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Biomedical subjects

M Carlier

Publications and source records attributed to M Carlier.

90 records · Page 5Linked to original sources
PubMed1982

Arterialization of the portal vein in conjunction with a therapeutic portacaval shunt. Hemodynamic investigations and results in 75 patients.

Seventy-five cirrhotic patients were submitted to peroperative hemodynamic investigations including flow and pressure studies. Sixty-two patients with hepatopedal portal flow underwent a therapeutic end-to-site portacaval shunt (PC) in conjunction with arterialization of the portal vein and 13 with a stagnant flow a PC shunt alone. Thirty-five patients were operated on in emergency and 40 electively. In 61 patients portal flow was correlated with maximum perfusion pressure (r=0.66), and in 33 patients with the reduction of corrected sinusoidal pressure induced by the occlusion of the portal vein (r=0.72). Operative mortality, which was 3.5% for 57 class A and B patients and 55.5% for 18 class C patients, differed significantly (p less than 0.05) in emergency between arterialized (14.8%) and nonarterialized patients (62.5%). At the time this study was ended on July 15, 1981, the follow-up was over two years for all the patients. The five-year actuarial survival rate of the arterialized patients was 48% for the whole group and 56% for class A and B patients; the overall incidence of chronic encephalopathy was 20%. It is concluded that arterialization is a safe surgical procedure that could be beneficial in respect with operative mortality in emergency, late survival, and tolerance to portacaval shunt. However, a prospective randomized study such as the one undertaken in December 1979 is the only method to prove clearly that arterialization is really able to minimize the risk of encephalopathy and to prolong the long-term survival after portacaval shunt.

Adult↗
PubMed1982

Maximal hydration during anesthesia increases pulmonary arterial pressures and improves early function of human renal transplants.

The recipient's hemodynamic condition during anesthesia for renal transplantation has a major influence on the early diuresis of the graft. The effect of maximal hydration during operation was studied in a series of 120 primary human cadaver kidney transplantations performed under peroperative monitoring of the pulmonary arterial pressures (PAPs). The PAPs levels before and at the time of clamp release were correlated with the frequency of postoperative acute tubular necrosis (ATN). The 120 patients were divided in two groups according to the PAPs levels before release of the vascular clamps: group 1 (22 patients) with a mean PAP (PAP) of less than or equal to 20 mm Hg and a diastolic PAP (DPAP) of less than or equal to 15 mm Hg was compared with group 2 (98 patients) with a PAP of greater than 20 mm Hg and a DPAP of greater than 15 mm Hg. Both groups were comparable with regard to the donor's data and the quantity of peroperative fluids. The frequency of ATN was 36% in group 1 versus only 6% in group 2. This difference is attributed to the different hemodynamic conditions in both groups: at the beginning of the transplant procedure, PAP, DPAP, and central venous pressure (CVP) were higher in group 2; at the time of clamp release, PAP, DPAP, CVP, and systolic blood pressure (SBP) were also higher in group 2. This study emphasizes the importance of the PAPs levels at the time of release of vascular clamps to avoid postoperative ATN of a kidney transplant.

Adult↗
PubMed1980

Spectral characterization of cytochrome P-450 of a strain of Candida tropicalis grown on tetradecane.

Several properties of the cytochrome P-450 induced in the yeast Candida tropicalis by growth on tetradecane have been studied by differential visible spectroscopy on microsomes. The spectral changes typical of this cytochrome have been obtained by subtraction of an unspecific spectral change, possibly due to the presence of other hemoproteins in microsomes, from the experimental difference spectra. Like the previously described cytochromes P-450 from yeast and mammalian liver, C. tropicalis cytochrome P-450 is in spin-state equilibrium at ambient temperature: about 30% of the originally low-spin cytochrome is converted to the high-spin state upon increasing the ionic strength of the medium, whereas 30% of the originally high-spin cytochrome is converted to the low-spin state upon addition of hydrophobic alcohols. C. tropicalis cytochrome P-450 readily binds nitrogenous ligands, isocyanides and phosphines in the ferric and ferrous state with spectral characteristics similar to those reported for other yeast or mammalian cytochromes P-450. It also reacts sucessively with cumylhydroperoxide and 1,3-benzodioxole to form a high-valent iron-oxo species and an iron-carbene metabolite complex. However it fails to produce any spectral or spin-state change upon addition of hydrophobic non-coordinating compounds such as n-tetradecane, its substrate in vivo.

Alkanes↗
PubMed1978

[Intelligence : individual differences, genetic factors, environmental factors and interaction between the genotype and the environment (author's transl)].

The authors undertook a review of published work on the sources of variation in individual differences in intelligence. They should : 1) that methods of quantitative genetics concerning intelligence are not applicable to human populations ; 2) that the results of studies on adoptions and on twins do not permit one to estimate the respective roles of environment and heredity ; 3) that this division of variance had no heuristic value in the study of human intelligence.

Animals↗
PubMed1977

[Upper gastrointestinal haemorrhage after venous bypass in cirrhotics (author's transl)].

In a series of 76 patients who had undergone venous bypass for upper gastrointestinal haemorrhage, the authors noted 13 recurrences of bleeding, six resulting in death directly or secondary to hepatic failure. Repeated rupture of esophageal varices after thrombosis of an anastomosis is well known but in one out of two cases a second bypass involving another part of the portal territory resulted in cure. The important problem remains that of the precise aetiological diagnosis of the haemorrhage, there often being a doubt between esophageal varices and haemorrhagic gastritis. In certain cases there is no good indication for a bypass, as indicated by the absence of further bleeding after certain anastomotic thromboses. Ulcers due to venous bypass are rare. Secondary medical or surgical treatment in patients with a patent anastomosis should be undertaken with caution, in particular in the case of splenectomy for residual hypersplenism.

