[So-called spontaneous pneumoperitoneum in adults].
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Biomedical subjects
B Andréassian
Publications and source records attributed to B Andréassian.
[Carotid surgery under cervical plexus block. 405 consecutive operations].
There is controversy over the choice of anaesthesia for carotid surgery. The aim of this retrospective study was to report the early results of carotid surgery performed with loco-regional anaesthesia by blockade of the cervical plexus. From 1987 to 1992, 405 consecutive operations on the carotid bifurcation were performed using this technique. Among these patients, 202 (50%) were asymptomatic, the indication being carotid narrowing of 80% or more, while clinical signs were observed in the other 203 patients (50%). According to the Sundt classification, 360 patients (89%) had a medical risk and 45 (11%) had a neurological risk. Occlusion of the controllateral internal carotid was present in 47 patients (12%). The deep blocade affected roots C2-C3-C4 followed by a superficial block using 0.5% Bupivacaine. An endarteriectomy was performed in 96% of the cases. In 10 (2.5%), there were complications or the cervical plexus blocade was insufficient: 6 caused the operation to be postponed and/or use of general anaesthesia, but none of these led to postoperative complication. In 35 patients (8.6%) neurological events during clamping required establishing a shunt (6.1% and 27.6% in cases with permeable or occluded controlateral carotids respectively). Neurological recovery was rapid and complete except in 4 cases. There were 8 central neurological complications which persisted or appeared postoperatively: 5 regressive ischaemic events, 2 persistent ischaemic events and one which led to the patient's death. No cardiac complications were seen. We conclude that blocade of the cervical plexus is a simple and effective technique for surgery of the carotid bifurcation. With this method, detection of clamp intolerance is more reliable and it gives enough time for endarteriectomy. The risk of coronarian complications is low due to good haemodynamic stability. This method is a low-cost technique and is better adapted to understanding the mechanisms of neurological complications.
Adult↗
Redo lung transplantation: a North American-European experience.
An international survey of redo lung transplantation was performed to identify the morbidity and mortality rates and factors correlating with increased or decreased survival after this procedure. Twenty institutions in North America and Europe participated, and the study cohort included 61 patients who underwent 63 redo lung transplantation operations. Patients undergoing a redo heart-lung transplantation were excluded. The indications for reoperation included obliterative bronchiolitis (32 patients), graft failure (14 patients), intractable airway problems (8 patients), severe acute lung rejection (5 patients), and miscellaneous complications (4 patients). Five types of retransplantation procedures were performed, including redo ipsilateral single lung transplantation (24 patients), redo contralateral single lung transplantation (11 patients), single lung transplantation after double lung or heart-lung transplantation (13 patients), redo double lung transplantation (8 patients), and double lung transplantation after a previous single lung transplantation (7 patients). Actuarial survival was 65%, 49%, 42%, 35%, and 32% at 1, 3, 6, 12, and 24 months, respectively; survival was significantly (p < 0.05) worse than that of first-time lung transplant recipients recorded in the International Society for Heart and Lung Transplantation Registry. Actuarial survival did not differ according to the original diagnosis of the recipients, the indication for reoperation, or the type of retransplantation procedure performed. Similarly, recipient cytomegalovirus status and ventilator status before reoperation did not affect postoperative survival. Trends toward an improved outcome were noted in patients who were ambulatory before reoperation and in those receiving an ABO identical, as opposed to ABO compatible, graft at reoperation. Life table and step-wise logistic regression analysis identified donor cytomegalovirus status at reoperation to be an important determinant of outcome, with significantly (p < 0.05) improved survival in the donor cytomegalovirus-negative group. Polymicrobial infection was the most common cause of death at all time intervals after reoperation. The presence of disseminated infection and established multiorgan failure was almost uniformly associated with a fatal outcome. We conclude that redo lung transplantation may be indicated only in well-selected patients with obliterative bronchiolitis, severe airway complications, or graft failure. Donor cytomegalovirus status at reoperation is an important predictor of survival. The presence of disseminated infection and established multiorgan failure should be contraindications to lung retransplantation.
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