Search PubMed⌕ Search

Biomedical subjects

J M Cormier

Publications and source records attributed to J M Cormier.

At least 55 records · Page 3Linked to original sources
PubMed1993

[Congestive cardiac failure secondary to hepatico-portal arteriovenous fistula. Apropos of a case and review of the literature].

A 66 year old man with mild hypertension developed congestive cardiac failure of rapid onset associated with a continuous epigastric murmur suggesting an arteriovenous fistula. Doppler ultrasonography, computed tomography, magnetic resonance imaging and abdominal arteriography showed the fistula to arise from a large thrombosed aneurysm of the hepatic artery which had ruptured into the portal vein. Echocardiography and radionuclide angiography showed normal left ventricular systolic function. The patient underwent aneurysmorrhaphy and suture of the portal vein without any complications and the murmur and signs of cardiac failure disappeared. Histological examination showed the arterial lesion to be due to atherosclerosis. The authors underline the rarity of aneurysms of the hepatic artery and, above all, of their rupture into the portal system as there have only been 7 previously reported cases. Fistulae of the portal system are usually well tolerated, the commonest complication being portal hypertension. Cardiac failure is an exceptionally rare occurrence: it may be observed when the fistula develops suddenly and has a high flow rate, and in patients with abnormal myocardial function.

Aged↗
PubMed1993

[Fifty-three atherosclerotic carotid stenoses in an irradiated environment].

Fifty-three atheromatous carotid stenosis in a previously irradiated zone were operated upon between January 1983 and December 1991. A case control (retrospective) study confirmed the reality, even within the context of multiple artery atheromatous localizations, of an atypical profile suggestive of incrimination of the radiation: extension of the atheromatous lesions distally in the common carotid, proximally beyond the bulb. An isolated atheromatous lesion in the common carotid is very suggestive of postradiation atheroma, which also presents specific histologic features: peri-adventitial inflammation, adventitial and medial sclerosis. These changes are not accompanied by any particular neurologic clinical manifestations, but require frequent changes in surgical strategy: bypass rather than endarterectomy; the extent of the lesions decides whether the proximal implantation of the bypass is in the lower part of the common carotid or the subclavian. Radiotherapy adds to the difficulty of dissection and provokes a slight increase in morbidity, but the long term prognosis is analogous to that of usual atheromatous lesions with, however, the risk of atherosclerotic changes proximally.

Adult↗
PubMed1993

[General principles of medical care of the diabetic foot].

In diabetic patients the foot is the focal point of neurologic, arterial and infectious complications. Affections of the foot are generally synonymous with a diabetic trophic disorder: the risk of gangrene is 17 times greater in diabetics than in non diabetics. Trophic disorders can affect the functional prognosis when they lead to amputation with subsequent altered weight bearing. They can provoke worsening of a subjacent arteriopathy, until then partially or totally asymptomatic, when the excision wound lacks the hemodynamic capacity for healing because of the associated arteriopathy. They can also induce local, regional (cellulitis) or even general (septicemia) infectious complications. They have a major socio-economic effect, by the loss of quality of life, the inability to work, and the cost of hospital and general care they engender. Finally, they have to be experienced by the patient and the treating team as a failure since, in the majority of cases, they imply an insufficient a priori knowledge of the predisposing factors: arteriopathy of legs and neuropathy with loss of sensitivity depriving the patient of the pain alarm signal if cutaneous lesions develop, and a delay in the recognition of triggering factors represented by microtrauma caused by shoes, particularly burns, frostbite or infections.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacterial Infections↗
PubMed1993

[Treatment of diabetic arteriopathy. Importance of transluminal angioplasty].

