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Biomedical subjects

C Rioux

Publications and source records attributed to C Rioux.

At least 19 recordsLinked to original sources
PubMed2006

The postoperative bacteriuria score: a new way to predict nosocomial infection after prostate surgery.

OBJECTIVE: Urinary tract infections are the leading nosocomial urologic infections and may be a cause of added morbidity and costs, and sometimes sepsis. The aim of this study was to design a predictive score for these complications after prostate surgery. DESIGN: Multicenter prospective survey. SETTING: Eleven French urology centers. PATIENTS: All patients undergoing transurethral resection of prostate (TURP) during a 3-month period. RESULTS: The overall incidence of postoperative bacteriuria was 25.0% (95% confidence interval, 17.7%-29.5%). Almost all patients (95.7%) received antibiotic prophylaxis. A predictive postoperative bacteriuria score (POBS), with a 6-point scale of 0 to 5, was constructed on the basis of independent risk factors identified in multivariate analysis of a test sample of patients (n=135) and tested in a validation sample (n=73). Significantly more infections occurred in patients with a POBS of 2 or higher (87 [8%] vs 48 [50%]; P<.0001). With the test sample, this yielded a sensitivity of 77%, a specificity of 77%, a positive predictive value of 50%, a negative predictive value of 92%, and a global accuracy of 77%. CONCLUSIONS: POBS could be used to distinguish patients at risk of developing infection after TURP. This information might be useful for implementing selective prevention measures or for adjustment for differences in nosocomial infection rates when comparing data between urology centers.

Aged↗
PubMed2002

[Incidence of surgical site infection in ambulatory surgery: results of the INCISCO surveillance network in 1999-2000].

OBJECTIVES: To estimate the incidence of surgical-site infections (SSI) in ambulatory surgery and to identify risk factors based on the surveillance network INCISO in 1999-2000. PATIENTS AND METHODS: Annually, during a three-month period, each surgical ward had to include 200 consecutive operations. Patients were surveyed over the month following surgery. For each patient, data including peri-operative factors, type of procedure and SSI occurrence were collected on a standardized form by a surgical staff committed for the study. RESULTS: Of the 5,183 patients who underwent an ambulatory surgery, the SSI incidence ratio was 0.4% (95% CI [0.3-0.7]). Orthopedic, gynecologic/obstetrics, head and neck, skin and soft tissues surgery accounted for 83% of all ambulatory procedures. 93% of patients belonged to the 0 risk category of the National Nosocomial Infections Surveillance system (NNIS) index. Emergency, age, american anesthesia risk score (ASA), Altemeier wound class, and procedure duration were not found to be risk factors for SSI in ambulatory surgery. CONCLUSION: Based on these surveillance data, infectious risk was low in ambulatory surgery and was not associated with known SSI risk factors.

Adult↗
PubMed2002

[Audit of preoperative antibiotic prophylaxis in a surgical site infections surveillance network].

OBJECTIVE: To evaluate the preoperative antibiotic prophylaxis (PAP) prescriptions in a surgical site infection (SSI) surveillance network. STUDY DESIGN: Auto-evaluative audit in a prospective multicenter cohort included in a surveillance system. PATIENTS AND METHODS: Since 1997, surgical wards in volunteer centers monitored all surgery patients each year during a period of two months. Patients were evaluated for SSI during the 30 days following surgery. Participating centers were asked in 2000 to participate to a PAP practice assessment. For each surgery patient, a questionnaire was completed. The "Guidelines for Antibiotic Prophylaxis Prescription in Surgery" edited in 1999 by the Société française d'anesthésie et de réanimation was used as gold standard. RESULTS: 6109 patients were included in the survey from 34 health care centers and 3881 received PAP. 90% of patients received PAP intravenously and 63% received twice the curative dose. PAP was administered within 90 minutes prior to incision in 70% of cases. 78% of PAP lasted less than 24 hours. PAP indication with regards to the type of surgical procedures was assessed in 4629 patients. PAP guidelines were observed in 1573 (34%) patients: 999 patients in whom PAP was not indicated did not receive PAP and 574 received it in compliance with recommended dose and indications. CONCLUSION: Efforts should be made to improve PAP prescription according to standards guidelines.

