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J P Dereume

Publications and source records attributed to J P Dereume.

At least 19 recordsLinked to original sources
PubMed2002

[The medico-surgical department of vascular disease].

The Department of Vascular Diseases can be defined as a multidisciplinary integrated clinical entity involving internists and surgeons interested in patient care, education and research in the field of arterial, venous and lymphatic diseases. Because of the increasing medical complexity with the proliferation of treatment options available, the combined expertise of specialists from different training background is required to provide the optimal patient management. The truly integrated entity with interactions on daily basis between internists and surgeons also provides opportunities for improvement in the training of fellows in vascular medicine. Basic and clinical research is focused on thrombosis and atherosclerosis. The main topics that have been developed include: the pathophysiology of thrombosis, atherogenesis and the diagnosis and treatment of venous thromboembolic disease. The successful development of our Department demonstrates that the combined expertise of internists and surgeons has resulted in marked improvement in the efficiency of patient management.

Belgium↗
PubMed2000

Early inflammatory response after elective abdominal aortic aneurysm repair: a comparison between endovascular procedure and conventional surgery.

OBJECTIVE: To determine the nature of and to compare the inflammatory responses induced by (1) endovascular and (2) conventional abdominal aortic aneurysm (AAA) repair. MATERIAL AND METHODS: Twelve consecutive patients undergoing elective infrarenal AAA repair were prospectively studied. Seven patients were selected for endovascular procedures (the EAAA group); five patients underwent open surgery (the OAAA group). Three control patients undergoing carotid thromboendarterectomy were also included. Serial peripheral venous blood samples were collected preoperatively, immediately after declamping or placement of the endograft, and at hours 1, 3, 6, 12, 24, 48, and 72. Acute phase response expression of peripheral T lymphocyte and monocyte activation markers and adhesion molecules (flow cytometry), soluble levels of cell adhesion molecules (enzyme-linked immunosorbent assay), cytokine (tumor necrosis factor alpha, interleukin-6, and interleukin-8) release (enzyme-linked immunosorbent assay), and liberation of complement products (nephelometry) were measured. RESULTS: Regarding acute phase response, the EAAA and OAAA groups showed significant increases in C-reactive protein (P <.001 and P =.001), body temperature (P =.035 and P =.048), and leukocyte count (P <.001 and P <.001). Similar time course patterns were observed with respect to body temperature (P =.372). Statistically significant different patterns were demonstrated for C-reactive protein (P =.032) and leukocyte count (P =.002). Regarding leukocyte activation, a significant upregulation of peripheral T lymphocyte CD38 expression was observed in the OAAA group only (P =.001). Analysis of markers such as CD69, CD40L, CD25, and CD54 revealed no perioperative fluctuations in any group. Regarding circulating cell adhesion molecules, the EAAA and OAAA groups displayed significant increases in soluble intercellular adhesion molecule-1 (P =.003 and P =.001); there was no intergroup difference (P =.193). All groups demonstrated high soluble von Willebrand factor levels (P =.018, P =. 007, and P =.027), there being no differences in the patterns (P =. 772). Otherwise, soluble vascular cell adhesion molecule-1, soluble E-selectin, and soluble P-selectin did not appear to vary in any group. Regarding cytokine release, although a tendency toward high tumor necrosis factor alpha and interleukin-8 levels was noticed in the EAAA group, global time course effects failed to reach statistical significance (P =.543 and P =.080). In contrast, interleukin-6 showed elevations in all groups (P =.058, P <.001, and P =.004). Time course patterns did not differ between the EAAA and OAAA groups (P =.840). Regarding complement activation, the C3d/C3 ratio disclosed significant postoperative elevations in the EAAA and OAAA groups (P =.013 and P =.009). This complement product release was reduced in the EAAA group (P <.001). CONCLUSIONS: The current study indicated that both endovascular and coventional AAA repair induced significant inflammatory responses. Our findings showed that there were no large differences between the procedures with respect to circulating cell adhesion molecule and cytokine release. Moreover, the endoluminal approach produced a limited response in terms of acute phase reaction, T lymphocyte activation, and complement product liberation. This might support the concept that endovascular AAA repair represents an attractive alternative to open surgery. Given the relatively small sample size, further larger studies are required for confirmation of our observations.

