Search PubMed⌕ Search

Biomedical subjects

R Limet

Publications and source records attributed to R Limet.

At least 55 records · Page 3Linked to original sources
PubMed2003

[Prevention of lower limb necrosis and amputation by femoro-crural bypass: indications, techniques and results].

Limb threatening ischemia is a challenge for the vascular surgeon. Recent progress in revascularization procedures allow to minimize the primary amputation rate in the management of chronic critical limb ischemia. The authors discuss the prevalence and causes of chronic critical limb ischemia, with a special interest for diabetic arteriopathy. The technique of crural and pedal vessel revascularization is described, as well as the innovative tourniquet technique for distal bypass surgery. A review of published series of infrapopliteal bypass surgery is made. The experience of the authors during last decade with crural and pedal bypass surgery is analyzed.

Arteries↗
PubMed2002

Positron emission tomography (PET) evaluation of abdominal aortic aneurysm (AAA).

BACKGROUND: aneurysmal disease is associated with an inflammatory cell infiltrate and enzymatic degradation of the vessel wall. AIM OF THE STUDY: to detect increased metabolic activity in abdominal aortic aneurysms (AAA) by means of positron emission tomography (PET-imaging). STUDY DESIGN: twenty-six patients with AAA underwent PET-imaging. RESULTS: in ten patients, PET-imaging revealed increased fluoro-deoxy-glucose (18-FDG) uptake at the level of the aneurysm. Patients with positive PET-imaging had one or more of the following elements in their clinical history: history of recent non-aortic surgery (n = 4), a painful inflammatory aortic aneurysm (n = 2), moderate low back pain (n = 2), rapid (> 2;5 mm in 6 months) expansion (n = 4), discovery by PET-scan of a previously undiagnosed lung cancer (n = 3) or parotid tumour (n = 1). Five patients with a positive PET scan required urgent surgery within two to 30 days. Among the 16 patients with negative PET-imaging of their aneurysm, only one had recent non-aortic surgery, none of them required urgent surgery, only two had a rapidly expanding AAA, and in only one patient, PET-imaging revealed an unknown lung cancer. CONCLUSION: these data suggest a possible association between increased 18-FDG uptake and AAA expansion and rupture.

Aged↗
PubMed2002

Axillary artery injury secondary to anterior shoulder dislocation: report of two cases.

Vascular injuries secondary to isolated shoulder dislocation are rare. Unawareness for closed axillary artery trauma by many physicians treating shoulder dislocations, counts often for missed or delayed diagnosis. The authors describe two cases that presented with an anterior shoulder dislocation, complicated by a disruption of the axillary artery with subsequent thrombosis. The various pathogenic mechanisms are discussed. The pathognomic triad consists of anterior shoulder dislocation, absent or diminished distal pulse and an axillary protruding hematoma. Prompt surgical arterial repair is mandatory.

Accidental Falls↗
PubMed2002

Levels of inflammatory markers in the blood processed by autotransfusion devices during cardiac surgery associated with cardiopulmonary bypass circuit.

Intraoperative blood salvage devices allowing a reinfusion of red blood cells (RBCs) after processing of shed blood and stagnant blood in the mediastinal cavity are more and more used to reduce homologous blood requirements in cardiac surgery with cardiopulmonary bypass (CPB). As the proinflammatory activity of the shed blood also contributes to morbidity during CPB, we conducted a prospective study in order to examine the quality of autologous blood before and after processing with five different devices [BRAT2, Sequestra, Compact Advanced, Cell Saver 5 (CS5), Continuous Autologous Transfusion System (CATS)]. All systems resulted in an excellent haemoconcentration, ranging from 53.7% (Compact) to 68.9% (CATS). The concentrations and elimination rates of several inflammatory markers [IL-1beta, IL-2, IL-8, TNFalpha, myeloperoxidase (MPO), elastase] were examined. Except for the Sequestra, an important increase in concentration of IL-1beta (between 30% and 220%) has been observed after processing with each device. In contrast, the attenuation rate of IL-6 and TNFalpha (95%) was optimal for all investigated blood salvages systems. Regarding IL-8, only the CATS and CS5 systems were able to attenuate this biological parameter with an excellent efficacy. The rate of attenuation in MPO and elastase, as markers of leukocyte activation, was higher than 80% for all devices. In conclusion, the different RBC washing systems tested in this study resulted in a significant attenuation of the inflammatory response. Increased levels of IL-1beta after processing remained, however, unclear. According to the type of protocol, based on inlet haematocrit, fill and wash speeds, and wash volumes, small variations in reducing the inflammatory response have been observed from one device to another.

Aged↗
PubMed2002

[Acute dissecting aneurysm: the great imposter].

Dissecting aneurysm is capable to induce death by cardiac complications, internal haemorrhage or acute ischemia of any organ supplied by an aortic branch. Only early and precise diagnosis can oppose the fatal evolution.

