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Biomedical subjects

P Julia

Publications and source records attributed to P Julia.

At least 37 records · Page 2Linked to original sources
PubMed1996

Improvement of postischemic renal function by limitation of initial reperfusion pressure.

PURPOSE: This study was designed to determine whether lowering the initial reperfusion pressure can improve renal function after ischemia. MATERIALS AND DESIGN: Sixty minutes of warm renal ischemia was induced in 2 groups of 8 minipigs by clamping the left renal artery. Right kidneys were kept in situ as controls. In the standard reperfusion group, ischemic kidneys were immediately reperfused at systemic pressure. In the controlled reperfusion group, the renal artery reperfusion pressure was maintained at 60 mm. Hg for the initial 20 minutes of reperfusion by use of a regulating pump and then at systemic pressure for the next 100 minutes. RESULTS: On the basis of the postischemic anuria rate, glomerular filtration rate and renal histology, renal tolerance to ischemia was significantly improved in the controlled reperfusion group. CONCLUSION: These findings of improved renal function recovery after warm ischemia by controlled low reperfusion pressure may have clinical relevance to the reperfusion technique used after renal transplantation in humans.

Animals↗
PubMed1996

[Acute femoro-popliteal ischemia. New therapeutic approach. Respective role of thrombo-aspiration and in situ thrombolysis].

The purpose of this paper is to describe, based on our experience, the respective place of percutaneous thrombo-aspiration and in situ thrombolysis in acute inferior limb ischemia. Between july 1991 and April 1995, 46 patients presenting with acute arterial occlusion were treated by percutaneous thrombo-aspiration related to arterial emboly (n = 24) or acute in situ thrombosis (n = 22). Most of the occlusions lied in the popliteal and distal leg arteries. Complementary balloon angioplasty of the underlying stenosis was performed in 26 cases (53%). Immediat angiographical success was obtained in 96% of the embolic occlusion and 59% of the in situ thrombosis. Based on this experience, we believe that thrombo-aspiration can be performed to treat a recent acute arterial occlusion (10-20 days) of the terminal part of the superficial femoral artery, with extension distaly to the origin of the leg arteries. This technique is easy to perform and can be proposed as a alternative to the Fogarty catheter in acute short emboli occlusion (length than 15 cm long) on normal or pathologic arteries. Extension of this indication for critical ischemia in patients with no possibility of surgical revascularization, can be proposed using combination of in situ fibrinolysis and thrombo-aspiration with percutaneous angioplasty, at the site or on run off.

Acute Disease↗
PubMed1995

Improvement of postischemic kidney function by reperfusion with a specifically developed solution (BT01).

Reperfusion is a critical phase of organ preservation. The purpose of this study was to develop a solution specifically for postischemic kidney reperfusion. Unilateral left normothermic kidney ischemia was induced for 60 minutes in two groups of micropigs. In group 1 (control pigs, n = 6) the kidney was reperfused immediately with pure blood at systemic pressure by unclamping the renal artery. In group 2 (test animals, n = 6) the kidney was initially reperfused with an intracellular flush solution enriched with solution BT01 composed of cytoprotectors (natriuretic factor, PGI2), free radical chelating agents (allopurinol, mannitol), and substrates for the mitochondrial respiratory chain (aspartate, glutamate). This solution was mixed immediately before use with blood in a ration of 1:4 parts and injected into the left renal artery with a perfuser at a constant pressure of 60 mm Hg. After 20 minutes, the kidney was reperfused with systemic blood for 100 minutes. Glomerular filtration rate (GFR) was determined by measuring inulin clearance. Kidney blood flow was measured throughout the experiment. After 120 minutes of reperfusion, the kidneys were removed for histologic examination. In the control pigs (group 1) 50% of the animals were anuric. The ratio between GFR measured in the left kidney at the end of perfusion and at equilibrium in the remaining animals was 0.16 +/- 0.01. In test animals (group 2) all animals recovered diuresis. The ratio between GFR measured in the left kidney at the end of perfusion and equilibrium was 0.51 +/- 0.12 (p < 0.001, group 2 vs. group 1). In group 2 postperfusion kidney blood flow was higher than in group 1 (63.0 ml/min vs. 27.4 ml/min; p < 0.05) because of a decrease in renal vascular resistance. Light microscopic examination of kidneys form animals in group 1 revealed tubular necrosis that extended to the parenchyma, with exposure of tubular interstitium. In group 2 only degenerative lesions with edema of tubular cells and disappearance of brush borders were observed. Our findings indicate that flushing the kidneys with BT01 solution mixed with blood improves postischemic kidney function by reducing reperfusion damage.

Animals↗
PubMed1995

Neutrophil degranulation related to the reperfusion of ischemic human heart during cardiopulmonary bypass.

