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Biomedical subjects

D Midy

Publications and source records attributed to D Midy.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Aortic aneurysms due to Yersinia enterocolitica: three new cases and a review of the literature].

We report three cases of mycotic aortic aneurysms due to Yersinia enterocolitica. In all cases, serogroups are O:9. The three patients more than 70 year-old men with immunodeficiency underlying conditions allowing bacterial graft (neoplasia, diabetes mellitus, dysimmunitary syndrome, hematologic diseases). The six cases of the literature were clinically, biologically and epidemiologically similar. The strains of Y enterocolitica responsible for septicemia are especially serogroups O:9. This is probably due to particular virulence factors in this serogroup (phagocytosis resistance gene: yopH, ypkA et yop E) (yop: Yersinia outer membrane proteins). The presence of a pYV plasmid (plasmid yersinia virulence), found in Yersinia pathogen strains, lead to bacterial proliferation in the tissues. The authors discuss pathophysiological mechanisms involved in arterial bacterial graft following an Y. enterocolitica infection.

Aged↗
PubMed1996

[Paresthesia, pain, coldness of the arm and possible responsibility of the thoraco-brachial outlet syndrome].

Paresthesia, pain and coldness of the upper limb strongly suggest ischemia. The questions raised concern the etiology and treatment. 1) Treatment is based on confirmation of the unilateral nature of the disorder requiring search for the a locoregional cause (examination of the subclavian outlet) and on elimination of a cardiac or general origin. Two noninvasive examinations are indicated. An X-ray examination of the upper chest bones is performed to search for an abnormal formation, usually a cervical rib. Presence of a cervical rib indicates a possible damage to the sub-clavian artery in the thoraco-brachial outlet and, inversely, absence of a cervical rib suggests either arterial damage or a fibromuscular cause. Ischemia of the upper limb results from repeated microtrauma to the sub-clavian artery due to a bone-ligament anomaly resulting in thickening and parietal ulceration, and sometimes post-stenosis embolism or in situ thrombosis. Duplex Doppler may be able to identify the nature of the cause without dynamic manoeuvres. An arteriography is essential to confirm the level of the obstacle, its nature, the status of the downstream bed and possible relationship between a bone anomaly and the sub-clavian artery. Several incidences may be required. 2) Therapeutic modalities must take into account the ischemia and its cause. Surgery is required to remove the obstacle and repair the arterial damage, and possibly to remove an embolus. It is relatively easy to remove a cervical rib or repair a bone muscle anomaly, allowing arterial repair with or without venous bypass. Embolectomy of an earlier embolus may require major reconstruction vascular surgery.

Arm↗
PubMed1995

A study of the fasciocutaneous vascularisation of the arm. Surgical applications.

The data on the fasciocutaneous vascularisation of the medial aspect of the arm are incomplete in the literature. This study presents the methodology and results of an anatomic study on 19 upper limbs with arterial injection. The vascularisation of the upper part of this region is provided in 68% of cases by the superficial fasciocutaneous branch (SFCB) of the superior ulnar collateral artery (SUC), that of the middle and lower part by 3-4 fasciocutaneous pedicles originating from the SUC which are prolonged distally by the recurrent posterior ulnar artery. The SFCB has important relations with the ulnar nerve; it travels dorsal to the nerve in 64% of cases and then allows the raising of a distally-pedicled ulnar flap with a 3:1 ratio. In other anatomic configurations, a flap with retrograde flow supplied by the inferior pedicles of the SUC can always be raised. Its ratio is then 2:1. this flap allows coverage of all cases of posterior or anterior losses of substance at the elbow. These results supplement the data required for the raising of a distally-pedicled medial brachial flap, but also of a proximally-pedicled superior medial brachial flap and of a free superior medial brachial flap transposed by microsurgical means.

Adult↗
PubMed1995

The intraorbital arrangement of the anterior and posterior ethmoidal foramina.

