and source records attributed to F Bacourt.

At least 37 records · Page 2Linked to original sources
PubMed1989

[Carotid surgery under locoregional anesthesia].

Eight-five carotid endarterectomies were performed in 77 patients, under regional anaesthesia using 2 different techniques: cervical epidural anaesthesia (35 cases) and cervical plexus block (50 cases). The patients' mean age was 71 years; 80 per cent had arterial hypertension and 41 per cent coronary disease. Transoperative cerebral ischaemia was detected by a 5-minute carotid clamping test, the occurrence of a neurological event indicating that shunting was required. In 62 patients this test was combined with measurement of carotid back pressure. None of the patients needed general anaesthesia. Intraoperative neurological events occurred more frequently (P less than 0.01) when the carotid back pressure was 25 mmHg or less, and 12 temporary shunts were installed for that reason (14.1 per cent). Three neurological events occurred at the end of endarterectomy: no shunt was installed and complete recovery was observed immediately after declamping. No complications ascribable to the anesthetic techniques were recorded. Mortality was nil, and the only neurological morbidity was a brachio-facial deficit which left few sequelae. The frequency of intra- or postoperative arterial hypertension was similar in both groups. Intraoperative hypotension, frequent under epidural anaesthesia, was observed in only one patient who had brachial plexus block (P less than 0.01). The analgesia obtained was equally good with both anaesthetic techniques, but cervical plexus block anaesthesia is easier to perform, had less haemodynamic repercussions and therefore tends to be preferred to cervical epidural anaesthesia. The lack of mortality, low morbidity and absence of systemic complications in this series despite the high number of patients at risk are in favour of this type of anaesthesia, notably for such patients. Moreover, because vigilance is preserved attention can be paid to the quality rather than the rapidity of endarterectomy, which is the best way of preventing embolism.

Adult↗
PubMed1988

Experimental colonization of a polyester vascular graft with Staphylococcus aureus: a quantitative and morphologic study.

Colonization of a polyester (Dacron) vascular graft by Staphylococcus aureus 209P-R was studied. Twenty-five dogs had thoracoabdominal aortic bypass. After intervals of 2 hours (three dogs), 8 days (five dogs), 1 month (six dogs), 2 months (six dogs), or 6 months (five dogs), a bacteremic challenge was produced by intravenous injection of 6 x 10(8) colony-forming units of S. aureus. Two hours later grafts were removed and cut into 10 fragments, each submitted to bacterial counts and scanning electron microscopic studies. Results of bacterial counts were expressed in colony-forming units (CFU) per square centimeter of graft segment (median [lower to upper quartiles]). Normal canine aortas (n = 2) used as controls trapped no bacteria. Colonization of Dacron grafts varied according to the duration of graft function (p less than 0.01): after 2 hours, 4416.5 CFU (1158 to 9073 CFU); after 8 days, 1515 CFU (963 to 2893 CFU); after 1 month, 199 CFU (86 to 538 CFU); after 2 months, 615 CFU (243 to 1407 CFU); and after 6 months, 1 CFU (1 to 5 CFU). Heavily colonized fragments were observed for duration of graft function of 2 months or less, whereas at 6 months all the fragments trapped fewer than 50 CFU/cm2 of graft segment. Scanning electron microscopy showed that colonization was closely associated with healing. Staphylococcal entrapment was related to the amount of fibrin deposits, which were especially abundant where the thrombotic matrix was unorganized and on bare polyester filaments. Graft colonization is especially to be feared in the first weeks after graft implantation, an observation which may help to define guidelines for preventing hematogenous vascular graft infection.

Animals↗
PubMed1987

[Prevalence of gastric or duodenal ulcer in patients with arteritis. 100 systematic fibroscopies].

A 19% prevalence rate of gastric or duodenal ulcer was found by systematic fibroscopy in a population of 100 patients with lower limb arteritis hospitalized in a vascular surgery unit. This morbid association raises pathogenic problems which remain unsolved, but peptic ulcers were unevenly distributed throughout this population. Their prevalence was higher in patients under 50 years of age (P less than 0.05) and in those who had trophic disorders and occlusive lesions of digestive tract arteries or progressive coronary disease. Systematic fibroscopy may be justified in these categories of patients, since 7% of those with ulcer were asymptomatic.

Adult↗
PubMed1987

Experimental colonization of an expanded polytetrafluoroethylene vascular graft with Staphylococcus aureus: a quantitative and morphologic study.

