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Biomedical subjects

F Farhat

Publications and source records attributed to F Farhat.

At least 19 recordsLinked to original sources
PubMed2006

[Air embolism during lumbar discal hernia repair. Retroperioneal vessels lesions have to be suspected].

Occurrence of deep PETCO(2) drop during surgical lumbar disk repair is rare but dramatic. This case report leads to the diagnosis of retroperitoneal vessels lesions. We review the different diagnosis related to the drop of the PETCO(2) during surgery in the genupectoral position. We recommend that the diagnosis of retroperitoneal vessels lesion have to be suspected early if air embolism occurs during lumbar disk surgery.

Aged↗
PubMed2006

[Results of video-assisted mitral surgery in a non-selected population].

A prospective 'analysis of operative risk and results in video-assisted mitral valve surgery performed in a non selected population is reported. Seventy two consecutive patients (1997-2004) with mean age 60 +/- 12 years underwent a video-assisted mitral valve procedure using a femoral CPB. A transthoracic direct aortic clamping was done in 28 patients (TT) and an endo-aortic occlusion balloon was used in 44 patients (Endo). The surgical approach was a right lateral minithoracotomy in all cases; 16 patients had a previous cardiac surgery. The expected mitral operation (39 repairs, 33 replacements) was done in all cases, without conversion. There were 4 early deaths (1 st month), all in Endo group: 1 aortic dissection, 1 heart failure and 2 sudden deaths. Postoperative complication occurred in 17 patients with 5 reoperations for hemostasis of the thoracic wall. Cumulative rate of mortality and morbidity was 29% in Endo and 28% in TT (ns). Hospital stay was 8 +/- 2 days. At discharge, 4 patients had a residual grade 2 echocardiographic mitral regurgitation after valve repair. In January 2005, with a 1.8 years follow-up, there were 4 late deaths, 3 patients underwent a valve reoperation, 2 patients were still in NYHA class 3 and 5 patients had a residual grade 1 or 2 mitral regurgitation. The 3-year actuarial survival was 86 +/- 10% and the 3-year probability to be free of reoperation was 95 +/- 6%. In mitral valve surgery, video-assisted approach is reliable, the operative risk is controlled and midterm results are not compromised. Video-assisted mitral valve surgery is a new less invasive standard; it is the procedure of choice in valve replacement, in reoperation and in non complex valve repair with good cosmetic results.

Cardiopulmonary Bypass↗
PubMed2005

[Preliminary clinical experience with the Ventrica automatic distal anastomosis system in coronary surgery].

The surgical treatment of coronary lesions is based on bypassing the anatomical lesions with autologous vascular grafts. This procedure has traditionally been "invasive", requiring a micro-surgery technique, institution of extra-corporeal circulation, as well as temporary cardiac arrest with a cardioplegic solution. Recently, an automatic distal anastomosis procedure has been developed (Ventrica, Medtronic Inc.), based on a magnetic coupling with two implanted intravascular magnets, allowing easy connection between the graft and the coronary artery. The immediately obvious advantages are the time saved, ease of use, reproducibility and reliability. The learning curve is fast. Furthermore, the use of this automatic process does not compromise a manual anastomosis in case of implantation failure. The immediate post-operative results, as well as angiography immediately and at 6 months are all satisfactory. This technique is applicable for multiple revascularisations, all types of autologous grafts, terminal or sequential bypasses, as well as nearly all types of coronaries. The contribution to beating heart, closed thorax coronary surgery seems equally promising.

Aged↗
PubMed2005

Management of an aortic wall ulcer after an aortic dissecting hematoma.

We report the case of a 40-year-old woman who presented with an ulcer of the descending aorta 9 months after ascending aortic surgery for intramural aortic hematoma, which was treated surgically with a supra-coronary aortic replacement. Treatment of the second aortic lesion and the choice between endovascular or surgical approaches are discussed.

Adult↗
PubMed2003

Prospective randomized comparison between redon catheters and chest tubes in drainage after cardiac surgery.

AIM: To compare in a prospective randomized study chest tube (CT) and redon drains (RD) for effectiveness, cost, pain and complications after heart surgery using cardiopulmonary bypass. METHODS: Forty patients undergoing heart surgery were analyzed prospectively. Twenty patients had small RD with strong (-700 mmHg) vacuum and 20 others standard CT. All patients had patient controlled analgesia in the postoperative period and pain was noted. Residual pericardial effusion (RPE) was controlled and quantified at postoperative day 7 with transthoracic echocardiography. Drainage complications were noted and compared in both groups. RESULTS: Surgical statistics were comparable in both groups. Two patients underwent reoperation in CT for clotting, and 1 in RD for active surgical bleeding. One patient had orifice infection in CT. Drainage volumes and times were comparable in both groups at removal (992+/-507 ml in RD, 1154+/-571 ml in CT, p=ns). Morphine consumption and pain estimation were comparable in both groups in the postoperative period and at drainage removal. Echographic control showed important RPE for 3 patients in both groups. System cost was higher in CT compared to RD (up to 7 times). CONCLUSION: RD are comparable to CT in terms of drainage, pain and complications. Nevertheless, they offer better handling and removal conditions and limited cost.

