Biomedical subjects
D Parmentier
Publications and source records attributed to D Parmentier.
The Impact of Laparoscopic Surgery on Vaginal Hysterectomy
The development of laparoscopic surgery may be used either to replace (laparoscopic hysterectomy, LH) or to extend the indications (laparoscopically assisted vaginal hysterectomy, LAVH) of the vaginal route. A 2-year (March 1991-March 1993) prospective study of the impact of laparoscopic surgery has been carried out by a group of surgeons experienced in both vaginal and laparoscopic surgery. The design of the study protocol was as follows: use the vaginal route whenever possible; select LH in women with very narrow vaginal access or LAVH to improve the feasibility and safety of vaginal hysterectomy in case of adnexal disease; and select laparotomy only when both laparoscopic and vaginal surgery are impossible. Women with genital prolapse or pelvic relaxation were excluded as well as women with invasive malignant disease of the genital tract. Four hundred twenty-eight patients were included. Abdominal hysterectomy was used in only 44 cases (10.3%), including 4 cases of failure of the vaginal technique. Vaginal hysterectomy was completed without laparoscopic assistance in 339 (79.2%) of cases. LAVH was performed in 45 cases (10.5%), LH in 0. Laparoscopic surgery is an efficient modality for the vaginal surgeon in the presence of adnexal disease, but does not replace the less expensive, quicker and probably safer vaginal hysterectomy.
[The "hazards" of using a Gore-Tex sling in the treatment of stress urinary incontinence].
OBJECTIVE: To analyze the use of the Gore-Tex in the treatment of exertion incontinence. METHODS: During 1991, two gynecology units used the Mouchel technique and a Goebell-Stoeckel type technique in 72 patients with exertion incontinence, alone in 36 and in combination with a cure for prolapsus in 36 others. Results were analyzed with the chi 2 squared test and the Student's test for paired series. RESULTS: The rate of incontinence was 65% with a range from 60 to 66.7% according to the type of technique used and whether a cure for prolapsus was also performed. Gore-Tex was not well tolerated in 23/72 cases. Rejection was seen in 20 to 37.5% according to the type of vaginal suture and the type of protection. CONCLUSION: The high rate of rejection suggests prudence in using Gore-Tex.
[Results of tibial valgus osteotomy for internal femoro-tibial arthritis with an average 8-year follow-up].
One hundred and eighteen knees treated by valgus osteotomy for medial femorotibial osteoarthritis were reviewed with an average follow-up of 8 years (2-23 years). Seventy-four percent of the results were good and excellent after 5 years, 64% at 10 years and 61% after 10 years. The best results were observed in patients younger than 60 years, with femorotibial osteoarthritis not exceeding grade II of Ahlback's classification, and moderate femoropatellar osteoarthritis. The optimal final valgus observed was between 3 and 10 degrees. Four knees have been reoperated by arthroplasty.
[Ovarian cysts: strategy and prognosis].
The management of an adnexal masses involves several steps: establish the diagnosis of organic ovarian cyst, avoiding a useless and iatrogenic surgery of a functional cyst, knowing that functional cysts may persist more than 3 months and may occur even on low-dose oral contraceptives; cure painful cysts, by ultrasound guided aspiration of some functional cysts or laparoscopic detorsion of twisted adnexae; exclude malignancy, with the help of ultrasound, Doppler and Ca-125 preoperatively, then laparoscopic examination and pathology; failed diagnosis of cancer becomes rare (1 out of 300 laparoscopic surgeries for ovarian cyst); the association of a benign ultrasound and Doppler pattern and of a Ca-125 lower than 35 mUI/ml is almost pathognomonic of a benign cyst; cure benign ovarian cysts with a minimum of surgical trauma; in our series, 84.4% of ovarian cysts are managed laparoscopically, 11.1% by elective laparotomy, 4.5% by laparotomy after an attempt at laparoscopic surgery (that implies that the patient must be informed of the risk of laparotomy); adapt the surgical technique to the pathologic type and size of the cyst, with a high rate of laparotomy in large dermoid cysts, and a high rate of (salpingo-)oophorectomy in peri or postmenopausal cysts; ensure an adequate therapy of early ovarian carcinomas, avoiding understadification and undertreatment; prevent ovarian cancer by a careful long-term follow-up of patients with benign ovarian cysts and by the use of bilateral oophorectomy in postmenopausal patients.
