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Biomedical subjects

A C Benhamou

Publications and source records attributed to A C Benhamou.

At least 19 recordsLinked to original sources
PubMed2004

The French language virtual medical university.

The work program of the French Language Virtual Medical University started about 2 years ago, and entered into a real active phase of development and implementation in 2002. Various national programs and organizational initiatives should accelerate and facilitate further appropriation of modem pedagogical approaches by knowledge providers and all users of the FSVMU, so as to advance on the way of virtual education. The French Language Virtual Medical University under the auspices of both the National Conference of Deans of Medical Schools and the International Conference of Deans of French-Speaking Medical Schools has been developed to create a major Internet portal for French-speaking distance medical learning and teaching. This construct should be representative of all medical schools in France and French-speaking countries. Contents will also be translated into English, Spanish and Arabic. All medical disciplines with their various levels of teaching are to be included. Cross-related fields are also going to be present in order to offer full range programs. The latter are intended to provide both initial and continuing education for medical students as well as all other categories of health professionals and medical and scientific research workers. To develop the appropriate technology and make such a portal, on one hand correspond to the specific educational requirements and proper training for health professionals, and on the other hand provide a general access to e-learning in all schools of medicine; in keeping with such goals, the following approaches should be stressed upon. To build a virtual space where individual patients, their families, patient associations as well as the general public, can obtain medical information of good quality for the purposes of both education and prevention. Providing such categories with reliable and validated sources of information, and offering an ethical basis for the increasing practice of e-medicine, represent in today's and tomorrow's world one of the great modern challenges for the medical community. Beyond the sole medical domain, the model offered by the FSVMU should be useful for the French-speaking Universities in all the fields of knowledge and training which are candidate to benefit from new educational means and methods.

Computer Simulation↗
PubMed2000

Treatment of aortic arch dissection using the elephant trunk technique.

The elephant trunk technique was developed to facilitate multiple-stage treatment of extensive aneurysm of the thoracic aorta. However, little information is available concerning its usefulness for aortic dissection. From April 1992 to July 1998, we used the elephant trunk technique for treatment of aortic arch dissection in 22 patients (including 19 men) with a mean age of 58.5 years (range 21 to 85 years). Twelve patients presented with type A dissection (acute in 3 and chronic in 9), 3 with type B acute dissection, and 7 with "non A/non B" dissections with retrograde extension to the aortic arch or entry site located in the aortic arch without involvement of the ascending aorta. All patients had aneurysms of the descending (n = 7) or thoracoabdominal (n = 15) aorta. Procedures were performed under hypothermic circulatory arrest at between 15 degrees and 20 degrees C. Antegrade cerebral perfusion was used in three cases. The procedure was associated with aortic valve replacement and/or coronary bypass in 6 cases and bypass of one or more supraaortic vessels in 13. In two patients the distal end of the elephant trunk was attached with an endovascular prosthesis during the same procedure. The ensuing results in these patients indicate that the elephant trunk technique can be highly effective for treatment of complex aortic arch dissection.

Adult↗
PubMed1999

Endovascular treatment of aortoiliac aneurysms: made-to-measure stent-grafts increase feasibility.

We describe here our preliminary experience with use of a range of made-to-measure stent-grafts made from commercially available components. From January 1996 to June 1998, 94 aortoiliac aneurysms (AIA) were treated with stent-grafts that were made to measure using Z autoexpandable stainless steel stents connected with polyester sutures and covered with commercially available polyester vascular prostheses. These stent-grafts were implanted through 18 to 24 (typically 20) Fr commercially available introducers via a surgical remote access. Made-to-measure tubular, bifurcated, tapered, and/or blind stents combined with extraanatomic bypass designs increased the rate of endovascular treatment (ET) of AIA in this series. This rate was further increased through the use of uncovered proximal or distal stents when dealing with short or tortuous necks near major collaterals and through use of hybrid, partly surgical designs, one with stented and the other with stentless ends, the latter allowing for a surgically made anastomosis. The results of our experience with these techniques show that use of made to-measure stent-grafts greatly increases the feasibility of the ET of AIA among unselected patients while offering enough efficiency and safety to deserve further investigation.

