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J C Baste

Publications and source records attributed to J C Baste.

At least 37 records · Page 2Linked to original sources
PubMed1994

[Antheor percutaneous endocaval filter. Multicenter evaluation based on 300 cases].

The authors report a follow up from 6 months to 2 1/2 years concerning 300 Antheor caval filters. This multicenter study was brought about so as to assess the effectiveness of the interruption barrier as well as possible complications stemming from features of the filter. The biomechanical parameters and the specifications for the filter are presented: filtration principle, nature of the alloy and biocompatibility, self-centered doubly fixed mechanism and antimigration clipping system. The main indications taken into account are pulmonary embolism (65% of cases), floating femoro-ilio-caval thrombus (33%) and contraindications of anticoagulants. Insertion conditions are analyzed as is the technique employed almost constantly percutaneous, and somewhat more often femoral than jugulo-sub-clavian. The authors then expose the modalities of the surveillance protocol. Controls are made after 1 week, 2 months, 6 months, 12 months, 18 months, and 24 months an half. They consist of a clinical evaluation, an analysis of the nature of the anticoagulant or anti-aggregation treatment, a plain abdominal radiology, a venous duplex scan examination of the lower limbs and the inferior vena cava and, in some case, a phlebographic and scanographic examination. In terms of the effectiveness, the reported results are convincing, with a rate of only 1% of recurrent embolism and 98% of vena cava patency.

Adult↗
PubMed1994

[Retroperitoneal Castelman disease. Apropos of a new case].

A retroperitoneal localization of Castleman's disease was characterized by angiolymphoid hyperplasia. This rare disease (58 cases of abdominal localization reported to date) raises a question of nosology. The clinical features are not specific. Localized forms in young patients involve deep lymph nodes and have a good prognosis after complete surgical exeresis. Inversely, the clinical picture is much more aggressive in multiple localizations involving preferentially superficial nodes with associated plasmocyte proliferation. The prognosis is mediocre in these forms. Although transition stages have been described due to the lack of any known aetiology, the question of nosology remains open: should the different forms be separated or identified simply as two pathological forms?

Aged↗
PubMed1993

Superior vena cava thrombosis related to catheter malposition in cancer chemotherapy given through implanted ports.

BACKGROUND: Thrombosis of the central veins is one of the most frequent complications of implanted venous access devices. Among the first cases occurring in our patients, most were associated with left-sided placement of the ports, with catheter tips lying against the external wall in the upper half of the superior vena cava. Some chest radiographs showed lateromediastinal opacities centered on the catheter tip, suggesting a vessel injury. This position allows a narrow contact between the catheter tip and the vessel wall, thus endothelial injuries might result from mechanical and chemical attack. METHODS: To assess the role of catheter position, we reviewed the routine chest radiographs of 379 patients who received chemotherapy through venous access devices and were followed up at our department between December 1985 and December 1990. Four groups (upper left, upper right, lower left, and lower right) were defined according to the level of the catheter tip (innominate veins or upper half of the vena cava versus lower half of the vena cava or auricula) and to the side of port implantation. RESULTS: Ten patients developed symptomatic venous thrombosis (superior vena cava in 9 patient, left subclavian vein in 1 patient). A strong correlation existed between catheter position and incidence of thrombosis: upper left, 8/28 (28.6%); upper right, 1/33 (3%); lower right, 1/68 (1.5%); and lower left, 0/250. Since 1988, we have insisted on replacement of malpositioned catheters, and we have observed fewer thromboses (2/191 versus 8/188). CONCLUSIONS: The current study suggests that patients with left-sided ports and catheter tips lying in the upper part of the vena cava are at high risk for severe thrombotic complications.

Antineoplastic Agents↗
PubMed1993

Levels of plasma thrombomodulin are increased in atheromatous arterial disease.

