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Biomedical subjects

R Limet

Publications and source records attributed to R Limet.

At least 235 records · Page 13Linked to original sources
PubMed1990

Heparin-induced thrombocytopenia: a case report.

The authors report a case of heparin-induced thrombocytopenia, in whom massive pulmonary embolism occurred in spite of heparin anticoagulation. Successful pulmonary thrombectomy was carried out under cardiopulmonary bypass, with limitation of platelet clumping during bypass by aggregation inhibitors. This report is a comprehensive contribution to a better understanding of this rare immunoallergic complication of heparin administration, with a high incidence of serious thromboembolic events. The optimal management for cases of unavoidable reexposure to heparin is discussed.

Drug Hypersensitivity↗
PubMed1990

[Mitral valve replacement in post-infarction rupture of the papillary muscle. Apropos of 13 cases surgically treated during the acute phase of infarction].

Between 1983 and 1988, thirteen patients (12 men and 1 women, average age 63 years) were operated in the acute phase of myocardial infarction for papillary muscle rupture (PMR). The rupture involved the posterior papillary muscle in 12 cases. The average left ventricular ejection fraction was 47 +/- 9 per cent (range 34 to 63%). Pulmonary capillary pressures ranged from 76 to 41 mmHg (average 35 mmHg). Eleven patients presented with acute pulmonary oedema and 7 had cardiogenic shock. Coronary arteriography showed triple vessel disease in 3 cases, double vessel disease in 7 cases and single vessel disease in 3 cases. Surgery was carried out on average 2.7 days after the rupture and 10 days after the initial infarct. In addition to mitral valve replacement (N = 13), 11 patients underwent a myocardial revascularisation procedure. The operative mortality was 15 per cent (N = 2). Papillary muscle rupture in the acute phase of myocardial infarction causes cardiac failure which is related more to the mechanical abnormality than to an alteration of left ventricular function. Considering the operative mortality and the natural history of PMR treated medically, the authors recommend early surgery as the only management which can improve the precarious haemodynamic status of patients with this complication.

Aged↗
PubMed1990

[Spontaneous dissection of the internal carotid artery. Apropos of 7 cases and a review of the literature].

Since 1978, the authors have observed 7 cases of dissecting aneurysm in the internal carotid artery. Symptoms were severe headache and subsequent neurologic deficit in young persons (3 women, 4 men; mean age 35 years). The underlying pathology was spontaneous dissection of the cervical internal carotid artery, with surgical confirmation in 3 cases and typical angiographic patterns in all cases. Spontaneous dissection of the cervical internal carotid artery is being increasingly recognized as a cause of cerebral ischemia in young adults. Moreover this clinicopathologic event is more common than had previously been supposed. The etiology remains unclear, except in 15% of cases in which dystrophy of the media (Marfan's syndrome) is in cause. No history of cervical trauma can be found. Typical clinical features consist in ipsilateral headache preceding an abrupt neurologic deficit in a 40-year-old person. An incomplete Horner syndrome (oculosympathetic paresis without facial anhidrosis) associated with facial pain and numbness is pathognomonic, but the majority of dissections are less typical. The typical angiographic pattern is an elongated regular stenosis of the high cervical internal carotid artery, 2 cm above the non-involved bulbus ("string sign"). The dissection may modify to a tapered occlusion above the point of origin of the internal carotid artery. The natural course is spontaneous resolution of the stricture, without relapse. Optimal management is non-operative since medical treatment has proved to be efficient. These cases confirm the benign course and overall good prognosis of spontaneous dissections of the internal carotid artery which are not as rare as the scarcity of reports might indicate.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Value and limits of bypassing the distal ileum in the treatment of hypercholesterolemia].

