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Biomedical subjects

F Joffre

Publications and source records attributed to F Joffre.

At least 73 records · Page 4Linked to original sources
PubMed1994

[Transjugular intrahepatic portasystemic shunt and liver transplantation].

From the first one hundred consecutive patients treated by transjugular intrahepatic portosystemic shunt (TIPS), 12 subsequently underwent liver transplantation (a mean of 103 +/- 109 days after TIPS). Fourteen TIPS were created in 12 patients, with advanced cirrhosis (Child B = 5, C = 7) and portal hypertension. Seven patients presented either active variceal hemorrhage or refractory variceal bleeding, and 5 cases of refractory ascites. The shunt could be performed in all cases. Two patients experienced rebleeding (one after a shunt obstruction) and were successfully treated by insertion of a second TIPS. A histological study was performed in 10 cases. The shunt was patent in all cases (except in one case previously described), and the endoluminal surface was covered by a connective tissue layer and a new endothelium. We therefore conclude that this method is a safe and effective therapy for complications of portal hypertension, in patients referred for liver transplantation.

Adult↗
PubMed1994

[Effect of buflomedil perfusion on peripheral tissue oxygenation during transluminal angioplasty in patients with advanced arteriopathy of the lower limbs].

Randomized double-blind placebo controlled trial performed in two parallel groups of patients, aged 43 to 92, suffering from advanced arterial disease of the lower limbs to be treated with angioplasty. The aim was to compare the efficacy of infusions of buflomedil with placebo on peripheral tissue oxygenation following lower limb angioplasties. Treatments consisted of 3 hour infusion of buflomedil or isotonic saline combined with arterial disobstruction. The major outcome measures were transcutaneous oxygen tension (TCpO2) correlated to ankle systolic pressure index (SPI). An increase of TCpO2 values (p < 0.01) as well as the mean individual variations of TCpO2 (p < 0.05) before and after angioplasty were observed in the buflomedil-treated group, whereas SPI values varied similarly in both groups. No adverse event was shown. In conclusion, buflomedil infusions during angioplasties of the lower limbs may improve tissue oxygenation subsequent to arterial disobstruction and are well tolerated.

Aged↗
PubMed1994

[Popliteal aneurysm and leg ischemia: thrombolysis first].

Popliteal aneurysms may threaten the viability of lower limbs, especially in the case of occlusion and poor run-off. In case of acute ischemia, thrombolysis can be used before surgery to clear the tibial arteries and enhance the results of subsequent bypasses. The procedure starts with an arteriography to show the arterial tree, then a recanalization is attempted. By means of a microcatheter pushed into the thrombosis, Heparin (1000 Units/h) and Urokinase (4,000 Units/h) are injected in situ. Arteriograms are repeated in order to control the placement of the catheter. Anticoagulant and fibrinolytic doses are biologically surveyed. Local and general complications are rare with the new techniques of fibrinolysis. Hemorrhagic complications following surgery are low despite the previous fibrinolytic treatment. Better success rates of bypasses, performed to relieve acute ischemic complications of popliteal aneurysms, should be achieved with this new modality of treatment.

Aged↗
PubMed1993

Self-expandable prostheses in the tracheobronchial tree.

Under endoscopic and radiologic control, two types of self-expandable metal prostheses were implanted in tracheobronchial lesions to help reestablish airway caliber. Thirty-nine metal stent prostheses (6-20 mm in diameter) and 35 Gianturco stents (30 mm in diameter) were used in 55 adult patients with 62 lesions of the trachea (n = 33) or bronchi (n = 29). All lesions except one were endoscopically confirmed to be noninflammatory. Immediately after implantation, radiologic and endoscopic studies verified reestablishment of a satisfactory airway diameter in all patients. At a mean follow-up of 10.35 (range, 3-27) months, improvement in the respiratory status of 49 of the 55 patients (89%) was maintained and tolerance of the device was excellent. For the Wallstent endoprosthesis, the six complications observed at endoscopy were successfully treated. The Gianturco stent, however, led to a high rate of complications: 30% of cases had migration and/or rupture of the metallic mesh, potentially leading to obstruction or wall perforation; one case of respiratory distress was fatal. This procedure offers rapid epithelialization and incorporation of the device into the tracheobronchial wall.

Adult↗
PubMed1993

[Treatment of hemorrhages by rupture of cardio-tuberous varices with transjugular intrahepatic portasystemic shunt].

Twelve consecutive patients admitted for bleeding from ruptured gastric varices were treated with transjugular intrahepatic portosystemic shunts and followed for a mean of 6 +/- 3 months (range: 8-293 days). The shunt was performed successfully in all 12 patients. The shunt occluded in 3 patients (respectively 19, 101 and 103 days after insertion) of whom one remained asymptomatic and two experienced rebleeding. Four patients presented with acute encephalopathy, spontaneously in two and after rebleeding in two. Three patients died, two after rebleeding and one of septic shock secondary to pneumonia. Overall, 9 patients survived a mean of 211 +/- 92 days with no rebleeding, 8 of whom have not yet experienced any complications. These results suggest that transjugular intrahepatic portosystemic shunts could be useful in treating hemorrhages from ruptured gastric varices and in preventing their recurrence.

Adult↗
PubMed1992

[Evaluation of efficacy and tolerability of ioversol in intravenous urography. A comparative double-blind study versus iopamidol].

