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Biomedical subjects

D Lyonnet

Publications and source records attributed to D Lyonnet.

At least 37 records · Page 2Linked to original sources
PubMed1994

Outcome of cadaver kidney transplantation in small children.

Small children have often been reported to have poor outcome after kidney transplantation (KT). Recent reports from North America have shown that the use of living-related donors improves patient and graft survival. We report the experience in one centre of primary cadaveric KT using sequential immunosuppression in nine children aged 8-30 months and weighing 5.4-9.8 kg; donors were 0.7-12.3 years old. Four patients had pre-emptive KT and the other five were on peritoneal dialysis; the mean +/- SD waiting time was 2.0 +/- 2.4 months. Perioperative care has been published previously. The surgical approach was intraperitoneal if the aorta and vena cava were used (n = 7) and extraperitoneal for common iliac vessels anastomosis (n = 2); the duration of surgery was 3.5 +/- 0.9 h and the time for vascular anastomosis was 32 +/- 6 min. The recipients received ATG, azathioprine, prednisone and delayed administration of cyclosporin A. The patients were followed for 12-98 (median 41) months and showed good graft function (inulin clearance 63-100 ml/min/1.73 m2); only one child with recurrent haemolytic uraemic syndrome lost his graft three months post-transplantation and died after he had received a second graft. None of the recipients required post-transplant dialysis; arterial hypertension involved four children and was related to graft artery stenosis in two. Growth improved by 0.24 +/- 0.48 SD score of height per year.(ABSTRACT TRUNCATED AT 250 WORDS)

Cadaver↗
PubMed1993

Familial ovarian carcinoma: pedigree studies and preliminary results from linkage analysis.

Thirty-seven ovarian cancer-prone families have been identified through a French co-operative network. Three main clinical presentations were observed: site-specific ovarian cancer, breast/ovarian carcinoma syndrome and Lynch syndrome II. An additional kindred with features of Li-Fraumeni syndrome is reported. It is expected that a better understanding of the mechanisms of carcinogenesis will allow the development of new methods of screening and treatment. With this aim, recent studies have mapped the gene for early-onset familial breast cancer and breast/ovarian carcinoma syndrome to the same locus in the chromosome 17q12-q23 region. Results from linkage analysis of two breast/ovarian carcinoma families and three breast cancer families favour the hypothesis of genetic heterogeneity among breast and ovarian tumors.

Adult↗
PubMed1990

Nosocomial maxillary sinusitis during mechanical ventilation: a prospective comparison of orotracheal versus the nasotracheal route for intubation.

Nosocomial maxillary sinusitis during mechanical ventilation may cause life-threatening complications in ICU patients. The aim of this prospective study was to compare the incidence of maxillary sinusitis according to the route of intubation. 111 consecutive adult patients (mean age: 53, mean SAPS: 12) were randomly assigned to receive either orotracheal (n = 53) or nasotracheal (n = 58) intubation. All had a nasogastric feeding tube. Patients with head trauma or mechanical ventilation for less than 48 h were excluded. Sinusitis diagnosis was made by radiography (waters' view) at the bedside. The two groups were similar in age, SAPS, duration of ventilation. Maxillary sinusitis occurred in 1/53 (1.8%) of the orotracheal group (on the nasogastric tube side), and in 25/58 (43.1%) of the nasotracheal group (7 on the nasogastric tube side, 11 on the endotracheal tube side, 7 bilateral; p less than 0.001). Nine of the 26 cases of sinusitis were initially treated by sinus drainage because of signs of infection (3 failures) and the 17 others were treated by tube removal. This procedure proved successful in 12 out of 17 cases but secondary drainage was performed in 5 cases (1 failure). Incidents related to the route for long-term intubation were significantly (p less than 0.001) more frequent in the orotracheal group (8/53 vs 2/58), however no patient died because of them. In this study, long-term orotracheal intubation reduced significantly the incidence of maxillary sinusitis in comparison with nasotracheal intubation.