Laryngotomy as a treatment for chronic laryngeal obstruction in cattle: a review of 130 cases.
One hundred and thirty cattle with chronic laryngeal obstruction were treated by surgery; the diagnostic and operative techniques are discussed. A simplified technique using local anaesthesia of the laryngeal area was used in sedated calves weighing up to 200 kg. Inhalation anaesthesia through a distal tracheotomy was needed in heavier animals. Complications related to the surgical intervention are described. The animals were reviewed from five months to over one year after discharge from the clinic. The long term survival rate of the 130 animals was 58 per cent. The results after surgery were excellent in 40.9 per cent and good in 15.2 per cent of the animals.
Haemodynamic effects of change in position and respiration mode during a standard halothane anaesthesia in ponies.
The effects of change in position and respiration modes were studied in 5 experimental ponies during a standard halothane anaesthesia. A marked cardiovascular depression (decrease in mean arterial blood pressure, cardiac output, stroke volume and left ventricle work) occurred in recumbent, spontaneously breathing ponies. No significant differences were found between right and left lateral recumbency. The most pronounced cardiovascular depression was observed in the dorsal position. Sternal recumbency appeared to be slightly beneficial (higher systemic blood pressure and arterial oxygenation). Peripheral resistance tended to decrease in the lateral positions (peripheral vasodilatation) but increased slightly in dorsally recumbent ponies. The mean pulmonary artery pressure decreased significantly in the dorsal position. Pulmonary resistance increased slightly in the laterally and the sternally positioned ponies, suggesting a pulmonary vasoconstriction. On the other hand, pulmonary resistance decreased in dorsal recumbency. Arterial oxygenation decreased progressively during anaesthesia but remained always above standing control values. Hypoventilation (increase in arterial carbon dioxide to +/- 60 mm Hg) was observed in all positions. Controlled intermittent positive pressure ventilation (I.P.P.V.) induced a further decrease of all cardiovascular parameters although no significant differences in cardiac indexes were found regarding the spontaneous breathing protocol. In ventilated ponies the greatest cardiovascular depression was again observed in dorsal recumbency. Peripheral resistance increased slightly in the sternally positioned ponies. A gradual time-dependent increase in pulmonary resistance was observed. Apparently, the arterial oxygenation improved slightly in all positions (especially the sternal posture) when I.P.P.V. was applied.
Influence of dopamine and dobutamine on the cardiovascular depression during a standard halothane anaesthesia in dorsally recumbent, ventilated ponies.
The influence of different rates of dopamine and dobutamine on the cardiovascular depression during a standard halothane anesthesia was studied in dorsally recumbent ventilated ponies. Haemodynamic and respiratory responses were investigated by means of cardiac output (CO) determination (thermodilution technique), mean systemic (MAP) and pulmonary artery pressure (MPAP) (direct intravascular method) and arterial blood analysis (blood gases and packed cell volume). An important cardiopulmonary depression characterized by decreases (55% of the standing values) in CO, cardiac index (CI), MAP, MPAP and other cardiovascular related parameters occurred in the dorsally recumbent anaesthetized ponies after a stabilization period of 30 minutes. Dopamine at 2 different infusion rates (2.5 and 5.0 micrograms/kg/min) induced few changes of the cardiopulmonary parameters (non-significant increases in MAP, CI, left ventricular work [LVW], stroke volume [SV]; non-significant decrease in total peripheral resistance [TPR]). Several minor time related influences were also observed (increases in MPAP and total pulmonary resistance [TpR]). Arterial blood gases did not change during the different dopamine infusions. Low doses of dobutamine (1.25 micrograms/kg/min) were efficient to counteract the cardiovascular depression. Significant increases in CO, CI, MAP, MPAP and SV were observed. TPR and TpR tended to decrease but non-significantly. Heart rate and blood gases remained constant. The higher doses of dobutamine (2.5 and 5.0 micrograms/kg/min) accentuated these changes but a significant increase in heart rate with even periods of severe tachycardia and an increase of the packed cell volume were also observed. Apparently, low doses of dobutamine were indicated for the management of the cardiovascular depression during anaesthesia in the dorsally recumbent ventilated horse.