Acute Disease↗
PubMed2002

["Take this heart away!": from fear of rejection to post-transplant delirium].

Orthotopic heart transplantation is a major surgical intervention inducing conscious and unconscious psychological distress. Though all reports indicated global improvement of quality of life from pre- to post-transplantation, most retrospective and longitudinal studies found a high prevalence of psychopathology before and after surgery. Post-operative acute psychotic disorders are uncommon but they severely hamper the medical progress and require an immediate psychiatric assistance. The case of Pascal, a young receiver who presented a brief persecution delusional disorder after the first transplantation, showed the dramatic character of such unexpected symptoms.

Adult↗
PubMed2002

[Arterial revascularization with free tissue transfer for salvage of ischemic limbs with extensive tissue loss: an alternative to amputation].

Severe limb ischemia is a common problem encountered in medical practice. Aggressive attempts at revascularization have extended the limits of limb salvage. However, in certain cases, extended tissue loss compromises the healing process. It often results in amputation despite bypass graft patency. Microvascular free tissue transfer combined with arterial revascularization allows healing of these wounds and limb preservation. This combined approach is the ultimate alternative to amputation.

Amputation, Surgical↗
PubMed2002

[Homograft mitral valve replacement].

The total homograft replacement of the left AV valve and subvalvular apparatus constitutes a delicate operation, which may prove beneficial in young patients with extensive bacterial endocarditis. The case of a staphylococcal endocarditis in a young drug addicted patient, operated three years previously of mitral valve repair for the same pathology, is presented. In addition to the complete excision of infected tissues and valvular substitution with biological material, this technique has the advantage of avoiding long term anticoagulation. The history, technical key points, and current indications of mitral homograft in the surgery of the left atrio-ventricular valves are reviewed.

Adult↗
PubMed2002

[Clinical case of the month. Type A aortic dissection after valve replacement].

The risk for aortic dissection or further dilation of the ascending aorta exists after aortic valve replacement. We present a case of acute aortic dissection following replacement of the aortic valve. The management and treatment of dilated ascending aorta associated with aortic valve disease are reviewed and discussed.

Acute Disease↗
PubMed2001

Psychological distress of surgical patients after orthotopic heart transplantation.

Orthotopic heart transplantation (OHT) is a major surgical intervention inducing distress and anxiety. Psychological problems after OHT have been described in many studies. Little is known, however, about the relationship between the psychological state of the patient and time after surgery. The present study involved 41 consecutive OHT patients that underwent transplantation from January 1991 to December 1992, with a retrospective review of pretransplant psychiatric evaluations to define a Diagnostic and Statistical Manual of Mental Disorders, 3rd edn., revised (DSM III-R) Axis I diagnosis. Patients completed the Beck Depression Inventory (BDI-13), Spielberger's State Trait-Anxiety Inventory (STAI-Y), and the General Health Questionnaire (GHQ-28) between 1 and 41 months after transplantation. For comparison, 29 presumably healthy volunteers were given the same questionnaires. The study confirms the occurrence of abnormal psychological scores in the OHT group as compared to the reference population. Psychological scores, however, do not appear to be related to the time they were recorded after surgery.

Adult↗
PubMed2001

Chronic rupture of abdominal aortic aneurysm manifesting as crural neuropathy.

Chronic rupture of abdominal aortic aneurysm (AAA) resulting in unusual clinical manifestations can occur if the resistance of structures surrounding the aorta is sufficient to contain hemorrhage. In this report, we describe five cases of chronic ruptured AAA in which the presenting feature was crural neuropathy. All patients were male with a mean age of 74 +/- 1.8 years. At the time of presentation, crural neuropathy had been ongoing for 3 to 9 weeks. In three cases, AAA was not initially suspected because an inadequate clinical examination was performed (not in the vascular surgery department) and because of the small diameter of the aorta in relation to the patient's morphology. Two patients had one episode of hypotension that was wrongly attributed to vagal attack. Abdominal CT scanning was always diagnostic of chronic rupture. In two cases, rupture was associated with erosion of the body of one or more vertebrae and laboratory evidence of inflammation, i.e., increase in sedimentation rate and fibrinogen level. The mean diameter of the AAA was 7.1 +/- 0.9 cm (range 5-10 cm). All patients underwent midline laparotomy, which was performed under emergency conditions in two cases, under semi-emergency conditions in one case, and electively in two cases. Perforation was consistently located on the posterolateral wall of the aorta and varied from 1 to 3 cm in length. Repair was performed using an aortobifemoral prosthesis in four cases, and a straight tube in one case. The patient who underwent emergency surgery died 4 days after the procedure. The remaining four patients recovered uneventfully and were discharged after 10 days. In the elderly, ruptured AAA should be included in the differential diagnosis of crural neuropathy. An episode of hypotension, regardless of its duration, in an elderly patient should be given serious consideration as a possible sign of ruptured AAA with ongoing retroperitoneal hemorrhage.

