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Biomedical subjects

L Noyez

Publications and source records attributed to L Noyez.

54 records · Page 3Linked to original sources
PubMed1989

The use of the internal mammary artery for myocardial revascularisation in patients 70 years of age and older. Does it complicate the early post-operative period?

In the last years common agreement has been reached that the internal mammary artery (IMA) is the conduit of choice for elective myocardial revasculariation. This trend has been stimulated by the long-term patency of the IMA grafts and the better long-term survival. However, with the increase in life-expectancy, an increasing number of elderly patients is referred for coronary artery bypass grafting. In this patient population the long-term survival is generally limited, and therefore many surgeons do not use the IMA as graft. However, there is not only the better long-term survival but also a reduction in recurrence of angina, cardiac events, and need for reoperations associated with the IMA use. In this study the perioperative (peroperative and early postoperative) mortality and morbidity of coronary artery surgery with IMA use and without IMA use in patients aged 70 years and older is compared. Based on the early clinical results it is suggested that the use of an IMA graft does not influence the perioperative morbidity and mortality of coronary artery surgery in the patient over 70, who thus should not be denied the conduit of choice on such grounds.

Age Factors↗
PubMed1988

The Ionescu-Shiley pericardial valve: results in 473 patients.

From January 1, 1980, through December 31, 1985, 473 patients underwent valve replacement with an Ionescu-Shiley valve. Overall hospital mortality was 7.8%. Major associated procedures and preoperative New York Heart Association (NYHA) Classes IV and V influenced hospital mortality significantly. The mean follow-up was 2.6 +/- 1.3 years. Late mortality was 5.9%. Overall actuarial survival was 81% at 5 years. A chief cause of reoperation was cusp rupture of a mitral prosthesis in 5 patients (all after aortic and mitral valve replacement). The overall actuarial reoperation-free incidence was 93% at 5 years. Thromboembolic (TB) phenomena occurred at a linear incidence of 1.4 +/- 0.3% per patient-year or an actuarial thromboembolism-free incidence of 92% at 5 years. Univariate and multivariate analyses showed that postoperative NYHA Class, rhythm at follow-up, and anticoagulant therapy significantly influenced the incidence of TE phenomena.

Aged↗
PubMed1987

Comparison of quantification methods of 111In-labelled platelet deposition in peripheral bypass grafts.

The action of antithrombotic drugs can be evaluated by measuring the deposition of 111In-labelled platelets on peripheral bypass grafts several days after injection. This evaluation can be performed qualitatively (visual interpretation on the daily images) or quantitatively. Four different methods which calculate the ratio of platelet uptake with a reference region are compared: two methods use a gamma camera and two a detector. A blood sample or the region under the sternal angle are used as reference. The daily ratio of the counts, recorded by a gamma camera in a region of interest covering the graft, and the blood radioactivity interpolated from a platelet survival curve appears to be the most reliable method. The information of all the ratios can be combined in a single thrombogenicity index which reflects the daily rise of a linear or exponential regression versus time.

Aged↗
PubMedDate not supplied

Surgical repair of subacute left ventricular free wall rupture.

BACKGROUND: The natural course of subacute ventricular free wall rupture (FWR) as a complication of acute myocardial infarction (MI) is usually lethal. The aim of this study was to investigate the curability of this entity and to report on five patients successfully treated by rapid diagnosis, hemodynamic stabilization, and emergency surgical repair. METHODS: Five patients with subacute FWR of the left ventricle after previous MI were operated on. Infarctectomy with subsequent closure of the ruptured area was carried out in two patients with anterolateral infarction. Three other patients (two with posterior and one with lateral infarction) were treated by direct closure and the application of a patch. Furthermore, in two patients, concomitant myocardial revascularization was performed. RESULTS: All patients survived the procedure and were alive and well at long-term follow-up (mean 36.4 months). None of the patients suffered recurrent MI. CONCLUSIONS: Our experience and a review of the literature shows that prompt diagnosis and emergency surgical intervention may save the patient. Anterior rupture (with a moderate sized infarcted area) is best treated by infarctectomy and subsequent closure of the ventriculotomy with sutures buttressed with felt, whereas posterior rupture may be treated by direct closure and the application of an epicardial patch. Considering our results, we cannot conclude whether additional coronary artery bypass grafting is beneficial or not. Our suggestion is to perform additional myocardial revascularization only if indicated.

Aged↗
PubMedDate not supplied

Retrograde delivery of cardioplegia in aortic valve replacement.

Myocardial protection is the corner stone of cardiac surgery. In recent years there has been a renewed interest in the retrograde delivery of cardioplegia in coronary artery surgery and also in aortic valve replacement several reports have suggested the advantages of this technique. We describe our experience with retrograde cardioplegia in 25 patients undergoing aortic valve surgery, and discuss the advantages and limitations of this technique.

Adult↗
PubMedDate not supplied

Management of postcardiotomy cardiogenic shock with a new pulsatile ventricular assist device. Initial clinical results.