Aortic Aneurysm, Abdominal↗
PubMed1987

Visualization of the thoracic duct by lymphoscintigraphy.

Imaging of the thoracic duct is usually performed by radiological lymphography. However, this procedure, which uses an oil based dye injected directly into the lymph channels, has some adverse effects. In this paper we note that lymphoscintigraphy, a physiological and non invasive method, may visualize thoracic duct abnormalities, and might be particularly useful when radiological lymphography is contraindicated.

Chylothorax↗
PubMed1986

[Peroperative endoluminal dilatation or recanalization (DELPO or RCPO) in arteriopathies of the lower extremities. A new therapeutic weapon for the vascular surgeon. Apropos of 42 cases].

Forty-two DELPO or RCPO were performed using coaxial balloon catheters through surgical vascular approach for 35 cases of advanced lower limb arterial disease (stages: pronounced II: 6, III: 13, IV: 12, subacute ischemic: 4). The DELPO involved the following arteries: iliac: 12, deep femoral: 3, superficial femoral: 12, popliteal: 5, leg artery: 8, stenosis of popliteal anastomosis: 2, and was combined with a reconstructive arterial operation in 26 cases (proximal: 11 times, distal: 14 times or intersegmental: twice in relation to the surgical procedure). The DELPO was conducted alone in 9 cases and the RCPO alone in 6 cases, the surgical approach being preferred to the percutaneous route. Early results were rated as good in 89%, with clinical failures requiring amputation in 4% and failure of the method in 7%. The DELPO allows two objectives to be reached. First, when combined with a surgical procedure it reduces the extent and therefore the degree of surgical aggression while creating improved hemodynamic conditions for vascular reconstruction (improved proximal or distal beds or both). Second, when performed alone DELPO or RCPO enable safe, reliable treatment of lesions usually approached by a percutaneous endoluminal dilatation procedure.

Aged↗
PubMed1985

[Technic for the indirect revascularization of corpus cavernosum in sexual impotence from distal arterial origin by double epigastro-veno-cavernous fistula].

A new technique of indirect revascularization of the corpora cavernosa in patients with sexual impotence of distal arterial origin is described. It consists of a termino-lateral anastomosis between the epigastric artery and the deep dorsal vein of the penis, followed by a latero-lateral anastomosis between that vein and one of the corpora cavernosa. This double epigastro-venous and veno-cavernous fistula has proved effective and has given satisfactory functional results in 5 patients followed up for a mean period of 12 months.

Arteries↗
PubMed1985

[Ultrasonic, arteriographic and anatomopathological correlation in 59 cases of carotid atherosclerosis].

This study was carried out on 49 patients who underwent an ultrasound study by continuous Doppler and echotomography B real-time, an angiography of supra-aortic arteries, and a carotid endarterectomy. Thirteen had had transient ischemic attacks and 20 a stroke. A quantification of the carotid stenosis in 4 stages was established for each method. For detection of lesion an excellent correlation was observed between the results of echotomography and pathology. For the quantification of lesion the correlation between echotomography and pathology was excellent also in 79,7 p. 100 of the cases, discordant in 20,3 p. 100. It was similar to the correlation between arteriography and pathology (excellent in 83 p. 100 of the cases). The correlation with pathology enabled to distinguish for stages of atherosclerotic lesions, to clarify their type of complications, and to evaluate their functional significance, particularly those with a high risk of embolism.

Adult↗
PubMed1985

[Anatomy and surveillance of key sites and collateral pathways in arteriopathies of the lower extermities].