We developed an animal model to reproduce hematogenous seeding of vascular grafts with Staphylococcus aureus. Expanded polytetrafluoroethylene (ePTFE) grafts were implanted in 41 dogs as thoracoabdominal aortic bypasses for six durations of implantation between 2 hours and 6 months. The inoculum containing an average of 10(8) viable bacteria/ml was then injected intravenously in 1 minute. Normal dog aortas were used as controls. They entrapped very few bacteria (0.7 +/- 1.7 colony-forming unit [CFU]/cm2). Colonization of ePTFE grafts was maximal after 2 hours of implantation (589 +/- 733 CFU/cm2). Bacterial entrapment decreased after 2 days (225 +/- 315 CFU/cm2, p less than 0.001) and 8 days (70 +/- 115 CFU/cm2, p less than 0.001) of implantation, but it was similar after 8 days, 1 month (83 +/- 90 CFU/cm2), or 6 months (93 +/- 143 CFU/cm2) of implantation. Colonization of ePTFE measured after 2 months of implantation (371 +/- 591 CFU/cm2) was significantly higher (p less than 0.001) than after 1 or 6 months of implantation. More than 500 CFU/cm2 were seen in 37% of the prosthetic fragments tested after 2 hours of exposure to blood; 99% of the fragments tested after 6 months of implantation trapped less than 500 CFU/cm2. Scanning electron microscopy showed that staphylococci were mostly seen on native fibrin deposits, particularly after 2 hours and 2 months of implantation. That persistent susceptibility of a flow surface devoid of endothelium to hematogenous bacterial colonization has to be taken into account to prevent delayed graft infections. Furthermore, it would be important to compare the ePTFE with other types of grafts whose healing phenomena are different.

Animals↗
PubMed1987

[Indications of the trans-diaphragmatic approach to the supra-celiac aorta].

The trans-diaphragmatic approach of the supra-celiac aorta can be performed in two different ways, according to the indications of this approach: The approach through a restrictive way, by simple dissociation of the muscular fibers of the posterior angle of the oesophagal hiatus allows an high and fast aortic clamping, especially helpful when a serious sub-diaphragmatic bleeding is encountered. It can also be used at the time of reintervention on the sub-renal aorta, in case of juxta-renal aortic thrombosis or in case of abdominal aortic aneurysm involving renal arteries. The approach through an extensive way, by saggital section of the muscular fibers of the posterior angle of the oesophagal hiatus and of the arcate ligament increases considerably the length of the exposed aortic segment and allows the implant of a by-pass graft on the lower thoracic aorta; this graft can be used to revascularize the underlying aortic step; it can also be used to shunt a lesion of the thoracic aorta.

Aorta, Thoracic↗
PubMed1986

[Thoracic outlet syndrome. Value of non-invasive arterial studies].

The value of non-invasive clinical evaluation of arterial compression at thoracic outlet was evaluated in 150 normal subjects and in 103 patients operated upon (127 sides). The specificity of arm abduction manoeuvres was good for angles of 90 degrees or less. Their sensitivity was poor in forms with neurological symptoms and better in forms with vascular symptoms. In these two forms, their predictive value was excellent (congruent 90%) with angles of less than 90 degrees. Their negative predictive value was mediocre in forms with neurological symptoms. It is concluded that a positive response to manoeuvres at an angle of less than 90 degrees is a strong argument in favour of arterial compression in the thoracic outlet, but that a negative response should not rule out a diagnosis of thoracic outlet syndrome, especially when neurological symptoms are present.

Adolescent↗
PubMed1986

Multifactorial study of prognostic factors in differentiated thyroid carcinoma and a re-evaluation of the importance of age.

A multivariate analysis of prognostic factors has been carried out with 375 cases of differentiated thyroid cancer (DTC) treated in the same centre by total thyroidectomy and 131I therapy. The patients have been followed for 5 to 23 years. The isolated prognostic roles of age, sex, clinical stage and histology were confirmed, but these factors were found to be strongly interrelated. Multifactorial analysis was conducted following Cox's model. It demonstrated that the prevalent role of clinical staging (nodular versus lobar or massive form) is as important as the initial presence of metastases (P = 0.0001). Histological assessment of differentiation, age and sex were of lesser importance. Thus, the most significant prognostic variable is clinical stage. These data must be taken into account when formulating management protocols for DTC.

Adolescent↗
PubMed1986

Surgical treatment of a tuberculous thoracoabdominal aneurysm.

We report a case of tuberculous thoracoabdominal aneurysm successfully treated by surgery. Computerized tomography was diagnostic for location and etiology. The therapeutic plan included antituberculosis drug therapy started before surgery, direct PTFE prosthetic replacement and omentoplasty. A survey of other reports dealing with tuberculous abdominal or thoracic aorta involvement shows that their frequency, as that of tuberculosis in general, is diminishing.

Aorta, Abdominal↗
PubMed1986

Aortic stump closure: a new technique.