Anti-Bacterial Agents↗
PubMed2001

Morbidity and mortality associated with surgical site infections: results from the 1997-1999 INCISO surveillance.

Since 1997, a surgical-site infections (SSI) surveillance network (INCISO) has been implemented in volunteer general surgical units in Northern France. For three months each year, all patients who undergo a surgical procedure are consecutively reviewed for their peri-operative condition and traced for outcome with a 30-day follow-up. Of the 38973 surgical patients included over a three-year period, 1344 (3.4%) developed SSI and 568 died (1.5%) including 78 with an SSI. Organ-space and deep incisional SSI were associated with a higher mortality and required re-operation more frequently than did superficial incisional SSI. SSI incidence and mortality varied according to the surgical procedure. SSI was a significant predictor of mortality, independently of NNIS risk index and other survival predictors. Thirty-eight percent of deaths in SSI patients were attributable to infection. Hence, the significant impact of SSI on mortality and morbidity in surgical patients is now an additional reason to reinforce compliance of surgical staff with preventive measures and hygiene practices.

France↗
PubMed2001

[Results of surgical treatment of calcified aortic valve stenosis: report of a series of 4,129 interventions].

Aortic stenosis (AS) is the most common lesion currently encountered among valvular heart disease, particularly in elderly people. Severe functional impairment and risk of sudden death explain that surgical treatment is largely accepted. We report a retrospective analysis of institutional experience with aortic valve replacement (AVR) for AS from 1971-1997 in 4,129 patients. Age ranged from 13 to 91 years (mean 68 +/- 10) and degenerative disease was largely predominant (86%). For AVR, mechanical prostheses were used in 2,054 patients (50.2%) and bioprostheses in 2,075 (48.8%) in elderly group. Coronary artery revascularization was associated in 670 patients (16%). Operative mortality was 7% (303 pts) and main cause was left ventricular failure (52%). Late results were studied with a maximum follow-up of 26 years. Total follow-up represents 21,533 pt-years. Late death occurred in 1,108 patients between 1 month and 24 years after operation (mean 6.6 years). Reoperation was necessary in 136 cases. Actuarial survival--including operative mortality--was 77% and 56% at 5 and 10 years. A large functional improvement was observed in the vast majority of patients, 73% being I or II subgroups of the NYHA classification. Incremental risk factors for death (immediate as well as late) were older age, preoperative functional status, emergency, presence of cardiac failure, coronary artery lesions and associated morbidity. The choice of valvular prosthesis remains controversial, but the results show that AVR is the procedure of choice for the vast majority of patients wtih significant aortic valve disease.

Adolescent↗
PubMed1999

Aortic Carpentier-Edwards supraannular porcine bioprosthesis: a 12-year experience.

BACKGROUND: After 35 years of cardiac valve replacement, the ideal substitute remains to be found. Homografts are considered best but, due to their scarcity, cannot meet the need of valve replacement. Artificial valves (mechanical or biological) remain the most commonly used but controversy is still present as to the better choice. We tested the Carpentier-Edwards bioprosthesis for its efficacy in valve replacement operations. METHODS: From 1983 to 1995, 1,108 consecutive patients had an isolated aortic valve replacement with a porcine Carpentier-Edwards bioprosthesis, model 2650 supraannular valve. Mean age was 73.8+/-8.3 years. Aortic stenosis was the most common lesion (1,049 patients, 94.7%). The follow-up of 980 operative survivors was 96% complete and represented a total of 4,735 patient-years (maximum, 13.8 years; mean, 4 years and 10 months). RESULTS: Actuarial survival including operative mortality (128 patients, 11.6%) was 43.6%+/-2.3% at 10 years and 27.3%+/-3.3% at 12 years and, at that time, was not statistically different from those of the normal French population matched for age and sex. Structural deterioration of the valve was observed in 27 patients, an actuarial freedom of 94.2%+/-1.5% at 10 years and 83.8%+/-4.5% at 12 years. Hazard function revealed a stable and low risk of structural deterioration until 10 years and significantly increased risk after that. Young age was found to be an increasing risk factor of deterioration. Reoperation for valve-related complications was necessary in 30 patients, an actuarial freedom of 94.5%+/-1.4% at 10 years. CONCLUSIONS: The Carpentier-Edwards porcine supraannular valve affords a good durability up to 10 years, with a low rate of reoperation. The risk of structural deterioration decreases with older age. It is our valve of choice in elderly patients.

