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Biomedical subjects

D Mathieu

Publications and source records attributed to D Mathieu.

At least 145 records · Page 8Linked to original sources
PubMed1990

Post-traumatic limb ischemia: prediction of final outcome by transcutaneous oxygen measurements in hyperbaric oxygen.

In limb injuries (amputation, laceration injuries, or compartment syndrome), a circulatory insufficiency with a total or subtotal ischemia may occur and jeopardize the result of reconstructive surgery. Transcutaneous oxygen monitoring has been shown to reflect tissue perfusion and has been advocated to predict the final outcome of major vascular trauma of the limb. Unfortunately, in normal atmospheric conditions, this test is not sufficiently discriminative; we evaluate the effect of hyperbaric oxygen on the efficiency of this test. 23 patients with major vascular trauma of the limbs were evaluated by clinical examination and transcutaneous oxygen pressure (PTCO2) measurements. Sixteen had arterial repair and seven had clinical evidence of peripheral ischemia without an arterial lesion. In normal air, the transcutaneous oxygen values in the traumatized limb, of these 23 patients, were significantly lower than in the nontraumatized limb. But neither the absolute PTCO2 value nor the ratio between the traumatized limb's PTCO2 and that of the nontraumatized one can predict the final outcome (amputation). In hyperbaric oxygen (2.5 ATA), this ratio is significantly higher in the group where the surgery will succeed than in the group where final amputation will be needed (81.2 +/- 26.0 vs. 15.2 +/- 13.1; p less than 0.01). The overall sensitivity and specificity of prediction of the limb's final outcome when the bilateral PTCO2 ratio in 2.5 ATA pure oxygen is less than 0.40, are 100% and 94%, respectively. But what is perhaps more interesting is that, when considering a ratio value of less than 0.20, amputation can be predicted with a 100% true predictive value.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1990

Hyperbaric oxygen therapy in chronic vascular wound management.

Many nonhealing tissues are hypoxic, with oxygen tensions frequently ranging from 5 to 15 mmHg. In such an environment, the normal wound healing sequence is disrupted or halted and phagocytic killing activity depressed. So the adjunctive use of hyperbaric oxygen (HBO), based on physiologic data and clinical observations, can provide the substrate necessary to initiate and sustain the healing process. During a twelve-month period, 20 patients with a nonhealing wound were referred to the hyperbaric center: chronic arterial insufficiency ulcers in 9 cases, diabetic wounds (foot lesions) in 11 cases. Adjunctive HBO therapy, initiated twice a day, consisted of pure oxygen, 2.5 ATA, 90 min. The average length of sessions was 46 (15-108). Complete healing was observed in 15 of 20 cases. The wound management can be helped with the transcutaneous oxygen measurements under hyperbaric oxygen. The distal TCPO2 at 2.5 ATA pure oxygen is a reliable test to predict final outcome (healing or no change), when these values were not different in normal air and in normobaric oxygen: (table; see text) In hyperbaric oxygen therapy, when the distal TCPO2 value was inferior to 100 mmHg, all patients showed either no improvement or aggravation, and when the value was higher than 100 mmHg, wound healing was achieved with all patients.

Blood Gas Monitoring, Transcutaneous↗
PubMed1990

[Hyperbaric oxygen therapy in the treatment of wounds, in plastic and reconstructive surgery].

After recalling the mechanism of action of hyperbaric oxygen (HBO) on healing processes, the authors review the principal indications for this technique in plastic and reconstructive surgery, such as crush injuries and acute post-traumatic ischemia of the limbs, skin flaps and skin grafts, when there is a risk of their not taking, and burns. They stress the importance of strict, stratified therapeutic protocols with control of the hyperoxygenation induced by HBO. In the authors' experience, transcutaneous measurements of the partial pressure of oxygen under the hyperbaric atmosphere is a very useful method with a predictive value to determine the indications for treatment with HBO and to monitor its effects.

Blood Gas Monitoring, Transcutaneous↗
PubMed1990

[Gastric duplication. Apropos of 3 cases].

