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J O Defraigne

Publications and source records attributed to J O Defraigne.

At least 37 records · Page 2Linked to original sources
PubMed1997

Advantages of inferior vena caval flow preservation in combined transplantation of the liver and heart.

Only a few cases of combined liver and heart transplantation have been reported in the literature, and no standard surgical procedure has yet been established. We report the successful transplantation of both liver and heart in a 28-year-old patient suffering from homozygous beta-thalassemia. We used Belghiti's technique of inferior vena caval flow preservation for liver transplantation, which avoids inferior vena cava occlusion by a side-to-side caval anastomosis. Applied to combined liver and heart transplantation, preservation of caval flow during liver transplantation may allow early discontinuation of cardiopulmonary bypass and, thus, minimize the general consequences of prolonged bypass.

Adult↗
PubMed1997

Successful controlled limb reperfusion after severe prolonged ischemia.

Controlled limb reperfusion was performed in two patients who were admitted for lower limb-threatening ischemia as a result of embolism. After embolectomy, the inflow blood was drained with a cannula and mixed with a crystalloid solution to obtain an hyperosmolar, hypocalcemic, alkalotic, and substrate-enriched (aspartate, glutamate) reperfusate. This reperfusate was reinjected with a roller pump for 30 minutes through two cannulas inserted in the profunda and superficial femoral arteries. Temperature, intraarterial pressures, and flow were closely controlled. No complications occurred, and complete recovery of motor and sensory functions were observed, with restoration of pedal pulses.

Aged↗
PubMed1997

Comparison between three- and four-element Windkessel models to characterize vascular properties of pulmonary circulation.

In 11 anaesthetised pigs the accuracy of the three-element (WK3) and the four-element (WK4) Windkessel models to describe hemodynamic properties of the pulmonary circulation was compared during six different experimental conditions increasing pulmonary arterial pressure: increase in left atrial pressure, increase in alveolar pressure, increase in pulmonary blood flow, endotoxin shock, mechanical obstruction of left pulmonary artery or histamine infusion. Our results showed that WK4 fitted better the data than did WK3 because values of 1-R2 decreased from 6 percent (WK3) to 1.4 percent (WK4) when WK4 was used (P < 0.0005). 1-R2 was an adequate marker of the accuracy of the linear regression used to solve equations of both models. Compliance values estimated by WK4 were decreased by 5% comparatively to WK3 (P = 0.008). However, this difference can be considered as not physiologically relevant. Values of characteristic resistance corresponding to R1 + (L/R2C) in WK4 and to R1 in WK3 were not different (P = 0.22). The relative changes in R1, R2, and C observed due to the different experimental conditions were comparable regardless of the model. In conclusion, the conversion of WK3 in WK4 by adding an inductance, whose physiological meaning is not clear, resulted in an increased statistical accuracy of the model, but did not seem to have relevant influence on parameters or their evolution during experimental conditions.

Animals↗
PubMed1997

Fatal mural endocarditis and cutaneous botryomycosis after heart transplantation.

Fatal mural endocarditis and botryomycosis occurred concurrently in a 62-year-old women 4 months after orthotopic heart transplantation. Subsequent to mild mitral regurgitation, infection developed on a left atrial thrombus and was complicated by cerebral embolization. Simultaneously, skin nodules manifested on both forearms. Histologic examination revealed typical aspects of early evolving botryomycosis with massive infiltration of the dermis and hypodermis by necrotic granulomas framed by grains of Gram-positive coccoid forms. Bacteria were decorated by a nonspecific polyclonal antibody to Mycobacterium bovis.

Endocarditis, Bacterial↗
PubMed1997

Ruptured aneurysm of the profunda femoral artery associated with polyaneurysmal disease.

A 73-year-old man was admitted for rupture of an atherosclerotic aneurysm of the profunda femoris artery associated to popliteal and bilateral axillary arteries aneurysms. The aneurysm of the profunda femoris artery was developed between the branches of the crural nerves. Considering the patency of the superficial femoral artery and of the leg arterie, and to avoid injury to the crural nerve, no reconstruction of the profunda femoris was attempted. The aneurysm was ligated proximally and buttress sutures were placed on the site of rupture to achieve thrombosis of the aneurysms. Most of the published cases of aneurysm of the profunda femoris artery are false aneurysms developed after various trauma. Atherosclerotic aneurysm of the profunda femoris artery is a rare lesion and rupture is exceptional.

