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H Lacroix

Publications and source records attributed to H Lacroix.

At least 37 records · Page 2Linked to original sources
PubMed1997

Ehlers-Danlos syndrome type IV: a heterogeneous disease.

The Ehlers-Danlos syndrome is an inherited disorder of connective tissue, consisting of at least 10 different clinical subtypes. Type IV Ehlers-Danlos syndrome is an autosomal dominant condition characterized by the joint and dermal manifestations as in other forms of the syndrome but also by the proneness to spontaneous rupture of bowel and large arteries. The authors describe their experience with three patients presenting type IV Ehlers-Danlos syndrome: the first presented with several subsequent arterial ruptures, the second with multiple aneurysms, and the third with a dissection of the internal carotid artery. Clinical features, incidence, diagnosis, and treatment of the syndrome are discussed.

Adolescent↗
PubMed1997

Stent grafts for iliofemoral occlusive disease.

This report summarizes the technical feasibility and early results of endovascular iliofemoral stented grafts in the treatment of iliofemoral occlusive disease. Twenty-four patients (mean age 71 years) underwent 29 lower-extremity inflow procedures for claudication (n = 7) or limb threatening ischaemia (n = 17). The technical success rate for endovascular grafts was 93% (n = 27). Some 85% of the grafts originated from the aortoiliacjunction or the common iliac arteries. Outflow procedures were performed in all cases and consisted of profundaplasty (n = 17) and/or femorodistal grafting (n = 13). The operative mortality rate was 9% and one occlusion was noted in the early postoperative period. The mean (s.d.) primary and secondary cumulative patency rates after 1 year were 85(10)% and 95(5)% respectively. The corresponding limb salvage rate was 95(4)%. The authors conclude that endovascular iliofemoral stented grafts through a single groin incision are technically feasible and that early patency rates are acceptable. More experience is needed however before widespread application of these new techniques can be justified.

Aged↗
PubMed1997

Transfemoral treatment for iliac occlusive disease with endoluminal stent-grafts.

OBJECTIVES: Percutaneous treatment of iliac artery occlusive disease has replaced open vascular reconstruction for several indications. A balloon angioplasty with or without stent is not an option in the presence of infrainguinal extension of the disease. The authors describe a technique that allows the construction of an aorto- or iliofemoral graft through a single groin incision, using a 4 mm PTFE graft, anchoring it proximally with a Palmaz stent and dilating both to the desired diameter. DESIGN: Retrospective non-randomised study. MATERIALS AND METHODS: Nineteen procedures were performed in 16 patients mainly because of ischaemic rest pain, often with trophic skin changes or minor gangrene. Three patients had a bilateral procedure. Twelve patients had one or more associated procedures: 10 distal bypasses, one thrombectomy, one reimplantation of a distal bypass on the iliofemoral graft, one contralateral profundaplasty and two stents of the contralateral common iliac artery. RESULTS: Two patients died, one of small bowel ischaemia and the other of a myocardial infarction. During the mean follow-up of 8.8 months, two graft thromboses occurred. In another patient bilateral stenting of a residual stenosis was necessary. CONCLUSIONS: Our experience shows that the reported technique is feasible. Whether the procedure is truly "less invasive" and the long-term results acceptable remains to be shown.

Aged↗
PubMed1997

Vitamin C supplementation does not modify bone mineral content or mineral absorption in growing pigs.

