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Biomedical subjects

T Carrel

Publications and source records attributed to T Carrel.

At least 199 records · Page 11Linked to original sources
PubMed1991

[Preventive cytolytic treatment following heart transplantation: ATG versus OKT3].

The postoperative prophylactic cytolytic therapy with rabbit-ATG and OKT3 after heart transplantation are compared. The first 20 recipients were treated with ATG (5 days), the next 20 with OKT3 (14 days). The medium histological rejection grade (Texas classification) was significantly higher after 2 weeks in ATG group and after 4 weeks in OKT3 group. The linearised rejection rate was 7.1 (ATG) vs. 0.7 (OKT3) (p less than 0.005) at 2 weeks, resp. 3.6 vs. 8.6 (p less than 0.05) and 1.3 vs. 2.9 (p less than 0.005) at 4 weeks and 2 months. After 3 months there was no difference in histological rejection grade (3.6 +/- 1.5 vs. 3.3 +/- 1.7) and linearised rejection rate (2.4 vs. 2.6 per 100 days and patient) between the two groups. Severe rejections are more frequent after OKT3 (6 vs. 11) and probability of rejection free survival is higher after ATG (25% vs. 0%, resp. 21% vs. 0% after 2 resp. 3 months; p less than 0.05). In this study we find no short and medium term benefit of a rejection prophylaxis with OKT3 (14 days) compared with ATG (5 days). Acute allograft rejections in OKT3 group tend to be more severe with a higher mortality.

Antibodies, Monoclonal↗
PubMed1991

[Simultaneous coronary and vascular surgery interventions: indications,technique and results].

Atherosclerosis is often a generalized disease, affecting not only coronary circulation, but other parts of vascular system as well. Vascular diseases most commonly encountered in patients with coronary atherosclerosis are carotid disease, abdominal aortic aneurysm and obliterative atherosclerosis in aortoiliac segment. In such situation two options are available: to treat the more significant, life-threatening manifestation first and postpone the other operation--staged approach; or to perform coronary artery bypass grafting (CABG) and other vascular procedures during one single operation--synchronous surgery. The advantages of this latter approach are obvious: patient has to undergo only one operation; there is no additional risk in the waiting period for second operation; surgical treatment is greatly accelerated. From 1978 until July 1990 a total of 123 synchronous CABG and vascular procedures were carried out in our clinic. In the same period, CABG was performed in 3867 pts in the same institution; combined procedures amount to 3.5% of all coronary revascularisations performed in the same period. CABG was done together with carotid endarterectomy (CEA) in 45 pts, associated with resection of abdominal aortic aneurysm (AAA) in 31 and in 28 pts it was combined with vascular procedures in aorto-iliac or femoral segment. In 4 pts a triple procedure--CABG, CEA and peripheral vascular reconstruction--were undertaken. Thoracic aortic aneurysm and CABG were performed in 15 pts. CEA is performed immediately prior to CABG in symptomatic carotid disease, past history of transient ischemic attack, severe bilateral carotid disease and unilateral carotid obstruction with contralateral stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Aneurysm↗
PubMed1991

[Simultaneous revascularization of the renal arteries in conjunction with reconstruction of aneurysms of the abdominal aorta].

Simultaneous revascularization of stenosed renal arteries during resection of aneurysms of the abdominal aorta was performed in a consecutive series of 30 patients (mean age: 65 +/- 7 years; men 27 [90%]; women 3 [10%]). Right renal artery was operated upon in 20/30 cases (66%) and left renal artery in 15/30 cases (50%) for a mean degree of stenosis of 79 +/- 19%. Suprarenal extension of the aneurysm of the abdominal aorta was observed in 7/30 cases (23%). Emergency operation because of rupture of the aneurysm was necessary in 7/30 cases (23%). The following procedures were performed upon the renal arteries, either isolated or combined, in addition to resection of the aneurysm of the abdominal aorta: reimplantation of the renal artery in 15 cases, thrombendarteriectomy of the renal artery in 11 cases, patchangioplasty in 8 cases, bypass in 4 cases, dilatation in 1 case, autotransplantation in 1 case. The 30-day mortality was 1/23 (4%) for elective procedures versus 3/7 (43%) for emergency procedures (ruptures). Systolic (diastolic) blood pressure dropped from a preoperative mean value of 181 +/- 139 (104 +/- 18) mm Hg to a postoperative mean value of 147 +/- 18 (80 +/- 18) mm Hg: p less than 0.05 (p less than 0.05). Hence, simultaneous revascularization of stenosed renal arteries during resection of aneurysms of the abdominal aorta helps not only to salvage renal parenchyma but also to control the risk factor hypertonia in a significant number of patients.