Adult↗
PubMed2001

Norepinephrine release after acute brain death abolishes the cardioprotective effects of ischemic preconditioning in rabbit.

OBJECTIVE: Brain death (BD) abolishes the infarct-limiting effect of ischemic preconditioning (IP) in rabbits. We wished to define the role of the norepinephrine storm in this observation. METHODS: Rabbits were randomized into six groups of ten animals each. In control group (CTRL), anaesthetized rabbits were subjected to 30 min left coronary marginal branch occlusion and 90 min reperfusion. In CTRL+IP group, anaesthetized rabbits were preconditioned with a 5-min ischemia and 5-min reperfusion sequence before coronary occlusion. In CTRL+NE+IP group, anaesthetized rabbits received a 10 microg/kg norepinephrine injection 90 min before IP. In BD group, rabbits were subjected to 90 min of BD before coronary occlusion. In BD+IP group, brain-dead rabbits were preconditioned before coronary occlusion. In BD+LA+IP group, rabbits received an intra-arterial bolus injection of an alpha and beta adrenoreceptor blocking agent (labetolol, 1 mg/kg) prior to brain death induction and subsequent preconditioning. BD was induced by rapid inflation of an intracranial balloon. At termination of the experiment, left ventricular volume (LVV), myocardial volume at risk (VAR) and infarct volume (IV) were determined with methylene blue and tetrazolium staining, and measured using planimetry. RESULTS: LVV was not significantly different among groups. Myocardial VAR/LVV was not significantly different between groups (CTRL, 22.5+/-6.9%; CTRL+IP, 23.3+/-2.2%; CTRL+NE+IP, 25.9+/-12.7%; BD, 19.9+/-4.8%; BD+IP, 21.7+/-3.1%; BD+LA+IP, 23.4+/-5.8%; P=NS). IV/VAR was significantly reduced in the CTRL+IP group as compared with CTRL and CTR+NE+IP groups (12.2+/-1.2 vs. 49.7+/-1.7 and 49.3+/-4.7%; P<0.0001). There was no significant difference in IV/VAR between BD and BD+IP groups. In contrast, IV/VAR was reduced in BD+LA+IP compared to BD and BD+IP groups (13.9+/-5.4 vs. 50.0+/-1.4 and 49.6+/-1.5%; P<0.001). CONCLUSION: The loss of infarct-limiting effect of IP in brain-dead rabbits is related to the massive release of norepinephrine that occurs as a consequence of BD.

Animals↗
PubMed2001

Cardioscopy and robotic assistance for the diagnosis of intraventricular endocarditis.

A 44-year-old male patient with an undefined mass in the left ventricular endocardium was scheduled for minimally invasive cardiac surgery. Ventricular investigation and tissue biopsies were completed with the help of a voice-controlled robotic arm. Pathologic examination revealed non-bacterial thrombotic endocarditis. In addition to videoscopy, robotic assistance allows an easier diagnostic and therapeutic approach of intraventricular pathologies.

Adult↗
PubMed2000

Acute brain death abolishes the cardioprotective effects of ischemic preconditioning in the rabbit.