Aged↗
PubMed1999

Abdominal aortic coarctation with splanchnic arterial occlusion.

Abdominal aortic coarctation is found in only 2% of aortic coarctation and is usually manifested by renovascular hypertension. Splanchnic arterial occlusive lesions occur in 22% of these patients and are exceptionally symptomatic. We present a case report of a young patient with abdominal aortic coarctation causing hypertension and visceral angina. The aetiopathogeny and treatment are discussed.

Adult↗
PubMed1998

Occluding aortic endoluminal stent graft combined with extra-anatomic axillofemoral bypass as alternative management of abdominal aortic aneurysms for patients at high risk with complex anatomic features: a preliminary report.

PURPOSE: To describe an exclusion endoluminal technique for management of abdominal aortic aneurysms among high-risk patients with complex anatomic features. METHODS: From January 1995 to December 1996, among 143 patients with infrarenal abdominal aortic aneurysm treated by means of endograft placement, 9 (6.3%) had complex aortic or aortoiliac morphologic features. For these patients, the endograft was delivered through a femoral cutdown in an occluding aortoiliac configuration. The contralateral iliac artery was occluded with an iliac endograft. Axillofemoral bypass grafting was performed. Computed tomographic scans were obtained regularly. RESULTS: There was 1 postoperative death of severe arrhythmia. All aneurysms were found to be affected by thrombosis on immediately postoperative computed tomographic scans, except in 1 patient with a proximal leak, which was managed successfully with angiographic embolization. The mean follow-up time was 12 months. Aortic aneurysm diameter decreased from 2 mm at 6 months (2 patients) to 6 mm at 12 months (6 patients). All axillofemoral bypass grafts are patent. CONCLUSIONS: Placement of an occluding endograft associated with axillofemoral bypass grafting is a good alternative for patients at high risk with complex anatomic features. Longer-term follow-up study is needed to evaluate this endoluminal technique.

Aged↗
PubMed1998

Adventitial cystic disease of the popliteal artery communicating with the knee joint. A case report.

We describe the case of a patient with adventitial cystic disease of the popliteal artery in which a direct anatomic communication between the cysts and the nearby knee joint was demonstrated by magnetic resonance imaging and confirmed by surgery. This unusual observation could shed some light on the much debated question of the cause, the pathogenesis, and the management of the affection. Moreover, it emphasizes the importance and the role of magnetic resonance imaging in the diagnosis of adventitial cystic disease of the popliteal artery.

Adult↗
PubMed1998

[The role of season in the incidence of deep venous thrombosis].

INTRODUCTION: The question of the role of season as a predisposing factor for development of venous thromboembolic disease still remains a matter of debate. Actually, most reports described a higher incidence of thrombotic disorders in winter, while a recent study showed no seasonal variation in the incidence of deep vein thrombosis (DVT). These data led us to study the seasonal distribution of all outpatients with DVT admitted to our Department over a period of 14 years. METHODS: Retrospective review of the files of all outpatients with confirmed (venography or ultrasound) DVT of the legs admitted from Jan. 1st 1982 to Dec. 31st 1995 (n = 512; mean age 59.4 years; 49.4% women). RESULTS: DVT occurred in spring in 135 (26.4%), in summer in 104 (20.3%), in autumn in 142 (27.7%) and in winter in 131 (25.6%) patients. This distribution appears to be similar to an expected uniform distribution [chi 2(3) df = 6.48; p = 0.090 (NS)]. CONCLUSIONS: In our study, by investigating retrospectively 512 outpatients with confirmed DVT, no correlation was found between season and development of thrombosis, suggesting that cold seasons do not represent a predisposing factor for DVT. Further large prospective studies are needed in order to validate our data and to investigate the clinical implications and the precise role of the season in the risk of occurrence of venous thrombosis.

Adolescent↗
PubMed1997

Intravenous nicardipine in the treatment of postoperative arterial hypertension.

