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Biomedical subjects

F Gouin

Publications and source records attributed to F Gouin.

At least 19 recordsLinked to original sources
PubMed2003

[Perioperative management of ventricular assist devices].

OBJECTIVE: To review the perioperative anaesthetic management of ventricular assist devices. DATA SOURCES: Extraction from Pubmed database of french and english articles on the perioperative anaesthetic management of ventricular assist devices for 15 years. DATA SELECTION: The collected articles were reviewed and selected according to their quality and originality. The more recent data were selected. DATA SYNTHESIS: Cardiac transplantation is an effective treatment for patients in end stage cardiac failure, but the average waiting time of 17 months, associated with the lack of organs (357 out of 832 candidates were transplanted in 1996) results in a high number of deaths in patients awaiting transplantation. The appearance in the 1980's, of the first ventricular assist device (VAD) provided a new possibility for the management of patients with end-stage cardiac failure awaiting transplantation ("bridge to transplant"). The perioperative anaesthetic management of these patients is complex. End stage cardiac failure, poorly responsive to pharmacological interventions, results rapidly in secondary organ dysfunctions. VADs produce a rapid improvement in haemodynamic, renal, hepatic and neuro-endocrine functions over a 2 months period, allowing transplantation to take place under optimal conditions. However VADs are not without complications (1 year mortality of 20%), of which the major are: infections (40%), perioperative haemorrhage (30%) and thrombo-embolic sequelae (30%). A best knowledge of pathophysiology of these complications is necessary to an optimal management of patients with ventricular assist devices.

Anesthesia↗
PubMed2003

[Topical methylprednisolone vs lidocaïne for the prevention of postoperative sore throat].

OBJECTIVE: We assessed the efficacy of topical methylprednisolone or lidocaine for prevention of postoperative sore throat. STUDY DESIGN: Randomised, prospective in single blind study. PATIENTS AND METHODS: Sixty patients ASA 1 or 2 undergoing tracheal intubation for dental surgery received before intubation either topical lidocaine 5% (15 puffs) or aerosolized methylprednisolone (80 mg). Postoperative pain was assessed by the patients using a VAS and a specific scoring system for sore throat, cough and hoarseness. Evaluations were performed immediately after emergence from anaesthesia, 1 h later, at time of the first postoperative drink, at time of the first postoperative meal and 24 h after surgery. RESULTS: Patients receiving methylprednisolone showed slightly better scores for sore throat and cough 1 h after surgery. CONCLUSION: Topical methylprednisolone may therefore be a useful adjuvant in the prevention of sore throat after intubation.

Adult↗
PubMed2002

Leukaemia inhibitory factor (lif) is expressed in hypertrophic chondrocytes and vascular sprouts during osteogenesis.

Avascular cartilage is replaced by highly vascularized bone tissue during endochondral ossification, a process involving capillary invasion of calcified hypertrophic cartilage in association with apoptosis of hypertrophic chondrocytes, degradation of cartilage matrix and deposition of bone matrix. All of these events are closely controlled, especially by cytokines and growth factors. Leukaemia inhibitory factor (LIF), a member of the gp130 cytokine family, is involved in osteoarticular tissue metabolism and might participate in osteogenesis. Immunohistochemical staining showed that LIF is expressed in hypertrophic chondrocytes and vascular sprouts of cartilage and bone during rat and human osteogenesis. LIF is also present in osteoblasts but not in osteoclasts. Observations in a rat endochondral ossification model were confirmed by studies of human cartilage biopsies from foetuses with osteogenesis imperfecta. LIF was never detected in adult articular chondrocytes and bone-marrow mesenchymal cells. These results and other data in the literature suggest that LIF is involved in the delicate balance between the rate of formation of calcified cartilage and its vascularization for bone development.

Animals↗
PubMed2002

[Fusarium pleural effusion after a ventricular assist device].

We report the case of a 36-year-old man with a pleural effusion that complicates the postoperative period after the implantation of a ventricular assist device (VAD). The epidemiological, etiologic and therapeutic features of Fusarium infections were reviewed. Complete recovery of the infection was obtained after a treatment by liposomal amphotericine B (AmBisome) and 5 fluorocytosine.