The authors began ventricular assist pumping as treatment for postcardiotomy cardiogenic shock in November 1988 with a new automated pulsatile support system, the ABIOMED BVS 5000 Bi-Ventricular Support System. Five patients (0.6% of total cardiac surgery patients) have been placed on support, four after coronary artery bypass grafting, and one after bypass grafting and mitral valve repair. All patients were refractory to pharmacologic and intraaortic balloon pump therapy. Three patients had left ventricular support and two had biventricular support. Four patients were successfully weaned, and three are long-term survivors. Duration of support ranged from 39 to 118 hours (mean, 89.4 hours). Resternotomy was performed in four patients: twice for hemostasis, once for tamponade, and once for inadequate left ventricular drainage. Three patients, two nonsurvivors and one survivor, had perioperative myocardial infarctions. No device related thromboembolic complications, hemolysis, or infection were experienced. Follow-up at more than 1 year demonstrated that all patients are in NYHA Class 1. Ventricular assist pumping with the ABIOMED BVS 5000 Bi-Ventricular Support System is an effective treatment for postcardiotomy cardiogenic shock.

Coronary Artery Bypass↗
PubMedDate not supplied

Perioperative morbidity and mortality of coronary artery surgery after the age of 70 years.

The aim of this study was to compare the actual perioperative (operative and hospital) morbidity and mortality of coronary bypass surgery in patients aged 70 years or older and patients aged 69 years of younger. From January 1987 to September 1988, 102 patients aged 70 years or older underwent isolated aortocoronary bypass surgery. They were compared with the younger patients operated in the same period. Preoperative, operative and postoperative data were analyzed. There was no significant difference between the mortality and morbidity of the two groups. Morbidity was evaluated according to several parameters, low cardiac output, prolonged ventilation, cerebrovascular accident, transient ischemic attacks, pulmonary problems, psychosis, renal failure, wound problems and reoperations. Because this is a limited experience it may be premature to conclude than older patients can be operated on as safely as their young counterparts, but this study shows that age is not in itself a risk factor.

Age Factors↗
PubMedDate not supplied

Value of indium-111-labeled leukocytes scintigraphy in patients after arterial reconstructive surgery.

The study was performed to evaluate the diagnostic value of Indium-111-leukocytes scintigraphy in arterial prosthetic infection. Scintigrams were performed in 19 patients in two groups. Group A consisted of 11 patients, where ten days after uncomplicated graft implantation, an Indium-111-scintigraphy was performed. Group B consisted of 8 patients, where we suspected an infected arterial graft. In group A we had one false-positive scan and in group B one false-negative scan. This gives an accuracy of 89%, a sensitivity of 87% and a specificity of 90%. These results indicate that Indium-111-leukocytes scintigraphy is a favourable test to detect a vascular graft infection.

Aorta↗
PubMedDate not supplied

[Abdominal aneurysms: long-term results].

437 patients who underwent surgery for abdominal aortic aneurysm have been studied. Of these, 206 patients (medium age 63 years) had elective surgery, 231 patients (medium age 73 years) had acute surgery. The five-year survival rate was 65% for the elective group and 40% for the acute group, but these percentages are influenced by the perioperative mortality. When the survival curves of the 198 survivors of elective surgery and the 153 survivors of acute surgery were compared with these of a demographically similar population, we noted lower survival probabilities than for the standard population in the elective group, whereas the patients who underwent emergency surgery have similar survival probabilities as the standard population. The influence of age is especially related to the perioperative period and arteriosclerosis is the most determining factor for long time survival.

Acute Disease↗
PubMedDate not supplied

[Infrarenal abdominal aneurysms. Course and their effect on perioperative mortality. A 23-year study].

The perioperative mortality rate in elective aneurysmectomy progressively declined to 2%; despite the fact that the percentage of patients with risk factors has increased. Important is that this perioperative mortality is not related to the age of the patients. In acute situations the perioperative mortality has increased to 30 à 50%. This can be explained by the increasing number of ruptured aneurysms and the influence of increasing age at the time of surgery. These results support the concept of elective resection of abdominal aortic aneurysms.

Aged↗
PubMedDate not supplied

[Inflammatory aneurysms].

Inflammatory aneurysms are not so frequent, etiology and pathogenesis are uncertain. Resection can be a problem because of the dense inflammatory fibrous reaction. Preoperative diagnosis may be possible with the aid of intravenous urography and CAT-scan. The treatment of choice is an aortic replacement followed by uni- or bilateral ureterolysis and omentoplasty to cover the entire vascular reconstruction and protect the ureters.

Aged↗
PubMedDate not supplied

[Thymectomy in myasthenia gravis].

Myasthenia gravis is an autoimmundisease characterized by muscle fatigability due to a reduction in available acetylcholinereceptors at neuromuscular junction. Although the role of the thymus in the pathophysiology remains obscure, the results of thymectomy are out of discussion. However, controversy continues concerning the indications for thymectomy. In a period of six years and a half, 24 patients underwent a thymectomy. 22 of the patients benefited from the procedure. Their was no relation with sex, age, and severity of the disease; but how sooner we operate, how greater the changes for a total remission. With this results we propose thymectomy as essential in the treatment of myasthenia gravis. We found no relationship between anatomopathological results and these of the thymectomy. But we can confirm that a reduction in the acetylcholine antibodies titer is not essential for clinical benefit.

Acetylcholine↗
PubMedDate not supplied

[Lung hernia or pneumocele. Literature study and case report].

Case-report of a "spontaneous" rupture of intercostale muscles between the 7th and 8th ribs on the right side is presented. The case was combined with a herniation of the lung in the defect of the thoracic wall. Surgical treatment consisted of closure of the defect utilizing tissues in the immediate vicinity. Review of frequency, signs and therapy of lunghernia in literature.

Adult↗