Partial ileal bypass (PIB) was performed in 8 young adults (5 males and 3 females, mean age 37 +/- 5 years) with a history of vascular surgery (aorto-coronary bypass, ACB, n = 6; stroke, n = 2), presenting with hyperlipidemia (II B: n = 7; IIA: n = 1). None of the patients had diabetes, 2 had mild hypertension, and all were cigarette smokers. Hypolipidemic drugs were discontinued prior to PIB. Following bypass surgery, patients received vitamin B12 injections twice monthly. Total plasma cholesterol (TPC) and total plasma triglycerides (TPT) were assayed at 3 months and 1 year after surgery. The mean follow-up period was 84 months. Mean TPC level was significantly lower (3.96 +/- 0.57 preoperatively vs 2.19 +/- 0.79 (p less than 0.001) and 2.54 +/- 0.76 (p less than 0.01) 3 months and 1 year postsurgery, respectively. Mean TPT level was significantly lower 3 months after the intervention (4.85 +/- 2.37 vs 2.33 +/- 0.62, p. less than 0.02), but not after one year. Similar trends were observed throughout the follow-up period. One of the ACB patients died of drowing, while three others had recurring angina pectoris symptoms. Coronary angiography showed that, despite low TPC levels, coronary artery disease had extended either to other vessels not included in the former bypass, or beyond the anastomoses. Patients with a history of stroke were asymptomatic. PIB is effective in normalizing TPC. Nonetheless, this isolated procedure is insufficient to prevent the evolution of multifactorial atherosclerosis.

Adult↗
PubMed1990

Primary pulmonary hemangiopericytoma: early local recurrence after perioperative rupture of the giant tumor mass (two cases).

We report two recent observations of giant hemangiopericytoma of the lung, one in a 4-year-old child and another in a 65-year-old man. There were no specific clinical signs, but the radiologic appearance was rather characteristic in both cases, as were the histologic findings. Pneumonectomy was carried out, complicated in each case by rupture of the fragile, incomplete pseudocapsule and diffuse dissemination of necrotic tumor tissue in the operative field and opposite bronchial tree. Outcome was fatal in both cases within a few months, with extensive, rapidly growing metastases in the subcutaneous scar tissue of the thoracotomy and in the other lung and in one case with diffuse diaphragmatic and intraabdominal metastases. These two observations will offer some guidelines for better understanding of this rare localization of hemangiopericytoma, its natural history, and its optimal treatment, with special reference to the malignant potential and local recurrence rate.

Aged↗
PubMed1989

Giant cell arteritis (Horton's disease) of the axillary artery--case reports.

The authors recently observed 2 elderly female patients with ischemic pain of the upper extremity as the first manifestation of giant cell arteritis. They presented with rest pain of both upper extremities and even gangrene of the thumb in 1 case. Subclavian and radial pulses were absent while peripheral pulses in the lower limbs were preserved. The angiography was so typical that the diagnosis of inflammatory arteritis was made, despite negative temporal artery biopsy. The patient with thumb gangrene was successfully operated on, the occlusive axillary lesions being bypassed by a long venous carotid humeral bypass graft. A biopsy of the axillary artery showed a granulomatous lymphoplasmocellular infiltration. A high-dose corticotherapy (24 mg daily) was begun in both cases, with dramatic improvements of general state, lowering of the erythrocyte sedimentation rate, and even reapparition of a reduced radial pulse in 1 patient. The authors discuss the incidence, symptoms, diagnosis, and treatment of systemic giant cell arteritis, with special attention to extracranial involvement. These case reports may broaden the knowledge of the diverse manifestations of giant cell arteritis and of its systemic character with widespread vascular involvement.

Aged↗
PubMed1989

[Aortic surgery in the presence of cholelithiasis. Should simultaneous cholecystectomy be performed?].

From 1984 to 1987, a cholecystectomy for biliary lithiasis was carried out at the same time as aortic vascular surgery in 21 patients. Seventy six percent of patients presented an abdominal aortic aneurysm and 24% occlusive atherosclerosis. Thirty eight percent had previously presented symptoms related to biliary lithiasis. Biliary surgery was conducted after closure of the retroperitoneum. The gall bladder region was drained separately. The technique did not increase operative morbidity or mortality. Combined cholecystectomy and vascular surgery depends on two arguments. Firstly, patients with stones present a higher risk of post-operative cholecystitis. Secondly, a significant percentage of non-cholecystectomized patients will present with biliary symptomatology in the months following vascular surgery.

Aged↗