Key sites to be followed up are defined as a function of initial explorations of lesions in operated or unoperated arterial disease of the lower limb. Details of these key sites were obtained from pathologic examination of collateral vessel networks. Precise studies were conducted of the collateral circulation after infrarenal aortic obliterations, and femoral and tibial artery occlusions. Prediction of the ischemic risk and therefore of prognosis, and choice of therapy, can be obtained only by a detailed study of the reentry value through the bias of this collateral circulation.

Arterial Occlusive Diseases↗
PubMed1985

[What key zones should be monitored as a function of the assessment of the initial lesion? Collateral pathways?].

Key zones to be kept under surveillance are defined as a function of initial lesion features of operated or unoperated arteriopathy of lower limbs. Knowledge of these key zones resides in the anatomical knowledge of the supply network and of the physiopathology involved and its coming into play. Collateral circulations of infrarenal aortic obstructions are studied in detail, and then those that develop after femoral and tibial artery occlusions. Valid prediction of the ischemic risk can only be made after obtaining precise data on the re-entry effectiveness through this collateral circulation, allowing a prognosis to be established and a reasoned choice of therapy to be made.

Aorta, Abdominal↗
PubMed1985

[Resection graft prosthesis (PTFE) of the carotid bifurcation (RGPCB). A new alternative to endarterectomy or to venous bypasses for the treatment of cervical carotid atheromatous stenoses. Technique and indications].

Carotid endarterectomy, possibly followed by an enlarging angioplasty using a venous patch or a prosthesis, is standard treatment for cervical atheromatous lesions. However, this technique may be impossible to apply and a bypass operation may be necessary. J.M. Cormier has proposed the use of a venous by-pass by autologous internal saphenous graft as an alternative to endarterectomy, and reported very favorable results. The usual procedure is lateral implantation into common carotid artery followed by end-to-end implantation into internal carotid artery. The object of this paper is to demonstrate the interest of total resection of the pathologic carotid artery bifurcation followed by total replacement with a prosthesis in PTFE (Goretex) with bifurcated thin walls (new bifurcation constructed by the surgeon) and 3 end-to-end anastomoses (common carotid proximally and internal and external carotids distally). This repair procedure is simple, orthoanatomic, and complete, ensuring permeability of the two axes, internal and external, and is logical. It avoids the thrombo-embolic risk related to the walls after endarterectomy which are often imperfectly smooth leaving a distal intimal projection difficult to prevent or to fix. This thrombotic in situ risk of the endarterectomized wall is shown by isotopic studies with Indium 111-labelled platelets, and most secondary neurologic accidents, definitive, sometimes fatal, or transient, are due to this phenomenon. The three anastomoses in healthy zones considerably reduces this risk. The use of PTFE in femorodistal bypass surgery has been shown to give a good level of long-term permeability even for poor distal beds, and to present a low septic risk compared with Dacron prosthesis. This material was therefore considered a good alternative to a venous graft for the carotid vessels. The technique was used 12 times in 11 patients, between 1984 and 1985, without occlusion, or mortality. One patient developed a transient ischemic accident related to a low output and with multiple pedicles lesions, but there were no sequelae. All shunts were seen to be permeable on follow up venous angiography. Wider experience and a longer review period are necessary before proposing this method, but initial results of its use have been encouraging.

Aged↗
PubMed1984

[Echotomography and spectral analysis of the Doppler signal in the assessment of carotid lesions].