We have demonstrated that alkaline phosphatase activity and collagen synthesis are dose-dependently stimulated by ascorbic acid in differentiated pig osteoblasts. In this study we further examined the relationship between ascorbic acid and bone metabolism by feeding young pigs large amounts of ascorbic acid. Three groups of seven 47-d-old pigs were given no ascorbic acid supplement (control), 500 (500 AA) or 1000 (1000 AA) mg ascorbic acid/kg diet for 4 mo. Calcium and P absorption and retention were evaluated by a 14-d balance trial immediately before killing in control and 1000 AA groups only (n = 6). Bones were collected at death and the bone ash and bending moment (three-point bending test) determined. Various plasma and urine indices of bone metabolism, especially those reflecting collagen degradation (hydroxyproline, deoxypyridinoline) and synthesis (carboxyterminal propeptide of type I collagen) were monitored. The plasma ascorbic acid concentrations increased with time and paralleled the dietary concentrations (P < 0.01). The Ca and P balances and the bone ash and bending moments in the ascorbic acid-supplemented pigs did not differ from those of the controls. Plasma osteocalcin was elevated (P < 0.05), whereas the other bone formation markers, alkaline phosphatase and carboxy terminal propeptide of type I collagen, were not affected by ascorbic acid. The plasma concentrations of Ca, P and 1,25-dihydroxycholecalciferol did not differ among the three groups. The unaffected urinary excretion of deoxypyridinoline and hydroxyproline in the ascorbic acid-supplemented pigs indicates that ascorbic acid does not alter bone resorption. Thus, high intakes of ascorbic acid have no positive influence on bone metabolism and bone characteristics in pigs. The in vivo long-term effects do not correlate with the short-term in vitro effects previously reported.

Absorption↗
PubMed1997

Inflammatory abdominal aortic aneurysms. A retrospective study of 110 cases.

OBJECTIVE: The purpose of this study is to review our experience with the surgical treatment of 110 patients with an inflammatory abdominal aortic aneurysm (IAAA). Furthermore, we focus especially on 37 ureteral obstructions. PATIENTS AND METHODS: Between 1978 and 1996 we treated 110 patients for an IAAA. It concerned 101 men and nine women with mean age of 66.8 years. Emergency surgery was performed in 32 patients (13 ruptures) and elective surgery in 78 patients (only 23 asymptomatic). The IAAA diagnosis was made by CT scan preoperatively in 40% of the patients. Compression of 37 ureters in 23 patients (14 bilateral, 9 unilateral) was noticed and ureteral stenting was performed preoperatively in nine patients (12 ureters). The surgical approach was median laparotomy (88 patients) or retroperitoneal approach (21 patients). One patient was treated with an endovascular Min-Tec Stentor aortic graft by femoral approach. Suprarenal clamping was necessary in 44 patients. Ureterolysis of 23 ureters was performed. Three peroperative iatrogenic lesions were successfully treated intraoperatively. RESULTS: Fatal complications occurred in nine patients (8%), five patients after urgent surgery and four patients after elective surgery, all of them related to technical problems. Non fatal complications occurred in 22 patients, renal insufficiency was most important in ten patients (two permanent dialysis). The mean follow-up was 4.5 years (range, 0.5 to 15 years). Late survival was 68% at 5 years and 42% after 10 years. Seven patients presented late graft related complications, one fatal. In 14 surviving patients with 21 ureterolysed ureters, one needed a nefrectomy and one a bilateral Boari-plasty. In eight surviving patients with 11 stented ureters, one patient needed a small bowel interposition for ureteral stricture. After CT evaluation, all ureteral stents were removed 3 to 6 months after surgery. CONCLUSIONS: 1. Surgery for IAAA is quite complex. Mortality and morbidity are often associated with emergency or combined vascular and non vascular procedures. 2. When carefull operative repair is performed with minimal dissection of structures from the aneurysmal wall, excellent results can be expected. 3. Ureteral compression should be treated by ureteral stenting, preoperatively, to facilitate ureterolysis or even to avoid it. Regular follow-up CT control is recommended.

Aged↗
PubMed1997

The clinical value of duplex surveillance following internal carotid artery reconstruction.

BACKGROUND: The purpose of this retrospective analysis was to evaluate the benefit of a yearly duplex ultrasonography of both the reconstructed and the contralateral internal carotid artery (ICA). METHODS: From 1985 to 1994, 1210 unilateral, primary ICA reconstructions were performed. Although these patients received yearly invitations, duplex follow-up was not available in 114 patients (9%). RESULTS: At 5 years a stenosis of 50% or more was found in 9% and at 10 years in 14% of patients. During the follow-up period 20 patients developed a stenosis of 80-99%. Ten patients had a redo-procedure. The others remained asymptomatic, even though one patient developed an occlusion. A stroke occurred in 96 patients. 58 of these had no significant stenoses. 57% of all patients had no significant contralateral lesion at the time of the first procedure. In only 4% of these a contralateral CAE was performed during the follow-up. CONCLUSIONS: In view of the above data, we would conclude that the clinical benefit of duplex surveillance is doubtful.

