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Biomedical subjects

G Fournial

Publications and source records attributed to G Fournial.

82 records · Page 5Linked to original sources
PubMedDate not supplied

Evolution of untreated mild rejection in heart transplant recipients.

To elucidate whether mild rejection requires treatment, we retrospectively examined the spontaneous natural history of this histologic feature without an increase of immunosuppression. During a 4-year period, 55 heart transplantations were performed in 54 patients on whom 958 endomyocardial biopsies were performed. Among these biopsies, 162 specimens showed features of mild rejection. We studied the results of subsequent biopsies performed 7 to 10 days later, without any change in immunosuppression. These revealed regression of lesions to minimal rejection in 51 cases (31%), the same histologic feature in 82 cases (51%), or progression to moderate or severe rejection in 29 cases (18%). In 82% of these cases, therefore, no aggravation of histologic feature was observed. We separated the cases in which current-study biopsies showed mild rejection into three groups according to the result of the most recent biopsy, that is, minimal, mild, or moderate-severe rejection. The percentage of good outcome was not modified by the nature of the previous biopsy specimen: 84%, if minimal rejection was preceding the study biopsy; 82%, in the cases of mild rejection; and 77%, for moderate or severe rejection. We did not find significant differences in this evolution between patients with fewer or more than two moderate or severe acute rejections in the first 4-month period after heart transplantation (respectively, 15% or 24% progression to moderate or severe acute rejection after nontreated mild rejection).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

A new device: the quick cannulation system.

We describe a new technique for the placing and fixing of extracorporeal circulation cannulae in the heart. Two devices are involved, the first for an atrial or venous return cannula and the second for an aortic perfusion cannula. These allow quick easy cannulation which is very important in emergency surgery.

Cardiac Catheterization↗
PubMedDate not supplied

Abdominal aortic aneurysmectomy in octogenarian patients.

The authors report 56 patients. 80 years of age or older who had an abdominal aortic aneurysm (AAA): twenty seven were operated upon as emergencies, 7 with intra-peritoneal (Group I) and 20 with retro-peritoneal rupture (Group II). Twenty nine underwent elective surgery (Group III). Renal pulmonary and cardiac disease are frequent in octogenarian patients. The surgical repair consisted of 40 knitted bifurcated grafts and 16 aorto-aortic woven grafts. The overall in-hospital mortality rate is high (28.5%: 16 patients) essentially in "emergency" surgery: 71% for the seven Group I patients and 45% for the twenty Group II patients. The in-hospital mortality rate of 6.9% for the Group III of "elective" procedure is higher than the mortality rate of patients of all ages operated on for asymptomatic AAA in our institution which is 4.3%. Once a patient has been operated on successfully his life expectancy tends to parallel that of a normal population for his age group. These results can be improved with preventive measures such as elective surgery for asymptomatic AAA with a diameter of 6 cm or more. Operative contraindications are severe congestive heart failure, advanced pulmonary disease or neoplastic disease. The age "per se" is not a contraindication to aneurysmectomy. Physiologic rather than chronologic age should determine the selection for AAA in the over-80 age group. CT scans and MR are safe fast and non-invasive preoperative examinations for AAA.

Aged↗
PubMedDate not supplied

Cardiovascular surgery and heparin induced thrombocytopenia.

The Authors report a series of 21 cases of heparin induced thrombocytopenia (HIT) observed in a Department of Cardiovascular Surgery. The indication for heparin treatment was a cardiac procedure in 12 cases, peripheral arterial reconstructive surgery in 3 cases and in 6 cases a prevention of embolism. Two routes were used for heparin administration: subcutaneous and intravenous injections. The diagnosis was biological on low platelet counts (p.c.) in 4 cases, in 7 cases a deep venous thrombophlebitis and in 9 cases an acute arterial ischemia complicated the heparin treatment. From the 7th to 15th day after heparin treatment the p.c. had risen to the average value of 46,857/mm3. The diagnosis was clinical in 3 cases, biological with a positive aggregation test in the presence of heparin in 11 cases out of 14 biological tests performed and pathological with observation of white clots in 11 cases. The related mortality rate to HIT was 28.5% of the cases (6 cases). HIT is a rare but severe complication often associated with thrombo-embolic complications. The routine check of p.c. before and after the first week of heparin treatment is reasonable. The negative aggregation test in the presence of heparin does not permit to confirm this diagnosis. The drop in the p.c. between the 6th to 10th day after heparin treatment required an immediate arrest of this type of anticoagulation and replacement with Coumadin. The low molecular weight Heparin may induce cross matching reactions with heparin and therefore is not used as treatment for HIT. In emergency, cardiac surgery with the use of the extra-corporeal circulation device can be performed with success with heparin (2 cases).

Adult↗
PubMedDate not supplied

Neoplastic tracheal stenosis.

Primary tracheal tumors (PTT) are relatively rare and their diagnosis often late because the symptomatology is noncharacteristic and the signs only appear when over 60% of the lumen is obstructed. The most frequent histologic type is epithelioma (50 to 60%), but the glandular type which has a low malignant potential constitutes 25% to 40% of PTT, especially cystic adenoid carcinoma (cylindroma), which has a slow development but widely infiltrates the submucosa, distant from the macroscopic limits of the tumor. True benign tumors are rare. It is very important to know the tumor dimensions, and radiology is the best means of diagnosis in suspect cases. The usual treatment is surgery alone or associated with radiotherapy. The surgical techniques are now well-known and the operative mortality is very low when the indications are good. Excellent long-term results have been obtained with benign tumors, poor results, but sometimes with long palliation, in cases of epithelioma, and good results in cases of recurrent cylindroma. Statistics are, however, unavailable due to the fact that there is no large and homogeneous series.

Humans↗
PubMedDate not supplied

[Aneurysms of the popliteal artery. Intravascular bypass using the internal saphenous vein].

We used the internal saphenous vein to create an intravascular bypass for the treatment of aneurysms of the popliteal artery. The saphenous vein was positioned within the lumen of the aneurysmal popliteal artery and in the superficial femoral artery at its origin. Two end-to-end anastomoses were made including the venous wall within the suture. This new surgical technique is based on 3 criteria. i) anatomic: the venous bypass follows the exact path as the artery since it is situated within the lumen; ii) haemodynamic: end-to-end anastomoses are used to avoid turbulence created with end-to-side sutures; iii) histologic: the venous endothelium protects better against thrombus formation ensuring good long-term permeability.

Aneurysm↗
PubMedDate not supplied

[Use of acrylic prosthesis for the repair of large defects of the chest wall (author's transl)].

The experience of the authors is based on 17 patients 28 to 76 years old. The defect was always too large to be filled by the surrounding tissues. Six resections were on the sternum or the sternum with ribs. In 4 cases there was also a large resection of skin and muscles and in 3 cases pulmonary resection was associated. Prior to 1971 the authors used a crinoplate 3 times, a thin Marlex plate once and a thick one 5 times. Since 1971, 11 prostheses of methyl methacrylate were fixed with a double metal mesh (3 cases) or a Marlex mesh (8 cases). The authors insist on the interest of the latter prosthesis, made concurrently, easily and solidly fixed, and immediately and indefinitely well tolerated. In cases of large resections of muscle and skin the greater omentum can be used as described by Kiricuta to protect skin flaps from the plate prosthesis.

Adult↗