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Biomedical subjects

P Lacroix

Publications and source records attributed to P Lacroix.

At least 55 records · Page 3Linked to original sources
PubMed1995

[Prognostic effect of diverse surgical parameters in significant stenoses of the left coronary trunk. Retrospective study of 185 cases].

A retrospective study of 185 cases of left main coronary artery stenosis operated between 1980-01-01 and 1991-06-15 at the Limoges University Hospital Center was performed. The influence of operative procedures: cardiopulmonary bypass and aortic cross clamping times, type and number of coronary grafts, time between coronary surgery and coronary angiography, on early (before the 30th days after surgery) and late postoperative vital prognosis was studied. This study confirms in our study the poor early postoperative prognosis of: 1) cardiopulmonary bypass time over 140 min; 2) coronary bypasses in an emergency context (surgery less than 24 h after coronary angiography); 3) incomplete coronary revascularization. The nature of grafts and the aortic cross clamping time have no influence. The actuarial survival studies confirm the poor long-term postoperative prognosis of incomplete coronary revascularization; the other surgical procedures have no influence.

Adult↗
PubMed1994

[Significant stenosis of the common trunk of the left coronary artery. Retrospective study of 227 cases].

Significant left main coronary artery disease is a separate disease entity in coronary artery disease. The prognosis is classically poor and the treatment of choice is surgical. A retrospective study of patients with left main coronary disease, diagnosed and treated at the CHRU Dupuytren, Limoges, between 1/01/80 and 15/06/91 was undertaken to determine the aetiological, clinical and therapeutic factors which influence mortality related to this condition. During this period, 8198 coronary angiographies were performed in the cardiology department. The diagnosis of significant left main coronary disease (> or = 50% stenosis) was made in 250 cases (3% of all investigations). Of these 250 cases, 227 were treated medically or surgically by our group during the study period. Twenty patients were treated in another centre and 3 underwent surgery after the 15/06/91. Seven patients died in the period immediately after coronary angiography. Of the 220 survivors of coronary angiography, 185 (85%) were referred for surgery (direct or sequential venous and/or arterial bypass or coronary endarteriectomy). Four patients died within 30 days of surgery. Thirty five patients were treated medically. The therapeutic decision was based on the absence of surgical contra-indications. The retrospective, non-randomized nature of this study with allocation of patients to surgical or medical treatment without control invalidated statistical analysis. At the date of the last follow-up appointment, arbitrarily chosen as the 1/01/93, 163 operated patients (88.1%) of which 130 (79.7%) were asymptomatic and 13 medically treated patients (37%) were alive. The prognostic factors after surgery in this study were: stage IV dyspnoea at the time of diagnosis, severe abnormalities on catheter study (end diastolic pressure over 18 mmHg after angiography), left ventricular wall abnormalities (functional score > 10) and incomplete revascularization. The risk of coronary angiography in this condition were confirmed in this study.

Actuarial Analysis↗
PubMed1994

[The causes of intracranial hemorrhagic complications induced by antivitamins K].

Cerebral haemorrhage is the main life-threatening complication of oral anticoagulant therapy. In order to identify a means of prevention, the authors undertook a retrospective study of 68 consecutive cases of anticoagulant-related intracerebral haemorrhage. The mortality was 38.5%. The respective frequency of intracerebral haemorrhage, subarachnoid haemorrhage, acute and chronic subdural haematomas was 63.2, 16.2, 10.3 and 10.3%, respectively. On admission, nearly half the patients (53%) had prothrombin ratios inferior to 25%. A predisposing factor was found in 58% of cases: hypertension (30.6%), head injury (14.5%), alcoholism or drug interaction (11.2%), and one case of intracerebral aneurysm. A history of a transient ischaemic attack or of a cerebrovascular accident was found in 10.2% of cases and 11.7% had a previous anticoagulant related extracranial haemorrhage. The initial indications for oral anticoagulation were ischaemic heart disease (32%), atrial fibrillation (20.5%), secondary prevention of venous thromboembolic disease (17.6%) and primary prevention of venous thrombosis (11.7%). The duration of treatment for isolated ischaemic heart disease was over 6 months in all cases: the average duration of treatment was 12.4 months in phlebitis and pulmonary embolism. A critical review of the indications of treatment in the light of recent recommendations showed that if inappropriate indications were rare, the sometimes unnecessary prolongation of treatment was more common. Nearly half of these cases were receiving anticoagulants when the potential benefits were questionable at the time of the haemorrhagic complication. Clinical and biological follow-up is necessary for patients on anticoagulants; minor bleeding complications may be the prelude to major haemorrhage. Biological follow-up is based on control of the international normalised ratio.(ABSTRACT TRUNCATED AT 250 WORDS)

4-Hydroxycoumarins↗
PubMed1993

[Popliteal venous aneurysm. Apropos of 2 cases].

