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Biomedical subjects

M Duruble

Publications and source records attributed to M Duruble.

28 records · Page 2Linked to original sources
PubMedDate not supplied

[Autotransfusion].

The risk of contracting certain disorders following a blood transfusion is currently becoming worrisome not only for physicians who are aware of this problem, but also for patients who, with increased media attention on AIDS, are more afraid of this potential risk than of the surgical or anesthetic risks. In fact, hepatitis constitute the major risk involved in homologous transfusion since some 60,000 cases are reported each year in France. Prevention of transmission of disease by blood transfusion is based on decreasing homologous transfusions and especially by saving blood. Indeed, when surgery is planned, units of the patient's blood can be obtained in the weeks prior to it to be used during the operation or the immediate follow-up period. In case of emergency surgery, blood is collected preoperatively making it possible to obtain hemodilution during surgery and an autotransfusion if necessary at the conclusion of the procedure. Finally, there are methods to recover blood at the actual site of the surgical procedure.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Hemodilution and pain].

The combination of the different chemical mediators likely to promote pain is often at the root of disturbances affecting both microcirculation and capillary permeability, as several studies have shown. These same disturbances are to be encountered in different types of illnesses in which pain dominates the clinical picture. Recent theoretical and experimental studies have also suggested that haemodilution might have beneficial effects on these rheological disorders. Three clinical observations (arteritis of the lower limbs, persistent post-phlebitic ulcer, myocardiac ischemia) demonstrate the therapeutic benefits of this technique, particularly regarding pain.

Aged↗
PubMedDate not supplied

[Simulation of transcapillary exchange of liquids].

The transcapillary exchanges of liquids between vascular and interstitial sections can be described with the help of a mathematical model describing variation in filtration, reabsorption, plasmatic flux and lymphatic flow in relation to the different active pressures, that is to say the arteriolar and venular pressures, the oncotic pressures of the proteins, and interstitial pressure. Also taking into account the modifications of the volemia in relation to blood loss and perfusions, modifications of the essential haemodynamic variables and diuresis, it is possible to reproduce various situations following the reduction in venous or lymphatic return, hypovolemia, and hypoproteinemia. The advantages in these simulations is demonstrated by the example of a blood depletion, compensated or otherwise, as follows: volemia, proteinemia, lymphatic flow. These simulations permit us to follow the sequence of events accompanying haemodilution, and to assess the qualities of a plasmatic substitute: oncotic strength, demi-vie, effect on the extravascular mobilisation of proteins. They also provide a reflexion tool permitting a better comprehension of transcapillary exchanges and the optimisation of strategies of vascular refill.

Body Fluids↗
PubMedDate not supplied

[Precautions to be taken from the anesthesiologic point of view during venous surgery in the obese].

Certain precautions must be taken in venous surgery on the obese patient, as obesity is always accompanied by a number of particular pathological manifestations: haemodynamic disorders (breakdown of the functioning of the left ventricle and hypovolemia), or respiratory disorders (reduction of residual functional capacity and of expiratory volume of the reserve). The posture of the patient on the operating table can also exacerbate the operative risk. Prior to the operation, respiratory functional exploration and gymnastics therefore play an important role. The anaesthetic has to take account of certain considerations. After the operation, the main risk is of respiratory deficiency.

Anesthesia↗
PubMedDate not supplied

[Hemodilution in persistent postphlebitic ulcers].

By definition, rebel post-phlebitic ulcers are very difficult to cure. However, it has recently been apparent that the classic treatments associated with permanent normovolemic haemodilution are more effective. Two research procedures have been implemented simultaneously to try and explain this beneficial effect of haemodilution, one based on an experimental study of isolated rabbit hearts, and the other on a theoretical model of the blood-flow at capillary level. These studies lead us to believe that a better distribution of tissular oxygenation might be one of the mechanisms responsible for the beneficial effect of permanent normovolemic haemodilution in treatment of rebel post-phlebitic ulcers.

Animals↗
PubMedDate not supplied

[Practical methods of long-term normovolemic hemodilution].

Permanent haemodilution aims at lowering the level of blood viscosity during several weeks by maintaining the haemotocrity at about 30-32 per cent. In surgery this is achieved at the end of the operation, before the patient comes to, by replacing the necessary quantities of blood, calculated using a table, by the equivalent quantity of a fluid gelatine solution. In non-surgery it is achieved in the same way but in several successive stages. Experience shows that when done in this way, haemodilution is easily practicable, rarely counter-indicated, and almost always well tolerated.

Blood Volume↗
PubMedDate not supplied

[Simulation of liquid transcapillary exchanges].

The exchange between capillaries and the interstitial spaces are analysed using Wiederhielm's technique, and programmed in Basic language. The physiological variants represented are the hydrostatic pressures: arteriolar, venular and interstitial, and the oncotic, plasmatic and interstitial pressures. This technique enables us to analyses the relations between filtration, reabsorption. Plasmatic protein leaks, and lymphatic flux. It also enables us to simulate oedema of venous obstruction or lymphatic oedema, or protein deficiency oedema.

Arterioles↗
PubMedDate not supplied

[Value of hemodilution in the prevention of post-operative thromboses].

The principal consequence of normovolaemic haemodilution is an increase in the venous return. We have studied the effects of two different levels of pre-operative haemodilution on the incidence of post-operative thromboembolic complications in 5 004 patients. We monitored pulse, arterial pressure, central venous pressure and diuresis. Losses of blood, water and electrolytes were made up by perfusions of Ringerlactate or solution of balanced Gelatin Fluid. Where significant haemorrhage occurred, these solutions were used alternately with transfusions. According to the level of the haematocrit on the day following operation, the patients undergoing major surgery (1 388 cases) were divided into 3 groups. Group A (307 cases) had a haematocrit less than or equal to 32 %, Group B (497 cases) had a haematocrit between 32 and 38 %, and Group C (control) (584 cases) had a haematocrit greater than or equal to 38 %. The percentages of complications in each group were as follows : Group A = 0 % - Group B = 0.2 % - Group C = 1.8 %. Our favourable clinical impression in regard to Group B was confirmed by a double blind study carried out with the clinicians concerned. We could not find any complication referable to the use of this method.

Animals↗