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Biomedical subjects

G Fournial

Publications and source records attributed to G Fournial.

At least 55 records · Page 3Linked to original sources
PubMed1985

[Disobliteration of coronary arteries by the laser. Peroperative experience].

The authors report their experience of coronary artery disobliteration by laser in 10 patients. This was a preliminary study to assess the effects of an Argon laser on atheromatous coronary stenosis in vivo. This technique was used during coronary bypass surgery. Two series of patients were treated: an initial group of 5 patients who underwent laser therapy associated with coronary bypass surgery; a second group undergoing laser therapy alone without distal bypass grafting. The results were assessed by immediate angiography in the first series and by the passage of calibrated probes in both series. Secondary control angiography after 3 weeks was carried out in all patients. The immediate results showed a constant improvement (less than 25%) in the degree of stenosis. However, secondary angiography showed secondary occlusion in 88% of cases. These preliminary results show: the immediate efficacy of Argon laser in reducing the size of atheromatous plaques, the innocuity of the method as there were no postoperative deaths, a high incidence of secondary failure which could be related to the type of indication (competitive flow in the first group and poor distal run off in the second group of patients) or to the type of laser used. The authors consider this to be a promising technique but a lot of clinical and experimental work remains to be done before it can be adopted for routine use.

Aged↗
PubMed1984

Human coronary laser recanalization.

Five patients undergoing distal saphenous vein bypass had an attempt at intraoperative laser vaporization of a proximal coronary stenosis. Laser treatment of three patients was technically successful. One patient's successfully treated native vessel was competing with the graft at angiographic restudy 25 days after the procedure. This first human intraoperative laser recanalization trial generated questions regarding the energy source, power parameters, and catheter modifications required for satisfactory clinical laser therapy. The trial is directing future experiments toward more efficient and complete laser vaporization of atherosclerotic plaques in the human coronary vasculature.

Aged↗
PubMed1983

[Suppurative thyroiditis and epithelioma of the piriform sinus].

The authors report a case of suppurative thyroiditis revealing cancer of the piriform sinus. The course ran two distinct phases. Initially, symptoms resolved under methylprednisolone and ampicillin given with a diagnosis of acute thyroiditis. After corticosteroids were discontinued, a tumefaction in the thyroid area recurred, with clinical features indicating centesis that removed 30 cc of pus ORL examination connected this suppurative thyroiditis to an epithelioma of a piriform sinus.

Aged↗
PubMed1982

Surgery for cardiac complications caused by endocardial mural fibrin deposits in a hypereosinophilic syndrome.

A 31-year-old man presented with rapid onset of intractable congestive heart failure during the course of chemotherapy for eosinophilic leukemia. Patients with a hypereosinophilic syndrome usually die from complications of eosinophilic infiltration and fibrosis in target organs. The resulting cardiac lesions are a cause of death among these patients. Surgical intervention enabled our patient to survive the immediate medical crisis and has prolonged his life.

Adult↗
PubMed1981

Repair of large chest wall defects: experience with 23 patients.

The repair of large chest wall defects has been done on 23 patients who had 28 operations. Twenty-two patients had a neoplasm of the thoracic cage, while 1 had a large inflammatory mass. Nine patients had a partial lung and 3 a partial diaphragmatic resection done en bloc with the ribs. Seven resections were on the sternum. The repair was made either with a soft prosthesis (nylon mesh in 3 and Marlex mesh in 12 operations) or with a composite prosthesis of methyl methacrylate and metallic or Marlex mesh (13 operations). The association of methyl methacrylate and Marlex combines the solidity and the easy shaping of methyl methacrylate with the advantages of the mesh for an easy fixation and excellent incorporation. When the skin and the muscles are resected with the osteocartilaginous wall, an omentum flap is placed between the skin and the prosthesis to facilitate healing. There was one postoperative wound infection, which cleared with appropriate antibiotics. No prosthesis has extruded. The cosmetic and functional results are satisfactory. Repair of very large chest wall defects after resection can be done safely.

Adolescent↗
PubMed1981

[Transluminal angioplasty of the coronary vessels. Preliminary results].

