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Biomedical subjects

J Ninet

Publications and source records attributed to J Ninet.

At least 109 records · Page 6Linked to original sources
PubMed1994

Pulsatility improves hemodynamics during fetal bypass. Experimental comparative study of pulsatile versus steady flow.

BACKGROUND: The main advantage of pulsatile flow compared with steady flow during cardiopulmonary bypass is to prevent a rise in systemic vascular resistances. We hypothesized that pulsatile flow could overcome the progressive rise in peripheral and placental vascular resistances observed during fetal bypass and leading to progressive irreversible hypoxemia. METHODS AND RESULTS: A study was undertaken in 17 fetal lambs (110 to 140 days of gestation). Fetal bypass was established for a 30-minute period through right atrial and main pulmonary artery cannulation. The circuit had no oxygenator. Flow was delivered by a standard roller pump for the continuous study (group 1, n = 9) or by a centrifugal pulsatile pump for the pulsatile study (group 2, n = 8). Oxymetric and hemodynamic parameters, along with organ blood flow determined by radiolabeled microspheres counting, were recorded before (T1) and after 10 minutes (T2) and 30 minutes (T3) of bypass. SaO2 and PaO2 were significantly higher in group 2 than in group 1 at T2 but thereafter deteriorated similarly in both groups, whereas PCO2 remained unchanged. Pump flow in group 2 was significantly higher than in group 1 at T2 and T3 (957.6 +/- 49 and 1104 +/- 152 versus 437.6 +/- 23 and 467.8 +/- 43 mL/min, respectively). Systemic vascular resistances during pulsatile bypass were also significantly lower than in group 1 at T2 (402 +/- 12 versus 930 +/- 79 dynes/sec/cm-5) and T3 (374 +/- 60 versus 1017 +/- 192 dynes/sec/cm-5). At T2 and T3, all individual blood flows except the brain but including the placenta were statistically higher in group 2 than in group 1. Placental vascular resistances gradually increased during bypass in group 1 to reach 2.9 +/- 0.2 mm Hg.mL-1.min-1.kg-1 at T3 and remained approximately stable in group 2 during 30 minutes of pulsatile bypass, varying from 0.35 +/- 0.02 to 1.26 +/- 0.14 from T2 to T3 (P < .01). CONCLUSIONS: The data suggest that pulsatile flow for 30 minutes of bypass in a fetal lamb preparation temporarily prevents the progressive hypoxemia observed under steady-flow bypass. Pulsatile flow allows higher pump flow through a significant decrease in systemic vascular resistances. Individual organ blood flow, including placenta, was significantly higher under pulsatile bypass. With technical improvements in the design of pulsatile devices adapted to more physiological beat rates, pulsatility may become a valuable adjunct to overcome placental dysfunction observed during experimental fetal cardiac surgery.

Animals↗
PubMed1994

[Digestive arterial obstructive diseases in three young women].

The authors report three cases of severe intestinal ischaemia occurring in young women (age 29-44), all of them being smokers. In all cases, intestinal ischaemia was recognized lately and lead to death within two years. The occlusive arterial lesions concerned nearly exclusively the intestinal arteries. Microscopic lesions were heterogeneous and non-specific. In a case, an occlusive intimal fibrosis was noted; in another case, fibrosis of the media and the adventitia was observed; and in the last case, the lesions were suggestive of thromboangiitis obliterans. The authors advocate for the systematic recording of cases of intestinal ischaemia in young women, in order to identify the risk factors and pathogenic features of this rare condition.

Adult↗
PubMed1993

[Cytoplasm antibodies of polynuclear neutrophils in Wegener's granulomatosis and systemic vasculitis].

In retrospective and prospective studies the sera of 442 patients recruited from an Internal Medicine department were examined by acetone indirect immunofluorescence and immunoblot in search of anti-neutrophil cytoplasm antibodies (ANCA). Twenty-three patients had Wegener's granulomatosis, and 419 had various control diseases including connective tissue diseases, vasculitis and granulomatosis. The sera from 100 healthy blood donors were used as controls. Among the 23 patients with generalized (n = 15) or localized (n = 8) Wegener's granulomatosis (active in 21/23), the indirect immunofluorescence test was positive in 92 percent of those with the generalized form and in 62 percent of those with the localized form. Nine of the 13 sera examined by immunoblot (69 percent) were positive (31 +/- 57 kDa bands). On the other hand, the sera from 38 (6.9 percent) patients with control diseases were positive at immunofluorescence: vasculitis (14 cases, 50 percent), connective tissue diseases (4 cases, 14.3 percent) and miscellaneous diseases including 3 neoplasms (10 cases, 35.7 percent). Only 6 of these 28 sera showed a 1/100th titer of ANCA. The sera of all healthy controls were negative. The sensitivity of ANCA for Wegener's granulomatosis at all stages was 72.2 percent, and its specificity 94.4 percent. This study confirms the value of ANCA as third diagnostic criterion of Wegener's granulomatosis, after the clinical and histological criteria.