Adult↗
PubMed2002

Hyperprocalcitonemia is related to noninfectious postoperative severe systemic inflammatory response syndrome associated with cardiovascular dysfunction after coronary artery bypass graft surgery.

OBJECTIVE: To investigate the role of 3 inflammatory parameters as early markers of severe systemic inflammatory response syndrome (SIRS) induced by coronary artery bypass graft surgery. DESIGN: Prospective study. SETTING: University hospital. PARTICIPANTS: Patients (n = 63) undergoing elective coronary artery bypass graft surgery with cardiopulmonary bypass. MEASUREMENTS AND MAIN RESULTS: The American College of Chest Physicians/Society of Critical Care Medicine classification was used to diagnose SIRS. Organ system failures were used to define severe SIRS. Serum concentrations of the inflammatory parameters (procalcitonin [PCT], C-reactive protein, leukocyte count) were determined before, during, and after surgery. SIRS occurred in 30 (47%) patients after surgery. Seven patients (11%) showed SIRS with greater-than-or-equal1 organ dysfunction (severe SIRS), whereas patients without SIRS had no organ dysfunction. Significantly higher serum levels of PCT were found in patients with severe SIRS from the 6th postoperative hour until the 3rd postoperative day with a peak level of 10.7 plus minus 13.2 ng/mL. No significant difference was detected between serum PCT of patients with SIRS but without any organ dysfunction and patients without SIRS. PCT levels of these patients remained lower than 1.7 ng/mL. Compared with PCT, plasma concentrations of C-reactive protein peaked later on the 2nd postoperative day and were not able to confirm the severity of SIRS. Leukocyte counts were not significantly modified. CONCLUSIONS: PCT seems to be an appropriate marker to identify the early development of noninfectious postoperative severe SIRS after coronary artery bypass graft surgery with cardiopulmonary bypass.

Aged↗
PubMed2002

Bone remodelling and tumour grade modifications induced by interactions between bone and swarm rat chondrosarcoma.

Chondrosarcoma is currently defined as a malignant cartilage tumour arising de novo or within a pre-existing benign cartilage tumour. Chondrosarcoma can be surgically resected, but all grades have significant rates of local recurrence. The purpose of the present study was to develop an animal intraosseous chondrosarcoma model simulating the progression of human chondrosarcoma and elucidating its behaviour and biology. An intraosseous Swarm rat model was designed to assess interactions between bone and chondrosarcoma. A comparison of tumour grading was carried out according to transplantation site. The effects of chondrosarcoma cells (SRC cells) on the mineralisation capacities of osteoblasts and on osteoclast differentiation were studied in relation to modifications observed in vivo at the cellular level. Transplantation of Swarm rat chondrosarcoma within bone marrow or contiguous to induced periosteal lesions led to extensive bone remodelling with trabecular bone rarefaction and periosteal apposition. Transplantation in close contact to bone but without any periosteal lesion had no effect on bone, suggesting that bone healing factors interact with tumour development. With the intramedullary model, the development of tumours of different grade confirms that bone environment is an important factor in malignancy. A decrease of bone nodule formation was noted after cocultures of SRC cells with rat bone marrow, but there was no modification of osteoclast differentiation after cultures of total rabbit bone cells with SRC cells. These data reveal the importance of interactions between bone environment and tumour in inducing bone remodelling and variations in tumour malignancy.

Animals↗
PubMed2001

Possible use of arthrodesis for intractable sacroiliitis in spondylarthropathy: report of two cases.

STUDY DESIGN: Two cases of successful sacroiliac joint arthrodesis for medically intractable aseptic sacroiliitis are reported. SUMMARY OF BACKGROUND DATA: Although successful arthrodesis of the sacroiliac joint had been reported previously for septic sacroiliitis, no report had shown the procedure to be effective for spondylarthropathy. METHODS: Two women with spondylarthropathy involving very painful sacroiliac arthritis for 18 and 24 months had been relieved only transiently by several injections of steroids into the sacroiliac joint under fluoroscopy and by Bermuda casts. Both patients underwent sacroiliac joint arthrodesis. RESULTS: Both patients showed dramatic improvement after sacroiliac joint arthrodesis. Moreover, no relapses had occurred, respectively, after 2 and 3 years of follow-up evaluation despite continuing spondylarthropathy in other joints. CONCLUSIONS: After a careful selection of patients, including positive blocks in the sacroiliac joint, arthrodesis of sacroiliac joint might be considered for so-called "intractable" aseptic sacroiliitis.