Aged↗
PubMed1999

[Teaching resources of a hospital Gynecology-Obstetrics service. Review of the literature and practical applications].

OBJECTIVES: To summarize the methods encountered in a gynecological department for teaching medical students. STUDY: Review of the Medline literature underlying the benefits and disadvantages of each method using the issues of the modern theories of teaching. RESULTS: All the methods are helpful for learning, with different and complementary objectives. Students can constitute a set of skills using a teaching program containing clear objectives and evaluation on which the future medical practice will be based. CONCLUSION: Students have immediate benefits from an active clinical learning involving them and are prepared to the Continued Medical Education.

Case Management↗
PubMed1999

[Long-term results of valve replacement using the Cobomedics prosthesis].

The Carbomedics valve prosthesis is a second generation mechanical prosthesis with a double hemi-disc. This study analysed long-term morbidity and mortality associated with this prosthesis. Between 1987 and 1996, 397 prostheses were implanted, 306 aortic, 42 mitral and 26 double replacements (3 combining a Carbomedics aortic prothesis with a mitral valve from another type) in 370 patients with a mean age of 62 (range 4 to 88 years). The global operative mortality was 7.4%. A questionnaire sent to treating cardiologists, general practitioners and patients updated the prospective data base of the cardiac surgical department. The follow-up was 99%, representing a total of 1244 patient-years with an average of 41 months (range 1.1 month to 9.9 years). The 1, 3, 5 and 7 year survival (operative mortality included) was 88%, 80%, 76% and 69.6% respectively. Haemorrhagic complications were the most common (17 cases, 1.36% per patient-year) and 11 thromboembolic episodes were observed (0.88% per patient-year) with a higher incidence (p < 10-4) in mitral valve replacement (3.8% in patient-year). The other complications observed were: 5 aseptic paravalvular leaks (0.4% per patient-year) and 5 prosthetic valve infections; no structural alterations were observed. In all, ten reoperations (0.8% per patient-year) were required for prosthetic valve complications. This study shows the reliability of Carbomedics valve prostheses with a low complication rate comparable to that of other modern mechanical valve prostheses.

Aortic Valve Insufficiency↗
PubMed1998

Aortic valve replacement in the elderly: bioprosthesis or mechanical valve?

BACKGROUND: With increased life expectancy, valve operations are more and more common in elderly patients. The choice of valve substitute-mechanical valve or bioprosthesis-remains debated. METHODS: Two groups of patients of the same age (69, 70, and 71 years) with isolated aortic valve replacement (mechanical 240, bioprostheses 289) were compared for mortality, morbidity, and valve-related complications. RESULTS: No significant difference was found in survival, valve-related mortality, valve endocarditis, and thromboembolism. Mechanical valve had more bleeding events; bioprostheses had more structural deterioration, reoperation, and valve-related morbidity and mortality. CONCLUSIONS: To avoid reoperations in octogenarians, the 10-year durability of current bioprostheses should be matched with the life expectancy of the particular patient. Bioprostheses should be used after 74 years in men and 78 years in women.

Age Factors↗
PubMed1998

Aneurysms and pseudoaneurysms of saphenous vein coronary artery bypass grafts.

Aneurysms of saphenous vein grafts to coronary arteries are unusual complications of coronary artery bypass graft (CABG) surgery. Three patients (men aged 47, 62, and 68 years) are presented with spontaneous chest pains 10, 21, and 17 years after CABG surgery. In one case, the saphenous vein graft had eroded into the right atrium and had established a fistula between the graft and the right atrium. Diagnosis of saphenous vein graft aneurysms was confirmed by echocardiography, computed tomography or magnetic resonance imaging, and by arteriography. Two patients were treated surgically, the third by percutaneous coil embolisation followed by balloon angioplasty of the right coronary artery.