Gastrointestinal Hemorrhage↗
PubMedDate not supplied

[Inferior mesenteric arteriovenous fistulas. Report of a case].

We report a case of postoperative inferior mesenteric arteriovenous fistula. Arteriovenous fistula represents a rare disease. Symptoms are due to portal hypertension and distal ischemy. Treatment of these fistulas is embolization. Surgery is possible by ligature or excision of the fistula because vascularisation is obtained by Riolan arcade and hypogastric artery.

Arteriovenous Fistula↗
PubMedDate not supplied

[Study of the relationships between self-injurious behavior and pain reactivity in infantile autism].

Autism can be considered as an early general developmental disorder, characterized by problems of social interaction, problems of verbal and non verbal communication, and behavioral or ideational stereotypes. However, within autism we observe a clinical heterogeneity of autistic disorders which suggests the possibility of autistic subtypes. Several authors hypothesize an analgesia among autistic children; this analgesia may be related to self-mutilation found among autistics. The current research had two objectives: 1) to develop and validate evaluation tools for measuring aggression directed towards the self (Yale-Paris Self-Injurious Behavior Scale: YAPA SIB) and pain reactivity (Pre-Linguistic Behavioral Pain Reactivity Scale: PLBPRS); instruments appropriate for autistics and capable of showing different behavioral sub-types; 2) to study in 80 autistic children pain reactivity, self-injurious behavior, and their relation in different observational situations. The results show that the scales of self-injurious behavior and pain reactivity have good discriminative capacity, good test-retest reliability, and good validity. The results suggest additionally that the apparent decreased pain reactivity observed in autistics does not derive from a real analgesia but from a different mode of pain expression related to difficulties with verbal communication, body representation and certain cognitive disorders (learning disorders, problems representing sensations and emotions, problems establishing cause-effect relationships). Additionally, there is a significant relationship between certain self-injurious behaviors and the apparent reduced pain reactivity. Interpretations of this result are presented and the possible role of stress in autism is discussed.

Autistic Disorder↗
PubMedDate not supplied

The paediatric liver transplantation program at the Université catholique de Louvain.

The Paediatric Liver Transplant Program at Saint-Luc University Clinics constitutes a substantial single centre experience, including 667 transplantations performed between March 1984 and April 2003, and the history of this program reflects the tremendous progress in this field since twenty years. Liver transplantation in children constitutes a considerable undertaking and its results depend on multiple, intermingled risk factors. An analysis of the respective impact of several surgical and immunological parameters on patient/graft outcome and allograft rejection after paediatric liver transplantation showed a significant learning curve effect as well as the respective impact of pre-transplant diagnosis on survival and of primary immunosuppression on the rejection incidence. The introduction of living related liver transplantation in 1993 not only permitted to provide access to liver replacement in as many as 74% more candidate recipients, but also resulted in better graft survival and reduced retransplantation rate. The results of a recent pilot study suggest that steroid avoidance is not harmful, and could even be beneficial for paediatric liver recipients, particularly regarding growth, and that combining tacrolimus with basiliximab (anti-CD25 chimeric monoclonal antibody) for steroid substitution appears to constitute a safe alternative in this context. The long-term issues represent the main future challenges in the field, including the possibility of a full rehabilitation through immunosuppression withdrawal and tolerance induction, the development of adolescence transplant medicine, and the risk of early atherogenesis in the adulthood.

Adolescent↗
PubMedDate not supplied

[Arterialization of the portal vein associated with a portocaval shunt: long-term results of a controlled prospective study].

In order to evaluate the benefit of arterialization of the portal vein in conjunction with a therapeutic end-to-side porto-caval shunt, we started in December 1979 a prospective randomized study, comparing these two techniques in Child class A and B cirrhotic patients with a hepatopetal portal flow of at least 100 ml per min. Sixty-four patients have been included in the study: 33 underwent a porto-caval shunt (NART) and 31 were arterialized (ART). The two groups of patients were similar as regards clinical and hemodynamic parameters. The operative mortality was lower after arterialization, considering the whole group (ART: 6.5%, NART: 12%) and high risk patients (Child class B: ART: 0%, NART: 22%--emergency operation: ART: 0%, NART: 17%) but the differences were not statistically significant. Postoperative ascites was more frequent in arterialized patients (ART: 45%, NART: 18%; p = 0.02), with an increased need for reoperation (ART: 26%, NART: 6%; p less than 0.05). The mean follow-up period is 56.9 +/- 28.1 months (SD) for the 58 surviving patients. The five-year actuarial survival rate is 68% for ART patients and 60.6% for NART patients (NS). In child B patients the five-year actuarial survival rate is 75% in ART patients and 22% in NART patients (p less than 0.05). Actuarial estimation of arterialization patency--proved by angioscan--is 38% at five years. There were no significant differences in the incidences of postoperative and long-term encephalopathy and liver function between the two groups. In conclusion, arterialization of the portal vein in conjunction with a therapeutic end-to-side porto-caval shunt improved survival in high risk patients (Child class B), did not increase operative mortality in Child A and B patients, was followed by a higher incidence of postoperative ascites and did not decrease the incidence of long-term encephalopathy.

Adult↗
PubMedDate not supplied

[Mediastinal parathyroid cyst].

Parathyroid cysts of the mediastinum are rare lesions. They are, in most cases, non functional and the symptoms are those of a mass compressing adjacent organs. The clinical characters and the pathogenesis of these cysts are discussed.

Aged↗