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Biomedical subjects

J L Michaud

Publications and source records attributed to J L Michaud.

At least 73 records · Page 4Linked to original sources
PubMed1985

[Acute renal failure after extracorporeal circulation with aortic counterpulsation in surgically treated patients].

In a series of 604 adults operated on for cardiac surgery with cardiopulmonary bypass (CPB), 21 (3.5%) underwent circulatory assistance by intra-aortic balloon pump (IABP); in 5 of them (24%), acute renal failure (ARF) was observed. ARF occurred in only 26 (4.4%) of the other patients who did not require IABP. Evolution of ARF and its factors were therefore investigated in those patients having received IABP. ARF was defined as serum blood urea nitrogen (BUN) greater than or equal to 16 mmol X 1(-1), urinary urea/BUN less than 10, creatinine clearance less than 40 ml X min-1 X 1.73 m-2. Some perioperative features were compared between patients with postoperative ARF and those without ARF. ARF occurred in the 5 patients with IABP during, or immediately after, weaning from IABP. ARF was more frequent in patients operated on for mechanical complications of myocardial infarction with a significant more severe haemodynamic status. They had significantly longer CPB and aortic clamping times. The prognosis depended on the cardiac failure and not on the ARF. In patients with mechanical complications of infarction, early IABP seemed to be the predominant preventive measure. Other therapeutic implications are suggested, particularly the use of dopamine (1 to 3 micrograms X kg-1 X min-1) because of its renal vasodilating action which can contribute to the maintenance of urinary flow.

Acute Kidney Injury↗
PubMed1985

[Arterial diseases of the lower limbs in subjects less than 40 years old. Nature and prognosis. Apropos of 41 surgically treated patients].

This study of 41 cases of young patients with obliterative arterial disease treated surgically, with follow-up for 6 and a half years, used the standard classification. Collection of the patients from a department of treatment falsified their true distribution. Atheroma was present in 90% of cases. Sixty eight per cent of patients were initially at stage II and 44% had a good long term result, essentially following the insertion of an aorto-bifemoral bypass. The mortality was 12%. The choice of surgical technique and ideal timing remain difficult to define. It would seem necessary to delay the date of the first operation for as long as possible, stressing the gravity of the first decision to operate.

Adult↗
PubMed1985

[Recurrent atelectasis disclosing a post-traumatic aneurysm of the thoracic aorta. Apropos of 2 cases].

The authors report 2 cases, in which recurrent and reversible atelectasis of the left lung was the only manifestation leading to a diagnosis of post-traumatic aneurysm of the thoracic aorta at an early stage (D + 5). Other classically described signs were absent. These 2 cases demonstrate the need to seek an aortic aneurysm following any severe trauma. They emphasize the importance of bronchial endoscopy in this type of trauma. They confirm the value of CAT scan investigation.

Adult↗
PubMed1984

Mitral valve replacement with St Jude Medical prosthesis. Incidence of thromboembolic events in 349 patients.

This study reports incidence of thromboembolic episodes in a series of 349 patients where the St. Jude Medical (SJM) valve was implanted in the mitral position (252 isolated mitral, 91 mitral and aortic, 4 triple valve and 2 mitral and tricuspid valve replacements). The mean follow up was 28 months (range 6 to 57 months) which represents 784 patient-years. Overall operative mortality was 15 patients (4.3%). There were no valve-related deaths. Late post-operative prosthetic thrombosis occurred in 3 poorly anticoagulated patients (0.4% patient-years). A further 4 patients had a thromboembolic episode (0.5% patient-years). The overall frequency of thromboembolic episodes was 0.9 events per 100 patient-years. Per- and post-operative anticoagulation methods are described. The frequency of thromboembolism was studied with respect to the performance of SJM valve analyzed by echocardiography regardless the positioning of the prosthesis in the mitral ring. Our experience indicates that the SJM valve offers an excellent alternative in the choice of mechanical valve.

Anticoagulants↗
PubMed1984

[Heart surgery with extracorporeal circulation in hemodialyzed patients with renal insufficiency].

The authors report 4 valvular replacements under cardiopulmonary bypass in chronic hemodialysis-dependent patients. The peri-operative management was the same in every case. The recent improvements of intensive care medicine amend this protocol. Considering the analysis of data from the literature and the results of our 4 valvular replacements these operations and coronary artery-bypass graft, can be scheduled with an acceptable risk in these patients. Because of the hemodynamic improvement secondary to the cardiac operation, which allows a better tolerance of hemodialysis, this surgery must not be delayed.

Adult↗
PubMed1983

[Resistant ventricular tachycardia caused by right ventricular dysplasia. A case of surgical recovery reported 6 years after intervention].

A 52 year old patient with no previous medical history had an attack of ventricular tachycardia, the configuration of which showed left sided delay. Electrical reduction was followed by multiple recurrences. There were ST-T wave changes over the right precordium on the basal ECG. The hydro-electrolytic equilibrium was normal. Coronary angiography and selective left ventricular cineangiography were also normal. Right angiocardiography showed an aneurysmal deformation of the pulmonary infundibulum. The recurrence of attacks over a two year period led to several hospital admissions, demonstrating the failure of antiarrhytmic therapy. The attacks became so frequent in the last three months that surgery was undertaken. Epicardial mapping showed delayed potentials over the pulmonary infundibulum and surgery consisted in resection of the abnormal infundibular zone. The macro- and microscopic pathological findings were of wall thinning and muscular degeneration with fibrosis and fatty infiltration. The authors discuss the relationship between right ventricular dysplasia and a localised form of Uhl's anomaly. Six years after surgery the patient has had no recurrence of the arrhythmia or shown signs of cardiac failure in the absence of any drug therapy.

Cardiomyopathies↗
PubMed1980

[Cardiac surgery under extracorporeal circulation in patients with chronic renal insufficiency. Apropos of 4 cases and review of the literature].

Four cases of cardiac valve replacement in patients with chronic renal failure are reported. The problem of surgery under cardiopulmonary bypass in these patients are discussed with respect to 36 other previously reported cases. Of this lot of 40 cases, 33 (82,5 p.100) underwent valve replacement (21 aortic, 9 mitral, 1 mitral and aortic, and 2 unspecified), 26 (79 p.100) for valvular lesions due to infective endocarditis. Coronary revascularisation was performed in 6 cases (15 p.100) and pericardectomy in 1 case. Operative mortality was within acceptable limits (4 deaths) ; the overall mortality was 10 cases. Valvular lesions due to endocarditis were the main cause of death (9 cases). A session of haemodialysis is performed 12 hours preoperatively. Post-operative care is directed to the control of the fluid balance, the neutralisation of metabolic acidosis with alkaline fluids (sodium lactate) and the correction of hyperkalaemia by kayexalate. In addition, dialysis is required between the 24 th post-operative hour and the 3 rd day. The main indications for cardiac surgery under cardiopulmonary bypass in patients with renal failure are valve replacement for infective endocarditis where the operative decision should be made early on, and aorto-coronary bypass grafting, the selection criteria for which should be very strict.

Adolescent↗
PubMed1978

[Myxoma of the right ventricle in monozygotic twins: surgical ablation].

Monozygotic twins aged 23 underwent surgery, at an interval of 4 months from each other, for a myxomatous tumour of the right ventricle which had been completely asymptomatic until then. The authors present the clinical, electrocardiographic and angiographic findings, together with details of the operation and of the histological findings. They recall how rare a site this is, and summarise some of the observations which have been made on familial myxomas.

Adult↗