Aged↗
PubMed1997

[The Carpentier-Edwards porcine valve in the supra annular aortic position. Results after 12 years in a series of 1108 patients].

In the decision concerning the choice of valvular prosthesis, certain prostheses are considered to be standards of reference: this is the case of the Carpentier-Edwards Supra Annular 2650 porcine bioprosthesis. This study reports the results in a series of patients followed up for 12 years. Between 1983 and 1995, 1108 patients were implanted with this prosthesis for isolated aortic valve replacement. The majority of patients was elderly (mean 78.3 +/- 8.3 years). The follow-up rate was 94%, representing a total of 3 925 patient-years (average 4 +/- 3 years). The survival at 5, 10 and 12 years, operative mortality included, was 70.7%, 46% and 28%. Thromboembolic events to dehiscence represented the commonest complication (0.7% per patient-year). Structural valve degeneration (21 cases) (0.5% per patient-year) was a low risk complication up to 10 years but increased suddenly at the 11th year: age and gender were risk factors for this complication. The actuarial complication-free rate was 94% at 10 years and 82% at 12 years. Other complications were much less common (infectious endocarditis, haemorrage). The Carpentier-Edwards Supra Annular porcine bioprosthesis is associated with a low risk of complications after 10 years' follow-up, especially of valve degeneration. It remains a competitive choice in the register of valve prostheses. As with the other bioprostheses, the main indications are observed in elderly patients.

Adult↗
PubMed1996

Azygos vein aneurysm: contribution of transesophageal echography.

We report a case of idiopathic aneurysm of the azygos vein associated with lung cancer. This abnormality is exceptional because we could find only 8 previous published cases. Computed tomographic scan and especially transesophageal echography were of major importance in identifying the vascular nature of the radiographic abnormality and thus excluding extension of lung cancer.

Aged↗
PubMed1996

[Coronary artery disease in patients with aortic abdominal aneurysm. Apropos of a consecutive series of 172 cases].

Coronary artery disease is common in patients with abdominal aortic aneurysms (AAA). It is responsible for half the operative deaths explaining the necessity of diagnosing asymptomatic coronary patients. Between 1980 and 1993, 172 patients aged 47 to 92 years (average 69 years) were operated for AAA. Fifty-four of them (31%) were known to have coronary artery disease; 30 preoperative coronary angiograms and 16 prophylactic coronary revascularisation procedures were performed before operating the AAA. In cases with ruptured AAA (42 cases) the operative mortality was 31% (13 patients) compared with 6% (8 patients) in those without rupture (130 cases). Myocardial disease was responsible for 25% of all deaths (2 out of 8) and for 40% of deaths (2 out of 5) in the subgroup of 54 coronary patients. The majority of non-lethal cardiac complications also occurred in this subgroup. On the other hand, no deaths were observed in the group of 16 patients who underwent myocardial revascularisation beforehand. Follow-up of the 151 patients discharged from hospital was complete (100%). With an average follow-up period of 3.5 years (range 5 months to 13 years), 39 secondary deaths have been observed (26%) including 6 (15%) of cardiac causes. In addition, 3 patients in the coronary subgroup and 1 patient from the non-coronary group underwent myocardial revascularisation after surgical cure of their AAA. Coronary artery disease may be totally asymptomatic and severe lesions go unrecognised; the main problem is therefore to detect silent myocardial ischaemia in the absence of totally reliable non-invasive techniques, in order to perform preventive coronary revascularisation in high risk patients before their surgery. Coronary angiography is essential in all documented cases of severe coronary artery disease; exercise testing and thallium scintigraphy should be proposed in cases with clinical or electrocardiographic presumption of angina. However, systematic investigation is not required in the absence of suggestive symptoms.

Actuarial Analysis↗
PubMed1996

[A rare complication of mediastinitis: rupture of the right ventricle].