Activation of polymorphonuclear neutrophils (PMNs) during cardiopulmonary bypass (CPB) is a wellknown phenomenon. This study aimed to determine if activated PMNs are sequestered and degranulated within the myocardium at reperfusion in patients undergoing coronary artery bypass grafting (CABG). Nineteen patients undergoing elective CABG were included in a prospective randomized study. Blood samples were obtained simultaneously from the radial artery (RA) and the coronary sinus (CS) at the following times: T0 (5 min after onset of CPB), T1 (2 min after aortic unclamping), and T2 (10 min after aortic unclamping). Neutrophil function was evaluated by PMN count and by elastase and lactoferrin concentrations. All patients survived. Neutrophils increased significantly from T0 to T1 and T2 in both RA and CS (p < 0.001 between T0 and T1 or T2). Pre-ischemia and reperfusion were associated with a significantly lower neutrophil count in CS compared with RA blood (p < 0.001), suggesting that PMNs were trapped within the myocardium at the onset of the CPB. Elastase and lactoferrin concentrations increased significantly from T0 to T1 and from T1 to T2 for each site, with greater concentrations (p < 0.001) in the CS compared with the RA, suggesting that activated neutrophils released their granular content into the plasma milieu only after reperfusion of the ischemic heart. This study establishes that neutrophil sequestration seems to be secondary to PMN activation by CPB but that the ischemia-reperfusion sequence induces specific degranulation of the PMNs trapped within the ischemic myocardium.

Adult↗
PubMed1995

[Effect of antisense oligonucleotides on myo-intimal hyperplasia in a model of abdominal aortic injury in the rat].

Restenosis at a rate > 30% at 6 months is the major complication of both coronary and peripheral arterial angioplasty. Restenosis is mainly due to proliferation of smooth muscle cells, extracellular matrix and collagen which form a neointima. The proto-oncogene c-myb is a gene with an immediate response which has been implicated in the proliferation and alteration of the phenotype of smooth muscle cells. The antisenses are molecules of single-helix DNA the sequence of which is inverse to that of messenger RNA of the target proto-oncogene. They therefore have the possibility of forming a double helix with the messenger RNA and of preventing its translation. The antisenses of c-myb have already been successfully tested in in vitro and in vivo models of neointimal proliferation. The aim of this study was to demonstrate the efficacy of c-myb antisenses on the proliferation of smooth muscle cells in a model of abdominal aortic injury in the rat. Thirty-five male Wistar rats with an average weight of 350 grams were operated. Smooth muscle cell proliferation was obtained by desendothelialisation of the abdominal aorta from the level of the left renal vein to the aortic bifurcation. Using a randomised, double-blind protocol, 17 rats were given 500 microliters of pluronic gel (control group), 9 a sense oligonucleotide of c-myb in 500 microliters of pluronic gel (sense group) and 9 a c-myb antisense oligonucleide in 500 microliters of pluronic gel (antisense group). Two rats were given fluorescinlabelled antisenses; one was sacrificed 4 hours and the other 24 hours later.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty↗
PubMed1995

[Calcified proliferation of the descending thoracic aorta].

Endoaortic calcific proliferation is a rare condition which causes progressive occlusion of the aortic lumen by endoluminal concretions. Symptoms are related to the resulting ischaemia and systemic hypertension caused by increased cardiac afterload. The authors report an exceptional case with a descending thoracic aortic lesion causing symptoms suggesting medullary ischaemia by partial occlusion of arteries supplying the spinal cord. The physiopathological mechanisms and therapeutic approaches are discussed with respect to a review of the literature.

Adult↗
PubMed1995

[Isolated stenosing calcified lesions of the aorta].

Two cases of isolated calcified lesions of the aorta are reported. The first observation is that of a 25 years old man suffering from mild intermittent claudication predominant in the left leg. Radiological examination showed a calcified isolated lesion of the infra renal abdominal aorta. The patient underwent surgical treatment (thromboendarteriectomy) and was asymptomatic after 6 months. The second observation concerns a 30 years old man treated for benign thrombocytemia in whom a severe arterial hypertension associated with a thoracic bruit was discovered incidentally. Radiological workup demonstrated a solitary calcified lesion of the descending thoracic aorta. Endarteriectomy was performed and the patient was still asymtomatic at 12 months. A review of the literature as well as physiopathological hypothesis and diagnostic and therapeutic management of these uncommon lesions is proposed.

Adult↗
PubMed1994

Combined coronary and femoral revascularization using an ascending aorta to bifemoral bypass.

OBJECTIVE: Coronary artery and aortoiliac disease frequently coexist. In rare instances simultaneous procedures may be required. This study reports our experience with ascending aorta to bifemoral bypass. DESIGN: Prospective consecutive sample study. PATIENTS: Ten male patients who underwent concomitant aortoiliac and coronary revascularization with the ascending aorta as the source of inflow to the femoral arteries between 1989 and 1991. RESULTS: One hospital death was unrelated to the surgical technique. All survivors displayed an uneventful recovery and were free of symptoms. Follow-up was obtained in all nine cases, they all stayed asymptomatic in terms of coronary artery disease and peripheral vascular disease. Echo-doppler studies showed perfect patency of the aorto-femoral grafts in all cases. CONCLUSIONS: This study shows that the ascending aorta to bifemoral bypass constitutes an interesting alternative in selected cases mainly those with severe ischemia coronary and leg ischemia. It offers the following advantages: (1) it is easy to perform, (2) does not require an intraperitoneal procedure, (3) the graft's position behind the muscles of the abdominal wall is not compressible, (4) the ascending aorta is the source of inflow, and (5) it allows a shorter duration of hospital stay.