Duplication of the stomach is a rare congenital malformation. Most reported cases involve infants or young children. On the basis of 3 cases identified at a later age, we describe the CT appearance of this malformation. Those 3 cases were demonstrated by the histological study of the surgical specimen.

Adenocarcinoma↗
PubMed1990

[Hepatic infarction of arterial origin. X-ray computed tomographic aspects].

Unlike other major abdominal organs, infarctions affecting the liver is extremely rare. In humans, the rarity of hepatic infarction is explained commonly on the basis of the double blood supply via the hepatic artery and portal vein. The imaging studies and clinical records of seven patients with hepatic infarcts were reviewed. These infarctions were essentially observed during post-operative periods: after aortoceliac graft and after accidental ligation of the hepatic artery (4 cases). The other etiologies included: acute hypovolemic shock in patients with atherosclerosis (2 cases) and finally one case of acute thrombocytosis. Dynamic CT was performed initially in all the cases and during the evolution, demonstrating peripheral low attenuation areas without enhancement. Associated splenic infarcts were present in 4 patients and renal infarcts in two. While the clinical and laboratory findings in hepatic infarction can be completely mimicked by hepatic abscess, CT-guided aspirations were performed in 6 patients demonstrating in only one case the presence of infection.

Aged↗
PubMed1989

[Diagnosis of disorders affecting the solid organs of the supra-mesocolic compartment].

Sonographic and computed tomographic (CT) examinations have modified the investigation of hepatic, splenic and pancreatic tumors. Because of advances in non-invasive diagnostic procedures, these different benign or malignant tumors are now more frequently detected and surgically treated. However, for these different lesions sonography is the gold standard imaging technique. The different indications for CT and magnetic resonance imaging are discussed for each tumor. For the diagnostic imaging of an acutely injured patient, sonography remains the useful examination in emergencies. The indications for CT scans are limited to the difficulties of sonographic diagnosis in stable trauma patients.

Humans↗
PubMed1989

Association of focal nodular hyperplasia and hepatic hemangioma.

The association between hepatic hemangioma and focal nodular hyperplasia has been occasionally reported. To evaluate the reality of this association, the prevalence of hemangioma was studied in 26 patients with focal nodular hyperplasia by comparison with 27 patients with hepatocellular adenoma. All of these patients underwent surgery, which provided the histologic confirmation of the type of tumor. The presence of hemangioma was assessed by preoperative ultrasonography, dynamic computed tomography, and pathological examination of resected liver specimens. No hemangioma was found in patients with hepatocellular adenoma, but 6 of the 26 patients with focal nodular hyperplasia (23%) had one or two associated hemangiomas that varied in size from 1.5 to 4 cm. All 6 patients having focal nodular hyperplasia and hemangioma were women who had previously used oral contraceptives. None of the patients who had not used oral contraceptives had this association. Moreover, oral contraceptives were taken for a significantly longer period by the women with focal nodular hyperplasia and hemangioma than by those without this association. It is concluded that (a) the association of hemangioma with focal nodular hyperplasia is frequent (23%) and not fortuitous, and (b) prolonged administration of oral contraceptives may facilitate the recognition of this association, possibly by affecting the growth of these tumors.

Adult↗
PubMed1989

Acute Budd-Chiari syndrome secondary to leiomyosarcoma of the inferior vena cava.

The authors report a case of leiomyosarcoma of the inferior vena cava, responsible for an acute Budd-Chiari syndrome. The diagnosis, suggested by lower limb edema, ascites, and renal failure, was confirmed by sonography, CT scan, and pathological examination. A mesoatrial shunt and right atrial thrombectomy were performed under extracorporeal circulation. The inferior vena cava was ligated because the tumor was considered to be unresectable.

Acute Disease↗
PubMed1989

Percutaneous management of pyogenic liver abscesses.

Twenty-four pyogenic liver abscesses have been treated during a six-year period percutaneously. Percutaneous management included percutaneous drainage and fine needle aspiration under ultrasound or CT scan guidance. Percutaneous management was successful in 92% of cases, and no further treatment was required in 91% of these. One patient died, giving a mortality rate of 4.1%. There were no complications related to this method. The authors conclude that percutaneous management of pyogenic liver abscesses should be attempted in all cases, since results compare favourably with surgical procedures.