Two cases of right ventricular free wall rupture secondary to mediastinitis after cardiac surgery are reported. This complication is unusual and characterized by the singular mechanism of rupture (traction involving right ventricular free wall and chest adhesion) which occurs during episodes of coughing. Treatment by omentoplasty en sureda favorable outcome in both cases.

Aged↗
PubMed1996

[Cardiac transplantation: clinical results. Apropos of 150 cases].

This retrospective study reports the clinical results obtained in a series of 150 heart transplantations performed from October 1986 to January 1995. Overall actuarial survival rate, including operative mortality, was 71% and 57% at 1 and 5 years respectively. Despite a certain level of morbidity, the spectacular functional results in this series are emphasized.

Adolescent↗
PubMed1996

[Long-term results over 20 years of aortic valve replacement with the standard Björk-Shiley prosthesis].

Between January 1971 and December 1978, 865 standard Björk-Shiley prostheses (spheric or conic carbon disc) were implanted in the Department of Thoracic and Cardiovascular Surgery of the University Hospital of Rennes. Three hundred and fifty seven consecutive patients who underwent isolated aortic valve replacement were included in the study : 246 men (69%) and 111 women (31%) with an average age of 57.5 years (range : 24-80 years). One hundred and sixty eight patients (48%) were in NYHA Class II. 141 (39%) in Class III and 48 (13%) in Class IV. The valvular disease was stenotic in 304 cases (85%) and regurgitant in 53 cases (15%). The hospital mortality was 35 (9.8%). The main causes of death were cardiac (23 cases, 66%). The long-term results contain 322 survivors of surgery (mean follow-up 12 years, follow-up rate 99%, representing 3726 patient-years). The actuarial survival (including hospital mortality) was 76% at 5 years. 61% at 10 years, 47% at 15 years and 26% at 20 years. The average age of the survivors at present is 71 years and 95% are NYHA classes I or II. The causes of the 171 late fatalities were cardiac in 49 cases (1.3% per patient-year). Death was related to the prosthesis in 32 cases (0.8% per patient-year) : 3 endocarditis, 17 bleeding complications, 12 systemic emboli. Deaths were extracardiac in 58 cases (1.5% per patient-year). Prosthesis-related complications were : 9 paravalvular leaks (0.2% per patient-year), 3 dysfunctions (0.1% per patient-year). 24 haemorrhages (0.6% per patient-year), 5 thromboembolic episodes (0.1% per patient-year). 5 endocarditis (0.1% per patient-year). No structural abnormalities of the prostheses were observed. The authors confirm the reliability of the standard Björk-Shiley valve prosthesis in the aortic position and the value of the aortic valve replacement by a mechanical prosthesis even at very long term.

Actuarial Analysis↗
PubMed1995

[Valvular replacement for aortic stenosis in octogenarians. Apropos of a consecutive series of 200 cases].

From 1978 to 1992, 200 patients aged 80 to 90 (average 82.16 +/- 2.04 years) with calcific aortic stenosis, underwent isolated aortic valve replacement (187 cases, 93.5%), or associated with coronary bypass surgery (12 cases, 6%), or mitral valve replacement (MVR) (1 case, 0.5%), or surgery of the ascending aorta (4 cases, 2%). These 200 patients represented 7.4% of the 2,716 cases of aortic stenosis operated during the same period. One hundred and forty-eight patients (74%) were in NYHA classes III or IV. The operative mortality was 11.5% (23 patients) and the average hospital stay in the surgical department was 12.7 days (4.83%). The follow-up of the 177 patients who were discharged from hospital was complete (100%) with an average of 2.8 years +/- 2.1 (1 month to 10.6 years). Forty-nine secondary fatalities were observed (28%). Of the 128 survivors at the end of the study, 127 (98.6%) were in the NYHA classes I or II. The actuarial 1, 3 and 5 year survivals were 81.7, 74.8 and 57.1%, respectively. The survival curve of the operated patients was identical to subjects of the same age without aortic stenosis. Despite the high but acceptable operative risk due to the age, valvular replacement surgery is justified by the double benefit of increased longivity and improved quality of life.

Actuarial Analysis↗