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Biomedical subjects

G Janvier

Publications and source records attributed to G Janvier.

At least 19 recordsLinked to original sources
PubMed1992

[Spontaneous splenic rupture disclosing a pheochromocytoma].

Clinical manifestation of a phaeochromocytoma may range from no symptoms to an acute abdominal emergency. These abdominal emergencies are related to haemorrhagic necrosis of the tumour, or massive bleeding in the retroperitoneal space. The authors report a case of splenic rupture revealing a phaeochromocytoma. The mechanism of splenic rupture is discussed as is the conservative treatment of phaeochromocytoma during splenic surgery. The authors observed no correlation between plasma catecholamine concentration and blood pressure.

Adrenal Gland Neoplasms↗
PubMed1992

Virus inactivation of fresh frozen plasma by a solvent detergent procedure: biological results.

In order to increase the safety of blood products, we have developed a procedure for the virus inactivation of fresh frozen plasma. Several batches have been prepared and with the first 10 batches, each of them composed of 60 litres of plasma, we have determined a set of biological parameters. Virus inactivation was realised using TnBP (1%) and Octoxynol 9 (1%). After their elimination with castor oil using chromatography on insolubilized C18 resin, glycine was added and the pH of the plasma was adjusted to 7.4. Plastic bags were aseptically filled with a mean volume of 200 ml of plasma. The mean levels of coagulation factors were all over 0.7 U/ml and their recovery from initial plasma was nearly the same as total protein except for factor VIII:C. The net loss in factor VIII:C was 16%, when including the dilution of plasma. In vivo and in vitro tests demonstrated that in the final product there were no activated factors. As in fresh frozen plasma, the protein concentration was over 50 g/l and the potassium level lower than 5 mmol/l. According to these results, virus-inactivated plasma has the same qualities of fresh frozen plasma and could now replace it.

Blood Coagulation Factors↗
PubMed1992

A new apheresis system using a copolymer (polyvinyl alcohol triethylene glycol diacrylate) for removal of LDL from dog whole blood.

Studies were undertaken to determine the effectiveness of a copolymer composed of PVA-TEGDA (Poly Vinyl Alcohol TriEthylene Glycol) as a plasma-cholesterol lowering procedure. For a comparative study, five dogs underwent plasmapheresis including the transfusion bag containing gel in the plasma line, while three control dogs underwent the same plasmapheresis without gel. Numerous biological determinations were performed firstly in whole blood circulation before and after treatment over 10 days, and secondly in plasma before and after LDL binding on the gel. In the whole blood circulation, the average significant depletion of cholesterol levels was 31-51% for treated, 0-16% for control dogs and the average significant depletion of LDL cholesterol was 26-75% for treated and 0-3% for control dogs. Gel was therefore able to bind 121-217 mg of total cholesterol and 34-70 mg of LDL cholesterol per gram of gel. Lipid and lipoprotein levels rebounded 3-4 days after treatment. Adverse effects were not observed during all plasmapheresis. No significant differences between control plasmapheresis and gel-plasmapheresis were obtained for blood cell counts while lengthened coagulation times were observed during 24 h. Complement was not significantly activated by the copolymer as shown by a same decreased activity in the blood stream of all dogs: in fact, CH 50 depletion in the gel incubated plasma was due to a protein adsorption on the hydrogel. This new approach for LDL apheresis appears to be a promising new technique.

Acrylic Resins↗
PubMed1992

[Central pontine myelinolysis after hepatic transplantation].

We report two cases of central pontine myelinolysis (CPM) following liver transplantation. The incidence may well be underestimated as in the past the diagnosis of CPM was based on postmortem findings. Malnutrition, poor clinical condition, encephalopathy are common features of transplanted patients developing CPM. The clinical course is characterized by a biphasic pattern; after normal recovery from anesthesia, there is a subsequent and gradual deterioration in the neurological state. The complex syndrome associates loss of consciousness, flaccid quadriplegia and pseudobulbar palsy. Among the many factors suspected of inducing CPM, a rapid correction of natremia (> 12 mmole/l/day) seems most probable. With regards to liver transplantation, CPM presents rather specific problems. Delaying transplantation to correct hyponatremia carries a risk of severe hepatic encephalopathy. On the other hand, the intraoperative compensation of blood losses with high sodium content blood products tends to induce an abrupt rise in sodium serum concentration. Moreover, renal capacity to excrete sodium is often impaired, due to hepatic insufficiency and surgical procedure. Transplantation should not be delayed, but as infusion of large amounts of sodium cannot be avoided (fresh frozen plasma, human albumin, red blood cells), natremia may be controlled by continuous veno-venous hemofiltration with low sodium content substitution fluids.

Adult↗
PubMed1992

[Perioperative transfusion strategy].

Tactics in blood transfusion have evolved considerably during the last ten years. Awareness of infectious risks and economic considerations have lead legislators to draw the guidelines for a safer transfusion. Their aim is to promote a better transfusion in smaller quantities at a lower risk. The goal of perioperative blood replacement is to maintain hemoglobin, blood volume and coagulation factors at an adequate level. This can be carried out by either homologous or autologous transfusion. Fresh frozen plasma transfusion is only required in severe bleeding where coagulation factors are depleted. The plasma substitutes must be used according to their intrinsic properties and their cost. The choice of an autologous technique depends on the type of surgical procedure, the expected blood loss and the economic resources available. Autologous blood transfusion may be optimized by the association of various techniques. This transfusion strategy must be elaborated by all the medical protagonists implicated in transfusion procedures.

