Search PubMed⌕ Search

Biomedical subjects

M Meurisse

Publications and source records attributed to M Meurisse.

At least 73 records · Page 4Linked to original sources
PubMed1999

Bilateral neck exploration under hypnosedation: a new standard of care in primary hyperparathyroidism?

OBJECTIVE: The authors review their experience with initial bilateral neck exploration under local anesthesia and hypnosedation for primary hyperparathyroidism. Efficacy, safety, and cost effectiveness of this new approach are examined. BACKGROUND: Standard bilateral parathyroid exploration under general anesthesia is associated with significant risk, especially in an elderly population. Image-guided unilateral approaches, although theoretically less invasive, expose patients to the potential risk of missing multiple adenomas or asymmetric hyperplasia. Initial bilateral neck exploration under hypnosedation may maximize the strengths of both approaches while minimizing their weaknesses. METHODS: In a consecutive series of 121 initial cervicotomies for primary hyperparathyroidism performed between 1995 and 1997, 31 patients were selected on the basis of their own request to undergo a conventional bilateral neck exploration under local anesthesia and hypnosedation. Neither preoperative testing of hypnotic susceptibility nor expensive localization studies were done. A hypnotic state (immobility, subjective well-being, and increased pain thresholds) was induced within 10 minutes; restoration of a fully conscious state was obtained within several seconds. Patient comfort and quiet surgical conditions were ensured by local anesthesia of the collar incision and minimal intravenous sedation titrated throughout surgery. Both peri- and postoperative records were examined to assess the safety and efficacy of this new approach. RESULTS: No conversion to general anesthesia was needed. No complications were observed. All the patients were cured with a mean follow-up of 18 +/- 12 months. Mean operating time was <1 hour. Four glands were identified in 84% of cases, three glands in 9.7%. Adenomas were found in 26 cases; among these, 6 were ectopic. Hyperplasia, requiring subtotal parathyroidectomy and transcervical thymectomy, was found in five cases (16.1%), all of which had gone undetected by localization studies when requested by the referring physicians. Concomitant thyroid lobectomy was performed in four cases. Patient comfort and recovery and surgical conditions were evaluated on visual analog scales as excellent. Postoperative analgesic consumption was minimal. Mean length of hospital stay was 1.5 +/- 0.5 days. CONCLUSIONS: Initial bilateral neck exploration for primary hyperparathyroidism can be performed safely, efficiently, and cost-effectively under hypnosedation, which may therefore be proposed as a new standard of care.

Adult↗
PubMed1999

Hypnosedation: a valuable alternative to traditional anaesthetic techniques.

Hypnosis has become routine practice in our plastic and endocrine surgery services. Revivication of pleasant life experiences has served as the hypnotic substratum in a series of over 1650 patients since 1992. In retrospective studies, followed by randomised prospective studies, we have confirmed the usefulness of hypnosedation (hypnosis in combination with conscious IV sedation) and local anaesthesia as a valuable alternative to traditional anaesthetic techniques. The credibility of hypnotic techniques and their acceptance by the scientific community will depend on independently-confirmed and reproducible criteria of assessing the hypnotic state. Based on the clinical success of this technique, we were interested in confirming this phenomenon in healthy volunteers. The revivication of pleasant life experiences thus served as the cornerstone of a basic research program developed to objectify the neurophysiological attributes of the hypnotic state. We compared hypnosis to normal alertness with similar thought content. In our experience, the activation profile obtained during the hypnotic state was completely different from simple re-memoration of the same subject matter during normal alertness. This represents an objective and independent criteria by which to assess the hypnotic state.

Anesthesia, Local↗
PubMed1999

Hypnosis with conscious sedation instead of general anaesthesia? Applications in cervical endocrine surgery.