Adult↗
PubMed1991

[Blood transfusion and reducing the need for blood in heart transplantation].

Viral infections transmitted by the donor organ or by blood and blood products are severe complications in heart transplantation. The use of blood and blood saving management is evaluated in 57 consecutive orthotopic heart transplantations. Indication was cardiomyopathy in 63%, coronary artery disease in 30%, valve disease in 5%, congenital in 5%, arrhythmia in 5% and primary cardiac malignancy in 2%. Previous open heart surgery was performed in 32%, and 81% had anticoagulation, with a mean quick value of 0.28 +/- 0.13. The total use of blood and blood products was 1151 units and was distributed as follows: whole blood and packed cells 41%, platelets 17%, fresh frozen plasma (FFP) and coagulation factors 36%, albumine 7%. Anticoagulated recipients received more FFP and factors, 7.9 +/- 5.7 U vs. 4.4 +/- 4.8 U. In the reoperation group 78% vs. 22% (p less than 0.001) in the primary operation group received platelets. Hemodilution to hematocrit 0.24 instead of 0.30 lead to a decrease of red cell transfusions per patient from 12.3 +/- 6.7 U to 6.3 +/- 7.4 U (p less than 0.001) and the percentage of patients receiving red cells was reduced from 100% to 82%. Intraoperative hemofiltration was performed in 49% (mean filtration volume was 1652 +/- 910 ml). No differences in the amount of blood and blood products could be shown. Heart transplantation is an operation with a high need for blood and blood products. Reoperation and anticoagulation are predictors for a higher use of platelets, FFP and coagulation factors. Hemodilution reduces the use of red cells, whereas intraoperative hemofiltration has no influence on the use of blood.

Adolescent↗
PubMed1991

[Surgery of extracranial aneurysms of the carotid artery. Analysis of 8 cases].

This article reviews the clinical manifestations, operative techniques, results and complications associated with the treatment of 8 aneurysms of the extracranial carotid artery encountered over a 13-year period. The etiology was atherosclerosis in 4 cases, congenital in two, posttraumatic in one and mycotic in another case. All patients were operated on because of symptomatic disease. Six patients had resection and reconstruction with end-to-end anastomosis, one with a patch of the saphenous vein. One patient had aneurysmorrhaphy and the last one had reconstruction with Gore Tex graft interposition. Two patients had a hemiparesis prior to the operation; this manifestation disappeared slowly in both patients but residual neurological deficit is still present in one of them 9 months postoperatively. One patient developed transient neurological symptomatology after the operation. We conclude that accessible aneurysms of the extracranial carotid artery can be operated with acceptable morbidity and mortality. Operative management is the treatment of choice because these lesions are attended by a high incidence of neurological complications if left untreated.

Adolescent↗
PubMed1991

[Peritoneal dialysis in treatment of postoperative heart failure after correction of complex heart defects in young children and infants].

Low cardiac output can be encountered after corrective surgery for complex congenital malformation in children and infants and is often accompanied by an impairment of renal function, ascites, hyperosmolarity and hyperpyrexia. In most instances, combined afterload-reduction and inotropic stimulation will be effective. If low cardiac output persists, a peritonealdialysis (PD) may allow correction of fluid balance and consecutive improvement of hemodynamics. During a 18 month-period, PD was performed in 14 children in the postoperative period following major cardiac surgery (transposition 5, Fallot tetralogy 5, various complex anomalies 4). This represents 3.1% of all cardiac operations performed in children with congenital heart disease throughout the same period. There were 8 males and 6 females with a median age of 2.5 years (range 3 days to 4 years) and a median bodyweight of 5.5 kg (range 3.4 to 10 kg). Low cardiac output was defined when two or more of the following factors were met: mean arterial pressure (MAP) below 40 mm Hg despite inotropic stimulation, central venous pressure (CVP) over 15 mm Hg, urine production less than 1 ml/kg/hour and/or increasing transaminases. Before starting peritoneal dialysis all children received combined positive inotropic and vasodilative therapy. The PD-catheter was introduced 8 to 30 hours after operation. We used a PD-solution with 1.5% and/or 4.5% glucose. Fluid balance was monitored hourly. Just after introduction of the catheter a mean of 65 ml +/- 25 ml/kg ascites could be removed and the total quantity of removed fluid was 175 ml +/- 45 ml/kg bodyweight.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗
PubMed1990