Influence of digoxin followed by dopamine on the cardiovascular depression during a standard halothane anaesthesia in dorsally recumbent, ventilated ponies.
The influence of digoxin (0.01 mg/kg) given as an intravenous bolus followed by dopamine at different infusion rates (1.25, 2.5 and 5.0 micrograms/kg/min) on the cardiovascular depression during a standard halothane anaesthesia was studied in dorsally recumbent ventilated ponies. Preanaesthetic digitalization induced no clear positive cardiovascular effects over 30 minutes, except for non-significant increases in mean pulmonary artery pressure and total pulmonary resistance. These changes were probably time-related. No specific side-effects related to the fast intravenous digitalization were noticed. Dopamine at lower infusion rates (1.25 and 2.5 micrograms/kg/min) given minimally 30 minutes after the digitalization did not induce further changes (only minor non-significant increases in cardiac output and systemic blood pressure). Dopamine infusions at a higher infusion rate (5.0 micrograms/kg/min) improved the cardiovascular depression (significant increases in cardiac output and systemic blood pressure while total peripheral resistance tended to decrease). Heart rate, blood gases and total pulmonary resistance remained constant. The combination of a fast acting inotropic agent, dopamine, and a slow acting inotropic drug, digoxin, induced positive effects in reversing the cardiovascular depression and might therefore be useful during clinical anaesthesia in the horse.
Cardiovascular effects of low dose calcium chloride infusions during halothane anaesthesia in dorsally recumbent ventilated ponies.
The effects of calcium chloride administered at low infusion rates on the cardiovascular depression and the blood calcium balance were studied during a constant halothane anaesthesia in dorsally recumbent ventilated ponies. A pronounced cardiopulmonary depression characterized by decreases of all cardiac parameters and lowering of the mean arterial blood pressure was observed after the initial anaesthetic stabilization period of 30 minutes in the ponies. A significant decrease in the total calcium plasma concentration together with a constant ionized and complexed calcium fraction was present after the stabilization period. Calcium chloride administration at different infusion rates (0.1, 0.2 and 0.3 mg/kg/min) induced a dose-dependent increase in mean systemic blood pressure, probably due to the observed increase in total peripheral resistance. A dose-dependent gradual decrease in heart rate, probably mediated by the increased vagal activity, was observed after the calcium infusions. The stroke volume increased also in a dose-dependent way. Cardiac output, arterial blood gases or packed cell volume were not influenced by the exogenous calcium infusions. The observed increases in mean pulmonary artery pressure and total pulmonary resistance were probably time-related responses. Overall, only the effects of the exogenous calcium on the peripheral vasculature, namely a vasoconstriction leading to an increase in blood pressure, were present in this study. Although LV dP/dt max was not measured in this study, minor positive inotropic effects of the exogenous calcium infusions might nevertheless be possible since the observed increase in stroke volume could be an indication of an increase in the ventricular contractility function. The different fractions of the calcium in the plasma (total and ionized & complexed calcium) increased during the exogenous calcium infusions but the proportion of the fractions remained always constant.(ABSTRACT TRUNCATED AT 250 WORDS)
Haemodynamic changes during sedation in ponies.