The plasma thrombomodulin (TM) level depends on the integrity of the endothelium and the clearance of the molecule. In several different pathological conditions, plasma TM levels increase with damage to the endothelium. We studied plasma TM levels in patients with various localizations of atheromatous arterial disease who had normal serum creatinine levels. Two groups of patients had a single symptomatic localization, which was either peripheral occlusive arterial disease (POAD) or ischemic heart disease (IHD) and a third group of patients had multiple symptomatic localizations (polyvascular). We compared the plasma TM levels with the plasma levels of other specific markers of endothelial cell activation such as: prostacyclin (PGI2), tissue-type plasminogen activator (t-PA) and plasminogen activator inhibitor (PAI-1). Plasma TM levels were significantly increased in all three individual groups and when all patients were considered (total patients), as compared with normal controls. When all patients were considered, there was a significant positive correlation between plasma TM levels and t-PA and between plasma TM levels and PGI2. A significant positive correlation was also found between the plasma TM levels and PAI-1 for patients with POAD. Thus, our findings suggest that an increased influx of TM into the plasma may be caused by endothelial cell damage in patients with atheromatous arterial disease. However in our study, the plasma TM levels obtained were similar for all three types of atheromatous arterial disease. Though plasma thrombomodulin is a marker of endothelial cell injury, it cannot be of a clinical interest until its levels are related to the extend of the atheromatous lesions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Horton's disease disclosed by involvement of the lower limbs].

We report the case of a 62-year old woman hospitalized for acute ischaemia of the right lower limb, caused by stenosis of the superficial femoral artery associated with thrombosis of the deep femoral artery. Thromboendarterectomy was performed, and histology of the operative specimen showed thickening of the media with clusters of giant cells and fragmentation of the internal elastic lamina, without atheroma. The diagnostic of giant cell arteritis was then considered and confirmed by the presence of headaches, 38 degrees C fever and inflammatory syndrome with ESR at 75 mm in the first hour. On the other hand, biopsy of a temporal artery was negative. Corticosteroid therapy was prescribed and gave excellent clinical, laboratory and arteriographic results. It has now been demonstrated that the arteries of the lower limbs may be involved in Horton's giant cell arteritis, which is often overlooked. This involvement is rare and exceptionally proven at histology. Clinically, the most frequently described form is one of pseudo-arteritis with claudication, but a few cases of gangrene have been reported. Withdrawal of corticosteroid might be a facilitating factor. As in our patient, the arteriographic lesions are often segmental, multifocal and symmetrical, predominant in the superficial femoral artery and the arteries of the legs. The lesions regress under corticosteroid therapy, and surgery can usually be avoided. Anticoagulants are commonly prescribed when the large vessels are involved. When surgery is not indicated the diagnosis can be confirmed by biopsy of the temporal artery, which is positive in the majority of cases.

Acute Disease↗
PubMed1993

[Evidence of elevated soluble plasma thrombomodulin in atherosclerosis].

Thrombomodulin (TM) is a very efficient natural anti-thrombin glycoprotein expressed on the endothelial cell surface. Circulating soluble thrombomodulin is also detected by enzyme immunoassay in plasma and represents some fragments of membrane TM with various molecular weight. Plasma TM (TMp) levels are elevated in diseases associated with endothelium damage. We have explored TMp in patients with atheromatous disease and compared its level with others endothelial cell markers, particularly those who indicate cell activation, as tissue-type plasminogen activator (t-PA), inhibitor of plasminogen activator (PAI-1) and prostacyclin (PG12). Thirty seven patients with documented atheromatous artery disease were included in this study. They were not diabetics and their hepatic and renal functions were normal. Mean age was 71 +/- years. Routine serum parameters were checked out as well as others more specific for endothelium activation (TMp, PG12, PAI-1, t-PA) measured by enzyme immunoassay. Patients were classified according to three localizations of atheromatous involvement: - 15 patients with peripheral occlusive arteriopathy disease (POAD) - 6 with coronary artery disease (CAD); and 16 with polyvascular involvement (POLY). They were compared with 21 controls without any vascular lesions (mean age: 43 +/- 13 years). In controls TMp was 36 +/- 8 ng/ml without significant change according with age and sex. In patients whatever the localization of atheroma, TMp was found significantly higher: POAD = 51.3 +/- 19.7 ng/ml (p = 0.003); CAD = 49.2 +/- 15.4 ng/ml (p = 0.008); POLY = 49.6 +/- 17.2 ng/ml (p = 0.003). A positive correlation was pointed out in all patients between TMp and t-PA (p = 0.047), TMp and PG12 (p = 0.008). A positive correlation between TMp and t-PA (p = 0.034) was found only in the subgroup with POAD. In this study, there was no correlation between TMp and the following parameters: leucocytes, haemoglobin, cholesterol, HDL, LDL-cholesterol, Lp(a), fibrinogen.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Iliac artery-ureteral fistula after aorto-iliac reconstructive surgery (apropos of 3 cases)].

