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Biomedical subjects

G Chiche

Publications and source records attributed to G Chiche.

32 records · Page 2Linked to original sources
PubMed1982

[Phlebography in venous thrombosis of the lower limbs (author's transl)].

Phlebography is the best diagnostic technique for deep venous thromboses of the lower limbs. The authors use the "free flow" technique which they have modified by visualisation of the I. V. C. and I. V. A lacunar appearance or cupola-shaped interruption are indicative of a recent thrombosis, whilst the absence of a main venous trunk and a collateral circulation are more common in the presence of an old thrombosis. They emphasise the possible sources of error in interpretation and the difficulty in determining how long the thrombosis has been present. Despite its disadvantages, phlebography remains the essential examination in order to select treatment in patients in whom there is a suspicion of venous thrombosis or pulmonary embolism. Venous Doppler and rheoplethysmography, less sensitive and less specific, have a place in routine detection and the surveillance of treatment.

Diagnosis, Differential↗
PubMed1982

[Angiography imaging in pulmonary embolism (author's transl)].

The principal angiography images found in cases of recent pulmonary embolism include intravascular lacunae, dome-shaped obstructions, a "dead tree" appearance and an avascular region. The first two are specific, but are mainly observed during the few days following the embolism. Highest quality images are obtained by selective angiography of the pulmonary artery, but this technique, which involves transfer of the patient to a specialized unit and catheterization of the pulmonary artery, is not without risk and, more particularly, does not explore the veins of the lower limbs. However, in a series of 110 cases of recent pulmonary embolism, venous thrombosis, usually femoroiliocaval, was present in 102 patients. A new technique is therefore proposed, ascending venous angiopneumography, which has two advantages: --It can be performed in any radiological department as a catheter does not have to be inserted. --It explores both pulmonary and venous systems. Though pulmonary images are less specific (false positives occur more frequently), the simultaneous exploration of the veins allows logical determination of therapy based on the size and site of the embolus and possible associated extension of the venous thrombosis.

Angiography↗
PubMed1981

[Effects of thrombolytic agents on pulmonary and venous clots in severe pulmonary embolism (author's transl)].

Thirty-eight patients admitted to hospital for pulmonary embolism of recent onset were divides into four treatment groups. Group I patients (10) received streptokinase in does of 250,000 units over 20 minutes, followed by 100,000 units/hour for a total of 24 hours. Group II patients (8) received urinary urokinase 4,500 CTA units/kg/hour during 12 hours. Group III patients (10) were treated with urinary urokinase (112,500 CTA) units/hour during 24 hours) and heparin (500 units/kg/24 hours). Group IV patients (10) were given tissue urokinase and heparin, both in the same dosage as in group III patients. Pulmonary angiography and cavography were performed in all patients before treatment and within 24 hours of its termination. With regard to pulmonary emboli, improvement was most pronounced with streptokinase, with a gain of 15.7 points on Miller's index of severity, as against 9.6, 10.5 and 5.7 points for Group II, III and IV patients respectively. In peripheral venous thrombosis, streptokinase showed even greater superiority over other treatment, with a gain of 16 points of Marder's index, as against zero, 4.5 and 11.2 points for patients in Groups II, III and IV respectively. On biochemical tests, the decrease in fibrinaemia was more pronounced in Group I patients than in other groups.

Adult↗
PubMed1981

[Medical treatment of ilio-caval venous thrombosis].