Aged↗
PubMed1994

Peripheral vascular involvement in heart transplant patients.

Between 1984 and 1991 a total of 200 patients underwent heart transplantation in our unit. The records of 121 patients who were followed up for more than 1 year were reviewed for peripheral vascular abnormalities, which were found in 12 (9.9%). Most of these patients underwent transplantation for ischemic heart disease, and peripheral vascular disease preceded the heart transplantation in 80%. Although surgical risks are low in this setting, particular caution should be exercised to prevent septic complications in the femoral triangle. Among the risk factors studied, only elevated blood cholesterol was frequently found in the vascular patients before or after transplantation. Peripheral vascular involvement in heart transplant patients corresponds to the natural course of atheroma rather than to an accelerated process of atherosclerosis.

Adolescent↗
PubMed1994

Is the incidence of recurrent carotid artery stenosis influenced by the choice of the surgical technique? Carotid endarterectomy versus saphenous vein bypass.

PURPOSE: The purpose of this study is to compare the incidence of recurrent carotid artery stenosis (RCS) after carotid endartarectomy (CEA) and saphenous vein grafting (SVG) in patients with bilateral carotid artery stenosis. METHODS: Between 1978 and 1990, 1483 patients underwent carotid artery surgery at our institution. Fifty-one patients were diagnosed with bilateral carotid artery stenosis and were included in a prospective study that consisted of performance of CEA on one side and SVG on the other. The patients consisted of 34 men and 17 women. Forty patients had symptoms, and 11 were symptom free with severe (> or = 90%) bilateral carotid artery stenosis. All patients underwent a two-stage procedure with an operative interval that ranged from 5 days to 6 months. RESULTS: All patients survived, and no permanent postoperative neurologic deficit was observed. Follow-up was available for all patients and ranged from 6 to 150 months (mean 52 months). Serial Doppler studies were performed in all patients at 6- to 9-month intervals. Unilateral RCS (> or = 80%) occurred in two cases (two of 102); one in a CEA (one of 51) and one in the distal anastomosis of a SVG (one of 51) at 6 and 8 months, respectively, after operation. The reoperative surgical technique performed in both cases was a SVG. CONCLUSIONS: The incidence of RCS requiring repeat operation after carotid artery surgery is not influenced by the choice of the surgical technique, namely CEA or saphenous vein bypass.

Adult↗
PubMed1993

Abdominal aortic aneurysm associated with horseshoe kidney and duplication of the inferior vena cava.

A patient with an abdominal aortic aneurysm associated with horseshoe kidney and duplication of the inferior vena cava is described. Of all the preoperative investigations, CT scan was the most accurate. Operative difficulties stemmed essentially from the abnormal origin of the renal arteries and the functional anatomy of the horseshoe kidney. An anterior approach, as opposed to the posterior approach, allowed easy access to the aneurysmal neck despite the presence of a duplicated inferior vena cava.

Abnormalities, Multiple↗
PubMed1993

[A rare cause of claudication in a young person: cystic adventitial degeneration of the popliteal artery. Case study].

The authors report a new case of cystic adventitial disease of the popliteal artery in a 43 year old woman. It is a rare disease in young people which concern essentially the adventitium of the arterial wall. When echographic aspect mimics thrombosed aneurysm aspect, the diagnostic is done by arteriography. Two surgical technics are convenient: the adventitiotomy and the venous bypass.

Adult↗
PubMed1991

Mycotic aneurysms of the carotid arteries--case report and review of the literature.

Mycotic aneurysms of the extracranial carotid arteries are rare. We report a new case with a mycotic aneurysm of the carotid bifurcation associated with acute bacterial endocarditis of the aortic valve. A concomitant treatment of both lesions was performed. Twenty-six cases of mycotic aneurysms of the extracranial carotid arteries have been reported in the literature. We present a review of all these cases.

Acute Disease↗
PubMed1991

Management of infected vascular prostheses. The vascular homograft revisited.

Treatment of infected aortic femoral grafts is difficult and controversial. We describe the case of a patient who presented for recurrent infections of an aorto-bifemoral prosthesis. An arterial homograft was used to replace the Dacron prosthesis. One year later, the patient is free of symptoms and is doing well. Although early experiences with long-term use of homografts showed late degeneration of the grafts, 2 points should now be raised in favor of homograft use: new techniques of fresh antibiotic storage of homografts appear to have improved durability; and if replacement of a homograft ever becomes necessary, implantation of a Dacron prosthesis could likely be performed in an aseptic environment. While the use of homografts may constitute a reasonable alternative for treating patients with infected vascular grafts, firm conclusions cannot be drawn until we have seen larger series of patients and longer follow-up periods than those few reported to date.

Journal Article↗