The authors report 3 cases of ilio-ureteric fistulae following aorto-iliac reconstructive surgery. They also review 6 similar cases published in the worldwide literature. All of these cases have in common the appearance of a uretero-arterial fistula several years after the vascular operation on the iliac artery. The postoperative course of iliac thromboendarterectomy appears to be principally responsible, as in the 3 cases presented here, resulting in a pseudoaneurysm over the arteriotomy closure, especially as a patch angioplasty had been performed. This complication is exceptional. The diagnosis must be suspected in the case of profuse haematuria and a suggestive history and should be confirmed, when possible, by intravenous urography, retrograde ureteropyelography, arteriography, or even computed tomography. Treatment is complex and consists of a vascular and urological procedure depending on the degree of urgency and the possibilities of reconstruction.

Aged↗
PubMed1992

[Peritoneal dialysis catheters. Immediate outcome after 30 days].

Results of a retrospective study of 124 peritoneal dialysis catheters introduced in 74 patients from October 1982 to November 1991 showed that 91% of catheters were functional at 30 day follow up, allowing continuous ambulatory peritoneal dialysis to proceed under satisfactory conditions. However, surgical replacement was necessary in 21.81% (26 catheters) during the first month, due essentially to mechanical complications: exteriorized or non exteriorized leaks (7 cases), dysfunction with faulty perfusion or emptying (11 cases) and catheter displacement (3 cases). Five catheters (4.25%) had to be withdrawn because of infection, suggestive of the need for prophylactic antibiotic therapy. No determining factor could be found in the present series or in the literature to explain the genesis of these mechanical complications, the cause of which is without doubt multifactorial. Rapid surgical replacement allows functional survival of the majority of catheters without increasing the risk of infection.

Abdominal Pain↗
PubMed1990

[Thrombophlebitis of the ovarian veins. A case report. Review of the literature].

The authors report on one case of thrombophlebitis of the two ovarian veins complicated by thrombosis of the vena cava inferior after a septic abortion. The diagnosis suggested by the persistence of symptoms of a severe pelvic infection was confirmed using computerized axial tomography. Faced with a clot floating in the vena cava inferior, a Greenfield filter was placed subrenally and combined with antibiotic therapy and IV heparin therapy. Clinical symptoms resolved but the scanographic image of thrombosis of the vena cava persisted after 7 months of treatment. This is a rare disease which is currently easy to diagnose, thanks to computerized axial tomography and nuclear magnetic resonance.

Abortion, Septic↗
PubMed1989

Experimental evaluation of a gelatin-coated polyester graft used as an arterial substitute.

Protein coating and endothelial cell preseeding have been proposed and studied as improvements to arterial prostheses. In this paper, an impervious polyester vascular graft which had been coated with cross-linked gelatin was compared to a porous one over a period of up to 8 months in dogs. This evaluation involved in vivo methods using radio tracers to study patency and thrombogenicity and in vitro controls of the healing processes. The main advantages offered by coated grafts over uncoated include the absence of preclotting and better biointegration.

Animals↗
PubMed1989

[Use of a thin wall Impra prosthesis for a vascular approach in chronic hemodialysis. Short- and middle-term evaluation. Apropos of 66 cases].

The authors report their experience of thin wall PTFE IMPRA prostheses in providing vascular access for chronic haemodialysis. Sixty-six prostheses were inserted between 14/10/1983 and 31/10/1986, with review of all patients at 31/6/1987. Twenty-three per cent of patients died during the study period. Patency analysed by the actuarial method was 49.07 +/- 15.7% at 2 years. There was no evidence of any significant difference between use of the forearm and of the arm. The main cause of failure was early (responsible for the loss of 9.2% of prostheses) or secondary (after the first month) thrombosis. A total of 30.3% of prostheses were lost by thrombosis by the end of 2 years, the principal cause being anastomotic or post-anastomotic venous stenosis. The use of thin walls in no way modified the incidence of this complication. The authors suggest its preventive protection by routine ansography. False aneurysms occurred beyond 18 months of dialysis requiring removal of the prosthesis in 3 cases. Thinning of the wall is one of the probable factors involved in this complications, justifying the abandonment of this type of prosthesis in this indication despite technical advantages at implantation and during use.

Adolescent↗