[Long-term results of surgical coronary vessel intervention in patients with reduced left ventricular function].

From 1975 to 1980, 112 patients with an ejection fraction below 45% underwent coronary artery bypass grafting (CABG) in the Cardiovascular Surgery Unit, University Hospital Zürich. The mean age was 35 years and the mean ejection fraction 32% (21-44%). The vast majority of patients had severe symptoms (angina pectoris or congestive heart failure). Elective surgery was performed in 62 patients (55%) and emergent or urgent in 50 (45%). All were operated on in mild hypothermia (26-30 degrees C). An average of 2.9 bypasses per patient were performed; in 57, internal mammary artery bypass was carried out for revascularization of the left anterior descending branch. - Early postoperative mortality (within 30 days of operation) was 3.6%; all deaths were of cardiac origin. Perioperative myocardial infarction occurred in 7.5% of all patients. Cumulative survival was 83% at 5 years and 68% at 9 years. Mean mortality rate/year was 3.8% with a maximum of 6.5% in the first year after operation. The incidence of angina pectoris and congestive heart failure was significantly lower after revascularization. Cumulative survival was significantly enhanced in patients with complete revascularization (91% at 5 years vs 71% for incomplete revascularization). Early postoperative mortality was especially high in urgent and emergent cases, and was higher after revascularization with internal mammary artery bypass than with venous graft. Postoperative ejection fraction was assessed in 20 patients (12 with 2- or 3-vessel disease and 8 with left main coronary artery stenosis). Ejection fraction was significantly increased only in the patient group with left main coronary artery stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

[Long-term performance of mitral valve bioprosthesis].

Long-term clinical performance of mitral tissue valves was analyzed in a consecutive series of 250 patients (131 men, 118 women; mean age 51 years) over a 13-year period. Mean follow-up was 71 months (range 1-141 months). The total cumulative follow-up period was 1466 years. The late mortality was 2.0% per patient-year, whereas thromboembolism occurred in 1.4% per patient-year, prosthetic valve endocarditis in 1.0% per patient-year, periprosthetic leaks in 0.3% per patient-year and structural valve deterioration in 3.0% per patient-year. The rate of reoperation was 3.4% per patient-year. Actuarial analysis showed the following results (1 year/5 years/10 years): Survival rate: 97 +/- 1%/89 +/- 2%/82 +/- 5%; free of embolisms: 98 +/- 1%/96 +/- 1%/86 +/- 5%; free of endocarditis: 99 +/- 1%/95 +/- 2%/90 +/- 3%; free of valve deterioration: 99 +/- 1%/96 +/- 1%/60 +/- 8%; no reoperation: 98 +/- 1%/94 +/- 2%/57 +/- 8%; free of late complications: 92 +/- 2%/77 +/- 4%/41 +/- 10%. On the basis of our statistical evaluation the probabilities are that, 11 years after implantation of a mitral bioprosthesis: (a) only 35% of patients are free of late complications (including thromboembolisms, prosthetic valve endocarditis, structural valve deterioration and death); (b) and only 50% of patients have not needed reoperation.

Actuarial Analysis↗
PubMed1990

[Injuries of the large brain-feeding arteries].