Between April 1994 and June 1997, 197 thyroidectomies and 21 cervical explorations for hyperparathyroidism were performed under hypnosedation (HYP) and compared to the operative data and postoperative courses of a closely-matched population (n = 121) of patients operated on under general anaesthesia (GA). Conversion from hypnosis to GA was needed in two cases (1%). All surgeons reported better operating conditions for cervicotomy using HYP. All patients having HYP reported a very pleasant experience and had significantly less postoperative pain while analgesic use was significantly reduced in this group. Hospital stay was also significantly shorter, providing a substantial reduction of the medical care costs. The postoperative convalescence was significantly improved after HYP and full return to social or professional activity was significantly shortened. We conclude that HYP is a very efficient technique providing physiological, psychological and economic benefits to the patient.

Acetaminophen↗
PubMed1999

Laparoscopic live donor nephrectomy: initial experience.

Transplanting a kidney graft harvested from a live donor has been proposed and used to shorten the waiting time of kidney transplant candidates and to increase the graft pool. Live donor renal transplants have demonstrated better results in term of graft survival rates, compared to renal transplants harvested from brain dead donor. Recently, laparoscopic live donor nephrectomy has been introduced to reduce the live procurement morbidity. This lower morbidity may result in increased acceptance of the donor operation. We initiated a program of laparoscopic live donor nephrectomy in January 1997 and up until June 1998, three cases were successfully performed in our department. The purpose of this paper was to report the first case of this program and its first year of follow-up.

Adolescent↗
PubMed1999

[Thyroid and parathyroid surgery under hypnosis: from fiction to clinical application].

Since 1992, we have used hypnosis routinely in more than 1400 procedures in plastic surgery. Our clinical success and experience with this technique led us to test wether hypnosis using active patient collaboration, could be used as an effective adjunct to conscious intravenous sedation ("hypnosedation", (HS)) for endocrine surgery, as an alternative to general anaesthesia. On a total of 1905 cervical endocrine surgical procedures performed between 1995 and 1998, 296 thyroidectomies and 33 cervical explorations for hyperparathyroidism were conducted under HS. Conversion to GA was needed in three cases (0.9%). All patients having HS reported a very pleasant experience and had significantly less postoperative pain while analgesic use was significantly reduced in this group. Hospital stay was also significantly shorter, providing a substantial reduction of the costs of medical care. The postoperative convalescence was significantly improved after HS and full return to social or professional activity was significantly shortened. We conclude that HS is a very efficient technique that provide physiological, psychological and economic benefits to the patient.

Alfentanil↗
PubMed1998

Creation of the "thymoheart" allograft: implantation of autologous thymus into the heart prior to procurement.

BACKGROUND: A state of tolerance may be more easily achieved if fully vascularized and functional donor thymus is transferred to the recipient at the time of whole organ transplantation. METHODS: A composite "thymoheart" allograft was created by implanting autologous thymus into a donor heart 60-90 days before organ procurement. Successful intracardiac engraftment of autologous thymus was documented by histology and by flow cytometric analysis. RESULTS: Histology of the thymic autografts at explantation revealed viable thymus with preservation of normal thymic architecture. Cells retrieved from thymic autografts 60 days after implantation exhibited the same MHC class I and class II staining profiles by flow cytometry as cells taken from the residual native thymus. CONCLUSION: We have created a novel composite organ that confers vascularized and functional donor thymus to heart allograft recipients at the time of transplantation without affecting cardiac function.

Animals↗
PubMed1998

Comparative effects of University of Wisconsin and Euro-Collins solutions on pulmonary mitochondrial function after ischemia and reperfusion.