Adolescent↗
PubMed1993

Subcutaneous low-molecular-weight heparin compared with continuous intravenous unfractionated heparin in the treatment of proximal deep vein thrombosis.

BACKGROUND: A low-molecular-weight heparin, enoxaparin sodium, has been shown to be effective and safe in preventing deep vein thrombosis both in general surgery and in high-risk orthopedic surgery. We conducted a controlled, randomized trial with enoxaparin in the treatment of established deep vein thrombosis. METHODS: In a multicenter trial, we compared fixed-dose subcutaneous enoxaparin, given twice daily, with adjusted-dose intravenous unfractionated heparin (UFH) given by continuous intravenous infusion for the initial 10 days of treatment of patients with proximal vein thrombosis. The primary efficacy outcome was the change of the size of the thrombus assessed by repeated venograms between day 0 and day 10. The primary analysis of safety was based on the incidence of major bleeding during 10 days of treatment. RESULTS: There were 67 patients in each group. Venographic assessment of clot size evolution between day 0 and day 10 showed a statistically significant superiority (P < .002) of enoxaparin over the reference treatment with UFH. Moreover, the incidence of overall recurrent thromboembolic events during 10 days of treatment was significantly higher (P < .002) in the UFH group (seven of 67) than in the enoxaparin group (one of 67). There were no serious bleeding complications in either group. CONCLUSIONS: Enoxaparin is at least as effective and safe as UFH under the conditions of this study. Moreover, it is more comfortable for patients and less time-consuming for nurses and laboratories. Thus, our study confirmed, with the use of enoxaparin, other observations that low-molecular-weight heparin provides a real therapeutic advance in the treatment of deep vein thrombosis.

Acute Disease↗
PubMed1993

[Systemic mastocytosis: incidence and risks of vasomotor seizures].

We report on 9 cases of systemic mastocytosis which underline the frequency and the potential severity of this disease. All patients had intercritical signs (usually urticaria). Seven patients had also typical crises with flush and vascular collapses are observed together, doctors should measure histamine blood level and perform correct biopsy.

Histamine Release↗
PubMed1993

Primary cardiogenic shock during acute myocardial infarction: results of emergency cardiac transplantation.

Fifteen patients with acute myocardial infarction and cardiogenic shock underwent emergency cardiac transplantation after medical treatment failed to improve their haemodynamic status. Their mean age was 49 +/- 7 years. The infarction was anterior in 12 cases, inferoposterior in two cases, and septal in one. Shock occurred within 3 days after the onset of chest pain in nine patients, and during the first day in six of them. Mechanical circulatory assistance was used in six patients as a bridge to transplantation when their haemodynamic status could not be stabilized pharmacologically. Orthotopic cardiac transplantation was performed an average of 15.6 +/- 14 days after onset of infarction. Three patients died during the early post-operative period. Another died 7 months after transplantation. During the mean follow-up period of 30.6 +/- 20.3 months, there were three acute rejections, all successfully treated, and one chronic rejection. The survival rate for this series is 70%. Thus, emergency cardiac transplantation may be the best option for selected patients with acute myocardial infarction and cardiogenic shock refractory to conventional therapy.

Adult↗
PubMed1993

Extracorporeal repair of primary renal artery dissection.

Four cases of isolated dissection of the renal artery were diagnosed and treated in our institution. In 2 cases, angiography showed dissection of the left renal artery with involvement of peripheral branches; in 1 case, the dissection involved the right renal artery with complete occlusion of an upper-pole branch and upper-pole infarction, and 1 patient presented a bilateral dissection, limited to the main trunk on the right side and involving prepelvic and retropelvic branches on the left side. Surgical treatment consisted in renal autotransplantation in the iliac fossa after extracorporeal reconstruction of the arterial pedicle. The results were encouraging with normalization of blood pressure and improvement of renal function in all cases.

Aortic Dissection↗
PubMed1993

[Thymoma and primary Gougerot-Sjögren syndrome progressing to severe bronchiolitis].