Adult↗
PubMed2001

[In vitro assessment of combining osteogenic cells with macroporous calcium-phosphate ceramics].

PURPOSE OF THE STUDY: Bone grafts or bone substitutes are required to fill bone defects resulting from trauma or surgical resection of tumors. Calcium-phosphate ceramics are synthetic bone substitutes which promote new bone formation by osteoconduction. These ceramics possess osteoconductive properties but have no intrinsic osteoinductive capacity. They are unable to induce new bone formation in extraossesous sites. One solution to develop bone substitutes with osteogenic properties would be to associate biomaterials with osteoprogenitors. MATERIALS AND METHODS: We studied the in vitro osteogenic potential of human bone-marrow cells cultured on macroporous calcium phosphate (CaP) ceramic, examining stromal cell proliferation and differentiation. Osteogenic differentiation was evaluated in terms of alkaline phosphatase activity and immunological characterization of the extracellular fibrillar matrix formed by these cells. The specimens were examined by scanning and transmission electron microscopy. RESULTS: Human bone-marrow cells proliferated on CaP ceramic. The proliferating bone-marrow cells expressed an osteoblastic phenotype as shown by alkaline phosphatase activity and synthesis in ceramic pores of an extracellular matrix composed of fibronectin, osteocalcin and collagen I. In addition, numerous microcrystals of apatite precipitated on the fibrillar matrix, producing a mineralized fibrillar network within the ceramic. CONCLUSION: This study demonstrates that human bone-marrow cells cultured on macroporous CaP ceramic do not lose their osteoblastic phenotype even after 21 days of culture, and that they can induce osteogenesis in a CaP ceramic in vitro. This type of new "hybrid material" appears promising for the future.

Bone Marrow Cells↗
PubMed2001

[The comparative costs of vancomycin treatment versus teicoplanin in osteoarticular infection caused by methicillin-resistant staphylococci].

This clinical and economical study compared two glycopeptides regimen i.e., vancomycin and teicoplanin in the treatment of osteoarticular infection involving methicillin-resistant staphylococcus. After randomization, 15 patients (group 1) received vancomycin (23 F per gram) in continuous infusion through a central venous catheter and 15 others (group 2) intramuscular teicoplanin (311-357 F a 400 mg vial). The clinical study focused on treatment tolerance in an in-patient setting as well as in a non in-patient one. The cost analysis focused on total expenses including those of antibiotics, those of medical devices for antibiotic administration and those of the complications caused by the antibiotics use. Total expenses per patient averaged 8744 F with vancomycin and 8555 F with teicoplanin (NS). The apparent money saving by using a cheap antibiotic (i.e. vancomycin) was illusionary as one took in account the expenses for medical devices e.g., central venous catheters required to administer vancomycin and the complications due to the use of these devices.

Acute Disease↗
PubMed2001

Long-term arterial cannulation in ICU patients using the radial artery or dorsalis pedis artery.

STUDY OBJECTIVES: To evaluate the rate of arterial thrombosis and catheter-related infection following radial artery or dorsalis pedis artery (DPA) cannulations lasting > or = 4 days. DESIGN: Prospective, observational study of two cohorts of ICU patients. SETTING: ICU of a university hospital. PATIENTS: In a first group of 131 consecutive patients, the DPA was selected for arterial cannulation. In the second group, 134 consecutive patients were considered for radial artery cannulation. MEASUREMENTS AND RESULTS: In the DPA group, the overall success rate for catheter placement was 85%. Patients were cannulated for 16 +/- 5 days (mean +/- SD). In the radial artery group, the overall success rate was 97.7% (129 of 132 patients; p < 0.0001 vs DPA group). Patients were cannulated for 13.3 +/- 4.0 days. In both groups, no signs of ischemia were detected at the clinical examination. In the DPA group, no thrombosis was detected at the angiographic examination in 21 patients (38%), a thrombosis without vessel obstruction was observed in 21 patients (31%), and a thrombosis with vessel obstruction was observed in 21 patients (31%). In the radial artery group, no thrombosis was observed in 31 patients (24%; not significant vs DPA group), a partial thrombosis was found in 73 patients (57%), and a total thrombosis with vessel obstruction was found in 25 patients (19%). Two cases of catheter-related infection were observed in the DPA group. In the radial artery group, four cases of catheter-related infection were diagnosed vs DPA group (not significant). CONCLUSIONS: The rate of serious complications was similar for both sites of arterial cannulation. Accepting a 12.7% lower rate of successful placement, the DPA route provides a safe and easily available alternative when radial arteries are not accessible.

