Biomedical subjects
Publications and source records attributed to A Bouillot.
Since silicone gel breast implants have been rehabilitated in 2001, we advised our patients to change prosthesis after 10 years. Our study including 150 patients shows clearly the rupture rate is very high (60%) for the textured prosthesis after 10 years, whereas it is much low for the double lumen implants (18%) after 14 years. This study and literature lead us to be very careful and change prosthesis every 12 or 13 years.
Upregulation of low-density lipoprotein receptor (LDLr) is a key mechanism to control elevated plasma LDL-cholesterol levels. Here we identify a new class of compounds that directly binds to the sterol regulatory element-binding protein (SREBP) cleavage-activating protein (SCAP). We show that a 14C-labeled, photo-activatable analog specifically labeled both SCAP and a truncated form of SCAP containing the sterol-sensing domain. When administered to hyperlipidemic hamsters, SCAP ligands reduced both LDL cholesterol and triglycerides levels by up to 80% with a three-fold increase in LDLr mRNA in the livers. Using human hepatoma cells, we show that these compounds act through the sterol-responsive element of the LDLr promoter and activate the SCAP/SREBP pathway, leading to increased LDLr expression and activity, even in presence of excess of sterols. These findings have led to the identification of a class of compounds that represent a promising new class of hypolipidemic drugs.
This article presents our technique of autologous breast reconstruction using the latissimus dorsi flap and studies the advantages, disadvantages, and results that can be expected. A consecutive sample of 100 patients was studied. The average length of follow-up was 20 months (range 8 to 44 months), and all of the subjects were reviewed in consultation without loss to follow-up. The supplementary volume of the latissimus dorsi was obtained from five fatty zones: fat on the cutaneous paddle, fat taken from the surface of the muscle, the scapular fat pad, the anterior fatty zone, and the supra-iliac fat pad. This technique must be measured against the transverse rectus abdominis muscle (TRAM) flap, free or pedicled, when the patient needs an autologous breast reconstruction. It can be used when the TRAM flap is contraindicated (this corresponds to 45 percent of patients of our sample) or when the dorsal donor site is preferred (55 percent of cases of our sample). The major complications are rare (1 percent partial necrosis and 1 percent total necrosis of the flap). The minor complications are represented mainly by the dorsal seroma. This is the main drawback of the technique, as it occurs in 79 percent of cases and regularly in obese patients. In view of this frequency, patients should be warned of its likely occurrence. The dorsal donor-site morbidity is relatively low; 4 percent of dorsal sequelae were classed as moderate, and 96 percent were considered low. The scapular sequelae have been classed as low in 97 percent of cases, and temporary scapular sequelae aggravation has been noted in 3 percent. Results of breast reconstruction using this technique are most encouraging. The level of patient satisfaction is high; 87 percent of them were deeply satisfied, 10 percent were satisfied, and only 3 percent were poorly satisfied. This group of poorly satisfied subjects (3 percent) consists of patients who suffered a serious postoperative complication. The aesthetic results have been judged excellent by surgeons in 85 percent of the cases, good in 12 percent of the cases, and poor in 3 percent of the cases; no result has been judged bad. This technique of breast reconstruction by autologous latissimus dorsi brings a major advance in breast reconstruction. The best indications of this technique are when one can bury the cutaneous paddle: cases of skin-sparing mastectomy, cases where the latissimus dorsi flap can be combined with an abdominal advancement flap, and cases of conversion of implant reconstruction to an autologous reconstruction.