Adult↗
PubMed1996

Supra- and juxtarenal aneurysms of the abdominal aorta: preoperative assessment with thin-section spiral CT.

PURPOSE: To assess the contribution of thin-section spiral computed tomography (CT) to the preoperative radiologic evaluation of juxta- and suprarenal abdominal aortic aneurysms. MATERIALS AND METHODS: Thirty-eight patients (26 men, 12 women; age range, 60-81 years) with infrarenal (n = 23), juxtarenal (n = 8), and suprarenal (n = 7) aneurysms underwent digital subtraction angiography (DSA) and 2-mm-collimation spiral CT. Cine-interactive display of overlapping axial, reformatted, and maximum intensity projection images were used for CT image analysis. CT findings were compared with angiographic and surgical findings. RESULTS: The proximal extent of the juxta- and suprarenal aneurysms (n = 15) could be correctly predicted in 12 cases (80%) with DSA and was exactly determined in 14 (93%) with CT. All renal arteries except three accessory renal arteries were correctly depicted with spiral CT (83 of 86 [96%]). With DSA as the standard of reference, renal artery stenoses of at least 70% were accurately assessed in 95% of cases. CONCLUSION: Thin-section spiral CT can provide additional information in the preoperative diagnosis of juxta- and suprarenal aneurysms.

Aged↗
PubMed1996

Technique and early results of videoscopic lumbar sympathectomy.

The authors describe their technique of videoscopic (VS) lumbar sympathectomy (LSE), compared to the open LSE. From 1992 to 1994, 21 open and 19 VS LSE were performed. The indication was reflex sympathetic dystrophy in 17 and arterial insufficiency in 23 patients. In the open LSE the mean duration of anaesthesia was 80 min (55-115) and of surgery 37 min (25-65). The length of the chain removed varied from 1 to 3 ganglia (6-7 cm). Complications were noted in 5 patients: 1 pneumonia, 2 superficial wound problems and 2 cases of postsympathectomy neuralgia. Hospital stay of patients with RSD varied from 2 to 5 days. Of the 19 attempts to perform a VS LSE 4 had to be converted to the open technique. The duration of anesthesia was 150 min (90-280) and of surgery 92 min (45-240). Lengths of chain removed varied from 1 to several ganglia (6-7 cm). A pneumoperitoneum was present in 10 procedures, but a Veress needle was placed in only 4 of these. Complications were present in 9 patients: 1 important subcutaneous emphysema, 1 severe costal pain, 2 neuralgia, 1 temporary psoas dysfunction, 1 haemorrhage from a lumbar vein with conversion to the open technique and 3 minor superficial wound problems. The hospital stay ranged from 2 to 5 days. This study suggests that the VS LSE has no benefit over the open technique as far as the operative and early results are concerned. Whether this technique avoids some of the late disadvantages of a lumbotomy remains to be seen.

Adolescent↗
PubMed1996

Carotid surgery in octogenarians: is it worthwhile?

Controversy surrounds the role of carotid endarterectomy in octogenarians. Although the prognosis of severe degree carotid stenosis is more ominous in the elderly, operative risk seems more important in the aged. To evaluate the presumed detrimental effect of advanced age on the mortality-morbidity of carotid endarterectomy, the authors reviewed their common experience with carotid surgery in patients aged 80 years or more. From 1980 to 1994, 129 octogenarians were operated on for occlusive carotid artery disease in two university hospitals. The data for these patients, 80 years of age and older (group 1) are compared to these for a large middle age group (less than 80 years) (group 2) operated by the same surgeons during that period. The baseline characteristics of both groups were similar, except for smoking, diabetes and previous myocardial revascularization, more prevalent in the younger age group. In the elderly group prophylactic surgery for asymptomatic stenosis was done in 36%, versus 40% of the middle aged patients, and for stroke in evolution in 8% versus 4% (p < 0.05). The perioperative stroke rate was 0.8% in the group older than 80 years, compared to 1.2% for non octogenarians (NS). The operative mortality was similar for both age groups (2.3 and 1.5 respectively). The long-term results gave a similar outlook for both age groups. The 5-year stroke-free rate reached 89% for group 1 versus 91% for group 2. The 5-year survival rate, however, was less for the elderly patients (47% versus 77%, mean follow-up periods of 30 and 49 months). These results suggest that carotid endarterectomy can be safely done in elderly patients, with a similar risk/benefit ratio as for the younger patients. Advanced age, by itself, is not to be considered as contraindication to carotid surgery.