Aged↗
PubMed1997

Successful management of acute aortic dissection in a heart transplant recipient.

A case of type III aortic dissection which occurred fourteen months after heart transplantation is presented. Medical therapy was instituted to achieve controlled hypotension. The evolution was favorable and the patient could be discharged after one month. Hypertension and increased ejection fraction after transplantation could have been predisposing factors via an increase of the shear stress in the aorta.

Aged↗
PubMed1997

Carotid chemodectomas. Experience with nine cases with reference to preoperative embolization and malignancy.

The medical records of nine patients (five female and four male, mean age 58 +/- 5 years) presenting with a carotid chemodectoma between 1983 and 1995 were reviewed. In two cases (22%) the diagnostic was not suspected at the time of initial presentation. The most common complaint was a swelling in the anterolateral region of the neck. One patient (11%) presented with a preoperative peripheral nerves deficits (vagus and hypoglossal palsies and Horner's syndrome). Two tumours were embolized preoperatively with polyvinyl alcohol particles. Complete surgical excision was possible in each patient and the plane of resection was adventitial. In three cases, early ligation of the external carotid artery facilitated the resection. In two patients, the vagus nerve was sacrificed because of tumour involvement. No operative mortality was observed and no vascular complication occurred. In addition to the patient with preoperative neurologic symptoms, three patients developed peripheral nerve deficits (vagus and hypoglossal nerves) postoperatively. Two of these deficits were transient. These peripheral neurologic complications were observed with the largest tumour sizes. Two cases were malignant (lymph nodes and bony metastases). These two patients received postoperative radiotherapy. The mean follow-up period 63 +/- 19 months. No patient developed local recurrence during the follow-up. Two patients died during the follow-up, one for condition unrelated to their disease and the second from metastatic dissemination. In conclusion, carotid chemodectomas may be safely resected. The best way to minimize the rate of complications is to operate them at an early stage of evolution.

Carotid Arteries↗
PubMed1997

Spinal ischaemia after surgery for abdominal infrarenal aortic aneurysm. Diagnosis with nuclear magnetic resonance.

A 76-year-old man underwent surgery for an infrarenal aortic aneurysm reaching 6 cm in maximal transverse diameter. The aorta was crossclamped below the level of the renal arteries. A tube graft was interposed and tend between the infrarenal aorta and the aortic bifurcation. Due to leakage on the suture line two consecutive episodes of crossclamping for a total duration of 40 min. were required. No hypotension was noted during or after the procedure. After operation, the patient complained of difficulties to move both legs and neurologic examination demonstrated paraparesis, with mild sensory deficit. Faecal and urinary incontinences were also noted and urodynamic testing demonstrated sphincterovesical palsy. Nuclear magnetic resonance imaging detected an ischaemic zone in the spinal cord at the level of T11. Faecal incontinence and motor deficit partially resolved but no bladder function recovery was observed. Spinal ischaemia is a rare complication after abdominal aortic surgery. Several risk factors have been suggested which include level and duration of the aortic crossclamping, possible interruption of the spinal cord blood supply via the greater medullary artery (the so-called artery of Adamkiewicz), presence of intra- or postoperative episodes of hypotension, atheromatous embolization, underlying occlusive arteriosclerosis of spinal arteries, and respect or not of the hypogastric circulation. In our case, the duration of the crossclamping and interruption of the blood flow in lumbar arteries probably supplying the distal spinal cord were likely contributive factors.

Aged↗
PubMed1997

[Lymphatic, hepatic and osseous metastasis of a carotid chemodectoma. Apropos of a case].

A case of malignant carotid body tumor with nodal, hepatic and bone metastases is reported. Carotid body chemodectomas are slow-growing tumors which invade local structures. These tumors are usually benign but can occasionally produce local and distant metastases. Development of metastatic localizations is the only formal proof of malignancy as histology cannot distinguish between benign and malignant chemodectomas. Bilateral carotid arteriography gives the diagnosis. Surgery is the basis of treatment and should be performed early in the course to limit operative complications. Radiotherapy can be given as adjuvant treatment.

Angiography↗