Results are reported of a retrospective analysis of transluminal angioplasty (TLA) interventions in 20 diabetic patients, 16 men and 4 women, mean age 56 years (range 32 to 82 years), with 24 dilated lesions, 16 patients having insulin-dependent diabetes. In 12 cases the lesions were at the intermittent claudication stage, trophic lesions being present in 8 cases. Stenotic lesions were iliac (12 cases), superficial femoral (2 cases), popliteal (6 cases) and tibial (4 cases). One patient developed an acute occlusion following popliteal-anterior tibial recanalization, the only direct complication of the angioplasty. Angiography showed immediate satisfactory results in 22 of the 24 dilated lesions. Functional and hemodynamic improvement was a constant finding in patients with intermittent claudication, trophic lesions being healed in 4 cases (50%) the other patient showing either no change or requiring an unavoidable amputation (2 cases). These overall findings suggest that at the intermittent claudication stage no differences exist in the results of TLA when compared with a non diabetic population; inversely, in the presence of trophic disorders, the local conditions (distal bed, infection, gangrene) interfere considerably in the course of the dilatation. Transluminal angioplasty should therefore be carried out as early as possible in diabetics; arteriography should be performed as soon as even minimal claudication appears and, a fortiori, even at the onset of a trophic lesion.

Adult↗
PubMed1993

[Foot equipment of diabetic arteriopathy].

Surgical appliances have a place of choice in the care of the foot with trophic lesions in diabetics, after partial amputation and as a preventive measure when it is free from trophic disorders. The type of appliance will depend on the footwear and the possibility of wearing orthopedic soles, whatever the stage of the affection. For the foot free from trophic disorders the shoes should be wide fitting, in soft leather and of the seamless type. Made to measure shoes should be reserved for badly deformed feet. The soles should be molded in silicone or polyurethane to distribute weight bearing and to avoid it over zones at risk. Appliances for the foot with trophic lesions should allow the resumption of walking. If the lesions are too extensive an orthosis is performed or a specific type of slipper with molded soles is worn to avoid pressure on the wounds. After amputation of toes a silicone orthoplasty is used to fill the interdigital space to avoid deformity of the other toes. If a front of foot has been amputated a corrected silicone molded sole with false extremity is applied. For a back of foot amputation an orthoprosthesis is made, preferentially in silicone introductible in a regular high sided shoe. In order to fulfil its preventive or temporary role, the appliance should evolve with time and be followed up regularly with close collaboration between the diabetic specialist the podologist and the orthotist.

Amputation, Surgical↗
PubMed1992

[Femoro-distal revascularization for "critical" chronic atheromatous ischemia. 695 cases].

The results of the revascularizations carried out over a 10-year period for "critical" chronic ischaemia, using the femoropopliteal bypass technique, have been retrospectively analyzed. In all, 600 patients underwent femoro-distal revascularization in 644 limbs, and 695 bypasses were performed. The hospital mortality rate was 4.3 percent. Among these 695 bypasses, postoperative occlusion occurred in 16.5 percent of the cases, and major amputations were necessary in 9.8 percent. The probability of 5-year survival was 47 percent. The probabilities of bypass patency and limb salvage were 50 and 76 percent respectively. The failure of revascularization ending in amputation did not significantly increase the postoperative mortality rate (4.1 percent versus 4.6 percent), but the life expectancy of patients who were amputated was significantly lower than that of patients who were not (55 +/- 5 percent versus 63 +/- 3 percent at 3 years; P = 0.03). The factors predictive of successful bypass were examined; they included age, clinical stage, diabetes, bypass material, site of distal implantation, revascularization procedure and reoperation. Femoro-distal revascularization makes it possible to cope with the challenge of limb salvage, even when the receiving vessel is an artery of the foot.

Aged↗
PubMed1992

Renal revascularization in high-risk patients: the role of iliac renal bypass.

