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Biomedical subjects

S Schlumberger

Publications and source records attributed to S Schlumberger.

30 records · Page 2Linked to original sources
PubMed1986

[Aneurysm of the aortic arch. Surgical therapy. 60 cases].

Sixty patients with aortic arch aneurysm have been operated upon at the Foch Medico-Surgical Centre between 1964 and 1984. This period can be subdivided into: January, 1964 to December, 1975 (24 cases) and January, 1976 to April, 1984 (36 cases). The technique used (closure by patch or segmental replacement prosthesis) depended on the type of lesion encountered. In most cases, the cardiopulmonary bypass was between the femoral artery and the right atrium. After experimenting with different methods, we now protect the brain by selective cold blood carotid perfusion, using independent circuit and heat-exchanger. Operative mortality was 12% in series I (1964-1975) and 0% in series II (1975-1984) patients. Hospital mortality was 25% in series I and 13% in series II patients. The improvements obtained during the last few years, using cold blood carotid perfusion and circulatory arrest in the lower half of the body, have made it possible to perform open distal anastomoses. This method ensures excellent brain protection and short cardiopulmonary bypass period.

Adult↗
PubMed1985

Circulatory responses to thiopentone and tracheal intubation in patients with coronary artery disease. Effects of pretreatment with labetalol.

The haemodynamic responses to induction and tracheal intubation have been studied in patients with coronary artery disease randomly assigned to a labetalol pretreatment group (n = 14) or to a placebo group (n = 16). Twelve hour before operation, treated patients received a bolus dose of labetalol 0.5 mg kg-1 followed by a constant infusion of 0.1 mg kg-1 h-1 i.v. Anaesthesia was induced with thiopentone and phenoperidine, and intubation performed following the administration of suxamethonium. At intubation, the changes in heart rate (P less than 0.01), mean arterial pressure (P less than 0.05) and rate-pressure product (P less than 0.01) were significantly smaller in the labetalol group compared with the placebo group. Labetalol pretreatment appears satisfactory and may be useful in patients with coronary artery disease who have a normal left ventricular ejection fraction.

Anesthesia, General↗
PubMed1985

[Repeated valvular replacements].

After more than two decades of cardiac valve replacement surgery, the number of reoperations has increased and third or even fourth replacements are no longer rare occurrences. Of the 2072 valves prostheses implanted at the Hôpital Foch between 1970 and December 1984, 134 (6.4%) have been changed at least once and 27 prostheses (1.3%) have been replaced three or more times in 23 patients. Eighteen patients were operated on three times and 5 patients 4 times, a total of 73 operations. Ten patients had aortic valve prostheses, 7 had mitral valve prostheses and 6 had double aortic and mitral valve prostheses. The technical difficulties due to previous cardiac surgery were not great or easily surmounted as every procedure was performed by a median sternotomy and only 2 out of 50 required cannulation of the femoral vessels for cardiopulmonary bypass. The repair itself consisted of simple valve replacement in 3 out of 4 cases (30 single and 3 double valve replacements, 3 valve reinsertions). The other operations required more complex techniques such as remodelling of the ring of insertion or the use of a valved tube. None of the patients died in the operating theatre. However, 3 patients died during the hospital period (13%) and there were 2 late deaths (10%) and 1 patient (5%) was lost to follow-up. The 17 survivors were followed up for 3 to 148 months (average 42 months). Half the patients are now in functional Classes I or II of the NYHA classification. These results show that repeated valve replacement has an acceptable operative risk.(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Valve↗
PubMed1984

[Dissection of the ascending aorta after aortic valve replacement].

From October, 1969 to December, 1982, 1117 aortic valve replacements were performed at the Foch Medico-Surgical Centre. Five of these operations (0.4%) were followed, within 6 months to 6 years (mean 37 months), by acute dissection of the whole ascending aorta with a varying degree of extension further down. Such accidents raise problems of aetiology, diagnosis, treatment and possibly prevention. All 5 patients had an emergency operation with prosthetic replacement of the ascending aorta; in some cases the 2 cylinders were glued to the distal and proximal aortic stumps. The other forms of treatment were related to the lesions encountered. All patients survived and underwent follow-up angiography after 6 months to 5 1/2 years. Lesions of cystic necrosis of the media were regularly found at histology. In every case during the first operation the surgeon reported that the aorta was dilated or particularly fragile. The question therefore arises as to whether ascending aortas that are fragile and of more than 5 cm in diameter should be systematically replaced.

Adult↗
PubMed1984

[Destruction of the bundle of His with the neodymium-YAG laser. Preliminary experimental study].

Experiments with a new technique for His bundle interruption were performed on 10 dogs. The atrioventricular node-His bundle track was destroyed by means of a neodymium-yttrium-aluminium-garnet laser (Nd-YAG laser) used in continuous emission at 35 watts. The operation was conducted under simple clamping of the vena cava for a mean period of 1 minute 30 seconds, and 30 seconds were required for destruction of the His bundle. An atrio-ventricular block was obtained immediately in all dogs and persisted for more than 3 weeks. No accident was recorded. The Nd-YAG laser therefore appears to be a reliable technique and could be used for surgical treatment of arrhythmias.

Aluminum↗
PubMed1984

[Median-term results of the Ionescu-Shiley valve bioprosthesis (98 patients)].

