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Biomedical subjects

J L Fasquel

Publications and source records attributed to J L Fasquel.

9 recordsLinked to original sources
PubMed1993

Anomalous origin of the brachiocephalic vessels with right aortic arch and contralateral subclavian steal syndrome.

Anomalies of origin of the brachiocephalic vessels are uncommon. The authors report a new case of such an abnormality revealed by a subclavian steal syndrome. The angiographic study showed a right aortic arch with hypoplasia of the origin of the left subclavian a., which arose from the descending aorta, and a collateral cervical circulation derived from the left vertebral a. and the right subclavian a.

Adult↗
PubMed1993

Recanalization of occluded superficial femoral arteries using the rotational transluminal angioplasty catheter system (ROTACS).

A total of 85 occluded superficial femoral arteries were treated using the rotational transluminal angioplasty catheter system (ROTACS). The mean length of the occlusions was 7cm; 76% were uncalcified or only slightly calcified whereas 24% were calcified or highly calcified. The mean preoperative ankle:brachial index was 0.51. Primary success was achieved in 62 of 85 cases (73%). The mean length of reperfused occlusions was 6.2 cm: 26% of these lesions were calcified. The mean ankle:brachial index was 0.91. There were 23 primary failures (27%): reperfusion was impossible in 11 cases (including one complicated by perforation) and there were eight dissections, three cases where residual stenosis exceeded 50%, and one other unspecified failure. The mean length of these occlusions was 10.5 cm; 17% were calcified. Two patients developed a distal embolus and one died 10 days after reperfusion. The probability of primary patency of a reperfused artery was 44% at 1 year. Forty-two of the 62 patients who achieved primary success remained symptom free; the mean length of the original occlusion was 4.5 cm. Fifteen patients developed a new area of stenosis whereas five others exhibited new occlusion after a mean interval of 6 months. The mean length of these reperfused arteries was 9 cm. The probability of secondary patency at 1 year was 58%. Arterial calcification did not appear to influence the feasibility of reperfusion using the catheter. The main factor determining successful reperfusion was the length of the occlusal defect (P < 0.05). Reperfusion using the ROTACS did not improve the feasibility of reperfusion by conventional transluminal angioplasty.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

[Calcified aortic stenosis in patients over 80 years of age. Results of surgical treatment. Observations in 67 consecutive cases].

The authors report the results of surgery performed between 1978 and 1988 for calcific aortic stenosis in 67 consecutive patients over 80 years of age; the operative risk is assessed ant the results are compared with those of balloon valvuloplasty. The operative risk seems to be relatively low (6 deaths; 8.9%). All survivors were followed-up and evaluated. The long-term results show a big improvement in survival (78.2% at 3 years) and in functional class (96% of patients in Classes I and II of the NYHA Classification). By comparison, the results of balloon valvuloplasty were very mediocre and are now generally considered to be disappointing to such an extent that the indications of dilatation seem very limited and difficult to define.

Aged↗
PubMed1990

[Gastropericardial fistula. Review of the literature apropos of an original case].

The authors present a case of pneumopericarditis consecutive to a perforating gastric ulcer complicating a left, post-traumatic diaphragmatic hernia, evolving favorably after radical surgery. 52 cases of gastro-pericardial fistulas were reported in the literature, 42 of which related to benign pathology. The overall mortality rate for this disease was 85%, although the course was favorable in one patient out of two, whenever radical surgery had been resorted to. In order to ensure these patients the best chances for survival, treatment should combine pericardial drainage and case-adapted gastro-intestinal surgery in an intensive care setting.

Aged↗
PubMed1990

[Traumatic rupture of the aortic isthmus. Apropos of 31 surgically treated cases from 1976 to 1988].

The authors start by presenting a series of 31 traumatic ruptures of the thoracic aorta operated at the stage of fresh rupture between January 1976 and January 1988. These lesions were caused by sudden anteroposterior (29 cases), vertical (1 case) or lateral (1 case) deceleration. The diagnosis was most frequently suggested (by enlargement of the mediastinum in 84% of cases) and was confirmed by aortography which was readily indicated. The aortic lesion was circumferential, respecting the adventitia (122 cases) or partial (8 cases). Surgical treatment consisted of restoring the aortic continuity under partial cardiopulmonary by-pass by direct suture (7 cases) or by means of a prosthesis (23 cases). The hospital mortality was 10%; the 28 survivors were reviewed with a mean follow-up of 5 years. One patient died on the 45th day after the operation due to complications of an oesophagotracheal fistula. The functional result evaluated in the 27 survivors was excellent or good in 87% of cases and poor in 13% of cases. In the light of the literature, the authors then define the principal clinical and radiological signs, discuss the various ways of medullary protection during aortic clamping, discuss the chronology of the operations to be performed (gastro-intestinal, vascular, neurosurgical and orthopaedic).

Adolescent↗
PubMed1990

[Current operative risk in emergency coronary surgery. Experience of the last 5 years].

Technique of fibrinolysis and angioplasty have changed the face of emergency coronary artery surgery, which had developed considerably over recent years. Between 1982 and 1986, in the Department of Cardiovascular and Thoracic Surgery of the University Hospital of Rennes, 1,232 patients underwent isolated coronary artery revascularisation (with the exclusion of mechanical complications of infarction). 1,040 patients were operated electively and 192 patients underwent emergency surgery with very different results: mortality of 2.4% with elective surgery versus 12.5% with emergency surgery, divided into four subgroups: revascularisation after thrombolysis (gradually being replaced by angioplasty), by-pass surgery after a complication of angioplasty (or coronary angiography), by-pass surgery in threatened unresponsive infarction (now less common), by-pass surgery in the context of threatened extension of pre-existing myocardial infraction. The factors of mortality are analysed according to the circumstances (emergency, presence or absence of haemodynamic repercussions), clinical context (age, sex, previous infarction, myocardial function) and lastly the surgical possibilities (complete or incomplete revascularisation in vessels of variable quality ...). In relation to this last point, the authors stress the limitations of reasonable indications for emergency surgery, although surgery is readily proposed in deteriorating patients unresponsive to medical treatment, on vessels with a severely pathological disal bed and in myocardia with severely altered ventricular function.

Aged↗