Biomedical subjects

Bernard Montreuil

Publications and source records attributed to Bernard Montreuil.

5 recordsLinked to original sources

PubMed2006

Tuberculous pseudoaneurysm of the femoral artery complicated by cutaneous tuberculosis of the foot: a case report.

An infected pseudoaneurysm of the right common femoral artery in a 69-year-old patient receiving methotrexate therapy was confirmed to have been caused by Mycobacterium tuberculosis. After surgical excision of the aneurysm and revascularization using femoral vein, cutaneous manifestations of M tuberculosis infection in the foot complicated the course. We hypothesized that methotrexate may have triggered the reactivation of dormant tuberculosis in this patient. Because extrapulmonary tuberculous pseudoaneurysms are clinically similar to other types of infected pseudoaneurysm, M tuberculosis infection should always be suspected during the initial diagnosis. We propose that mycobacterial cultures should be routine when initial cultures and Gram stain are negative.

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PubMed2005

Giant splenic artery aneurysms: case report and review of the literature.

Although splenic artery aneurysms (SAAs) are the most common visceral aneurysms, giant SAAs >10 cm in diameter have rarely been reported. We present the case of a 67-year-old asymptomatic man who was diagnosed with a 15-cm SAA in the absence of a clear etiologic factor. The patient underwent open surgical repair. A medial visceral rotation was performed to gain good vascular control and subsequently the aneurysm was ligated from within. A systematic review was carried out, allowing us to analyze 12 cases of giant SAAs >10 cm published to date. The difference in terms of demographics, clinical presentation, and arterial location between the giant SAA group and usual SAAs may indicate a different underlying physiopathology that remains unclear at this time.

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PubMed2005

What is so odd about odds?

In clinical studies, the relative likelihood of an event occurring between 2 groups is often expressed as the risk ratio (RR) or the odds ratio (OR). The RR is an intuitive parameter that is relatively easy to interpret. Quantitative interpretation of an OR is much more difficult and is often incorrectly equated to that of an RR. The problem is that OR may differ substantially from RR, especially when the outcome of interest is common in the study population. This article explains and clarifies controversial issues surrounding the use and interpretation of the OR. Theoretical concepts relating to ORs are illustrated by examples from the surgical literature. By reviewing articles from 5 surgical journals over a 5-year period, we show that the OR is often presented and misinterpreted as equivalent to the RR. When the discrepancy is large, using OR uncritically as an estimate of RR will strongly bias inferences about treatment effect or cause of disease by amplifying the apparent strength of an association between an exposure and an outcome.

Odds Ratio↗

PubMed2004

Management trends and early mortality rates for acute type B aortic dissection: a 10-year single-institution experience.

This study was undertaken to assess trends in management over time and to determine predictors of early mortality for acute type B aortic dissection. Fifty-three consecutive patients with acute type B aortic dissection over a 10-year period were reviewed. Baseline demographics as well as in-hospital data regarding symptoms, type of initial management, surgical indications, type of surgical intervention, and early mortality rates were collected. Independent predictors of early mortality were determined by logistic regression. Forty-one of 53 (77.4%) patients were initially managed medically with a total of 26 (49.1%) ultimately undergoing surgical repair during hospitalization. Crude early mortality was 30.8% in the surgical group vs. 14.8% in the medical group (p = 0.20). Improvements in early mortality were observed over time for surgery (58.3%, first half vs. 7.1%, second half; p = 0.019) and medical therapy (21.4%, first half vs. 7.7%, second half; p = 0.64). Early mortality was 50% in 16 patients having open aortic surgery vs. 0% in 10 patients undergoing endovascular stent graft repair (p < 0.005). Independent predictors of early mortality included only renal dysfunction (odds ratio [OR] 7.39), aortic rupture (OR 8.72), and date of admission during the study period (OR 0.712). Despite improvements over time in early mortality that appear associated with the increasing use of endovascular stent grafts, patient-specific factors are still the most important independent predictors of early mortality in acute type B aortic dissection.

Acute Disease↗

PubMed2004

The proximal landing zone in endovascular repair of the thoracic aorta.

In this study we evaluated the relationship between the site of the proximal landing zone during endovascular repair of thoracic aortic pathology and treatment outcomes. We reviewed all cases of endovascular repair of thoracic aortic lesions at our institution in the past 42 months. Thirty-seven Talent thoracic endografts were used to treat 20 thoracic aneurysms, 8 intramural hematomas, 6 aortic dissections, and 3 post-traumatic aneurysms. The proximal edge of the covered endograft was situated proximal to the left common carotid artery (zone 1) in 3 patients, between the left common carotid and subclavian arteries (zone 2) in 4 patients, <2 cm distal to the left subclavian artery (zone 3) in 9 patients, and >2 cm distal to the left subclavian (zone 4) in 21 patients. Five patients had extraanatomic bypass to revascularize one or more covered aortic branches. For zones 1, 2, 3, and 4 the endoleak rates were 100%, 0%, 11%, and 0%, respectively; the secondary procedure rates were 33%, 0%, 11%, and 5% respectively; and the treatment failure rates were 67%, 0%, 11%, and 0%, respectively (p < 0.05, for endoleak rates, using Fisher's exact test to compare zone 1 to zones 2, 3, and 4 individually, and as a group). All three endovascular failures were due to proximal type 1 endoleaks. In conclusion, despite the use of great-vessel ligation and extraanatomic bypass to extend the proximal landing zone into the aortic arch, we have been unable to reliably exclude thoracic aortic pathology through use of endografts when the proximal landing zone is proximal to the left common carotid artery.

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