Adolescent↗
PubMed1989

[Management of large adrenal glands discovered incidentally].

Incidental adrenal tumors are more and more often discovered with development of the new radiological techniques (CT scan, sonography). In such an occurrence, the largest panel of adrenal hormones measurements is needed. In the absence of hormonal abnormality, no exam can help for the clinical decision-making. According to epidemiological findings, we propose to operate upon tumors larger than 6 cm and to repeat CT scans at 2, 6 and 18 months for tumors smaller than 6 cm which should be operated upon if an enlargement of the adrenal tumor is demonstrated by a control exam. This attitude relies upon the quite higher frequency of adrenal adenomas (more than 99% of non-functioning adrenal tumors) and the more important risk of malignant adrenal carcinoma in front of a huge tumor. It appears to be the right choice in a cost-effectiveness perspective.

Adrenal Gland Neoplasms↗
PubMed1989

Pancreatic cystic neoplasms.

Cystic neoplasms are an uncommon group among pancreatic tumors. Because of advances in noninvasive diagnostic procedures, these lesions are more frequently detected and surgically treated. New pathological entities have been recently described with their own prognosis. 1. In a large number of cases, the imaging procedures can differentiate microcystic adenoma from mucinous cystadenoma, the more frequently encountered lesions. A well-defined mass with innumerable small cysts producing a honeycomb appearance with central stellate septae is suggestive of microcystic adenoma. A well-defined multilocular mass containing thin, straight or curvilinear septae with papillary projections and local thickening is suggestive of mucinous cystadenoma. 2. No sonographic or CT finding allows the differentiation between mucinous cystadenoma and cystadenocarcinoma, however; the imaging features depend on the grade of malignancy. 3. Thus, in the majority of cases of cystic lesions, fine needle aspiration with appropriate stains is recommended.

Biopsy, Needle↗
PubMed1989

[Abscess of the spleen: diagnosis and treatment. Apropos of 12 cases].

Twelve cases of splenic abscess, seen at our hospital between January 1980 and June 1987, were reviewed retrospectively. The most common causes of splenic abscesses were subacute endocarditis and intra abdominal sepsis. Diagnosis was suspected on clinical grounds and was always confirmed by sonography and/or computerized tomography. Two patients were drained unsuccessfully under CT scan guidance and underwent splenectomy. The other patients were operated primarily. One patient developed a subphrenic abscess postoperatively. One patient died from intractable cardiac failure due to subacute endocarditis. The authors stress the role of CT scan in the diagnosis of splenic abscess and recommend early splenectomy in cases of failure of percutaneous drainage.

Abscess↗
PubMed1989

[Tolerability of a new non-ionic contrast medium, iopromide in x-ray computed tomography. Comparison with ioxaglate 320 mgI/ml].

Three randomized prospective and comparative trials were conducted in 165 patients undergoing brain (80) and whole body (85) CT scans. The two products compared where a new non-ionic contrast medium iopromide 300 (brain) and 370 (whole body) and the ionic low osmolar contrast medium, ioxaglate 320. Imaging quality was not different but the tolerance of the non-ionic medium was significantly better (p less than 0.05).

Contrast Media↗
PubMed1989

[Ultrasonographic and x-ray computed tomographic aspects of Mirizzi's syndrome].

The Mirizzi syndrome is due to common hepatic duct obstruction secondary to the impaction of a large gallstone in the neck of the gallbladder or the cystic duct. The sonographic and computed tomography features in 3 cases of Mirizzi syndrome are described and compared with percutaneous transhepatic cholangiography or endoscopic retrograde cholangiography findings. The Mirizzi syndrome was diagnosed preoperatively on sonography in 2 out of 3 cases and on plain computed tomography scans in all 3 cases. However pre or intraoperative visualization of the biliary tract is mandatory in suspected Mirizzi syndrome to detect the presence or absence of cholecystobiliary fistula, in order to adapt the operative strategy.

Adult↗