The authors report a case of a thymoma associated with Gougerot-Sjögren's syndrome in a patient aged 40 years. The excision of the thymic tumour and complementary radiotherapy lead to a remission in the patient. There was an unfavourable progression of this syndrome from a respiratory stand-point with the development of a predominantly bronchiolitic picture over four years.

Adult↗
PubMed1993

[Pre- and postoperative right cardiac insufficiency in patients with mitral or mitral-aortic valve diseases].

The prognosis of right ventricular failure in patients with mitral valve disease would seem to depend on its chronicity and progression according to the results of a study of 382 cases of mitral valve disease: 231 women, 151 men: average age 55 +/- 13 years, operated between January 1983 and December 1986, most (321) for mitral valve replacement, one third (108) with associated aortic valve replacement. Right ventricular failure was or had been present before surgery in 161 patients: the peri-operative mortality was 11.2% and the secondary mortality 21.7% in these cases, significantly higher than in patients without RVF (respectively 5.0%, p = 0.02, and 8.1%, p < 0.0005). The RVF was present in the immediate post-operative phase in 43 patients, 8 of whom had no signs of this complication beforehand. The cause of this "de novo" early RVF is multifactorial. Ten other patients developed secondary RVF without any obvious cause in 3 cases. The prognosis of "de novo" RVF is very poor (28% survivors at 75 months). At the end of 60.4 +/- 13.6 months 20 patients were lost to follow-up, RVF was present in 60/286 patients followed up. The mortality was high in the patients with residual RVF (38.3% vs 4.0% in patients without: p < 0.0001). This study confirms the poor prognosis of RVF in patients with mitral valve disease whatever the timing with respect to surgery. Right ventricular failure occurring for the first time after surgery is rare (4.7% of cases), of uncertain cause, and carries a particularly poor prognosis.

Actuarial Analysis↗
PubMed1993

[Clinical study of 12 cases of malignant non-Hodgkin's lymphoma of the orbital region].

Over an 8-year period in the Departments of Hematology, Ophthalmology and Internal Medicine of our hospital, 12 cases of orbital and adnexal malignant non-Hodgkin's lymphoma were reported. Diagnostic elements varied, including local tumefaction, watering eyes, uveitis, and unexplained, long-term fever. Nine patients had primary paraocular lymphomas involving either orbital structures, the lacrimal gland or the eyeball, but after appropriate staging, the disease was found to be disseminated in 5; the 3 other cases were secondary orbital lymphomas. Intermediate or high grade histological types were predominant (9 patients) in our series. Radiation therapy, alone or combined (5 patients) with chemotherapy, was administered in 8 cases; other treatments consisted of chemotherapy (2 cases) or steroids (2 cases). Evolution was poor, with only 4 patients surviving at 34-180 months of follow-up. The main prognostic factors were tumor stage and histological grade. The clinical characteristics of this group are compared to those reported in the literature.

Adult↗
PubMed1992

Double-blind, randomized comparison of systemic continuous infusion of 0.25 versus 0.50 mg/kg/24 h of alteplase over 3 to 7 days for treatment of deep venous thrombosis in heparinized patients: results of the European Thrombolysis with rt-PA in Venous Thrombosis (ETTT) trial.

Thirty-two patients with acute, proximal-vein thrombosis were treated with heparin and alteplase (0.25 versus 0.5 mg/kg/24 h during 3-7 days) in a randomized, double-blind, multicenter, European (ETTT) trial. The treatment resulted in a decrease of the venographic Marder's score from 18 (6-25) to 13 (2-24) units (median, range) in Group I (0.25 mg/kg/24 h, n = 15, median decrease 3.0, p = 0.32) and from 17.5 (3-33) to 15.5 (0-27) in Group II (0.5 mg/kg/24 h, n = 16, median decrease 4.0, p = 0.23). Comparison of the sequential venograms could be performed in 14 cases of Group I and in 15 cases in Group II. A minority of patients showed substantial partial recanalization of the initially obstructed veins on the control venogram (one in each treatment group) and most of the control venograms showed either thrombus size reductions (5 in Group I, 7 in Group II) or no change or even deterioration (8 in Group I, 7 in Group II). Major bleedings were observed in 7 patients (7/32, 22%), 5 of them occurring in Group II (5/17, 29%). Thus, the results of the ETTT trial show that the used low dosages of alteplase administered intravenously over 3-7 days in heparinized patients cannot be recommended as a treatment for patients with deep venous thrombosis of lower limbs and/or pelvis. Further studies are needed to define a more suitable dosage regimen of alteplase in this indication.

Adolescent↗