The cardiovascular changes induced by several sedatives were investigated in five ponies with a subcutaneously transposed carotid artery by means of cardiac output determinations (thermodilution technique), systemic and pulmonary artery pressure measurements (direct intravascular method) and arterial blood analysis (blood gases and packed cell volume). The cardiovascular depression (decrease in systemic blood pressure and cardiac output) was long lasting (greater than 90 min) after administration of propionylpromazine (0.08 mg/kg intravenous (i.v.)) together with promethazine (0.08 mg/kg i.v.). The phenothiazine-induced sedation was not optimal. alpha 2-Agonists (xylazine (0.60 mg/kg i.v.) and detomidine (20 micrograms/kg i.v.)) induced initial but transient cardiovascular effects with an increase in systemic blood pressure and a decrease in cardiac output for about 15 min. Second degree atrioventricular blocks and bradycardia were seen during this period. The cardiovascular depression was more pronounced during detomidine sedation. Atropine (0.01 mg/kg i.v.) induced a tachycardia with a decrease in stroke volume but did not alter the cardiac output or other cardiovascular parameters. It prevented the occurrence of the bradycardia and heart blocks normally induced by xylazine or detomidine. Atropine potentiated the initial hypertension induced by the alpha 2-agonistic sedatives (especially detomidine). The decrease in cardiac output induced by xylazine, and to a lesser extent by detomidine, was partially counteracted when atropine was given in advance. The atropine-xylazine combination seemed the best premedication protocol before general anaesthesia as it only resulted in minor and transient cardiovascular changes.
A preliminary study on the effects of atropine sulphate on bradycardia and heart blocks during romifidine sedation in the horse.
Romifidine (STH 2130-Cl or Sedivet) is an alpha 2-agonistic imino-imidazol sedative for intravenous use in horses recently developed by Boehringer Ingelheim, Vetmedica GmbH. An exploratory study was done in nine warm-blood horses, randomly divided into three groups, which received different dosages of romifidine (0.04, 0.08 and 0.12 mg/kg of body weight (BWT) intravenously (i.v.)) with at least one week's interval between tests. Romifidine induced a marked bradycardia accompanied by second degree atrioventricular (AV) block and some sinus blocks at all tested dosages. A placebo (NaCl 0.9% i.v.) given 5 min before and after romifidine did not affect the cardiac disturbances induced by romifidine. A low dose of atropine sulphate (0.005 mg/kg of BWT i.v.) given 5 min before romifidine counteracted the bradycardia and caused a normal to increased heart rhythm at all romifidine dosages. A higher dose of atropine sulphate (0.01 mg/kg of BWT i.v.) administered 5 min before sedation induced a tachycardia (average 70 beats/min) at all romifidine dosages and completely prevented the bradycardia and the heart blocks. The positive chronotrope effects of atropine sulphate were attenuated by increasing doses of romifidine. The effects of atropine sulphate (low or high doses) given 5 min after romifidine only appeared after 5 min. Both dosages counteracted the bradycardia and suppressed the heart blocks. No atropine-dependent side effects were observed in non-fasted horses. The degree of the romifidine induced sedation was not affected by the use of atropine sulphate given before or after romifidine.
Ultrasound-guided transcervical metroplasty.
A new technique of metroplasty is described. The septum is divided with 4-mm endoscopic scissors introduced into the uterine cavity through the cervix. The whole procedure is monitored by a real-time ultrasound scanner. Twenty-four patients were operated on with this technique. No complication was encountered. Fifteen patients had third trimester deliveries or ongoing pregnancies. Among 12 patients who had suffered repetitive pregnancy losses, 11 desired pregnancy: 10 have been successfully pregnant beyond the second trimester (91.7%), 8 are delivered, and the living birth rate is 72.7%. These results equal those obtained after hysteroscopic metroplasty. The procedure is short, safe, requires no special equipment, and does not necessitate concomitant laparoscopy.
Time-related responses to a constant-dose halothane anaesthesia in dorsally recumbent ventilated ponies.