Blood Transfusion↗
PubMed1991

[Use of homologous erythrocyte concentrates. Analysis of economical factors].

The factors involved in reducing consumption of bank packed red cells (PRC) were studied over three one year periods (1983, 1987 and 1989) in a Department of Vascular and General Surgery. The effects of autologous blood salvage (started in 1987), associated with the management of homologous blood by a branch of the blood bank inside the operating theater suite were assessed. In 1989, intentional normovolaemic haemodilution became virtually systematic, on top of the intraoperative blood salvage, for all patients due to undergo surgery with a risk of severe blood loss. The number of surgical procedures carried out during those three years did not vary. However, in the same time, the annual consumption of homologous PRC decreased by an overall 56% (36.7% between 1983 and 1987, and 29.8% between 1987 and 1989). This decrease was mostly due to a fall in prescription in the operating theaters, and not in the wards. In the same time, albumin consumption increased sixfold. Such transfusional policies can only be carried out if there is good cooperation between the blood bank and the prescribers of blood products.

Blood Banks↗
PubMed1991

An open trial of enoxaparin in the treatment of deep vein thrombosis of the leg.

An open and prospective phase II trial assessing the action of a fixed dose of a low molecular weight heparin (enoxaparin), determined by the patient's weight, in the treatment of established deep vein thrombosis of the leg is hereby described. A series of 51 patients received a regimen of 1 mg.kg-1 or 105 anti-Xa IU.kg-1 s.c. every 12 h for a period of 12 days. Thromboses were categorized as postsurgical (28 cases) or medical (23 cases). There was a significant improvement in clinical signs (pain and edema) and phlebographic indices (Marder and Arnesen scores). The extent of vascular clearing was a 30% reduction in phlebographic scores between day 0 and day 12. Only 5 patients had an absence of improvement. Two of the 51 patients stopped the drug in the first week of treatment because of bleeding. There were no occurrences of thrombocytopenia, and the agent was well tolerated.

Aged↗
PubMed1991

Rationale for the design of biomaterials and the evaluation of their biocompatibility.

The biocompatibility of a material can be considered as the ideally expectable result of its interactions with living tissues with which it is interfaced. This property determines the ability of devices involving this material in their constitution, to correctly assume their ascribed function; reciprocally a bad fitting, between devices and their intended use, coming from a non-optimized design or from an inappropriate prescription, may alter the original biocompatibility of constitutive materials. Accordingly, the actual biocompatibility of a biomaterial depends upon both its intrinsic properties and the application in which it is involved. Such considerations must be taken into account by specialists who try to design more performant biomaterials, or new assist devices, should they be implantable or not; but they draw also methodological guidelines for the evaluation of the biocompatibility of these biomedical products.

Biocompatible Materials↗
PubMed1991

[Increased activated partial thrombin time: analysis of 250 cases discovered at laboratory].

This study evaluates and discusses the potential utility (clinical value) of complementary coagulation tests performed in cases with a prolonged aPTT of no obvious etiology from a total of 85,500 routine coagulation tests carried out in our general hospital. aPTT was measured using Actin F.S.L. (Dade, plant-derived and rabbit phospholipids complex with ellagic acid as activator) and Diagen (Biotrol, rabbit phospholipids with kaolin). Tests for acquired anticoagulants and endogenous pathway factors (XII, XI, IX, VIII) were assayed if the aPTT was prolonged by 7 sec or more. 250 abnormal aPTT of previously unknown etiology were found over a 14 months period. 46% of them were without any obvious cause, and were considered "spontaneous" increases: 2/3 of these spontaneous increases were 7-9 (group A), and 1/3 were 10-19 (group B). The diagnoses found in group A were mostly deficits in the contact system, while group B contained mostly cases with acquired anticoagulants and deficits in the contact system. In group C (increases over 20"), an etiology could be established in all cases, with a predominance of acquired anticoagulants and some deficits in factors VIII and XII.

Blood Coagulation Disorders↗
PubMed1990

Treatment of established venous thromboembolism with enoxaparin: preliminary report.

Unfractionated heparin is effective in the treatment of deep venous thrombosis and pulmonary embolism but may lead to significant side-effects (bleeding complications and thrombocytopenia). Low molecular weight heparin fragments have been shown to be as effective as unfractionated heparins during prophylaxis with a once-daily injection regimen. The aim of this open study was to assess the tolerance and the efficacy of enoxaparin in established venous thromboembolism. The study included 36 consecutive patients (mean age 60 years) (range 13-87) with recent deep vein thrombosis (less than 5 days) documented by venography. All patients received enoxaparin twice daily at a fixed dosage of 2 mg/kg/day. The efficacy was assessed by the evolution of Arnesen venographic score. Seventeen patients showed a moderate improvement (less than 35%) and 17 patients had a marked improvement (over 35%). Two patients were not evaluated for efficacy because they displayed bleeding complications. No relationship was found between anti-Factor Xa level and regression of venographic score. In conclusion, subcutaneous administration of enoxaparin proved to be an effective antithrombotic therapy. A fixed dosage of 2 mg/kg/24 h should be the basis of the randomized controlled study ongoing at the present time.

Drug Tolerance↗