BACKGROUND: Calcium entry blockers are commonly used in the management of postoperative hypertension. The hemodynamic and blood gas effects of nicardipine, a dihydropyridine derivative available intravenously, were studied in patients after abdominal aortic surgery. METHODS: Sixteen patients (66 +/- 8 years) who developed arterial hypertension (mean arterial pressure, > 90 mmHg) after abdominal aortic aneurysm reconstruction were studied. Fourteen patients had already been treated with a sodium nitroprusside infusion, the doses of which were maintained constant (mean dose: 1.42 +/- 1.04 micrograms/kg/min). Hemodynamic and blood gas data were collected at baseline, 15 minutes, and 45 minutes after a slow bolus administration of 3 to 5 mg of nicardipine. RESULTS: After the nicardipine administration, mean arterial pressure decreased from 101 +/- 11 to 83 +/- 11 mmHg (p < 0.001), and the cardiac index acutely increased from 3.96 +/- 0.74 to 4.57 +/- 0.83 L/min/m2 (p < 0.05). Systemic vascular resistance significantly decreased. There were no significant changes in heart rate, stroke volume, cardiac filling pressures, pulmonary artery pressures, pulmonary vascular resistance, left ventricular stroke work, or right ventricular stroke work. One patient developed acute pulmonary edema, associated with a dramatic increase in cardiac filling pressures, and electrocardiographic signs of myocardial ischemia. Nicardipine administration was also associated with an acute reduction in Pao2 from 85.0 +/- 12.1 mmHg to 70.3 +/- 9.2 mmHg (p < 0.001), associated with an increase in venous admixture from 21.7% +/- 3.2% to 28.0% +/- 5.2% (p < 0.01). Oxygen delivery increased moderately and oxygen extraction decreased, but oxygen consumption was unchanged. CONCLUSION: This study confirms the excellent efficacy of nicardipine in the management of postoperative hypertension, but underlines the risk of poor cardiac tolerance in patients after major surgery. Although oxygen delivery to the cells is usually well preserved, nicardipine can also significantly after blood oxygenation by increasing ventilation/perfusion mismatch.

Aged↗
PubMed1997

Endovascular aortic stent-grafts: transcatheter embolization of persistent perigraft leaks.

PURPOSE: To assess efficacy of transcatheter embolization of peri prosthetic leaks from aortic stent-grafts MATERIALS AND METHODS: Eight patients with a long-standing (3-13 months) perigraft leak after stent-graft implantation underwent transcatheter embolization. Leakage was demonstrated at helical computed tomography (CT). Angiography was performed for evaluation of outflow vessels and transcatheter embolization. All patients underwent helical CT follow-up after the procedure and every 3 months. RESULTS: Embolization was successful in seven patients and resulted in aneurysmal sac thrombosis. A second procedure was necessary in one patient to complete occlusion of the aneurysm. No further aneurysmal growth was detected during 4-9 months follow-up. Right leg paresis was observed in one patient immediately after the procedure, but symptoms disappeared completely after 8 days. Another patient had a minor sensory deficit in the region of the right crural nerve. CONCLUSION: Transcatheter embolization of perigraft leaks appears to be an effective technique to achieve aneurysmal thrombosis.

Aged↗
PubMed1996

[Livedo vasculitis: report of a case].

Livedo vasculitis is an occlusive thrombotic hyalinizing vessel disease characterized by parietal hyalinization, endothelial proliferation, fibrin deposits and formation of thrombi within the superficial and deep dermal vessels. Diagnosis, essentially clinical, emphasizes the clinical and histopathological features of livedo vasculitis. We conducted an etiological investigation in our case, as required to diagnose idiopathic livedo vasculitis. Several therapies have been suggested with inconstant results and recurrence after withdrawal. In our case, treatment with recombinant tissue plasminogen activator was successful but was unable to prevent recurrence.

Adult↗
PubMed1996

[Treatment of abdominal aortic aneurysm by application of a Corvita endoprosthesis. Medium-term results of a feasibility study].

Despite improvements in surgical techniques, progress in anesthesia and hemodynamic control, the risk of fatal outcome in the standard surgical technique for aneurysms of the abdominal aorta remains at about 5 to 6% due to associated coronary and pulmonary lesions. Surgical access to the aneurysm may also be hindered in patients with a past history of multiple abdominal operations. In collaboration with the Corvita company, we developed a modular endoprosthesis for endoluminal treatment of AAA and report the results of a feasibility study.

Aortic Aneurysm, Abdominal↗
PubMed1994

[Long occlusion of the superficial femoral artery: revascularization by compliant prosthesis].