Aged↗
PubMed1990

[Long-term results of transluminal angioplasty in the treatment of stenosis of the renal artery].

MATERIALS AND METHODS. A multicenter study was undertaken to determine the long-term results of renal angioplasty. Five teams with considerable experience in the procedure replied to a computerized questionnaire concerning transluminal angioplasty (TLA) performed with immediate success from 1979 to 1985 and followed up regularly (minimum of four years). The main purpose of the study was to assess the long-term results, both anatomical results and clinical, of renal TLA. Consideration was given to anatomical of average quality and their possible correlation with long-term results, in an attempt to foresee and even prevent restenosis. The main points of the study are given in figure 1. Two hundred and forty-seven renal TLA performed in 210 patients were included (insofar as clinical and radiologic follow-up was adequate, with a minimum of one control angiography beyond six months). Patients who had immediate failure (dilatation not possible or ineffective dilatation) were excluded from the analysis of long-term results. Likewise, TLA of the renal artery of grafted kidneys were not included in this study. The histogram of patients ages shows a clear predominance of subjects 60 to 65 years of age, with extremes ranging from 10 to 80 years (mean 53 years). TLA were done mainly by the femoral route according to a technique using a balloon catheter positioned on a previously inserted guide at the level of the stenosis. The examination was performed under local anesthesia. Balloon size was determined according to the diameter of the renal artery upstream from the stenosis and that of the contralateral renal artery. A balloon of the same or slightly larger caliber was used. The indication of angioplasty was determined after multidisciplinary discussion according to two main criteria: First, treatment of hypertension presumed to be in relation with a stenosis of the renal artery (renovascular hypertension). Secondly, conservation of the nephrotic capacities of a patient with a renal stenosis possibly associated with arterial hypertension, in relation with a bilateral stenosis of the renal arteries or with a unilateral stenosis affecting a functionally or anatomically single kidney. In this latter case, the purpose of TLA was to avoid development toward thrombosis of the renal artery and worsening of renal insufficiency. RESULTS. Two hundred and forty-seven TLA in 210 patients were included in the study. Nineteen patients (9%) had bilateral TLA. The lesions treated are indicated in figure 3. These were most often simple atheromatous and truncal lesions of the renal artery (73%) which were significant (greater than 50%) in 99% of cases. TLA was indicated in 77% of cases for treatment of arterial hypertension presumed to be renovascular. In 23% of cases, treatment of the stenosis was intended to conserve, especially, kidney vascularization, i.e., an indication of nephrotic protection. There were 9.7% immediate failures...

Acute Kidney Injury↗
PubMed1986

[Peroperative radiotherapy. Initial experience at the Red Cross Hospital].

Intra operative radiation therapy is a new look at an old idea (Rich). In relation with the first experience at the Croix-Rousse Hospital with orthovoltage, a review of technical choices, surgical problems, and biological questions is presented. The analysis of literature about accumulated clinical results suggest that local control in recurrence, residual, or inoperable tumor can be obtained by combined surgery IOR, and external beam irradiation. This short experience demonstrate the feasibility of the treatment as a routine and emphasizes the need for continued study.

Adult↗
PubMed1986

[Transparietal pulmonary puncture in the diagnosis of excavated pulmonary masses. Apropos of 18 cases].

The aetiological diagnosis of excavated pulmonary opacities is sometimes uneasy, hovering between squamous cell carcinoma and abscess. Normal results at bronchoscopy and two weeks of antibiotic therapy do not always provide a definite answer. The authors report 18 cases of such excavated masses and conclude that transparietal needle aspiration can establish the diagnosis provided some technical procedures are followed and the samples obtained are examined by skilled cytologists.

Aged↗
PubMed1984

[Value of transparietal lung biopsy in the cytological diagnosis of bronchiolo-alveolar carcinomas of the lung. Apropos of 3 cases].

