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Biomedical subjects

F Giron

Publications and source records attributed to F Giron.

At least 73 records · Page 4Linked to original sources
PubMed1966

Synchronous assisted circulation.

A summary of the work in synchronous assisted circulation undertaken at the Tufts-New England Medical Center Hospitals for the past year is presented.Counterpulsation, introduced in 1958, reduces myocardial oxygen consumption and increases coronary flow. It was applied to seven patients with terminal cardiogenic shock: one patient survived and three showed temporary improvement.The synchronous external assist makes possible control of the blood volume distribution, increases the cardiac output and decreases the pressure work of the left ventricle. The procedure does not require cannulation of the vascular system and is atraumatic.The same concept has been applied to the right ventricle using synchronous respiration.An "in-series" subcutaneously exteriorized prosthetic left ventricle, capable of long-term left ventricular assist, is under development. The device can atrialize the left ventricle. It requires no intracorporeal source of energy.This program offers hope for the development of effective temporary and long-term circulatory-assist procedures.

Aged↗
PubMedDate not supplied

Could X-ray microbeams inhibit angioplasty-induced restenosis in the rat carotid artery?

BACKGROUND: Parallel, thin (<100 microm) planes of synchrotron-generated X rays, have been shown to spare normal tissues and preferentially damage tumors in animal models. The aim of the present study was to assess the effect of such microbeams directed unidirectionally on angioplasted rat carotid arteries. METHODS AND MATERIALS: Three groups of Sprague-Dawley rats were studied: (a) rats with normal, untreated arteries, (b) rats treated by balloon angioplasty, but not irradiated, and (c) rats treated with balloon angioplasty and exposed to single fraction, unidirectional, parallel, microbeams an hour after angioplasty. The microbeam array, 15 mm widex7.6 mm high, consisting of 27-microm-wide beam slices, spaced 200 microm center-to-center laterally traversed the damaged artery. The in-depth in-beam dose was 150 Gy, the "valley" dose (dose midway between microbeams resulting mainly from X-ray scattering) was 4.5 Gy on average, and the "integrated" (averaged) dose was 26 Gy. RESULTS: Microbeam irradiation, as given in the present study, was tolerated, but was insufficient to significantly suppress the neointimal hyperplasia. DISCUSSION: The microbeam dose used is considered low. Dose escalation would be necessary to reach conclusive results regarding the X-ray microbeam efficacy to control restenosis.

Angioplasty, Balloon↗
PubMedDate not supplied

Arthroscopically assisted semitendinosus and gracilis tendon graft in reconstruction for acute anterior cruciate ligament injuries in athletes.

We evaluated 69 arthroscopically assisted anterior cruciate ligament reconstructions for acute tears at an average followup of 60 months. We used a distally based single semitendinosus and gracilis tendon graft passed over the top and fixed to the femur. Combined medial collateral ligament lesions were seen in 30 knees, and they were repaired when found in the distal third (18 knees). The patients were instructed to recover motion preoperatively, and an early range of motion program was used postoperatively. At followup, symptoms of giving way were seen in five knees (7%). Graft failure was seen in seven knees (10%); failure was defined as a positive pivot shift (clunk or gross) or a side-to-side difference in anterior tibial displacement greater than 5 mm, as measured with a KT-1000 arthrometer. Permanent extension loss (3 degrees to 5 degrees) was found in two knees (3%). Patellofemoral crepitation was seen in eight knees (12%), but the condition was symptomatic in only one knee. Forty-six patients (67%) were active in pivoting sports before surgery and 37 (54%) remained active in these sports at followup. We concluded that this operation is simple, effective, and has a low complication rate. Further studies are necessary to elucidate if a stronger graft (e.g., a patellar tendon) would decrease the rate of graft failure without increasing complications.

Acute Disease↗
PubMedDate not supplied

The retroperitoneal approach to aortic surgery associated with horseshoe kidney.

The horseshoe kidney is a rare anomaly that can significantly complicate aortic surgery. A bulky isthmus, abnormalities of renal anatomy, and a variable blood supply associated with a horseshoe kidney can pose technical difficulties in terms of aortic reconstruction. The left retroperitoneal approach affords an excellent exposure of the abdominal aorta in patients with a horseshoe kidney without dividing the renal isthmus and avoids the risk of injury to a ureter in an anomalous location. This is a case report of a patient with a horseshoe kidney who underwent a successful repair of an abdominal aortic aneurysm by a left retroperitoneal approach.

Aged↗
PubMedDate not supplied

Combined epidural and general anesthesia in aortic surgery.

The perioperative course of 144 consecutive patients undergoing aortic reconstructive surgery was studied to assess the potential benefit of employing a combined epidural and light general anesthesia technique. A group of 67 patients had general anesthesia alone (GA), while in the group of 77 remaining patients, a combined epidural and general anesthesia (Epi-GA) was employed. The two groups were similar in regards to age, medical risk factors, preoperative assessment of cardiac and pulmonary function, and type of surgical reconstruction. There was no significant difference in the anesthetic, operative time, or operative fluid requirements between the two groups. There was a lower rate pressure product in the Epi-GA group during aortic cross clamping (P less than 0.05). More patients in the GA group required a prolonged ventilatory support (P less than 0.05) and a high parenteral narcotic administration (P less than 0.025) during the first 48 hours. While the mortality rate was similar for the two groups (3.0% for GA group vs 5.2% for Epi-GA group), there was a higher percent of postoperative pulmonary complications observed in the GA group (7.6%) compared to the Epi-GA group (2.6%). By facilitating early extubation and a decreased need for systemic narcotics in the early postoperative period, Epi-GA may be beneficial in the high risk pulmonary patient undergoing aortic reconstruction.

Aged↗
PubMedDate not supplied

Alternative procedures to aortobifemoral bypass grafting.

The outcome of 175 bypass procedures performed on 174 patients with symptomatic aortoiliac occlusive disease during a five-year period were analyzed. Fifty-nine patients underwent a standard aortofemoral bypass and 116 patients underwent one of three alternative procedures consisting of femoro-femoral, iliofemoral, or axillofemoral bypass. The operative stress, morbidity, mortality and long-term results were compared. Although the aortofemoral group had a higher three-year cumulative patency rate (89% vs 81%), the alternative procedure group had a lower operative mortality (1.8% vs 7%). In addition, the patients in the alternative procedure group were slightly older, had a higher percentage of procedures performed for limb salvage, and had a less optimal run-off status, yet the complication rate was significantly less than that of the aortofemoral group (p less than 0.05). The use of these alternative procedures should be considered for patients with symptomatic aortoiliac disease, who represent a moderate operative risk as well as those in a high risk category.

Anastomosis, Surgical↗