The authors report two cases of primary popliteal venous aneurysm. This condition is rare. The lesion may be clinically asymptomatic and may remain unrecognised since it is discovered most often during the investigation of thrombo-embolic complications. The diagnosis is based upon ultrasonography and phlebography. Asymptomatic forms should merely be monitored. Apart from anticoagulants, the treatment of symptomatic forms is surgical. Methods remain controversial.

Aged↗
PubMed1993

[Failure and complications of transesophageal echocardiography. Apropos of 1500 consecutive cases].

Transesophageal echocardiography (TEE) requires the introduction of a flexible probe into the oesophagus and therefore cannot be strictly considered to be non-invasive. This manipulation exposes the patient to complications which are benign in the large majority of cases. The authors report their experience in a prospective study analysing the failures and complications of TEE in the first 1,500 cases performed in their laboratory between May 1988 and May 1992, in mainly adult and ambulatory patients. The probe could not be introduced in 24 patients (1.6%), including 5 cases during the initial learning period. No serious complications were observed during of after TEE. Minor incidents were noted in 28 cases (1.9%) intolerance of the probe (12 cases), nausea and/or vomiting (4 cases), dyspnea (4 cases) due to tracheal intubation in 2 patients, laryngeal in 1 patient and to cardiac failure in 1 case. Pharyngeal haemorrhage (2 cases), atrial fibrillation (3 cases), vertigo (1 case), mandibular dislocation (1 case) and salivary hypersecretion affecting the quality of the imaging (1 case), were also observed. The investigation had to be interrupted prematurely in 12 cases (0.8%) usually because of intolerance of the probe. These results show that TEE is not dangerous in trained hands. Failure to introduce the probe is usually encountered during the learning period, which reinforces the need for apprenticeship in a teaching center. The safety of this technique, plus its considerable diagnostic value in many clinical indications, justify its present role in everyday cardiological practice.

Atrial Fibrillation↗
PubMed1992

[Comparative results of flowmeter studies before and after urodynamic exploration].

Results of flowmeter studies in 145 patients before and then immediately after urodynamic exploration were unchanged in 80% of women and 72% of men. Abnormal results on flowmetric examination, detected in 18% of cases prior to urodynamic studies, were assessed as normal during follow-up urodynamic tests. These findings raise the question of the validity of flowmeter parameters determined during urethrocystometric exploration.

Adolescent↗
PubMed1992

[Distal ischemia of the upper limb due to obliteration of the ulnar artery at the wrist: surgical treatment].

So-called "Raynaud's distal ischaemic phenomena of the upper limb may be responsible for disabling functional impairement and even lesions requiring amputation of one or several fingers. The ulnar artery is usually involved in these phenomena because of its anatomical position and its importance in the blood supply of the hand and the fingers. The authors present three clinical cases of distal ischaemia of the upper limb due to obliteration of the ulnar artery at the wrist, treated by microsurgical vein graft. A review of the literature revealed only 23 well documented cases of this type of treatment, i.e. 10% of all treatment options, which gave 95 to 100% of favourable results. The three patients in our series, reviewed after 2, 3 and 5 years, were considered to be cured. Although the severity of the disease can be evaluated by the clinical course, arteriography appears to be the key examination for diagnosis, prognosis and choice of treatment. However, two practical attitudes are recommended to avoid the risk of progression towards digital necrosis: when the symptoms are chronic, arteriography is indicated in the case of resistance to medical treatment or immediately in the case of unstable symptoms. The diagnosis of occlusion of the ulnar artery at the wrist then justifies treatment by microsurgical vein graft; when the symptoms are acute, treatment should preserve as much as possible the palmar and digital ulnar arterial blood supply.

Adult↗
PubMed1992

[Cannonball pulmonary hamartochondroma. Apropos of a case--review of the literature].

Chondroid hamartomas disseminated in both lung fields were discovered in a 76 year old man presenting with recurrent haemoptysis. In view of this metastatic cannonball appearance and the negative investigations, exploratory thoracotomy was performed, revealing the correct diagnosis. Although classical, this form of hamartoma is rare and warrants a case report.

Aged↗
PubMed1992

[Bacterial endocarditis complicated by popliteal and mesenteric aneurysms].