120 patients with ilio-caval thrombosis were managed medically. 55 patients were given heparin (5 mg/Kg/day for 15 days), 50 patients received streptokinase (loading dose 250,000 u; maintenance dose 100,000 m/h for 48 hours) and 15 patients had urokinase (112,500 u/h for 44 hours). Thrombolytic therapy was prescribed, in the absence of contraindications, for patients below 70 year of age: other patients were treated with heparin. The results were assessed by venography performed before and after treatment: success was defined as the complete disappearance of the thrombus of disobliteration of the ilio-caval axis. The overall success rate was 32%, with 68% failures. Success was higher with streptokinase (50%) than with heparin (20%) or urokinase (13%). The site, extension ans aetiology of the thrombosis did not affect the results. On the other hand, two other factors seemed to play an important role: - the duration of thrombosis: this only affected the streptokinase group; 23 of the 25 successes were obtained in patients treated before the tenth day. The results were unaffected by the duration of the thrombosis in the heparin group; - the biological effectiveness of therapy: 7 out of the 11 successes in the heparin group had been constantly well anticoagulated; there were only 4 successes out of 38 patients in whom the biological effectiveness had been intermittent. There were 21 successes out of 32 patients treated by streptokinase with serum fibrin levels of less than 1 g. There were only 4 successes in the 18 other cases. The incidence of haemorrhage was identical in the 3 groups. Embolism was slightly commoner in the streptokinase (3) than in the heparin group (2).

Adult↗
PubMedDate not supplied

Single staged carotid and coronary arteries surgery. Indications and results.

The frequency of associated carotid and coronary stenosis is estimated to be 40% of cases including asymptomatic patients. The risk of death by myocardial infarction during carotid surgery is in the neighborhood of 1%. With Doppler and ultrasonic imaging, it is now possible to recognize carotid stenosis in 11% of these cases. Depending on the extent of the clinical manifestations caused by one or the other of these lesions, there are several therapeutic options: surgery of the carotid with special protection of the myocardium during and after surgery or simultaneous carotid and coronary surgery in high risk cases. Between 1979 and 1986, simultaneous surgery was performed in 18 cases in our department. During the same period, 1194 carotid endarterectomies and 505 coronary bypasses were performed. These 18 cases included 13 males and 5 females with a mean age of 62 years (range: 43 to 78 years). The procedure performed in these cases were 17 carotid endarterectomies, one bypass of the innominate artery and an average of 2 aorto-coronary bypasses per patient. One death from myocardial infarction occurred in the immediate postoperative period and another patient died suddenly 8 months later. The evolution of arterial disease was evaluated in the other patients. Simultaneous carotid and coronary artery surgery is indicated in high risk carotid and coronary patients. Perusal of the results in the literature allows a better appreciation of the indications and risks of this type of surgery. Our series indicates the necessity for a careful preoperative workup in these patients and the need for more accurate screening to obtain better results.

Adult↗
PubMedDate not supplied

Value of phlebography for diagnosis and treatment of pulmonary embolism.

The frequency of recurrencies and of post-phlebitic syndrome after PE lead the Authors to perform phlebography of the legs before and after treatment of PE. A venous thrombosis was found in 124 cases out of 144 recent PE proven by angiopneumography. The thrombosis affected the ilio-caval veins 43 times, in 27/103 severe PE cases (24%), in 16/33 moderate PE cases (40%). Patients were treated: by H. in 67 cases; 33 (group I) with moderate PE, (4 (group II) with severe PE; by Streptokinase (SK) 24 times: 5 cases with moderate PE, 19 (group III) with severe PE; but U.K., high dose (UKf) 19 times; by U.K., moderate dose (UKm) 40 times, 3 cases with moderate PE, 37 cases (group V) with severe PE. After treatment, the mean volume of the venous clot, measured by the Marder's index, decreased in all groups. However, S.K. lysed 7 out of 17 proximal thrombosis, whereas the other treatments were unefficient. Failures were less frequent with S.K. (3/16) than with U.K. f (11/15), U.K.m (12/28) and H. (29/65). Recurrency was noticed 8 times: in 7 cases, it was seen in patients affected with proximal V.T. and not treated by I.V.C. interruption. Such facts warrant the systematic search for V.T. when PE is suspected. They justify the use of thrombolytic drugs not only for severe PE, but also for moderate PE which are associated to a proximal V.T.

Adolescent↗