This study, instigated by surgical observations, and mainly carried out on the dry bone, attempts to analyse both the depth and variability of the anterior and posterior ethmoidal foramina through which pass the ethmoidal aa. The surgical implications of this study relate not only to ligation of the ethmoidal aa. in certain cases of epistaxis, their embolisation and the endonasal microsurgery of the ethmoid, but also to the surgery of the anterior cranial fossa. The study is based on 200 anatomic observations.

Arteries↗
PubMed1994

[Surgery for postthrombotic syndrome of the lower limbs].

Advances have been made in surgery of the post-thrombotic syndrome of the lower limbs with work involving the pathophysiology of the syndrome. It can now be imputed to superficial venous insufficiency involving the saphenous network and (or) perforating veins of the leg, or to deep venous insufficiency which requires careful analysis of its obstructive and reflux components. Surgery addresses only clinical manifestations that are not managed by conservative treatment. In these cases, in superficial venous insufficiency, it appears preferable to excise the saphenous network and (or) to ligate the perforating veins using a subfascial approach, which gives favorable long-term results in 45 to 98% of cases. In deep venous insufficiency, surgery can either by pass the obstructive lesions, or valve transposition or transplantation can be performed at the sites of reflux. Results are less satisfactory, however, leading to healing of recurring ulcers (the reference criterium) in 42 to 60% of the cases. In all cases, surgical results will be better maintained with continued medical treatment, especially compression.

Humans↗
PubMed1994

Anatomic basis of vascular distribution in combined removal of liver and pancreas (28.5.93).

Based on the study of the arterial distribution of 120 hepatic grafts removed from brain-dead patients, the authors assess the possibilities of vascular partition in cases of combined removal of the liver and pancreas. The discussion deals with the vascular distribution of each organ. The presence of a right hepatic artery arising from the superior mesenteric a. (SMA) requires preservation of the SMA with the hepatic graft, while the pancreas is removed with the celiac trunk (CT) and its branches. The presence of a left hepatic artery arising from the CT requires its preservation with the hepatic graft, the pancreas being removed with the SMA and the splenic artery.

Arteries↗
PubMed1994

[Antheor percutaneous endocaval filter. Multicenter evaluation based on 300 cases].

The authors report a follow up from 6 months to 2 1/2 years concerning 300 Antheor caval filters. This multicenter study was brought about so as to assess the effectiveness of the interruption barrier as well as possible complications stemming from features of the filter. The biomechanical parameters and the specifications for the filter are presented: filtration principle, nature of the alloy and biocompatibility, self-centered doubly fixed mechanism and antimigration clipping system. The main indications taken into account are pulmonary embolism (65% of cases), floating femoro-ilio-caval thrombus (33%) and contraindications of anticoagulants. Insertion conditions are analyzed as is the technique employed almost constantly percutaneous, and somewhat more often femoral than jugulo-sub-clavian. The authors then expose the modalities of the surveillance protocol. Controls are made after 1 week, 2 months, 6 months, 12 months, 18 months, and 24 months an half. They consist of a clinical evaluation, an analysis of the nature of the anticoagulant or anti-aggregation treatment, a plain abdominal radiology, a venous duplex scan examination of the lower limbs and the inferior vena cava and, in some case, a phlebographic and scanographic examination. In terms of the effectiveness, the reported results are convincing, with a rate of only 1% of recurrent embolism and 98% of vena cava patency.

Adult↗
PubMed1994

[Retroperitoneal Castelman disease. Apropos of a new case].

A retroperitoneal localization of Castleman's disease was characterized by angiolymphoid hyperplasia. This rare disease (58 cases of abdominal localization reported to date) raises a question of nosology. The clinical features are not specific. Localized forms in young patients involve deep lymph nodes and have a good prognosis after complete surgical exeresis. Inversely, the clinical picture is much more aggressive in multiple localizations involving preferentially superficial nodes with associated plasmocyte proliferation. The prognosis is mediocre in these forms. Although transition stages have been described due to the lack of any known aetiology, the question of nosology remains open: should the different forms be separated or identified simply as two pathological forms?

Aged↗
PubMed1993

Superior vena cava thrombosis related to catheter malposition in cancer chemotherapy given through implanted ports.