Between 1984 and 1989, 29 iliac renal artery bypasses were performed in 29 patients (mean age 67.8 years) with severe renovascular disease due to atheroma. The indication for renal artery reconstruction was hypertension in all patients, which was associated with kidney failure in 16 cases. In six cases, reconstruction was performed after failure or complications of percutaneous transluminal angioplasty. The bypass was constructed with polytetrafluoroethylene in 24 cases (83%) and vein graft in five cases (17%). There was no postoperative mortality. All bypasses were found to be patent on duplex scanning or digital subtraction arteriograms. One patient was lost to follow-up. Mean follow-up was 23.2 months. One patient died of acute kidney failure, probably related to occlusion of the bypass. Hypertension improved in 22 cases (79%), was cured in two cases (7%), and remained unchanged in four (14%). Renal function remained unchanged in six cases (40%) and improved in nine (60%). Iliac-to-renal artery bypass seems to be the surgical renal revascularization modality best adapted to high-risk patients or those who have severe atheroma. Additionally, this technique enables rapid treatment of failures or complications of percutaneous transluminal angioplasty of the renal artery.

Aged↗
PubMed1992

Acute colorectal ischemia after aortic surgery: pathophysiology and prognostic criteria.

Acute colorectal ischemia is a rare though potentially lethal complication of aortic surgery. We reviewed our recent experience with 16 cases in order to analyze its causative and prognostic factors. The incidence was 2.8%, and the inferior mesenteric artery was occluded in all cases. All patients also had severe occlusive disease of at least two of the hypogastric or deep femoral arteries. Hypoperfusion due to arterial ligation, prosthetic occlusion or embolism was responsible in half the cases. Ischemia and perfusion due to aortic cross-clamping or perioperative hemorrhage were involved in the rest of the cases. Postoperative mortality was 31%. The mortality was lower for partial, nontransmural necrosis, and for elective operations. Recurrent intestinal ischemia, transmural necrosis, surgery for ruptured aneurysm, intestinal hemorrhage and pulmonary edema were associated with a higher mortality rate. All patients with anuria or extrarenal epuration and hepatic cytolysis died. Although reconstruction of the inferior mesenteric artery might lessen the incidence of postoperative colonic ischemia due to hypoperfusion, the role of oxygen free radicals should be investigated in humans, in order to afford colonic protection against the consequences of ischemia-reperfusion.

Acute Disease↗
PubMed1992

Influence of surgery on in-vitro cytokine production by human monocytes.

Surgery leads to significant modulation of the immune system, in which cytokines play a major role. Circulating interleukin 6 (IL-6) and IL-1 have been reported following surgery whereas tumor necrosis factor alpha (TNF-alpha) is only found in gut ischemia-associated surgery. We have investigated the consequences of surgery on in-vitro cytokine production by human monocytes stimulated by lipopolysaccharide (LPS) and staphylococcal toxic shock syndrome toxin-1 (TSST-1). Comparisons were made between the responsiveness of cells obtained the day before (D-1), during (D0) and after (D1, D2, D3) surgery. Patients undergoing abdominal aortic surgery (N = 9), carotid surgery (N = 4) and spinal surgery (N = 4) have been studied. A significant decrease of TNF-alpha, IL-1 beta and IL-1 alpha production by monocytes prepared from blood samples taken during the surgery was noticed, whereas IL-6 production was not significantly modified. On D2 a significant increase of monocyte responsiveness was observed and levels of cytokine productions rose back to initial values by the end of the follow up. The diminished in-vitro cytokine production observed during surgery might be the consequence of the effects of anaesthetic drugs, whereas the enhancement observed on D2 might reflect the surgical stress, leading to in-vivo priming of circulating monocytes.

Aged↗
PubMed1992

Dissecting aneurysms of the main trunk of the superior mesenteric artery.

We treated four symptomatic patients who were admitted with a spontaneous and isolated dissecting aneurysm of the superior mesenteric artery. All four patients underwent operation. The superior mesenteric artery was repaired by means of either a bypass graft in two cases or an endoaneurysmorraphy in the latter two cases. Complete symptomatic relief with no postoperative complications was achieved in every case. The arterial repairs remained patent, and the patients remained free of symptoms, with follow-up ranging from 6 to 47 months. The available literature on this unusual lesion is reviewed.

Adult↗
PubMed1991

Atherosclerotic occlusive disease of the superior mesenteric artery: late results of reconstructive surgery.