Transluminal coronary angioplasty is a new therapeutic procedure perfected by Gruntzig in 1977 consisting of compressing atheromatous plaques and dilating the arterial lumen with an inflatable balloon-tipped catheter of fixed external diameter. This catheter is introduced into the coronary artery through a preformed catheter guide under radioscopic control. The authors describe their experience of 36 attempts at coronary angioplasty performed over a one year period. The stenosis was catheterised in 30 cases and a good immediate result was obtained in 28 patients (77%). The percentage narrowing was reduced from an average of 79 +/- 8% to 26 +/- 12% (p less than 0.001) and the trans stenotic gradient from 40 +/- 11 mm Hg to 4 +/- 8 mm Hg (p less than 0.001). No serious complications were observed during these procedures. The 8 other patients underwent aorto-coronary bypass surgery as an emergency (2 cases) or otherwise (5 cases). 26 patients with good immediate results are asymptomatic at medium term follow-up, 1 has improved from functional Class IV to II, and I has recurrent Class IV effort angina. 15 patients have been followed up after six months. 14 remain asymptomatic with negative maximal exercise stress testing; 1 has angina. 14/15 stenoses remain dilated, 1 stenosis has progressed (60%). 2 patients developed a new stenosis, 1 of whom underwent another angioplasty procedure (functional Class III). In the 13 remaining patient, clinical improvement was confirmed by exercise stress testing. With strict selection of patients and a prudent operative technique this method seems to be an attractive intermediate therapeutic procedure (over 60% good results at medium term) between medical and surgical management of patients with severe angina and a tight monotruncular stenosis.

Adult↗
PubMed1981

[Rupture of the heart in the acute phase of myocardial infarction operated on successfully].

This case of rupture of the left ventricular wall in the acute stage of myocardial infarction, presenting clinically as cardiac tamponnade with no electrical signs of transmural infarction, is reported. After cardiac catheterisation and angiography which confirmed the adiastole, the worsening of the patient's condition necessitated pericardial aspiration which showed the presence of a haemopericardium. This led to surgical exploration and to the repair of a cardiac rupture under cardiopulmonary bypass. The authors recall the incidence of cardiac rupture during myocardial infarction, its poor prognosis, the difficulty of preoperative diagnosis, the anatomical features of the infarct which are theoretically favourable for surgical repair and the rarity of survival after surgery which relies essentially on the availability of medicosurgical facilities for very early surgical intervention.

Acute Disease↗
PubMed1981

[Pump and muscle functions and the index of perfusion of the subendocardium in severe aortic stenosis in adults].

47 patients with severe aortic stenosis (AS) (valve area less than 0.7 cm2) and normal coronary angiography were divided into three groups, according to their functional class (NYHA classification): - Group 1 (n = 21): Classes 1 and 2 - Group 2 (n = 18): Class 3 - Group 3 (n = 8): Class 4. Haemodynamic and angiographic parameters and the index of subendocardial perfusion (ISEP) defined by Buckberg's method were compared with a control group (n = 14). In group 1, pump function was normal without end diastolic dilatation. Moderate hypertrophy was compensatory and isofunctional (SW/mass = normal). Despite normal EF and VCF, contractile function was reduce (dp/dt/p, % shortening, % thickening and velocity of systolic thickening were lower than the control group (p less than 0.05)), and there was chronic subendocardial ischaemia (ISEP = 0.58 +/- 0.2, p less than 0.01). In groups 2 and 3, pump function was depressed (Group 2: CI = 2.5 +/- 0.5 1/min/m2 (p less than 0.05)) (Group 3: CI =2.0 +/- 0.6 1/min/m2, p less than 0.01)) despite an increased preload (LVEDP and EDV increased), and a greater degree of hypertrophy (Mass Index, Group 1 = 130 +/- 30 g/m2, Group 2 = 190 +/- 30 g/m2 (p less than 0.01), Group 3 = 210- +/- 30 g/m2 (p less than 0.01)). (SW/mass decreased, p less than 0.01). EF and VCF and all other indices of contractility were depressed and subendocardial ischaemia was the same (0.5 +/- 0.2). The complete lack of adaptation of the preload, non-compensatory hypertrophy, decreased contractility and chronic subendocardial ischaemia, all affect the operative prognosis and the long-term result after valve replacement. This data is in favour of early surgical correction of severe AS before the appearance of signs of cardiac failure.