Among 2923 severely injured patients in the period 1980-1988, 17 had injuries or large supraaortic arteries. The incidence was 0.58%, with an overall mortality of 53%. In 75% of survivors there was a persistent neurological deficit. We treated 5 penetrating (A. carotis 4, A. vertebralis 1) and 12 nonpenetrating (A. carotis 11, A. vertebralis 1) injuries. In all penetrating carotid injuries (4) repair was performed on admission and mortality was 50%; 1 of 2 survivors has postoperative hemiparesis. Localization of nonpenetrating carotid injuries (11) was intrathoracic (2), in the neck (7) and intracranial (2). Main complication of nonpenetrating extracranial carotid injuries is neurological deficit (7/9) due to thrombosis (3) or stenosis (4) with embolism (2). Surgery was performed in 3 cases comprising pseudoaneurysm in 2 and concomitant aortic rupture in 1. Mortality was 44%, and 80% of survivors had persistent neurological deficits. Extracranial carotid injuries (n = 13) carried a mortality rate of 83% in occluded and 29% in nonoccluded vessels (p less than 0.05). Location of carotid injury in the neck (n = 11) carried a mortality of 55%, and intracranial (n = 2) of 100% respectively. Duplex-Doppler scanning of carotid arteries is a safe, noninvasive method which is essential in blunt carotid artery trauma. Prognosis is dependent upon the size of cerebral infarction. Once neurologic deficit has been established for more than 24 hours, reconstruction of the artery should be postponed and performed only for complications (pseudoaneurysm or embolization). Clamping of arteries without hypothermic circulatory arrest or shunt should be avoided. The danger of rupture in dissection and pseudoaneurysm is slight.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Liver transplantation with atrioatrial anastomosis for Budd-Chiari syndrome.

We report the case of a young woman with Budd-Chiari syndrome in whom mesentericoval shunt was first performed, followed by transcaval liver resection and hepatoatrial anatomosis 3 years later. Liver transplantation became necessary 5 years later because of deterioarating liver function with portal hypertension and bleeding. Successful transplantation was performed with atrioatrial anastomosis with help of cardiopulmonary bypass, simplifying considerably the technical procedure and reducing dramatically blood loss.

Adult↗
PubMed1990

En bloc resection for bronchogenic carcinoma with chest wall invasion. Value of pre-operative radiotherapy.

A small number of patients with lung cancer will have a tumour invading the chest wall. Pre-operative radiotherapy and surgical resection provide the best results in patients with Pancoast's tumours, although chest wall invasion is often considered to indicate incurability. We reviewed the outcome in 46 patients with bronchogenic carcinoma and non-apical chest wall invasion and have tried to clarify the role of adjuvant pre-operative radiotherapy. All patients underwent combined chest wall and lung resection for treatment of lung cancer which had extended grossly and microscopically into the chest wall. In this retrospective study, we identified two groups of patients, those (n = 21) who received and those (n = 25) who did not receive pre-operative radiotherapy. Curative resection had been possible in 80% of the patients. There was one early post-operative death, due to pneumonia. The survival in all 46 patients is 32% at 5 years. In the most favourable cases, those without nodal involvement and who received pre-operative radiotherapy, the 5-year survival is 56%. In our series, there was a notable difference in 5-year survival between irradiated and non-irradiated patients at every stage of disease.

Adult↗
PubMed1990

[Use of photoplethysmography with calibration in vivo for assessing venous hemodynamics of the lower extremity and particularly ambulatory venous pressure and refilling time after exercise].

Several invasive and non-invasive methods are used actually for the appreciation of the morphology and the function of the venous system of the lower extremity. Hemodynamic parameters like the ambulatory venous pressure and the venous refilling time can not be determined without invasive measurements. This report describes the results of a prospective comparison of the ambulatory venous pressure and the venous refilling time with the in vivo calibrated photoplethysmography and with invasive measurements. Postural changes of hydrostatic pressure permitted in vivo calibration of the photoplethysmograph. We recorded quantitative photoplethysmography (PPG) ambulatory venous pressure and venous refilling time in 20 normal subjects, 20 patients with superficial varicosis and in 20 patients with chronic venous insufficiency. Quantitative photoplethysmography correlated closely with invasive measurements of ambulatory venous pressure with respect to estimated drop in superficial venous pressure and recovery time. PPG estimates of intravenous pressure in normal patients (24 +/- 9 mm Hg), in patients with varicosis (42 +/- 7 mm Hg) and post-thrombosis patients (63 +/- 9 mm Hg) agreed with ambulatory venous pressure measurements 22 +/- 9 mm Hg, 40 +/- 6 mm Hg and 61 +/- 6 mm Hg, respectively. Non invasive, quantitative photoplethysmography may prove to be an accurate estimate of ambulatory venous pressure in patients with superficial varicosis and in patients with chronic venous insufficiency.