BACKGROUND: Myocardial preconditioning with brief coronary artery occlusions before a sustained ischemic period is reported to reduce infarct size. We wished to evaluate whether ischemic preconditioning (IP) is efficient in an experimental brain death (BD) model in the rabbit. METHODS: Rabbits were randomized into four experimental groups of eight animals each. In the control group (CTRL), anaesthetized rabbits were subjected to 30 min of left coronary marginal branch occlusion and 90 min of reperfusion without any pretreatment. In the CTRL+IP group, anaesthetized rabbits were preconditioned with a 3-min ischemia and 3-min reperfusion sequence before coronary occlusion. In the BD group, rabbits were subjected to 90 min of BD before 30 min of coronary occlusion and 90 min of reperfusion. In the BD+IP group, BD rabbits were preconditioned as in the CTRL+IP group before coronary occlusion. BD was induced by rapid inflation of an intracranial balloon and was validated by clinical and electroencephalographic examinations. At the termination of the experiment, left ventricular volume (LVV), myocardial volume at risk (VAR) and infarct volume (IV) were determined with methylene blue and tetrazolium staining and were measured using planimetry. RESULTS: LW was not significantly different among the four experimental groups (CTRL, 6.54+/-0.90 cm3; CTRL+IP, 5.92+/-0.60 cm3; BD, 5.87+/-0.81 cm3; BD+IP, 6.16+/-0.95 cm3; P=ns). Furthermore, myocardial VAR, expressed as a percentage of LVV, was not significantly different between groups (CTRL, 20.0+/-4.2%; CTRL+IP, 22.32+/-2.25%; BD, 21.38+/-3.36%; BD+IP, 21.64+/-3.39%; P=NS). IV, expressed as a percentage of VAR, was significantly reduced in the CTRL+IP group compared with the CTRL group (15.76+/-8.47% vs. 49.95+/-1.51%; P<0.0001). In contrast, there was no significant difference in IV, expressed as a percentage of VAR, between the BD and the BD+IP groups (50.0+/-1.52% vs. 49.72+/-1.58%; P=NS). CONCLUSION: The data indicate that the infarct-limiting effect of IP is lost in BD rabbits. Thus, the clinical potential of IP in the context of organ transplantation seems to be severely compromised.

Analysis of Variance↗
PubMed2000

Spasmolytic constituents from Eucalyptus camaldulensis var. obtusa leaves.

Phytochemical studies on the leaves of Eucalyptus camaldulensis var. obtusa have resulted in the isolation of a new triterpenoid camaldulin (3beta-formyloxyurs-11-en-28,13beta-olide) (1) along with ursolic acid lactone acetate (2), ursolic acid lactone (3), betulinic acid (4), and beta-sitosterol 3-O-beta-D-glucopyranoside (5). The structures were assigned on the basis of 1D and 2D NMR studies. Compounds 1-3 were tested for spasmolytic activity and were found to possess calcium antagonist activity.

Calcium Channel Blockers↗
PubMed2000

Video-assisted Port-Access combined mitral valve and CABG surgery.

Although conventional right thoracotomy is a well-known alternative for mid-sternotomy to access the left atrium, a combined video-assisted mitral and left anterior descending (LAD) approach via Port-Access has not yet been described. We report the case of a 68-year-old patient with severe mitral valve regurgitation due to myxoid degeneration associated with a critical LAD coronary artery stenosis. A totally video-assisted 'true' Port-Access (i.e. no costal retraction) mitral valve repair and direct coronary artery bypass were performed in combination, without complications.

Aged↗
PubMed1998

Postoperative hypoxaemia: continuous extradural infusion of bupivacaine and morphine vs patient-controlled analgesia with intravenous morphine.

We carried out a randomized prospective study in 60 patients who had undergone major abdominal surgery for cancer. For postoperative pain control, 30 patients received continuous extradural infusion of 0.125% bupivacaine 12.5 mg h-1 and morphine 0.25 mg h-1 (EXI group) and 30 received patient-controlled analgesia (PCA) with intravenous morphine (1 mg bolus, 5-min lock-out and maximum dose 20 mg 4h-1). Both groups had general anaesthesia. The two groups were compared for postoperative pain scores, satisfaction, sedation and oxygen saturation. Oxygen saturation was recorded continuously the night before surgery and for two consecutive postoperative nights. Episodes of moderate desaturation (90% > SpO2 85%) were more frequent in the EXI group than in the PCA group (P < 0.05). Pain scores were lower in the EXI group compared with the PCA group at rest and while coughing (P < 0.05). No significant difference was found for patient sedation and satisfaction.

Abdominal Neoplasms↗
PubMed1997

Brain monoamines and optokinetic performances in pigmented and albino rats.

The aim of this study was two-fold: 1) To provide in DA-HAN rats the basic brain monoamine data useful for later investigations of the neurochemical effects of sensory alterations and 2) to assess whether there is a relationship between the monoaminergic pattern in medial vestibular nuclei and optokinetic performances. We comparatively studied the regional brain monoamine distribution and the optokinetic performances in pigmented DA-HAN and albino Sprague-Dawley rats. As expected, the optokinetic responses and vestibulo-ocular reflex gain were by far more efficient in DA-HAN rats. Norepinephrine (NE), dopamine (DA), serotonin (5-HT) and their metabolites were determined in retina, brainstem nuclei and dopaminergic areas. DA-HAN rats exhibited an increased noradrenergic activity in the medial vestibular nuclei, locus coeruleus and anteroventral cochlear nucleus, an extended decrease of serotonergic activity in brainstem nuclei and increased DA stores with a reduced dopaminergic activity in most dopaminergic areas. These data confirm and extend the general findings that biochemical data obtained in one strain cannot be extrapolated to another strain. The possible role of the morphological neuronal abnormalities and functional impairment induced by albinism has been discussed especially in medial vestibular nucleus, cochlear nuclei and retina. Alternatively, behavioral factors may also explain some of the observed neurochemical differences.