The authors report about one case of bacterial endocarditis complicated by fungal aneurysms in a superior mesenteric and a popliteal site. While the diagnosis was easy for the popliteal aneurysm, it was not so for the mesenteric aneurysm. Arteriography must have wide indications. The treatment of such aneurysms must always be medical, but surgical as well. The surgical tactics must be carefully discussed, and the restoration of vascular continuity with autologous venous material through an extra-anatomic course should be preferred.

Adult↗
PubMed1992

[Necrotizing fasciitis: a medical and surgical emergency. Apropos of a case].

We report about a 66-years-old obese and diabetic female patient, treated with anti-inflammatories for osteoarthritis of the hip and operated for varices of the lower limbs by a bilateral stripping of the internal saphenous veins, who presented with a mortal necrotizing fasciitis during the postoperative period. Necrotizing fasciitis is a severe, infrequent disease jeopardizing the vital prognosis, in which an appropriate and early treatment (medical, using antibiotics, and surgical by extensive debridement) can prevent a fatal outcome. The most often involved germs are streptococci (45%). The association of anaerobic and aerobic germs sometimes causes mixed cellulitis. The vital prognosis is always threatened by postoperative fasciitis. The mortality rate ranges from 50 to 75%, the main causes of death being a septic shock or pulmonary embolism. The functional prognosis of the surviving patients depends on the extent and quality of surgery.

Aged↗
PubMed1991

[Perineal neuralgia].

Ninety cases of chronic perineal pain of neurological origin are reported. Alcock's canal syndrome, consecutive to damage of the pudendal nerve in the ischiorectal fossa, is the most frequent of these neuralgias. It is characterized by burning pain or paraesthesia increased in sitting position and relieved by standing up. The specific treatment is CT-guided infiltrations of the pudendal nerve. Other neurological causes are spinal cord lesions (notably tumours of the conus medullaris), sacral meningoradiculitis (perineal herpes zoster), plexitis and pudendal nerve neuritis. In some cases the responsibility of perineal stretching neuropathy may be considered. In all patients, electrophysiological exploration of the perineum (detection of perineal floor muscles, sacral latency, somatosensory and motor evoked potentials of the pudendal nerve) are necessary to confirm the aetiological diagnosis and guide neurological investigations.

Adnexal Diseases↗
PubMed1991

Diproteverine (BRL 40015): a new type of calcium antagonist with potential antianginal properties.

The calcium channel-blocking activity and associated cardiovascular effects of diproteverine, a novel compound derived from papaverine, were investigated. Electrophysiological measurements in sheep Purkinje fibres showed diproteverine to reduce the amplitude of the slow action potential (IC30 = 2 microM) and to shorten the duration of the fast action potential at 50% repolarisation (IC30 = 2.5 microM). Higher concentrations (4-5 times) were required to block block the sodium channel, as assessed by a reduction in Vmax of the fast action potential. Papaverine was found to possess marginal membrane channel-blocking activity and to be much more potent than diproteverine as a cAMP-phosphodiesterase inhibitor. The most significant haemodynamic property of diproteverine, seen in anaesthetised dogs and conscious dogs pretreated with atropine, was to cause a reduction in heart rate. This appeared to be a particular feature of diproteverine as the other calcium antagonists studied produced either a smaller decrease in heart rate or tachycardia as a reflex response to hypotension. In a chronic myocardial infarct model in dogs, diproteverine caused a redistribution of the available coronary blood flow, to the benefit of an ischaemic area of the myocardium. Diproteverine resembled diltiazem in its effects on coronary blood flow, with both these agents being preferable to nifedipine and verapamil, which caused coronary steal in this model. The combination of the reduction in heart rate, to lower cardiac oxygen demand, with the beneficial action on coronary blood flow should result in diproteverine being particularly beneficial for the treatment of angina pectoris.

Angina Pectoris↗
PubMed1991

[Perineal stretch neuropathy: its relationship to urinary stress incontinence in women].

For many years perineal neurogenic abnormalities in stress urinary incontinence have been described using electromyography examination, evoked potentials or neuromuscular biopsy. Swash suggested that progressive denervation of the stretched pelvic sphincter musculature that occurs in genuine stress incontinence is due to repeated stretch injury of the innervation of these muscles when the pelvic floor diaphragm is weak. New investigations such as perineal nerve motor latency confirmed this hypothesis. A real "perineal stretch neuropathy" can be described. It is probably very important to know about this neurogenic factor before considering surgery or rehabilitation therapy and in cases of recurrent stress incontinence. 40 cases are described.

Adult↗