Real-time echography and C.W. Doppler examination with spectrum analysis are the two methods most widely used for the study of the circulation. Echography allows the detection and the localization of the atheromatous defects whereas Doppler examination provides information on the blood flow. With the help of the frequency analysis of the Doppler signal it is possible to study much more accurately the local haemodynamic conditions. Spectrum analysis is one of the possible display mode for the Doppler signal. It provides in comparison with the zero crossing mode, much more haemodynamic parameters on the blood flow, such as velocity spectrum, density of red cells on each velocity... In this study, we tried to demonstrate that a relationship exists between the amplitude of the spectrum disturbances, recorded just after a stenosis and the degree of this stenosis. For that we propose a classification of the spectrum disturbances in five grades, each of them being related to an interval of possible values for the stenosis degree (grade I----stenosis less than 40% in area, grade II----40-60% stenosis, grade III----60-75% stenosis (extended defects) grade IV----70-90% (extended defects) and 60-90% short stenosis. Grade V: stenosis greater than 90%. The results provided by this classification were compared to those obtained by measurements of the stenosis degree on the piece of endarterectomy (72 cases). The results were in agreement in 94% of the cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Arteriosclerosis↗
PubMed1984

Place of intravenous arteriography with non-numerized processing in vascular pathology and surgery. Results of 424 investigations.

424 intra-venous arteriographies with non-numerized photographic subtraction have been carried out in 304 patients. Exploration concerned supra-aortic trunks in 204 cases, abdominal aorta in 107 cases, arteries of the lower limbs in 89 cases, thoracic aorta in 19 cases and arteries of the upper limbs in 5 cases. Technique is described, indications, results, complications and limits of the method are discussed for each explored area. This method is an interesting contribution as a morphological, slightly invasive evaluation of arterial lesions when computerized systems are not available.

Adolescent↗
PubMed1984

[Validation of quantitative and qualitative data of real-time carotid echotomography in comparison with standard Doppler tests, arteriography and anatomopathology. On 59 carotid endarterectomies].

Findings on ultrasound, arteriography and pathology examinations were compared in 49 patients undergoing 59 carotid endarterectomies between December 1981 and April 1983. Carotid artery lesions were investigated routinely by cervical Doppler, high resolution rapid ultrasound and either direct or more usually venous arteriography (with photographic subtractions). Postoperative endarterectomy specimens were examined to determine the exact degree of stenosis, and also qualitatively (gross pathology and histology of ulcerations and thromboses, the biochemical nature of the plaques, etc.). With respect to detection, that is demonstration of the existence or not of an atheromatous lesion, the ultrasonographic findings could always (100% of cases) be correlated with pathology data. Qualitative analysis of atheromatous lesions showed certain to be diagnosed with ease: calcified, fibrous or chondroid and lipidic plaques, while those complicated by hemorrhage, ulceration or mural thrombosis were less constantly diagnosed by ultrasound imaging. Occlusive plaques were easily detected, while recent intraluminal thrombosis was more difficult to diagnose by ultrasound alone. In this case the combined use of Doppler is a valuable aid, and is a routine procedure, in fact, in the department. Results of quantitative analysis showed good correlation between ultrasound and pathology findings in 79.7% of cases (insufficient in 20.3%). However, if ultrasonography is combined with other ultrasound methods of examination (standard Doppler and spectral analysis of Doppler) correlation is of the order of 95%, close to morphological data supplied by arteriography, with in addition a functional and qualitative approach not possible with arteriography alone.

Aged↗
PubMed1984

[Evaluation of the degree of carotid stenosis by spectral analysis of the Doppler signal. Comparison of the results of spectral analysis, angiography and anatomo-pathology].

With the single Doppler spectrum analysis, one can appreciate the degree of the carotid stenosis according to the importance of the haemodynamic disturbances induced by the stenosis. The purpose of our study is to show the possibilities and the limitations of this method. Spectrum disturbances were classified in 5 grades, each of them being related to the importance of the stenosis. The degree of stenosis has been evaluated by the C.W. Doppler spectrum analysis, the angiographies and the anatomical study of the endarteriectomies. We considered that we had a perfect concordance between the results of the different methods when the degree of stenosis measured on the angiographies or on the endarteriectomies was compatible with the spectrum analysis classification: grade I: stenosis inferior to 40% (in area), 23% (in diameter); grade II: stenosis ranging between 40 and 60% in area (23 and 40 in diameter); grade III: stenosis of 60 to 75% in area (40 to 50% in diameter) and of particular shape (extended plaque); grade IV: stenosis ranging between 60 and 90% in area (40 to 70% in diameter); grade V: stenosis higher than 90% in area (70% in diameter). The confrontation of spectrum analysis and angiographic date concerns 58 bifurcations. We got a perfect correlation in 93% of the cases. The confrontation of the spectrum analysis method and the anatomical study of the endarteriectomies concerns 38 bifurcations. We got a perfect correlation in 92% of the cases. The appreciation of the carotid stenosis degree is now performed in routine at the Hospital. For some patients, the endarteriectomy has been decided from the clinical and the spectrum analysis data, and an electro-encephalogram with compression. However these date are generally completed with an angiography with venous punction.