Bronchiolo-alveolar carcinoma is a rare primary lung tumour, which is difficult to diagnose by cytological techniques. This peripheral tumour, which develops on pre-existing alveolar walls, is not visible on bronchial endoscopy and brushing is often negative. The cellular material derived from aspiration or expectoration is characterised by numerous papillae, without any cytonuclear criteria of malignancy. The differential diagnosis is very difficult with reactive papillary hyperplasia and various forms of chronic bronchial inflammation. Transparietal aspiration lung biopsy facilitates the diagnosis of glandular carcinoma: the material examined corresponds to pathological tissue, as the biopsy is performed under image intensifier control. An inflammatory lesion is excluded by the rich cellularity and by the presence of architectural features of malignancy: cohesive and three-dimensional clumps of papillary tumour cells. The early cytological diagnosis of bronchiolo-alveolar and primary bronchiolar carcinomas of the lung by transparietal aspiration biopsy can allow the surgical cure of certain localised forms.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMed1982

[Embolization of benign non tumoral diseases of the kidney (author's transl)].

The material includes 11 traumatic lesions of the kidney after needle biopsy, one hemangioma of the kidney with arteriovenous fistula and 4 renal exclusions for malignant hypertension. In traumatic lesions of the kidney after needle biopsy, embolization was followed by 90,9 p. cent excellent, permanent results without any marked loss of renal parenchyma and with simple post-operative follow-up. A hemangioma with congenital arteriovenous fistula required complex embolization owing to multiple pedicles and caused devascularisation of part of the lower pole of the kidney. The clinical result was satisfactory, but an arteriographic control carried out as a routine 3 months later after the embolization showed the development of newly formed vessels around the renal pelvis. However, no relapse of the hematuria occurred after a follow-up of 2 years. During the same period, spontaneous disappearance of 3 hemangiomas of the kidney sent up for embolization was noted, which led us to treat only hemangiomas which bled and prefer embolization in order to keep the kidney intact. In malignant hypertension, embolization proved efficacious and lasting in one case of small unilateral kidney. Carried out in two stages in one case of chronic nephritis with small kidneys, it proved efficacious on one side, insufficient on the other and had to be followed by nephrectomy. Finally, embolization of a remaining kidney due to chronic glomerulonephritis, technically incomplete, was followed by an uncontrollable attack of hypertension with later death of the patient. The blood supply of the kidney must thus be interrupted completely and embolization should not be undertaken unless it appears technically possible. The degree of pain following embolization suggests the possibility of peridural anesthesia.

Adult↗
PubMed1982

[Severe digestive hemorrhage. Place and results of arterial embolization (author's transl)].

Arterial embolization for hemostatic purposes in digestive hemorrhage was carried out in 11 cases of acute hemorrhage and in 2 cases of chronic hemorrhage. In all cases (11) in which selective embolization was possible, immediate hemostasis was obtained. The two hemorrhagic relapses observed later were due to carcinomatous lesions. There was only one serious complication in the form of ischemic stenosis after jejunal embolization. Embolization is the method of choice in all cases in which surgery is contra-indicated. Apart from this category of patients of which the prognosis remains bad in spite of hemostasis, there are other indications in which embolization may permit in spite of a reasonable risk, transformation of emergency surgery into cold surgery with lesser mortality. Finally, in a few cases hemostasis alone and medical treatment may prove to be sufficient and avoid any further surgical operation.

Acute Disease↗
PubMed1980

[Warren's operation for portal hypertension. Evaluation of results by early angiography in 23 cases (author's transl)].

After distal splenorenal anastomosis, as described by Warren, in 23 patients, early assessment of results (after 2 weeks and 2 months) by endoscopic examination and celiomesenteric angiography was used to evaluate the effectiveness of the procedure and its effects on hepatic portal perfusion. The distal splenorenal shunt remained open in almost all cases (22 out of 23), the varices diminished, and postoperative hemorrhage rarely occurred (3/23 cases). The portogastric disconnection was incomplete in 8 patients, preservation of hepatoportal flow not being constant, as 6 cases with partial and 2 cases with complete portal thrombosis were observed.

Adult↗