Adult↗
PubMed1996

[Morbidity and mortality after elective surgery of complicated aneurysms].

The post-operative mortality and morbidity after elective surgery of a complicated (difficult) infrarenal abdominal aortic aneurysm are reported. The authors compare a group of 126 patients with a simple uncomplicated aneurysm to a group of 126 patients with a complicated aneurysm. Mortality (3.2%) is similar in both groups but the morbidity is very high in the group of patients with difficult aneurysms. The most frequent complication was renal insufficiency determined by preoperative renal insufficiency. The length of the hospital stay was much longer for the patients after a surgery for a difficult aneurysm. A preoperative correct diagnosis is always possible and the surgical technique varies according the type of anomaly. Even elective surgery of a complicated aneurysm remains a challenge.

Adult↗
PubMed1996

[Percutaneous intentional extraluminal recanalization of the femoropopliteal artery. Initial experiences and results].

Between July 1994 and April 1995, 14 patients with a chronic occlusion of the femoropopliteal artery were treated by percutaneous intentional extraluminal recanalisation (PIER). It concerned 11 males and 3 females with a mean age of 65 years (50-76 years). Twelve patients were smokers, two patients had diabetes mellitus. Ten patients had severe claudication, four patients suffered from rest pain, three of the latter had ulcerations. In all patients, recanalisation and balloon dilatation could be established. However, angiographic result was unsatisfactory in one case. There were no complications. Clinical follow-up varied from 2 weeks to 9 months. Two patients needed a surgical femoropopliteal bypass respectively 4 and 7 months after recanalisation because of claudication recurrence. A third patient had two percutaneous redilatations of a restenosis. The remaining 11 patients became free of complaints. PIER seems to be a feasible treatment for patients with chronic femoropopliteal occlusions with a very good technical success, low complication rate and promising initial clinical outcome. Follow-up studies have to prove its superiority over the established revascularisation techniques.

Aged↗
PubMed1996

Microbiological monitoring of aortic aneurysm sac contents during abdominal aneurysmectomy: results in 176 patients and review of the literature.

To investigate the clinical significance of intraoperative cultures, aneurysmal thrombus was cultured in 176 patients with clinically non suspected infected abdominal aortic aneurysm. The incidence of positive cultures was 14.2% and 88% of the microorganisms were Gram-positive. Differences between elective and urgent reconstruction were not significant. During follow-up, there were no cases of graft infection in either group. Review of the literature shows a positive culture rate of 19% in a series of 1867 patients. 93% Of the microorganisms are Gram-positive and 78% are considered as contaminants. The incidence of graft infection is 1.99% in the group with positive culture and 0.7% in the series with negative culture (P = 0.06). It is concluded that the clinical significance of routine cultures in clinically non suspected infected aortic aneurysms is negligible.

Aged↗
PubMed1996

Phase I/II study of gemcitabine and cisplatin in the treatment of advanced non-small cell lung cancer: preliminary results.

