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Biomedical subjects

R Limet

Publications and source records attributed to R Limet.

At least 217 records · Page 12Linked to original sources
PubMed1992

[Cardiomyoplasty].

Explore the source record for details and available documents.

Adaptation, Physiological↗
PubMed1991

Right aortic arch with aberrant left subclavian artery. Report of two cases.

Two cases of adult asymptomatic right aortic arch with an aberrant subclavian artery are reported. They were discovered at time of coronary surgery. Preoperative coronary arteriography failed to demonstrate the anomalies. In one case, the right arch was suspected on chest x-ray and preoperative barium oesophagography. In one case, the proximal suture of one saphenous bypass graft was performed on the left common carotid artery. Right aortic arch is a malformation rarely discovered in adults. It generally produces no symptoms when not associated with cardiac disease.

Abnormalities, Multiple↗
PubMed1991

Blowout of carotid venous patch angioplasty.

Two cases of vein patch blowout were observed five and seven days after carotid bifurcation endarterectomy with patch angioplasty. Both patients died in spite of emergency reoperation. One patient developed respiratory failure with subsequent fatal cardiac arrest seven days after reoperation; the other died of extensive hemispheric infarction on the fifth postoperative day. At reoperation both ruptures were found to be located in the middle of the patch whereas the suture lines were intact. Both patients were hypertensive. In the first case, an accessory saphenous vein retrieved from the calf had been the only venous material available for the patch, while the other patient had varicose veins in the contralateral leg. Pathology revealed central transmural tissue necrosis in one of the disrupted patches. A review of the literature regarding morphologic alterations of free vein grafts placed within the arterial circulation as well as hemodynamics in patched arterial segments may provide additional insight as to the inherent benefits and risks of vein patch angioplasty after carotid endarterectomy. When considering vein patch angioplasty, particular attention should be directed to the gross aspect of the vein to be used as well as to any antecedent history of phlebitis.

Aged↗
PubMed1991

Determination of the expansion rate and incidence of rupture of abdominal aortic aneurysms.

Expansion rate and incidence of rupture of abdominal aortic aneurysms in relation to their size is a source of debate. We studied 114 patients (out of a cohort of 752 consecutive patients admitted with abdominal aortic aneurysms) who were denied any immediate operation because of patient's refusal, high surgical risk, or small transverse diameter as assessed by CT scanning and ultrasonography. All patients not operated on underwent from two to six repeated examinations during an average follow-up period of 26.8 months (range, 3 to 132). Forty-seven patients (41.2%) were subsequently operated on electively because of marked increase of transverse diameter of the aneurysm (n = 44) or for other reasons (n = 3), with a death rate of 0%. Eighteen other patients underwent emergency operation for leaking or ruptured aneurysms, and there were five deaths. The incidence of rupture was clearly related to the final diameter value, rising from 0% in aneurysms less than 40 mm to 22% in large size aneurysms (greater than or equal to 50 mm). Among the 49 patients not operated on, one died of rupture before operation and five of causes unrelated to the disease. Using individual serial measurements, we determined the linear expansion rate of the aneurysm, which proved to be related to initial diameter values: 5.3 mm/year for diameters less than 40 mm (n = 49), 6.9 mm/year in the 40 to 49 mm group (n = 41), and 7.4 mm/year for diameters of 50 mm or more (n = 24).(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗
PubMed1991

Influence of tension reduction and peripheral dissection on histologic, biochemical and bioenergetic profiles, and kinetics of skeletal muscle fast-to-slow transformation.

Seven goat latissimus dorsi muscles were submitted to a progressive electrostimulation program through intramuscular electrodes (Medtronic SP5528). Group 1 (n = 3) consisted of muscles stimulated in situ, and group 2 (n = 4), of muscles dissected distally and reinserted on the chest wall with a reduced tension. In group 1, complete fiber switch from type II to I occurred within 60-100 days after the beginning of stimulation, as demonstrated by myosin isoforms and lactate dehydrogenase (LDH) isozymes pattern. Respiratory chain oxidases first increased within 30-70 days after stimulation, then progressively decreased to stabilized values, higher than the basal ones. Total LDH activity showed progressive decrease to one-fifth of the initial value. Morphological analysis confirmed the structural integrity and physical reinforcement of the muscles. In group 2, respiratory chain oxidases showed initial increase followed first by a fast reduction to values less than the starting ones, and then by a slow secondary increase between day 40 and 90. LDH activity displayed a sharp decrease between day 15 and 36. Myosin as well as LDH isoforms showed progressive conversion. This kinetic study suggests a three-phase adaptative evolution of the goat latissimus dorsi submitted to increased workload (group 1): a fast increase (phase I) in oxidative capacities is followed by the development of an efficient contractile machinery (phase II), with subsequent adaptation (phase III) of the terminal chemosmotic enzymes involved in energy production.+2

Adaptation, Physiological↗
PubMed1991

Myeloperoxidase and elastase as markers of leukocyte activation during cardiopulmonary bypass in humans.