We believe that the use of prosthetic grafts is justified in the treatment of long occlusions of the superficial femoral artery. However the surgery should only be done in cases where patients are suffering from severe claudication and in cases of critical ischemia of the lower limbs. We report herein the mid-term results of an European multicentric prospective study of a new prosthesis which is compliant, ultraporous and made of polycarbonate. We found a patency similar to that obtained with PTFE grafts as reported in the literature. In these indications, the choice of prosthetic grafts allows for a better management of atherosclerosis arterial disease. Thus autologous saphenous veins are still available to treat coronary artery disease or femoro tibial occlusion which remain a frequent evolution in that type of patient.

Arterial Occlusive Diseases↗
PubMed1993

Femoropopliteal bypass with a compliant, composite polyurethane/Dacron graft: short-term results of a multicentre trial.

A new, compliant, highly porous, non-woven, polyurethane vascular prosthesis has been developed in an effort to improve on the performance of currently available prosthetic grafts for infrainguinal reconstruction. From April 1990 to August 1991, 57 femoropopliteal bypass grafts were implanted in 47 patients by surgeons at five university centres. In all instances, the saphenous vein was unavailable, unusable or reserved for use elsewhere. An empirical perioperative risk score for acute occlusion (0-20) was developed, based on such factors as severity of clinical ischaemia, quality of inflow and outflow, site of distal anastomosis and associated drug therapy. Primary cumulative patency was calculated according to standard life-table analysis. Poor inflow and a distal anastomosis below the knee were significant factors affecting graft patency (P = 0.001 and P = 0.001 respectively). Six-month cumulative patency for the 25 grafts with good inflow and above or mid-knee anastomoses (79%) was superior to the cumulative patency for all 57 grafts (59%). There was a significant improvement in patency rates between 'low' (22 grafts) and 'medium risk' (27 grafts) patients and 'high risk' (eight grafts) ones (risk scores 0-10 and 11-20 respectively) at a level of P = 0.001. There were two operative deaths (4%). Of the 19 postoperative occlusions, six occurred within 30 days and 18 within 6 months. These data indicate that the patency rates achieved with this new graft compare favourably with other available prosthetic grafts. In addition, the graft demonstrates superior handling characteristics and eliminates bleeding through suture holes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Vascular graft infection caused by Aspergillus species: case report and review of the literature.

We report an unusual case of vascular graft infection caused by Aspergillus fumigatus that began with a false aneurysm, major arterial emboli, and septic arthritis. Successful treatment included resection of the infected graft, restoration of circulation by extraanatomic bypass, and administration of amphotericin B and itraconazole, a new antifungal agent. Graft infection in the case reported herein most likely occurred during surgery and took place during an insidious outbreak of postoperative infection.

Aged↗
PubMed1992

Role of the captopril test in renovascular hypertension: a case report.

This article reports the case of a rapidly severe stenosis of the right renal artery, causing uncontrolled hypertension. After failure of a percutaneous transluminal renal angioplasty, which provoked the thrombosis of the vessel, a surgical revascularization was performed after +/- eighteen hours of renal ischemia. Blood pressure, blood urea nitrogen and serum creatinine returned to normal values. A dramatic improvement of the right renal function was attested at the hippuran scintigraphy after a dose test of captopril. The results of renographic studies obtained in this clinical case underline the role of the captopril radionuclide test in detection and follow-up after treatment of renovascular hypertension.

Aged↗
PubMed1990

[Surgery of severe ischemias and infections of the foot in the diabetic. (Role of arterial revascularization)].

From overall data on 54 diabetic patients, who, over a period of 7 years, underwent operations to save their feet from ischaemia (whether linked or not to infection), the authors study 31 cases of revascularization through arterial bridging in the diabetic's lower limbs. The lesions were identified by doppler examination followed by arteriography. Various types of bridging were undertaken: 24 femoro-popliteal bridges, including 16 super-articular and 8 sub-articular ones; and 7 femoro-distal bridges on the leg artery trunks. For the post operational period, only one amputation, resulting from precocious thrombosis in the graft, had been noted. All the patients had been followed up, and the authors remarked that, after an average lapse of 43 months, actuarial survival without amputation of the lower limb amounted to 94.97% after 7 years, and the level of actuarial permeability of the bridges amounted to 72.61% after the same period. The authors stress that revascularization indications should be the same for atheromatous diabetics as for non diabetics.

Aged↗