Catheterization, Peripheral↗
PubMed2001

[Subfascial lipomatous tumors: management in a series of 37 consecutive cases].

PURPOSE OF THE STUDY: The prognosis of subfascial lipomatous soft tissue tumors depends greatly on their histological type ranging from benign lipomas that cause little local or general problems to the severe prognosis of liposarcomas that exhibit both local and distant extension. However, the clinical presentation of the two types of tumors may be similar and thus quite misleading, sometimes leading to inappropriate management and severe consequences. The main objective of this study was to determine whether the preoperative work-up in patients treated for musculoskeletal tumors within our recruitment zone is adequate, allowing appropriate therapeutic decisions. In addition, we wanted to know what explorations are most pertinent for the differential diagnosis between benign and malignant subfascial lipomatous soft tissue tumors. MATERIAL AND METHODS: Thirty-seven patients with subfascial tumors were included in this study. There were 16 with benign lipomas and 21 with liposarcomas. All the patients with benign lipomas but only 9 (43%) of those with liposarcoma had received initial care within our recruitment zone before final diagnosis. Two cases had been referred after biopsy and 1 after resection by morcellation; the 9 others were secondary referrals after tumor recurrence. Only 5 of these 12 referred patients had had an MRI exploration prior to surgery, 2 with an erroneous interpretation. An MRI series was obtained for all the patients with benign lipoma and for the 9 with liposarcomas who attended our units directly. A biopsy was also obtained in case of suspected liposarcoma. Two radiologists blinded to the final diagnosis reviewed the available MRI to assess their diagnostic value for subfascial lipomatous soft tissue tumors. RESULTS: No case of recurrence, after marginal resection (10 cases) was noted for lipomas. Six are under observation with regular MRI (with no change in size or signal). Four patients with liposarcoma died from their disease (19%) and 2 who had undergone "curative" resection had a recurrence (12%). Incorrect or imprecise (incomplete, incorrectly interpreted or no MRI) preoperative diagnosis led to additional morbidity with 3.4 surgical procedures (mean per patient) compared with 1 in patients who had had undergone a complete work-up and whose diagnosis was established after multidisciplinary discussions. Among the diagnostic elements available before pathology, only MRI findings had diagnostic value for subfascial lipomatous soft tissue tumors: for benign lipoma positive predictive value=92% and negative predictive value=93%. DISCUSSION: The clinical course of the benign lipomas and the sarcomas in this series confirm the radically different prognosis of these two tumors, both in terms of local extension and survival. Inadequate management in the initial diagnostic stages-i.e. lack of MRI with contrast injection, biopsy and multidisciplinary interpretation prior to treatment-raises the risk of higher morbidity, particularly a significantly greater number of reoperations, and progression to a higher grade of malignancy for two tumors. Our retrospective analysis enabled us to develop a decision making tree for patients with subfascial lipomatous tumors. Prospective validation will be necessary.

Decision Trees↗
PubMed2000

A synthetic porous ceramic as a bone graft substitute in the surgical management of scoliosis: a prospective, randomized study.

STUDY DESIGN: A prospective randomized study. OBJECTIVES: To assess the clinical and radiologic performances of a synthetic ceramic as a bone graft substitute in scoliosis surgery. SUMMARY OF BACKGROUND DATA: Surgery on the skeleton frequently requires harvesting of autogenous bone grafts from the pelvis, but this procedure often is complicated by problems. METHODS: Fifty-eight patients with idiopathic scoliosis, ages 13 to 25 years, were treated by posterior correction and arthrodesis using Cotrel-Dubousset instrumentation. Posterior spinal fusion was performed using local bone grafts combined with autogenous iliac bone grafts in 30 patients, and combined with porous biphasic calcium phosphate ceramic blocks comprising hydroxyapatite and tricalcium phosphate in another 28 patients. The patients were observed for a minimum of 24 months after surgery, with a mean postoperative observation time of 48 months. The results were assessed clinically and radiographically. RESULTS: Patients in the ceramic group had a lower average blood loss than those in the iliac graft group. They also were free from postoperative local complications in the iliac region, which were experienced by a significantly high proportion of patients belonging to the iliac graft group. Radiography demonstrated successful incorporation of the ceramic blocks within 12 months. The correction of the deformity was maintained similarly and satisfactorily in both groups. CONCLUSIONS: These results justify and favor the use of calcium phosphate ceramics as bone graft substitutes for instrumented posterior spinal fusion in teenagers and young adults. Potentially hazardous harvesting of pelvic bone is no longer necessary for such operations.