To assess leukocyte activation during cardiopulmonary bypass, we measured white blood cell and neutrophil counts and lysosomal enzyme release, especially myeloperoxidase and elastase, throughout the operation and for 5 days postoperatively. A newly developed double antibody radioimmunoassay of myeloperoxidase and an enzyme-linked immunosorbent assay for detection of the polymorphonuclear elastase-alpha 1-proteinase inhibitor complex were used to determine their plasma levels in 15 patients undergoing elective aorta-coronary bypass grafting. Preoperatively white blood cell counts and plasmatic levels of myeloperoxidase and elastase-alpha 1-proteinase inhibitor were normal. Because no correlation has yet been established between levels of myeloperoxidase and elastase-alpha 1-proteinase inhibitor, the aim of this prospective study was to evaluate the use of these enzyme levels as markers for leukocyte activation in vivo. We addressed the clinical situation of cardiopulmonary bypass because it offered the possibility of monitoring the comparative evolution of blood levels of these enzymes in parallel to white blood cell counts through well-defined steps corresponding to known events. We document the advantages of myeloperoxidase blood levels over elastase measurement as reflecting more rapidly the in vivo activation of leukocytes. The time course kinetics of these three measurements were not parallel. White blood cell counts remained stable at the beginning of bypass, whereas myeloperoxidase levels increased sharply and continuously as soon as bypass was instituted until the end of bypass. Elastase levels also increased, but later than myeloperoxidase, beginning when the patients was rewarmed. High elastase plasma levels persisted later than myeloperoxidase after bypass, in parallel with white blood cell counts. It thus clearly appears that changes in myeloperoxidase levels more rapidly reflect the activation state of leukocytes induced by cardiopulmonary bypass and surgery, whereas peak levels of elastase were delayed and parallel to white blood cell counts. From this model, in which the evolution of leukocyte numbers could be followed in relation with known steps of stimulation, it appears that myeloperoxidase is a sensitive marker for monitoring in vivo activation of white blood cells.

Adult↗
PubMed1991

[Stenosis of the right renal artery caused by the crura of the diaphragm. Report of a case].

We present one case of arterial hypertension that had rapidly developed in a 23-year-old patient. Arteriography demonstrates a light stenosis of the root of the right renal artery and an obstruction of the superior mesenteric artery. After an attempt of intraluminal dilatation had failed, we decided to carry out double revascularization with a venous graft. Postoperative control arteriography demonstrated early thrombosis in both grafts. Our second operation directly approached the lesion on the root of the renal artery, which was stenosed by muscle fibers from the right column of the diaphragm muscle. The resection of these fibers released the renal artery, which was otherwise normal, as was confirmed by the postoperative arteriogram. In a second part, we discuss the etiology of this double stenosis and our surgical strategy.

Adult↗
PubMed1991

[Sternal osteitis and mediastinitis after coronary artery bypass graft surgery].

Between 1980 and 1987, 31 cases of osteitis (n = 9) and/or mediastinitis (n = 22) were observed after 2,801 consecutive aorto-coronary bypasses (1.1%). Three types of treatment were used: 1) sternal debridement with osteosynthesis and continuous mediastinal irrigation (n = 25); 2) sternal and mediastinal debridement with open drainage without osteosynthesis (n = 2); 3) incision and debridement of sternal abscesses (n = 4). The overall mortality was 26% (8/31), i.e. 11% (1/9) for isolated osteitis and 32% (7/22) for mediastinitis. Four factors were statistically associated with infection: reoperation for hemorrhage (19.4%, p less than 0.001); preoperative diabetes (25%, p less than 0.001), postoperative low cardiac output (55%, p less than 0.001), postoperative respiratory insufficiency (45%, p less than 0.001).

Aged↗
PubMed1990

Cardiac transplantation beyond 55 years of age.

Between January 1985 and December 1988, 20 patients over the age of 55 years (extremes 56-63 years; 15 men and 5 women) underwent cardiac transplantation. The cause of cardiopathy was ischemic in 70% of the cases. The immunosuppressive regimen consisted of cyclosporin A, corticoids, and azathioprine. Rejection episodes were monitored by endomyocardial biopsies and treated by pulses of corticoids or monoclonal antibodies (OKT3). The operative mortality was 10% (n = 2). The 1-year survival rate was 70%. The 1-year incidence of infection and/or rejection episodes was 1 and 1.53 episodes/patient, respectively. One patient was successfully retransplanted after 9 months because of intractable rejection. Age beyond 55 years is no longer a contraindication to cardiac transplantation. This change in recipient selection policy should lead to parallel changes in donor selection criteria.

Age Factors↗
PubMed1990

Intraoperative electroencephalographic monitoring during carotid surgery with routine shunting.

Fifty-nine patients undergoing sixty-four carotid reconstructions with routine intraluminal shunting had intraoperative electroencephalographic monitoring. The onset of rhythm or amplitude disturbances was demonstrated in 14 patients during exposure of the carotid artery, and in 24 patients during initial carotid clamping. Disturbances were seen in 15 patients during the period of intraluminal shunting and increased momentarily during the second clamping period. During closure of the surgical wound, all abnormalities disappeared except in one patient who ultimately developed a neurologic deficit upon awakening. Although patients who maintained normal electroencephalographic readings had higher carotid stump pressure (59 mm) than those who did not (42 mm), individual values were scattered. Intraoperative monitoring during carotid surgery with routine shunting has little usefulness.

Aged↗
PubMed1990

Plasma renin activity and urine beta 2-microglobulin during and after cardiopulmonary bypass: pulsatile vs non-pulsatile perfusion.

Fourteen patients with normal preoperative renal function underwent aortocoronary bypass graft using cardiopulmonary bypass (CPB) with pulsatile (P;n = 7) or non pulsatile (NP;n = 7) perfusion. In the two groups prebypass values of plasma renin activity (PRA) and urine beta 2-microglobulin (beta 2-M) were within normal limits. PRA increased significantly during CPB and the first 6 h after CPB only in the non-pulsatile group. In both groups, the urine beta 2-M level increased significantly during and after CPB; however, there was no significant difference in urine beta 2-M levels between the two groups. Also, the amount of beta 2-M excreted in urines per unit of time increased significantly in both groups during and after CPB; there was no significant difference between the two groups.

Aged↗