Exercise Test↗
PubMed1990

[Drug-induced acute arterial occlusion].

An acute ischemia has almost its origin in a mechanical obstruction of the vessel caused by embolus, thrombose or dissection. An ischemia caused by medicament, excepted the erronated intraarterial injection of vasoconstrictive medicament, is very seldom encountered in the clinic. We describe the case of a young woman who was referred to our clinic for investigation and treatment of an acute ischemia of both limbs. In her past medical history she was treated because of a liver insufficiency occurring after a spontaneous abortion and received methylergometrine (Methergin) for uterine stimulation. Because of this unusual manifestation in a young patient with a complicated past medical history we considered the possibility of a drug induced ischemia caused by ergotamine-derivate. The rapid recovering after treatment with chlorpromazine and nifedipine confirmed the suspected diagnosis. A well defined therapy of this rare complication has not been described; vasodilatators, nitroglycerin, calcium-antagonists and even streptokinase and balloon dilatation are proposed.

Adult↗
PubMed1990

[Rupture of a subcapsular liver hematoma in the postpartum period associated with HELLP syndrome].

We describe the case of a 31-year-old woman who underwent a section caesarean and 24 hours later a laparotomy for treatment of a ruptured subcapsular liver hematoma due to a HELLP syndrome. The HELLP syndrome (hemolysis, elevated liver enzymes, low platelets count) is a serious complication of the pregnancy with or without eclampsia. This complication has a high mortality and morbidity and can occur during the pregnancy or after delivery. The diagnosis of a subcapsular hematoma of the liver should be considered in patients with acute abdominal pain in the last trimenon or just after delivery. Laparotomy must be performed at the first signs of hemodynamic instability.

Adult↗
PubMed1990

[Diagnosis and treatment of traumatic injuries of the duodenum and pancreas: 21 cases].

Twenty one consecutive patients who sustained injuries to the duodenum or/and pancreas were admitted to our hospital over a ten year period. Sixteen blunt injuries and 5 penetrating injuries were encountered. Penetrating injuries were always suspected and treated by time; following blunt injury diagnostic delay was encountered in 7 patients and insufficient surgical procedure because of intraoperative misinterpretation in 2 patients. Most of the patients had associated intra-abdominal organ injuries. Adjuncts to diagnosis such as abdominal roentgenograms, serum amylase levels and gastroduodenography were not helpful. CT-Scan and ultrasound allowed to confirm the suspected diagnosis in 3 cases only. Intraoperative diagnosis was also challenging. Complete mobilization of the structures surrounding the duodenum and the pancreas to provide entire exposure was necessary. In 6 patients treated first in a peripheral hospital, diagnosis of the injury have been missed at first laparotomy and reoperation was necessary in all of them. Suture closure of the duodenum and drainage of the pancreatic region were the most common reparative technique used. More complicated procedures with pancreatic and/or duodenal resection were performed in 6 patients. Overall mortality in patients surviving more than 24 hours was 14% (suture line dehiscence after delayed operation and one death due to brain injury).

Adolescent↗
PubMed1990

[Diagnosis, etiology and treatment of cholangitis following bilio-digestive surgery].

Cholangitis occurring after biliary-enteric anastomosis is a well-recognized but insufficiently analyzed surgical complication. Guidelines for assessment have not been established and management remains controversial. We examined a two-year experience with recurrent cholangitis following bilio-enteric anastomosis; cholangitis in the absence of anastomotic obstruction was surprisingly frequently encountered. Although selected cases without anastomotic stenosis may be amenable to nonoperative treatment, a low threshold for surgical reintervention should be maintained because radiologic assessment of anastomotic patency is often equivocal and the clinical problem is often best managed surgically.

Cholangitis↗