The usual closure of the aortic stump results in a cul-de-sac which favors secondary rupture. A new procedure utilizing an anterior-posterior suture line in two layers is described which creates a median strut. It allows a secure suture line in a short aortic stump, and may enhance the splitting of blood flow between the renal arteries.

Aged↗
PubMed1986

Naftidrofuryl in chronic arterial disease. Results of a six month controlled multicenter study using Naftidrofuryl tablets 200 mg.

The study was carried out on patients with intermittent claudication (Fontaine's stage II). The arterial and atheromatous origin of the disease was confirmed and localized by angiography or Doppler velocimetry examination. One hundred eighty-six patients were selected initially. Their pain-free walking distance on a treadmill (at a speed of 3 km/hour and an inclination of 10%) had to be 150-300 m. During the first month all patients received 3 placebo tablets daily. At the end of this run-in period (D-30; D 0) and after checking walking distance stability (allowed variation: +/- 20% between the two measurements) the patients were included in the study. One hundred fifty-four patients were selected and 118 remained during the whole study. The study was designed as a double-blind, using two parallel randomly selected groups. Sixty-four patients received for six months Naftidrofuryl (3 X 200 mg tablets daily with meals); 54 patients received placebo under the same conditions. During this period, clinical and paraclinical examinations were carried out every quarter (D 90 and D 180). After checking the initial homogeneity of the Naftidrofuryl and placebo-groups, the comparison between groups indicates a significant improvement in Naftidrofuryl group after 3 and 6 months of treatment. At the end of the study the observed differences in walking distance with Naftidrofuryl are approximately twice the difference in the reference group (D 90: p less than 0.05; D 180: p less than 0.02). The results of this study indicate that Naftidrofuryl is an efficient pharmacological tool for treatment of patients with chronic arterial disease (Fontaine's stage II).

Administration, Oral↗
PubMed1986

[Transdiaphragmatic approach to the supraceliac aorta. Surgical anatomy and operative technic].

The surgical anatomy and the practical modalities of the trans-peritoneal-diaphragmatic approach of the low thoracic aorta have been studied on the basis of 40 consecutive dissections. The trans-diaphragmatic approach of the supra-celiac aorta can be performed: either through a restrictive way, by dissociation of the muscular fibers of the posterior angle of the oesophagal hiatus, thus allowing the access to a mean 30 mm long part of supra-celiac aorta, large enough to perform a complete aortic clamping; either through an extensive way, by medial sagittal section, in front of the aorta of the muscular fibers of the posterior angle of the oesophagal hiatus and of the arcate ligament, thus permetting this exposure of a longer aortic part (60 mm on a average) and the realization of more important aortic procedures. These may be performed with a lateral aortic clamp, on account of the large diameter of the aorta at this level (30 mm on an average).

Aorta, Thoracic↗
PubMed1985

[Malignant pheochromocytoma. A case].

A case of malignant phaeochromocytoma is reported. The primary tumour was removed in 1970. Metastases were diagnosed in 1979 and management of the condition included antihypertensive treatment with alphamethylparatyrosine, antitumoral chemotherapy and surgical reduction of secreting tissue. In these rare tumours malignancy can only be confirmed by metastases, i.e. presence of chromaffin cells in loci where they are not usually found. Histology is of little value. High levels of catecholamine precursors or their metabolites in the urine may be a sign of malignancy, but some asymptomatic tumours are only revealed by metastases. Computerized tomography and radioisotope scanning with I131 metaiodobenzylguanidine are the best available methods to locate the lesions. In view of the small number of cases and of the unpredictable course (sometimes spread over many years) of malignant phaeochromocytomas, the effectiveness of treatments with alphamethylparatyrosine, chemotherapy and radiotherapy is difficult to evaluate.

Adrenal Gland Neoplasms↗
PubMed1984

[Aorto-enteric fistulas].

Aorto-enteric fistulae are either primary or spontaneous, resulting from aneurysms of the aorta, or secondary to aortic surgery. Four symptoms are common to these two types, but every patient known to have an aortic aneurysm or a history of aortic graft surgery who presents with gastrointestinal bleeding or unexplained infection must be regarded as having an aorto-enteric fistula until proved otherwise. The fistula may be detected by duodenoscopy, but it is most often diagnosed at laparotomy, which is indicated when all paraclinical investigations are negative. While primary aorto-enteric fistulae can be treated by insertion of a prosthesis into the aortic aneurysm, secondary fistulae frequently require " extraanatomical " bypasses. In view of the poor prognosis of secondary aorto-enteric fistulae, prophylactic measures in aortic surgery are of paramount importance.

Aorta, Abdominal↗