Sixty-six patients with advanced non-small cell lung cancer have been entered into a phase I/II study of a combination of gemcitabine and cisplatin. An initial phase I portion of the study has been completed, and 16 patients have been entered using a fixed dose of gemcitabine 1,000 mg/m2 as a 30-minute intravenous infusion weekly for 3 weeks. Cisplatin was administered on day 15 following gemcitabine with appropriate prehydration and posthydration. The study was designed to allow for sequential groups of three patients to receive three dose levels of cisplatin (60 mg/m2, 75 mg/ m2, and 100 mg/m2). Dose modification and patient numbers were to be increased at any dose level if significant toxicity was observed. The regimen was well tolerated at all doses, and the final level of cisplatin 100 mg/m2 was expanded to 10 patients before the phase II portion was opened. Neutropenia (World Health Organization grade 4 in three patients) and thrombocytopenia (grade 3 or 4 in five patients) were the main hematologic toxicities recorded. These episodes were brief and uncomplicated. Grade 3 nausea and vomiting occurred in 12 patients, but was no worse than would be expected from cisplatin alone. Alopecia, when it occurred, was minimal (no hair loss in 10 patients and grade 1 or 2 in six patients). No significant renal toxicity or neurotoxicity was seen. A phase II study with cisplatin 100 mg/m2 and gemcitabine 1,000 mg/m2 has been opened, and to date 43 patients are evaluable for response. Eighteen (42%) patients have achieved partial remissions. The study will close when 50 evaluable patients have been entered.

Adolescent↗
PubMed1995

Thrombolytic therapy of peripheral arterial occlusion with recombinant staphylokinase.

BACKGROUND: Recombinant staphylokinase (STAR) induces fibrin-specific coronary artery recanalization in patients with evolving myocardial infarction. The present pilot study evaluates its thrombolytic efficacy, safety, fibrin specificity, and immunogenicity in patients with peripheral arterial occlusive disease. METHODS AND RESULTS: Thirty patients (37 to 86 years of age) with angiographically documented thromboembolic peripheral arterial occlusion of recent origin (21 +/- 5.5 days, mean +/- SEM) were treated with heparin and intra-arterial STAR given as a 1-mg bolus followed by a 0.5-mg/h infusion in 20 patients or as a 2-mg bolus followed by a 1-mg/h infusion in 10 subsequent patients. With 7.0 +/- 0.7 mg STAR infused over 8.7 +/- 1.0 hours, recanalization was complete in 25 patients, partial in 2, and absent in 3. Two major hemorrhagic complications occurred: one fatal hemorrhagic stroke and one hypovolemic shock caused by bleeding at the angiographic puncture site. Administration of STAR did not induce fibrinogen breakdown or a significant prolongation of template bleeding time. STAR-neutralizing activity and anti-STAR IgG were low at baseline, increased markedly from the second week on, and remained elevated for several months. CONCLUSIONS: Intra-arterial administration of STAR restores vessel patency in patients with peripheral arterial occlusion in the absence of fibrinogen degradation.

Female↗
PubMed1995

Proximal migration of vena caval filters: report of two cases with operative retrieval.

Operative retrieval of two proximally migrated vena caval filters was performed in two patients, ages 42 and 45 years, respectively. In the first patient the filter was encrusted in the right ventricle, and in the second one the filter was found in the pulmonary artery. Both filters were retrieved under cardiopulmonary bypass via an incision in the right atrium and the pulmonary artery, respectively. These two observations underscore the risk of increased unwarranted indications and consequent higher complication rates of vena caval filters.

Adult↗
PubMed1995

Early inflammatory response to gelatin- and collagen-sealed Dacron prostheses.

The immediate inflammatory response following aortic reconstruction with two types of sealed Dacron grafts was studied in a prospective, randomized manner. C-reactive protein (CRP) levels were measured before surgery and on days 2 and 8 postoperatively. In the collagen-sealed group (n = 10) CRP levels were 10 +/- 9.6, 180.2 +/- 48.3, and 54.3 +/- 34.3 mg/L, respectively. In the gelatin-impregnated group (n = 10) the values were 10.5 +/- 8.7, 200.7 +/- 27.3, and 80.3 +/- 30.2 mg/L, respectively. The slight differences were not significant according to the analysis of variance test for repeated measurements. These findings suggest that implantation of a knitted Dacron graft sealed with collagen does not lead to a higher inflammatory reaction compared with a gelatin-sealed graft.

Aged↗