Between 1975 and 1988, 103 patients underwent reconstruction of the superior mesenteric artery for atherosclerotic occlusive disease. Patients undergoing revascularization with associated mesenteric infarction were excluded. There were 89 men and 14 women whose mean age was 57.2 years. Six patients were operated on emergently for impending mesenteric infarction; six patients underwent revascularization after intestinal resection for ischemic lesions; 20 patients had typical abdominal angina; 39 patients had nonspecific abdominal symptoms, and 32 patients underwent revascularization of their superior mesenteric artery for asymptomatic lesions. Revascularization of the celiac axis and inferior mesenteric artery was associated in 36 and four cases, respectively. Four patients (4%) died postoperatively. Four early occlusions (4%) were observed. During the follow-up period (mean = 69 months), 18 patients died; five patients had recurrent intestinal ischemic symptoms, four of whom died. All surviving patients underwent follow-up duplex scanning, examination, and arterial or venous digitalized angiograms in selected cases. Nine patients (9%) had anatomical abnormalities: two stenoses and seven occlusions. Failure of revascularization of the superior mesenteric artery was observed in patients with severe initial intestinal ischemia. Late complications were not statistically significantly related to the different techniques of revascularization used.

Adult↗
PubMed1991

[Surgical results in stage 2 arterial diseases].

The results of surgical treatment of peripheral artery disease at the stage of intermittent claudication may now be assessed with a 40 year follow-up. In selected cases the 10 year patency rate of aortoiliac revascularisation is 90% and the 5 year patency rate of femoropopliteal revascularisation is 85%. When the indications are widened to include less favourable lesions giving rise to severe claudication, the patency rate falls to 60% at 5 years. These results should improve with better preoperative assessment by Doppler ultrasonography the use of new material and methods (endovascular) and stricter control of the revascularisation procedure by angioscopy in patients with severe effort ischaemia which is the principal surgical indication; the association of endovascular revascularisation procedures has increased the therapeutic indications and improved the functional result.

Blood Vessel Prosthesis↗
PubMed1990

Takayasu's disease: diagnostic and therapeutic value of subclavian artery biopsy.

Seventeen surgical biopsy specimens of the axillary or subclavian artery were obtained from patients who had inflammatory, nonatherosclerotic arterial lesions and were studied retrospectively. Initial roentgenologic clinical, and histologic findings were evaluated and compared with final diagnosis. Histological examination suggested Takayasu's disease in 11 patients whereas the roentgenologic and clinical signs led us to suspect Takayasu's disease in only eight instances. Takayasu's disease was confirmed in these eight cases later in the course of the disease. In six patients subclavian artery biopsy specimens showed lesions consistent with Horton's disease in contrast to roentgenologic and clinical signs which suggested Takayasu's disease. In five patients, the final diagnosis was Horton's disease and in one, the diagnosis remained unknown. Of 13 patients who had revascularization procedures, bypasses remained patent in patients followed from nine months to 16 years (mean: 68 months). Histopathologic criteria are more reliable than roentgenologic or clinical signs in the diagnosis of Takayasu's disease. The subclavian artery is frequently involved in Takayasu's disease and is a desirable site for retrieval of diagnostic specimen when a revascularization procedure is entertained.

Adult↗
PubMed1990

Pelvic arteriovenous fistulas: therapeutic strategy in five cases.

Pelvic arteriovenous fistulas are rare. They may be defined as arteriovenous communications developing in the pelvis from the internal iliac artery, the origin of its posterior trunk or branches of its anterior trunk. Congenital arteriovenous malformations, more common in women, and posttraumatic arteriovenous fistulas are the two main etiological forms. Diagnostic problems include appreciation of visceral extension in arteriovenous malformations and precise localization of fistulas especially when they affect the internal iliac artery itself. Therapy is aimed at complete closure of arteriovenous communications using interventional radiologic methods or surgery. Although indications are difficult to assess, complete, one-stage therapy is preferable due to surgical difficulties following failed or incomplete radiological or surgical attempts.

Adult↗