BACKGROUND: The aim of this study was to compare the effects of Euro-Collins and University of Wisconsin solutions on pulmonary mitochondrial function after cold ischemia and subsequent warm reperfusion. METHODS: Seventeen pigs underwent lung harvesting after classical lung flush with either University of Wisconsin or Euro-Collins solutions. The mitochondria were isolated from fresh swine lungs, from swine lungs subjected to 24 hr of cold ischemia, and from swine lungs subjected to 24 hr of ischemia followed by 30 min of subsequent ex vivo reperfusion at 37 degrees C with Krebs-Henseleit buffer solution and air ventilation. Mitochondrial oxidative phosphorylation parameters were determined in isolated mitochondria by in vitro measurement of oxygen consumption rates. During reperfusion, the lung function was assessed by the pulmonary aerodynamic parameters and the pulmonary vascular resistance. RESULTS: Relative to controls, mitochondria submitted to cold ischemia showed an alteration in the oxidoreductase activities of the respiratory chain. However, the yield of oxidative phosphorylation was conserved. After reperfusion, pulmonary mitochondria underwent a significant worsening in the oxidoreductase activities of the respiratory chain, and a decrease in the respiratory control and the efficiency of oxidative phosphorylation. Meanwhile, the reperfused lungs showed evidence of early dysfunction, assessed by the aerodynamic parameters and pulmonary vascular resistance. In this model, there was no advantage of University of Wisconsin solution over Euro-Collins solution. CONCLUSIONS: The mild mitochondrial alterations after cold ischemia were not sufficient to explain the limited tolerance of lung to ischemia. After reperfusion, the mitochondrial damage was more severe and could be involved in the posttransplant lung dysfunction.

Adenosine↗
PubMed1998

Surgical management of amiodarone-associated thyrotoxicosis: too risky or too effective?

Amiodarone-associated thyrotoxicosis, often clinically mild and resolutive after amiodarone discontinuation or under medical therapy, is sometimes drug unresponsive and not uncommonly follows a dramatic, even fatal course. Therefore, we considered a surgical solution in 15 severely amiodarone-associated thyrotoxic patients. Twelve men and three women (mean age 68 years, range 50-84 years) underwent radical thyroidectomy for clinical and biologically proved amiodarone-associated thyrotoxicosis. In six surgery was the first-line therapeutic option. In the other nine thyroidectomy seemed unavoidable considering the unresponsiveness to medical therapy and rapid deterioration of the patients' clinical condition, with life-threatening cardiac failure in three. In every patient surgery was conducted without immediate or delayed complications. Total thyroidectomy proved uniformly, definitively, and rapidly effective in controlling thyrotoxicosis in all patients, with a spectacular reversal of cardiac failure in the three most critical cases. Surgery was beneficial to our 15 patients and undoubtedly life-saving in the three most worrying cases. These results suggest that thyroidectomy should be more liberally regarded as an interesting alternative to conventional, but unpredictably effective, medical therapies.

Aged↗
PubMed1998

[The current status of organ transplantation: the role of xenotransplantation?].

In the last few years, transplantation was an area of intense research activity. However, there is a worldwide shortage of donor organs for clinical transplantations. Currently, interest in xenotransplantation research is growing not only because of the increased demand for organs but also because of advances in molecular biology techniques that make possible the genetic or immunological manipulations of the animal donor rather than the human recipient. The better definitions of the mechanisms responsible for xenograft rejection should facilitate appropriate therapeutic strategies for long xenograft survival.

Animals↗
PubMed1998

[Is laparoscopic resection of a malignant corticoadrenaloma feasible? Case report of early, diffuse and massive peritoneal recurrence after attempted laparoscopic resection].

As surgeons wholeheartedly and intensely supporting (and deeply involved in) laparoscopic adrenal surgery, we think that laparoscopic resection of benign adrenal tumors is about to make conventional laparotomy obsolete. However, considering the many reported cases of tumor seeding after laparoscopy, we consider that proven or suspected adrenal cancer remains an absolute contra-indication for laparoscopy. It is precisely for this reason that we feel duty-bound to report the tragic and life-threatening case of a 25-year-old woman operated for malignant adrenal cancer and suffering from diffuse and massive peritoneal carcinomatosis diagnosed at the sixth postoperative month. A complete macroscopic debulking was carried out with removal of all visible tumor nodules followed by immediate intraperitoneal cisplatinum chemotherapy and six postoperative courses of systemic cisplatinum, etoposide and mitotane chemotherapy. This combined and aggressive therapy induced remission that perhaps could have been initially obtained with a more critical and proper surgical operation. We hope this paper will contribute in the future to avoiding similar catastrophes that could rapidly discredit such a promising new form of surgery.