Between April 1979 and September 1981, 98 patients have undergone valve replacement with an Ionescu-Shiley bovine pericardium xenograft (54 men and 44 women, average age 53 years, range 13 to 76 years). Fifty-three patients underwent aortic valve replacement (AVR); 28 had a mitral valve replacement (MVR) and 17 had double valve replacement (MAVR). Nine patients (9%) were operated as an emergency for endocarditis or for acute malfunction of a previously implanted prosthesis. The hospital mortality was 9% (AVR: 7%, MVR: 7%, MAVR: 17%). The eighty nine survivors were followed up for 6 to 37 months (average: 21 months). All patients were examined or contacted directly (as were the treating cardiologists) during the 2nd trimester of 1982. Eight patients were lost to follow-up. Six patients died during follow-up (6,7%) 3 to 22 months after surgery. The valvular prosthesis was the cause of death in 2 cases. Although only 37 patients (41%) were maintained on long-term anticoagulant therapy, there were no cases of thrombosis of the valve and the incidence of embolic complications was 0,9% per patient year in AVR and 2,6% per patient year in MVR. Four patients (2,6% per patient year) developed endocarditis on their prosthesis and 3 were cured by medical treatment alone. One patient was reoperated 1 year after the initial operation. One case (0,7% per patient year or 0,5% per valve year) of premature calcification was observed (18th month) in a 16 year old boy who was reoperated as an emergency without any success.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

[A new surgical technic for the treatment of left ventricular aneurysm: the overcoat aneurysmoplasty. Preliminary results. 11 cases].

The classical surgical techniques used in post-myocardial infarction left ventricular aneurysms consist in resecting as much as possible of visible fibrous tissues and closure of the two borders by "U"--shaped sutures supported by a Teflon bond. There are two drawbacks to this approach: resection often involves the surface arterial network which often has a significant role to play in vascularising the remaining myocardium; fibrous, akinetic or dyskinetic zones of the anterior 2/3 of the interventricular septum cannot be resected. The proposed technique consists in limiting the surface of resection and in lowering the left border of the aneurysm as far as the posterior 1/3 of the septum. The septum is then sutured over the aneurysm to the antero-lateral wall of the left ventricle. Ten patients were operated using this technique: there were no operative deaths; preoperative cardiac failure regressed in 4 out of 5 patients; one patient was operated for unstable ventricular tachycardia, the arrhythmias disappeared after surgery; one patient operated during the 3rd week for left ventricular pseudo-aneurysm required intra-aortic balloon pumping and developed episodes of VT which finally resolved.

Female↗
PubMed1984

[Computerized management of the medical record in cardiac surgery. Experience at Foch Hospital].

Between 1979 and 1983, about 2 000 case reports of patients undergoing cardiac surgery were computerised. The availability of the centralised computer facilities of Hôpital Foch made this experiment possible. The computerised case notes were divided into several chapters in which a certain amount of data was compulsive and provision was made for the addition of further information. The data was introduced in the form of a numerical code out of a possible choice of 700 contained in a dictionary. A terminal located in the department was used to introduce the information or to consult a given case file directly. Statistical analysis of the cases was performed using APL language, the basis of which must be known in order to continue interrogation, the reply being almost immediate. Several examples of the use of the system are given: number of patients, average duration of surgery, characteristics of the ten oldest patients. Other studies include the use of double entry tables to determine the relationship between two variables such as the variation of cardiothoracic index and the degree of postoperative bleeding. Each case takes about 20 minutes to be coded; the number of cases not entered has decreased greatly year by year. The differences in language used in comparison with already existing systems are: the use of syntax, the possibility of dating events, an "open" dictionary. The main drawbacks of the system are: forgetting to code certain data and restrictions of interrogation (easier for fixed than for facultative data). The overall results have been clearly positive.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Surgical Procedures↗
PubMed1983

[Metabolic myocardial modifications following surgical revascularization].

The effects of aorto-coronary bypass surgery on myocardial lactate, free fatty acid and certain amino acid metabolism were studied in 30 coronary patients presenting with unstable, invalidating angina resistant to medical therapy. These patients had electrical signs of anterior wall ischemia without necrosis, significant proximal stenosis of the left anterior descending artery with good distal run-off, and underwent bypass surgery on this artery without signs of postoperative myocardial infarction. This study involved pre- and postoperative hemodynamic investigation with a Swan-Ganz catheter and a metabolic study of the coronary arteriovenous lactate (n = 30), free fatty acid, alanine and glutamate (n = 12) levels under basal conditions and after atrial pacing. These results were compared with those in 10 non-coronary control patients, operated for monovascular replacements. The increase of the pulmonary capillary pressure associated with a fall in systolic index at the 6th postoperative hour showed a reduction in left ventricular performance which tended to correct itself at the 24th hour. In the coronary patients, myocardial lactate production increased, alanine production increased and the uptake of free fatty acids fell during atrial pacing after surgery. These metabolic changes reflect the stimulation of anaerobic glycolysis secondary to myocardial ischemia which disappeared after surgery to compare with the control subjects. Therefore, effective myocardial revascularisation in patients with coronary artery disease is accompanied by the regression of the metabolic stigmata of myocardial ischemia.

Adult↗