The efficacy and safety of Optiray (ioversol), a new low osmolar non-ionic contrast agent were compared with Iopamiron in a double-blind randomized trial for intravenous pyelography. Concerning the diagnostic efficacy, Optiray 300 was equivalent to Iopamiron 370 for identical injection volumes. Significantly less reinjections were necessary with Optiray. Tolerability was found to be excellent, equivalent to the reference product. Optiray was found to be both well tolerated and of satisfactory diagnostic value.

Adolescent↗
PubMed1992

[Primary mediastinal myxoid liposarcoma. Apropos of a case].

Liposarcoma is an uncommon mediastinal tumor provides limited CT histologic date. The prognosis depends on the histological grade and surgical possibilities. The authors report a case of mediastinal liposarcoma and discuss the correlation between imaging findings, outcome and histological status.

Humans↗
PubMed1991

Early postoperative sternal approximation after ITA harvesting: computed tomographic evaluation.

Between November 1989 and February 1990, 66 randomized sternotomized patients underwent aortocoronary bypass and were subjected to a sternal scanner in the early postoperative period. Each examination included a manubrial and a sternal body print. At each level, we studied the occurrence of spacing or misalignment of the sternal layers. The 66 patients were subdivided into four groups according to the type of conduit harvested (single left internal thoracic artery or saphenous vein) and the type of material used for the sternal closure (steel wires or nylon yarns). In all cases, adequate early sternal approximation, which is represented by a good alignment as well as by an excellent contact of the sternal layers, was infrequently demonstrated. Moreover, the two abnormalities most often observed were manubrial spacing and sternal body misalignment. The sternal closure technique and internal thoracic artery harvesting had no significant effect on the sternal approximation. To minimize manubrial spacing and sternal body misalignment, we propose that the surgeon should apply three threads through the manubrium, withdraw the shoulder roll beforehand, elevate both of the patient's shoulders, and maintain the two xyphoid layers in the same plane and in fairly close contact during the tightening of the wires.

Aged↗
PubMed1991

Iliac artery stenosis or obstruction after unsuccessful balloon angioplasty: treatment with a self-expandable stent.

Obstruction or stenosis of the iliac artery was treated by placement of a self-expandable stent in 91 patients. A total of 100 lesions was treated. All patients had had poor results of balloon angioplasty including residual stenosis, iliac occlusion, and dissection. The stent used in all cases was a self-expandable stainless steel endoprosthesis mounted on a 7- or 9-French catheter and covered by an invaginated tubular rolling membrane. The diameter of the expanded stent varied from 7 to 12 mm. A total of 129 stents was placed. Technical success was 97%. Thromboses occurred immediately after placement in two patients and within the first month in six; these were mainly due to residual obstruction. Eighty-two (93%) of 88 patients with a follow-up longer than 3 months had no recurrent symptoms. Restenosis caused by intimal hyperplasia inside the stent occurred in 10 patients; these required repeated intervention in only four cases. In the remaining six patients, no further complications occurred. Our results show that self-expanding endoprostheses are of value for improving the results of inadequate percutaneous transluminal angioplasty.

Adult↗
PubMed1991

[Different methods of percutaneous desobstruction of peripheral arteries].

Chronic arterial occlusion of the iliac and femoro-popliteal vessels has been considered, until recently, to be a contraindication to percutaneous transluminal angioplasty. However, recent advances in radiological and catheterisation equipment and the introduction of new methods of recanalisation (laser, mechanical devices) have increased the therapeutic possibilities. The immediate and long-term results of iliac recanalisation are usually excellent with conventional angioplasty methods. The success rate of recanalisation of the femoro-popliteal segments is about 80% irrespective of the method used, the failure rate increasing with the length of the occlusion. However, the long-term patency rate is poor, about 50%. These methods of percutaneous recanalisation are technically difficult and require special training and sophisticated equipment. The indications should be carefully evaluated in a pluridisciplinary manner taking into account the potential clinical benefits, the technical difficulties, the risks and other therapeutic possibilities.

Angioplasty, Balloon↗
PubMed1991

[Self-expanding endoprostheses. Applications in iliac and femoro-popliteal arteries].

Vascular endoprosthesis are aimed at optimizing the results of angioplasty. They are metallic cylinders, most often meshed, laid against the wall of the vessel and progressively incorporated into the intima by endothelial coverage. Experimental studies show that this incorporation occurs within a few weeks. The prosthesis are either self-expanding or mounted on a dilatation balloon. Their aim is to restore a good-quality caliber by smoothing the parietal irregularities that were frequently encountered after dilatation. They are a true parietal prop, inserted into the arterial lumen through a percutaneous approach. The middle-term results of iliac and femoropopliteal implants are very encouraging, and they suggest that this technique may be a very useful complement to transluminal angioplasty in cases of poor results or recurrence. The insertion of an endoprosthesis also allows to extend the indications of transluminal angioplasty to cases that had been regarded as hardly favorable so far: long, irregular stenosis, iliac obliteration, etc.

Blood Vessel Prosthesis↗
PubMed1990

Use of the Wallstent endourethral prosthesis in the treatment of recurrent urethral strictures.

Urethral strictures recur in about 30% of the cases irrespective of treatment. We describe a new urethral stent, originally developed in our institution for vascular use after transluminal angioplasty. We have previously tested the biocompatibility and tolerance in the normal urethra of dogs in a study with a 1-year follow-up undertaken in 1986. The stent has a braided structure, made of fine stainless steel wires and is self-expanding when released from a special endoscopic instrument. Since November 1987, we have implanted the stent in 25 men (mean age 54 years), after a previous urethrotomy had been performed. Eighteen were evaluated. Results are good, morbidity and complications occasional. This new technique has a considerable future in treating recurrent urethral stricture.

Adult↗