Haemodynamic and respiratory responses to halothane were investigated in dorsally recumbent, ventilated ponies during 2 hours. Normocapnia was maintained using intermittent positive pressure ventilation. Compared to the base line values at 30 minutes of constant dose halothane, no significant changes in heart rate, systemic blood pressure, cardiac output, cardiac index, stroke volume and left ventricle work were observed during a 2 hours anaesthesia. Arterial oxygenation increased initially (greater than 300 mm Hg) but tended to decrease non-significantly during the rest of the anaesthesia. Blood temperature decreased significantly during anaesthesia (p less than 0.05 after 30 minutes), probably due to the cold thermodilution injections but also to peripheral losses of body heat. Time-related increases in mean pulmonary artery pressure (p less than 0.05 after 90 minutes), total peripheral and pulmonary resistance (p less than 0.05 after respectively 60 and 90 minutes) were observed. Increases in peripheral and pulmonary resistance probably reflected vasoconstriction of respectively the peripheral and pulmonary vasculature. These changes might be caused by an increase in circulating catecholamines during prolonged anaesthesia. To avoid possible erroneous conclusions the observed time-dependent responses in anaesthetized dorsally recumbent ponies have to be taken in consideration when other influences (e.a. drugs) are investigated during anaesthesia.
Comparative trial of xylazine and medetomidine as preanaesthetics prior to Na pentobarbital anaesthesia in dogs.
The effects of medetomidine [20 and 40 micrograms/kg of body weight (BWT) i.m.] followed by sodium pentobarbital were assessed and compared with the effects of xylazine (1 mg/kg of BWT i.m.) in three groups each of 6 dogs. The effects of atipamezole as a specific antidote after anaesthesia were also studied. Medetomidine produced a reliable sedation which was clinically comparable with the xylazine premedication. 40 micrograms/kg medetomidine induced lower induction (non-significantly), total (p less than 0.05), anaesthetic (non-significantly) and anaesthetic per hour (non-significantly) doses of Na pentobarbital compared to the 20 micrograms/kg medetomidine and the xylazine protocols. No significant differences in the total number of re-injections were found between the sedative protocols although a gradual increase in number of re-injections per hour was observed. Significant decreases in heart and respiration rates were noticed during anaesthesia in all groups (p less than 0.01). The heart and respiration rates during anaesthesia in the 40 micrograms/kg medetomidine group were always significantly lower compared to the xylazine group. Body temperature decreased gradually in time during anaesthesia in all groups (p less than 0.05 after 1 hour, p less than 0.01 after 2 and 3 hours) without significant differences between the groups. The extubation time in the medetomidine protocols without antagonisation was significantly greater (p less than 0.01) than the extubation time after antagonisation with atipamezole.
[Can the risk of neonatal infection be reduced in prematurely ruptured membranes?].
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[Use of a slow-release form of salbutamol in the treatment of threatened premature labor. A comparative study of 52 randomized cases compared with the immediate release form].
A randomised study was carried out to compare the effect of ordinary salbutamol with controlled release salbutamol as far as the sedative effect on the uterine muscle was concerned. Modifying the molecule for salbutamol gives it characteristics of a true "retard" form. This makes it possible to prescribe 2 tablets a day in 2 doses to copy the sedative effect on uterine muscle achieved when the treatment is given intravenously in cases of threatened onset of labour. The study was a double blind one with a placebo being used in two parallel groups after the populations had been compared for similar characteristics as far as the past history, the body build and the number of pregnancies was concerned. This made it possible to show that the two forms are strictly comparable and that there are no adverse side effects. This form of "retard" salbutamol seems to be particularly useful in repeated attacks of threatened premature labour and makes it likely that it will be taken more regularly with the avoidance of peaks in plasma and therefore improved tolerance. Furthermore, the action is longer and effective overnight.
Isolation and characterization of new sus (amber) mutants of bacteriophage lambda.
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