Aged↗
PubMed1980

[Floating thrombus of the left ventricle after recent myocardial infarction, treated by surgery].

The case of a 55 year old man admitted with an uncomplicated anteroseptal myocardial infarction is reported. At the third week this young patient underwent complete assessment. On coronary angiography severe double vessel disease was demonstrated and ventriculography showed a "floating" pediculated thrombus attached to the akinetic anterior wall. The ejection fraction was calculated at 40%. Subacute ischaemia of the right lower limb developed in the hours following catheterisation. In the face of all these findings surgery was proposed; ablation of the "fresh" thrombus was associated with a ventricular resection and an aorto-coronary bypass graft on the left marginal branch, together with disobliteration of the distal ilio-femoral artery of the right leg. The following points are emphasised with respect to this report: - the rarity of such cases in the litterature despite the high incidence of mural thrombi after infarction; - the value of diagnosing this complication by systematic investigation of patients under 60 years of age in full socio-professional activity; - the indications of rational surgery comprising ablation of the thrombus and any necessary prophylactic coronary revascularisation.

Coronary Angiography↗
PubMed1980

[Interest of pleurectomy as a complement of emphysematous bullae resections (author's transl)].

Complementary pleurectomy following emphysematous bullae resection is justified only if it improves long-term results in comparison with surgical symphysis obtained by pleural irritation. This cannot be proved at this time. On the other hand, in spite of their limitations, experiments in man suggest that this pleurectomy does not cause any particular complications. In the animal, this parietal pleural resection causes cortical fibrous alveolitis which is not present after other symphysis processes. The authors suggest therefore the use of pleurectomy as a complement of bullae resections in acute and diffuse emphysema.

Acute Disease↗
PubMed1979

[Secondary tamponade following cardiac surgery with reference to 3 cases].

Secondary tamponnade after cardiac surgery occurs after a variable period, generally between the 15th day and the 5th post-operative week. Although this is a rare complication, it occurred three times in a consecutive series of 225 patients (1.3 p. 100). Based on this short experience as compared to the number of cases already published, the authors discuss their opinions on: -- the factors of inflammation and post-operative anticoagulation which predispose to this complication; -- the progress in diagnosis brought about by echocardiography; -- the minimal suggested management of pericardocentesis completed or not by surgical drainage; -- the possibilities of prevention based on prolonged follow-up of patients who present post-operative "pericardial problems". In this way it may be possible to eliminate a not negligeable cause of secondary mortality after cardiac surgery.

Aged↗
PubMed1979

[Unstable angina with threatening coronary lesions turned down for surgery. Outcome and prognostic factors].

The aim of this study based on a series of 200 patients, was to define the outcome and the prognostic factors of patients presenting with unstable angina, according to Bertolazi's criteria [3] and at least one stenosis greater than 80% on a proximal segment of a main coronary trunc, and to determine which factors should eventually be taken into consideration in the discussion of surgical indications. 70 out of 200 patients (35%) were turned down for direct revascularisation surgery because of an ejection fraction less than 0,35 and/or a poor arterial run off. Coronary arteriography showed 30% patients with a menacing stenosis (greater than 80%) on all three vessels, 36% on two vessels and 22% on a single vessel. The distribution and the extent of the lesions was about the same as in the operated patients. 20% patients had an ejection fraction less than 0,35, 24% between 0,34 and 0,50, and 56% greater than 0,50. At patient, the follow up period ranges from 22 to 66 months (average 32 months). In this group, the hospital mortality was 2,9%, the secondary cardiac deaths 16% and the global mortality 19% compared to 12,6% for the operated patients in the same period. The incidence of secondary non-fatal infarction was low (9%). 52% of survivors have persistent angina, 39% severe (Class II or III). Two prognostic factors were detected from this study: the type of angina: the intermediary syndrome had a bad prognosis, 38,5% mortality compared to 13% for aggravated chronic angina; and the ventriculography: patients with ejection fractions less than 0,35 had 64% mortality compared to 7,3% for those with ejection fractions greater than 0,40. The number of menacing lesions, the extent of the lesions of the artery involved did not affect the prognosis when severe abnormalities of left ventricular function were absent.

Adrenergic beta-Antagonists↗