Many women who have undergone or will undergo mastectomy request breast reconstruction and feel that it is an important part of their total cancer treatment. Autogenous tissue methods take a place more and more important in breast reconstruction. The autologous latissimus dorsi flap, is a recent method of autologous breast reconstruction. We have done a retrospective study based on a series of 60 consecutive reconstructions operated between march 1993 and april 1995. The advantages of the autologous latissimus dorsi flap are the same of the others autologous breast reconstruction methods: the reconstructed breasts are soft and match an opposite normal breast more successfully than those made with implants. The disadvantages of this technique is mainly the dorsal seroma that was observed in 70% of cases but was easily managed by aspirations. The aesthetics results have been judged by two surgeons as very good in 85% of cases, good in 11.6% and low in 3.3%. The satisfaction rate of the patients in high: 86.6% are pleased and 13.3% are satisfied. The autologous latissimus dorsi breast reconstruction is a safe and reliable technique and provides an excellent alternative to the TRAM flap, when the patient prefer the dorsal donor site or when there are some risk factors to do a TRAM flap. Finally this technique bring a major advance in the field of breast reconstruction, immediate or delayed.
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Fibrinogen glue of human origin was used in 44 patients. Indications are of two types: as a glue mainly for dermoepidermoid grafts but also to assist mucosal suturing and bone obturation, and for hemostasis after extractions in patients with coagulation disorders (hemophilia, cirrhosis, leukemia). Positive results were obtained, particularly in hemophilic patients, the incidence and severity of secondary hemorrhage appearing to diminish.
A technique of coronary perfusion with diluted blood, giving homogenous myocardial cooling (10-12 degrees C) under lignocaine perfusion, with or without potassium (K) cardioplegia is presented. The first 75 operated cases were used to adjust the optimal lignocaine (5 mg/min) and K (2 meq/min in continuous coronary perfusion, 5 meq/min in discontinuous coronary perfusion) dosage in the myocardial protection circuit. Then, 123 operated patients (78 aortic valve replacement, 30 mitro-aortic double valve replacement, 15 other operations on the ascending aorta) were classified into four groups prospectively: 1. Continuous coronary perfusion 10 degrees C, 2. Continuous coronary perfusion 10 degrees C with associated K cardioplegia, 3. Discontinuous coronary perfusion 10 degrees C, 4. Discontinuous coronary perfusion 10 degrees C with K cardioplegia. The best return of cardiac activity was observed in Group 1 and this was statistically significant with a high percentage of spontaneous heart beating after declamping the aorta (average 10 minutes), immediate efficacity of left ventricular contraction, and absence of arrhythmias, especially the transient conduction defects observed with K cardioplegia. In Group 1, during mitro-aortic valve replacement, after over 60 minutes aortic clamping, no significant reduction of ATP or myocardial phosphocreatinine or changes of hexosemonophosphates were observed, contrary to the findings after 15 minutes aortic clamping at 28 degrees C in a control group of mitral valve replacements (n = 10). Myocardial changes on electron microscopy in the subendocardial region of the left ventricle were minimal or absent, especially with respect to the mitochondria. The early post-operative course was the same in all four groups: of the 123 patients operated, early mortality was 2.4 p. 100 (1.6 p. 100 from intercurrent causes), severe arrhythmias were observed in 1.6 p. 100, supraventricular arrhythmias in 4.9 p. 100, myocardial infarction in 0.8 p. 100, electrocardiographic ischaemia in 0.8 p. 100, and atrioventricular block in 0.8 p. 100. The average enzyme level (CPK, SGOT, LDH) in the early postoperative period were low, with no correlation with the duration of aortic clamping.
A technique of myocardial protection using a perfusion circuit in deep hypothermia via the ascending aorta or by selective cannulation of the coronaries has been used over a period of 2 years in almost 200 patients undergoing surgery requiring prolonged aortic clamping. It ensures rapid and homogeneous cooling of the myocardium (10-12 degrees C) and meets its reduced oxygen needs. It may be completed by cardioplegia (infusion of potassium chloride or lidocaine using an automatic syringe at a determined level). This simple technique permits a rapid spontaneous return of normal effective cardiac action. No low cardiac output syndromes have been seen since it has been used. Laboratory, histological, biochemical and haemodynamic studies carried out have confirmed its harmless nature.