BACKGROUND: Thrombosis of the central veins is one of the most frequent complications of implanted venous access devices. Among the first cases occurring in our patients, most were associated with left-sided placement of the ports, with catheter tips lying against the external wall in the upper half of the superior vena cava. Some chest radiographs showed lateromediastinal opacities centered on the catheter tip, suggesting a vessel injury. This position allows a narrow contact between the catheter tip and the vessel wall, thus endothelial injuries might result from mechanical and chemical attack. METHODS: To assess the role of catheter position, we reviewed the routine chest radiographs of 379 patients who received chemotherapy through venous access devices and were followed up at our department between December 1985 and December 1990. Four groups (upper left, upper right, lower left, and lower right) were defined according to the level of the catheter tip (innominate veins or upper half of the vena cava versus lower half of the vena cava or auricula) and to the side of port implantation. RESULTS: Ten patients developed symptomatic venous thrombosis (superior vena cava in 9 patient, left subclavian vein in 1 patient). A strong correlation existed between catheter position and incidence of thrombosis: upper left, 8/28 (28.6%); upper right, 1/33 (3%); lower right, 1/68 (1.5%); and lower left, 0/250. Since 1988, we have insisted on replacement of malpositioned catheters, and we have observed fewer thromboses (2/191 versus 8/188). CONCLUSIONS: The current study suggests that patients with left-sided ports and catheter tips lying in the upper part of the vena cava are at high risk for severe thrombotic complications.

Antineoplastic Agents↗
PubMed1993

Levels of plasma thrombomodulin are increased in atheromatous arterial disease.

The plasma thrombomodulin (TM) level depends on the integrity of the endothelium and the clearance of the molecule. In several different pathological conditions, plasma TM levels increase with damage to the endothelium. We studied plasma TM levels in patients with various localizations of atheromatous arterial disease who had normal serum creatinine levels. Two groups of patients had a single symptomatic localization, which was either peripheral occlusive arterial disease (POAD) or ischemic heart disease (IHD) and a third group of patients had multiple symptomatic localizations (polyvascular). We compared the plasma TM levels with the plasma levels of other specific markers of endothelial cell activation such as: prostacyclin (PGI2), tissue-type plasminogen activator (t-PA) and plasminogen activator inhibitor (PAI-1). Plasma TM levels were significantly increased in all three individual groups and when all patients were considered (total patients), as compared with normal controls. When all patients were considered, there was a significant positive correlation between plasma TM levels and t-PA and between plasma TM levels and PGI2. A significant positive correlation was also found between the plasma TM levels and PAI-1 for patients with POAD. Thus, our findings suggest that an increased influx of TM into the plasma may be caused by endothelial cell damage in patients with atheromatous arterial disease. However in our study, the plasma TM levels obtained were similar for all three types of atheromatous arterial disease. Though plasma thrombomodulin is a marker of endothelial cell injury, it cannot be of a clinical interest until its levels are related to the extend of the atheromatous lesions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Horton's disease disclosed by involvement of the lower limbs].

We report the case of a 62-year old woman hospitalized for acute ischaemia of the right lower limb, caused by stenosis of the superficial femoral artery associated with thrombosis of the deep femoral artery. Thromboendarterectomy was performed, and histology of the operative specimen showed thickening of the media with clusters of giant cells and fragmentation of the internal elastic lamina, without atheroma. The diagnostic of giant cell arteritis was then considered and confirmed by the presence of headaches, 38 degrees C fever and inflammatory syndrome with ESR at 75 mm in the first hour. On the other hand, biopsy of a temporal artery was negative. Corticosteroid therapy was prescribed and gave excellent clinical, laboratory and arteriographic results. It has now been demonstrated that the arteries of the lower limbs may be involved in Horton's giant cell arteritis, which is often overlooked. This involvement is rare and exceptionally proven at histology. Clinically, the most frequently described form is one of pseudo-arteritis with claudication, but a few cases of gangrene have been reported. Withdrawal of corticosteroid might be a facilitating factor. As in our patient, the arteriographic lesions are often segmental, multifocal and symmetrical, predominant in the superficial femoral artery and the arteries of the legs. The lesions regress under corticosteroid therapy, and surgery can usually be avoided. Anticoagulants are commonly prescribed when the large vessels are involved. When surgery is not indicated the diagnosis can be confirmed by biopsy of the temporal artery, which is positive in the majority of cases.