Albinism↗
PubMed1997

Ca125 and neuron-specific enolase (NSE) as tumour markers for intra-abdominal desmoplastic small round-cell tumours.

Seven consecutive patients with intra-abdominal desmoplastic small round-cell tumours were screened at presentation for carcinoembryonic antigen (CEA), Ca19-9, Ca15-3, Ca125, alpha-fetoprotein (AFP), human chorionic gonadotrophin (hCG) and neuron-specific enolase (NSE). Initially elevated tumour markers were used to monitor therapy and follow-up. Tumour marker assays were all in the normal range, with the exception of Ca125 and NSE. The Ca125 level was initially high in six of the seven patients (86%) with a median value of 200 U ml-1 and a range of 22-735 U ml-1. The NSE value was elevated before therapy in three of the five patients (60%) for whom assay results were available, with a median of 19 ng ml-1 and a range of 6.8-37.5 ng ml-1 . Ca1 25 normalized in five out of six cases and NSE always normalized during chemotherapy, but neither of these two tumour markers correlated specifically with response, as only one patient experienced a partial response, five tumour stabilization and the remaining patient tumour progression. At progression, Ca125 was again elevated in two out of four cases several weeks before clinical relapse and NSE in only one out of three cases. Ca125 and NSE are frequently raised in the serum of patients with intra-abdominal desmoplastic small round-cell tumours before therapy, but are not reliable monitors of the course of the disease. However, normalization is frequently associated with an improvement of symptoms or a moderate clinical response.

Adolescent↗
PubMed1997

Experience with bleomycin, etoposide, cisplatin (BEP) and alternating cisplatin, cyclophosphamide, doxorubicin (CISCA(II))/vinblastine, bleomycin (VB(IV)) regimens of chemotherapy in poor-risk nonseminomatous germ cell tumors.

Forty poor-risk patients with metastatic nonseminomatous germ cell tumors were treated with a chemotherapy regimen that consisted of either the BEP protocol (bleomycin + etoposide + cisplatin) or the CISCA(II)/VB(IV) regimen (cyclophosphamide + doxorubicin + cisplatin/vinblastine + bleomycin). There was no randomization. Among 17 patients who received the CISCA(II)/VB(IV) protocol, three early deaths, four primary failures, and 10 complete responses were observed. Two relapses and one acute myeloid leukemia were subsequently noted. Nine (53%) of 17 patients remain free of disease 15-38 months after the end of therapy. In the group of patients treated with the BEP regimen, one early death, one primary failure, one toxic death, one partial response, and 19 complete responses were observed. There were eight relapses. Sixteen (70%) of 23 patients remain free of disease 26-52 months after the end of therapy. Myelosuppression and mucositis were clearly more severe with the CISCA(II)/VB(IV) regimen. However, no septic death was registered, whereas one patient died of septic shock after the fourth cycle of BEP. Investigators of the Genitourinary Group of the French Federation of Cancer Centers have now embarked on a prospective randomized trial of BEP versus CISCA(II)/VB(IV) in poor-risk patients.

Adolescent↗
PubMed1997

Evaluation of long-term results of a modified VAB-6 chemotherapy regimen in a cohort of good-risk metastatic non seminomatous germ-cell tumors.

From 1984 to 1988, we conducted at Institut Gustave-Roussy a phase II trial with a modified VAB-6 (mVAB-6) chemotherapy regimen in 50 patients with good prognosis metastatic non seminomatous germ-cell tumors, including 27 patients (54%) with retroperitoneal lymph nodes only. The mVAB-6 combination consisted of vinblastine 4 mg/m2/day at d1, of actinomycin D1 mg/m2/day at d1, of cyclophosphamide 600 mg/m2/day at d1, of cisplatin 120 mg/m2/day at d1 and of bleomycin 20 mg/day from d1 to d3. Four cycles of mVAB-6 were delivered every 4 weeks. A complete response was observed in 46 patients (92%). The other 4 patients achieved a partial response with normal serum tumor markers. Forty-two patients (84%) remain continuously free of disease. Eight relapses subsequently occurred 3 to 60 months after the end of treatment. Overall 45 patients (90%) remain free of disease after a median follow-up of 8 years. The long-term clinical toxicity was minimal. Three patients developed secondary tumors: 2 contralateral non seminomatous germ-cell tumors and 1 pancreatic adenocarcinoma. We conclude that the mVAB-6 regimen yielded excellent results and minimal long-term toxicity in this group of patients with very good-risk metastatic tumors.

Adolescent↗