Carotid Arteries↗
PubMed1984

[Development of a standardized form for mercury gauge plethysmography of veins and arteries].

Mercury strain gauge plethysmography will play an increasingly important role in vascular function exploration, participating in the detection of deep vein thrombosis and replacing arteriopathy in its arterio-capillary context. This required the development of a standardized reporting form for entering results of venous and arterial examinations and providing simple, clear evaluations of vascular function to assist therapeutic decisions. A standardized sheet in the form of rapidly scanned graphs and tables was established, this simplified representation facilitating decision making. Wider use of this type of form is proposed, with the aim of providing uniformity of data from mercury strain gauge plethysmography and statistical and computerized analysis of results of multicentre studies.

Computers↗
PubMed1983

[White clot syndrome. Arterial and venous thromboses during heparin therapy with thrombopenia after bone surgery].

The authors observed 9 patients submitted to prophylactic treatment with adequately doses subcutaneous heparin, for orthopaedic or traumatic surgery (chiefly total hip arthroplasty) who presented between the 7 and 9 day after starting heparin therapy, thrombotic complications including recurrent arterial occlusions and venous thrombosis associated with a profound thrombocytopenia, with a maximum platelet count below 30,000 per cubic millimeter. A rapid increase of platelet count after heparin withdrawal is observed, and the profound thrombocytopenia seems to be immune mediated with heparin dependent platelet antibodies, in most of the reported cases. We propose a platelet count for all surgical patients with heparin therapy, and if a thrombocytopenia appears, with a platelet count in the range of: 80,000 clinical inspection and platelet aggregation investigations, and immediate cessation of heparin therapy at 30,000 platelets/mm3.

Aged↗
PubMed1982

[Myocardial ischemia and carotid surgery. Holter study of 21 severe coronary patients. Preventive effect of intravenous trinitrin].

Cervical carotid artery surgery is increasingly being performed in elderly, polyvascular, high risk patients, some of whom have severe coronary artery disease. Is this right? The effects of this almost routine surgical procedure from the technical point of view were analysed with respect to the coronary lesions. 1. A retrospective study of coronary events occurring in the peroperative or immediate postoperative period and at short term was carried out in 367 patients aged over 70 years old (average 73,4 years) undergoing 424 cervical carotid artery procedures with a particularly high coronary risk. 2. A prospective study of ischemic ECG changes occurring in the period between induction of anaesthesia and the 4th postoperative day was performed by Holter monitoring in 21 patients with severe coronary artery disease. The mortality and morbidity observed were very low and could be further reduced by certain anaesthetic and pre-and postoperative techniques. In particular, prophylactic intravenous trinitrin (0,5 to 1,5 gamma kg/min) was most effective in protecting the myocardium in 15 patients with severe angina (classes III and IV of the NYHA classification). The authors conclude that the surgical result depends mainly on the neurological status of the patients, the best results being obtained in asymptomatic patients (stage 0) or those having suffered transient ischemic attacks (stage 1). The global mortality and morbidity rate was less than 2 p. 100 in those groups. On the other hand, long-term survival depends mainly on the severity of the coronary artery disease.

Aged↗