Adrenal Cortex Neoplasms↗
PubMed1998

[Surgery under hypnosedation. A new therapeutic approach to hyperparathyroidism].

The elective unilateral approach, sometimes under local anaesthesia, offers many advantages in terms of less invasive and faster surgical approach compared to the conventional surgery under general anaesthesia. Nevertheless this approach is restricted to patients unsuspected of multiglandular disease, free from thyroid disease and for whom localization studies are contributive. Surgery under hypnosedation offers the same advantages and provides the possibility of not only exploring the four glands but also of performing a partial thyroidectomy if needed. In our experience 21 patients underwent a cervicotomy under hypnosedation for primary hyperparathyroidism (HPT). No conversion to general anaesthesia was needed; mean operative time was 52 +/- 16 min. In 17 cases, HPT was due to a single adenoma, in 3 cases to hyperplasia (among them a MEN-1 case), and in one last case to a double adenoma. The four glands were identified in 85%. With a follow-up running from 4 to 45 months, all patients are cured. Hypnosedation offers the same medical and economic advantages than the unilateral access under local anaesthesia. Moreover indications are not restricted to selected patients.

Adult↗
PubMed1998

Management of recipients of hepatic allografts harvested from donors with malignancy diagnosed shortly after transplantation.

Transmission of undiagnosed malignancy with the graft is a dramatic complication of liver transplantation. Alternatives in the management of the recipients of livers, harvested from donors with malignancy diagnosed shortly after transplantation, are either early re-transplantation or close follow-up without re-operation. We reported 4 cases of liver recipients whose allografts were harvested from donors who were diagnosed with malignancy shortly after the liver transplantation. One recipient underwent re-transplantation, and the three other allografts were not removed. No recipient developed recurrence in the follow-up. While graft removal may be the only way to avoid tumor recurrence in recipients of liver graft harvested from donor with malignancy, close follow-up without re-operation may also be considered. The risk of tumor transferral may depend on the histopathological aggressiveness and metastatic potential of the donor tumor, and may be low for low-grade, local tumors. This risk should be evaluated by analyzing large series, using databases of Eurotransplant or United Network for Organ Sharing.

Adolescent↗
PubMed1998

[Transplantation of a kidney harvested laparoscopically from a related living donor].

Transplantation of kidney grafts harvested in living donors has demonstrated better results than grafts harvested from brain dead donors. Recently, laparoscopic live donor nephrectomy has been introduced to reduce the live procurement morbidity. In 1997, we performed two laparoscopic live donor nephrectomy and we report the first case of this program in this paper.

Adolescent↗
PubMed1998

Management of fulminant hepatic failure.

Fulminant hepatic failure is an infrequent but dreadful disease, occurring usually in young patients. Despite fulminant hepatic failure is reversible in most of the cases, some patients develop brain edema and intracranial hypertension, which are the most common cause of death in these patients. Liver transplantation significantly improves the prognosis of selected patients in who precise criteria predict a low chance of survival. This review summarizes the modern standard of care of patients with fulminant hepatic failure, with particular underlining of the management of brain oedema and intracranial hypertension.

Brain Edema↗
PubMed1998

[Hypnosis and its application in surgery].

Since 1992, we have used hypnosis routinely in more than 1400 patients undergoing surgery. We found that hypnosis used in patients as an adjunct to conscious sedation and local anesthesia was associated with improved intraoperative patient comfort, and with reduced anxiety, pain, intraoperative requirements for anxiolytic and analgesic drugs, optimal surgical conditions and a faster recovery of the patient. We reported our clinical experience and our fundamental research.

Anesthesia, Local↗