Aged↗
PubMed2001

Psychological evolution and assessment in patients undergoing orthotopic heart transplantation.

BACKGROUND: Orthotopic heart transplantation (OHT) is a major surgical intervention inducing distress and anxiety. Psychiatric evaluation of organ transplant candidates is now routinely proposed. This study purposed to assess the psychological evolution in patients having received psychological and/or psychiatric assistance before and during 1-6 postoperative months. METHODS: Twenty-two consecutive transplant candidates were psychically evaluated as part of the preoperative protocol. In the waiting period, 1 and 6 months after OHT, they were asked to fill out the following questionnaires: the General Health Questionnaire, the Spielberger's State-Trait Anxiety Inventory, the Beck Depression Inventory, the Perceived Social Support Scale, the Toronto Alexithymia Scale and the Personal Reaction Inventory. RESULTS: A DSM-IV Axis I diagnosis was found in nine patients (41%); four patients (18%) presented with an Axis II diagnosis. One month after OHT, scores of depression, anxiety and general health significantly improved, while scores of social support, alexithymia and social desirability did not differ. In the sixth postoperative month, all psychological scores remained stable. CONCLUSIONS: A high prevalence of preoperative psychopathology was reported in 22 candidates who received OHT. Surgical intervention obviously improved the quality of life after cardiac transplantation. If the impact of psychological and/or psychiatric aid remains difficult to appraise, these results emphasize the positive impact of surgery on psychological status and the appropriateness of the psychosomatician's social support intervention on patients facing the transplant process.

Adaptation, Psychological↗
PubMed2001

Cardiac surgery in octogenarians; peri-operative outcome and long-term results.

AIMS: Because the elderly are increasingly referred for operation, we reviewed the results of cardiac surgery in patients of 80 years or older. METHODS AND RESULTS: Records of 182 consecutive octogenarians who had had cardiac operations between 1992 and 1998 were reviewed. Follow-up was 100% complete. Seventy patients had coronary grafting (CABG), 70 aortic valve replacement, 30 aortic valve replacement+CABG, and 12 mitral valve repair/replacement. Rates of hospital death, stroke, and prolonged stay (>14 days) were as follows: CABG: 7 (10%), 2 (2.8%) and 41 (58%); aortic valve replacement: 6 (8.5%), 2 (2.8%) and 32 (45.7%); aortic valve replacement+CABG: 8 (26.5%), 1 (3.8%) and 14 (46.6%); mitral valve repair/replacement: 3 (25%), 1 (8.3%) and 5 (41.6%). Multivariate predictors (P<0.05) of hospital death were New York Heart Association functional class, urgent procedure, prolonged cardiopulmonary bypass time, and, after aortic valve replacement, previous percutaneous aortic valvuloplasty. Ascending aortic atheromatous disease was predictive of stroke, while pre-operative myocardial infarction was predictive of prolonged hospital stay. Actuarial 5-year survival was as follows: CABG, 65.8+/-8.8%; aortic valve replacement, 63.6+/-7.1%; aortic valve replacement+CABG, 62.4+/-6.8%; mitral valve repair/replacement, 57.1+/-5.6%; and total, 63.0+/-5.6%. Multivariate predictors of late death were pre-operative myocardial infarction, and urgent procedure. Ninety percent of long-term survivors were in New York Heart Association class I or II, and 87% believed having a heart operation after age 80 years was a good choice. CONCLUSION: Cardiac operations are successful in most octogenarians with increased hospital mortality, and longer hospital stay. Long-term survival and quality of life are good.

Aged↗
PubMed2001

[Clinical case of the month. Complete replacement of the ascending aorta and aortic arch in a case of chronic aortic dissection].

We report the case of a patient who developed an evolutive chronic aortic dissection after ascending aorta replacement for acute type A aortic dissection. Owing to the development of severe aortic regurgitation, aortic root pseudoaneurysm and aneurysmal dilatation of the arch and descending aorta, reoperation was adviced. Reoperation included Cabrol modification of the Bentall operation and aortic arch replacement with elephant trunk performed under deep hypothermic circulatory arrest. The incidence of late aneurysmal formation in type 1 aortic dissection has been reported to be 30%. Close postoperative follow-up of the aortic diameter is necessary to detect a critical dilatation and to permit elective reoperation.

Aortic Dissection↗
PubMed2001

[Coronary revascularization of the beating heart using complete arterial grafts].

A case of complete arterial revascularization using both mammary arteries and the left radial artery is reported. The operation was done on the beating heart with the adjunct of a Y graft owing to a severely calcified ascending aorta. This observation is the occasion to review the basic principles of beating heart surgery.

Aorta↗