Acute Disease↗
PubMed1993

[Estimation of liver volume as a function of the individual's morphology].

Computed tomography using transversal scanning, may be usefull in the determination of liver volume. The aim of this study is to evaluate this technique in living subjects and to determine a relationship between liver volume and morphological body surface area and other morphological criteria. In a series of 25 patients, liver volume was computed from the body surface area, using a mathematical function. This method allow a quick and accurate determination of the liver volume which could be used in liver transplantation for a better matching between donor liver and recipient.

Anthropometry↗
PubMed1993

[Arterial thrombosis of the arm and hemorrhagic rectocolitis. Report of a case].

Several cases of arterial thrombosis associated with inflammatory enterocolitis affections have been reported. In all but one case reported in the literature the outcome was favorable. A 40 year old woman developed thrombosis of the radial and ulnar arteries during an acute episode of ulcerative colitis. The course of the thrombotic lesions was irreversible and all fingers of the right hand had to be amputated. The corticotherapy as a possible predisposing factor for these thromboses is discussed, but their onset during an inflammatory episode suggests a role for the inflammatory enterocolitis. A thrombocytosis (807,000 platelets/mm3) could have predisposed to their onset, and in this case the hemostatic disturbances and fibrinolysis associated with the ulcerative colitis could have played a major role.

Adult↗
PubMed1992

[Iliac artery-ureteral fistula after aorto-iliac reconstructive surgery (apropos of 3 cases)].

The authors report 3 cases of ilio-ureteric fistulae following aorto-iliac reconstructive surgery. They also review 6 similar cases published in the worldwide literature. All of these cases have in common the appearance of a uretero-arterial fistula several years after the vascular operation on the iliac artery. The postoperative course of iliac thromboendarterectomy appears to be principally responsible, as in the 3 cases presented here, resulting in a pseudoaneurysm over the arteriotomy closure, especially as a patch angioplasty had been performed. This complication is exceptional. The diagnosis must be suspected in the case of profuse haematuria and a suggestive history and should be confirmed, when possible, by intravenous urography, retrograde ureteropyelography, arteriography, or even computed tomography. Treatment is complex and consists of a vascular and urological procedure depending on the degree of urgency and the possibilities of reconstruction.

Aged↗
PubMed1992

[Peritoneal dialysis catheters. Immediate outcome after 30 days].

Results of a retrospective study of 124 peritoneal dialysis catheters introduced in 74 patients from October 1982 to November 1991 showed that 91% of catheters were functional at 30 day follow up, allowing continuous ambulatory peritoneal dialysis to proceed under satisfactory conditions. However, surgical replacement was necessary in 21.81% (26 catheters) during the first month, due essentially to mechanical complications: exteriorized or non exteriorized leaks (7 cases), dysfunction with faulty perfusion or emptying (11 cases) and catheter displacement (3 cases). Five catheters (4.25%) had to be withdrawn because of infection, suggestive of the need for prophylactic antibiotic therapy. No determining factor could be found in the present series or in the literature to explain the genesis of these mechanical complications, the cause of which is without doubt multifactorial. Rapid surgical replacement allows functional survival of the majority of catheters without increasing the risk of infection.

Abdominal Pain↗
PubMed1991

A new radiologic measurement for the diagnosis of Haglund's deformity.

The authors describe a new method of radiologic measurement of "Haglund's deformity", based on a radiologic study of 31 feet operated for posterior heel pain and more especially for calcaneal tendinopathies related to deformity of the calcaneus, and on a series of 60 asymptomatic feet. This angular approach requires a lateral weight-bearing view and proved positive in 85% of symptomatic feet, with only 14% of false-positives in the control group. It thus proves markedly superior to previously described radiologic formulations, since it allows not only for the size and site of the deformity of the posterosuperior part of the calcaneus but also for the angle of verticalization of the latter.

Calcaneus↗