Adolescent↗
PubMed2000

[Monitoring jugular venous oxygen saturation in severe cerebral vasospasm after subarachnoid hemorrhage].

Cerebral arterial vasospasm is a major complication of aneurysmal subarachnoid haemorrhage. The conventional treatment of this complication includes haemodilution, hypervolaemia, arterial hypertension and nimodipine. Some patients do not respond to this therapy and require an intraarterial infusion of papaverine and/or a cerebral angioplasty. Transcranial Doppler detects cerebral vasospasm. However it does not provide an accurate metabolic information on the ischaemic status of the cerebral tissue. This article describes the monitoring of jugular venous bulb oxygen saturation to obtain a real time information on the metabolic effect of cerebral vasospasm and its variations after intra-arterial infusion of papaverine.

Adult↗
PubMed2000

[Sciatic nerve block: an new lateral mediofemoral approach. The value of its combination with a "3 in 1" block for invasive surgery of the knee].

OBJECTIVE: To describe a new midfemoral lateral approach for the sciatic nerve block. Its combination with the "3 in 1" block was tested for postoperative analgesia following major surgery of the knee. STUDY DESIGN: Descriptive, anatomical and clinical study prospective. PATIENTS: After testing in four unembalmed corpses the new approach was applied to 42 ASA 1-2 patients, in combination with a continuous "3 in 1" block. METHODS: The new approach was analysed for reliability of the surface landmarks (a line drawn from the posterior margin of the greater trochanter towards the knee and parallel to the femur) and block extent assessed on the foot. Its combination with the "3 in 1" block was evaluated with a visual analogue scale (VAS) scoring, for postoperative analgesia after total knee arthroplasty. RESULTS: The sciatic nerve was located in less than 10 min. A block of the sciatic nerve was fully achieved in all patients. Its median duration was 16 h. The median VAS score at rest was 0 mm (sciatic bloc + continuous block "3 in 1"), but increased to 40 mm (block "3 in 1" alone). CONCLUSION: The new lateral midfemoral sciatic block is easy to master. Combined with a continuous "3 in 1" block, it provides excellent analgesia during the early postoperative period after major surgery of the knee.

Adult↗
PubMed2000

[Acute poisoning with phenytoin caused by an error in the administration of fosphenytoin (Prodilantin)].

Following surgery for a chronic subdural haematoma, a 74-year-old patient received fosphenytoin as prophylaxis for epilepsy. The patient received 10 times the prescribed dose. This error in the administration of fosphenytoine was facilitated by a confusing labeling of the product. The phenytoin blood level was 79 micrograms.mL-1. The main adverse effect was a coma requiring 5 days of mechanical ventilation. No adverse cardiovascular event was noted. The phenytoin blood levels returned toward the therapeutic range in 8 days. At discharge from the hospital 20 days after surgery, the patient did not have any sequela from the fosphenytoin intoxication.

Aged↗
PubMed2000

Chondritis dissecans of concave articular surfaces (acetabulum and glenoid fossa). Two case reports.

We report two patients who had chronic mechanical pain due to substantial cartilage defects documented by arthrography. One of these patients had pain in the hip and declined surgical treatment. The other had pain in the glenohumeral joint; surgery found a fissure in the glenoid fossa cartilage and provided prompt pain relief. These two cases serve as reminders that investigation of the cartilage and subchondral bone in young patients with mechanical pain should not be confined to the convex articular surfaces, although these are more likely to sustain trauma-related damage than concave surfaces. In both our patients, the diagnosis required thin-section computed arthrotomography.

Acetabulum↗