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Biomedical subjects

H Rousseau

Publications and source records attributed to H Rousseau.

At least 73 records · Page 4Linked to original sources
PubMed1995

[Percutaneous treatment of popliteal aneurysms using a covered stent: preliminary clinical experience].

This report describes preliminary results with stented grafts (Cragg EndoPro) for treatment of popliteal aneurysms in 3 consecutive patients (3 men, average age 68 years, varying from 44 to 81 years old). One to 4 transluminally placed stented grafts (50 to 100 mm of length and 8 to 10 mm in diameter) were used to treat 3 popliteal aneurysms. The procedures were successful in all cases, under local anesthesia, without hameodynamic compromise or major complications. Angiography and color Doppler demonstrated patency and aneurysm exclusion, up to 9 months with these stented grafts in all cases except for one case occluded 15 days after stent insertion. Although technical success and short-term patency have been good with this technique, long-term patency is not yet known. The use of these stented grafts already appears justified in critically ill patients, but durability must be established in relation to traditional bypass surgery before it can be recommended on a wider scale.

Adult↗
PubMed1994

Balloon dilatation and self-expanding metal Wallstent insertion. For management of bronchostenosis following lung transplantation. The Toulouse Lung Transplantation Group.

Here we report our experience on the use of balloon dilatation or self-expandable metal Wallstent implantation, or both, for the management of twelve bronchial stenoses in ten lung transplant recipients during the past two years. Both techniques were carried out endoscopically, under fluoroscopic guidance and without general anesthesia. Both methods were straightforward, well tolerated, and resulted in immediate symptomatic and functional improvement. The first-line treatment relied on Wallstent insertion (n = 4) or on balloon dilatation (n = 8). Early restenosis occurred in four of eight dilated stenoses and subsequently led to Wallstent insertion. Following Wallstent implantation, growth of granulation tissue occurred in one case and necessitated repeated balloon dilatations inside the stent during the following months. On two occasions, the stenosis was located such that the lower end of the Wallstent overlapped the upper lobe bronchus orifice. This necessitated laser therapy to eliminate the filaments of the stent crossing the lobar orifice, preventing subsequent obstruction. Laser therapy was followed, in one case, by a fibroinflammatory stenosis which was successfully treated by balloon dilatation inside the prosthesis. At the time of writing, the mean +/- SE of the follow-up after Wallstent implantation is 15.3 +/- 2.7 (range: 6 to 32) months. Most Wallstent prostheses are overgrown with bronchial epithelium. We conclude (1) that self-expanding metal Wallstent implantation is a safe procedure and good alternative to silicone stent insertion for the treatment of bronchostenosis following lung transplantation, provided granulomas are not present and (2) that balloon dilatation, although possibly leading to recurrences, can be used to allow inflammatory tissue to mature or to dilate restenoses inside the Wallstent.

Adult↗
PubMed1994

[Transjugular intrahepatic portasystemic shunt and liver transplantation].

From the first one hundred consecutive patients treated by transjugular intrahepatic portosystemic shunt (TIPS), 12 subsequently underwent liver transplantation (a mean of 103 +/- 109 days after TIPS). Fourteen TIPS were created in 12 patients, with advanced cirrhosis (Child B = 5, C = 7) and portal hypertension. Seven patients presented either active variceal hemorrhage or refractory variceal bleeding, and 5 cases of refractory ascites. The shunt could be performed in all cases. Two patients experienced rebleeding (one after a shunt obstruction) and were successfully treated by insertion of a second TIPS. A histological study was performed in 10 cases. The shunt was patent in all cases (except in one case previously described), and the endoluminal surface was covered by a connective tissue layer and a new endothelium. We therefore conclude that this method is a safe and effective therapy for complications of portal hypertension, in patients referred for liver transplantation.

Adult↗
PubMed1994

[Effect of buflomedil perfusion on peripheral tissue oxygenation during transluminal angioplasty in patients with advanced arteriopathy of the lower limbs].

Randomized double-blind placebo controlled trial performed in two parallel groups of patients, aged 43 to 92, suffering from advanced arterial disease of the lower limbs to be treated with angioplasty. The aim was to compare the efficacy of infusions of buflomedil with placebo on peripheral tissue oxygenation following lower limb angioplasties. Treatments consisted of 3 hour infusion of buflomedil or isotonic saline combined with arterial disobstruction. The major outcome measures were transcutaneous oxygen tension (TCpO2) correlated to ankle systolic pressure index (SPI). An increase of TCpO2 values (p < 0.01) as well as the mean individual variations of TCpO2 (p < 0.05) before and after angioplasty were observed in the buflomedil-treated group, whereas SPI values varied similarly in both groups. No adverse event was shown. In conclusion, buflomedil infusions during angioplasties of the lower limbs may improve tissue oxygenation subsequent to arterial disobstruction and are well tolerated.

Aged↗
PubMed1994

[Popliteal aneurysm and leg ischemia: thrombolysis first].

Popliteal aneurysms may threaten the viability of lower limbs, especially in the case of occlusion and poor run-off. In case of acute ischemia, thrombolysis can be used before surgery to clear the tibial arteries and enhance the results of subsequent bypasses. The procedure starts with an arteriography to show the arterial tree, then a recanalization is attempted. By means of a microcatheter pushed into the thrombosis, Heparin (1000 Units/h) and Urokinase (4,000 Units/h) are injected in situ. Arteriograms are repeated in order to control the placement of the catheter. Anticoagulant and fibrinolytic doses are biologically surveyed. Local and general complications are rare with the new techniques of fibrinolysis. Hemorrhagic complications following surgery are low despite the previous fibrinolytic treatment. Better success rates of bypasses, performed to relieve acute ischemic complications of popliteal aneurysms, should be achieved with this new modality of treatment.

Aged↗
PubMed1993

Self-expandable prostheses in the tracheobronchial tree.

Under endoscopic and radiologic control, two types of self-expandable metal prostheses were implanted in tracheobronchial lesions to help reestablish airway caliber. Thirty-nine metal stent prostheses (6-20 mm in diameter) and 35 Gianturco stents (30 mm in diameter) were used in 55 adult patients with 62 lesions of the trachea (n = 33) or bronchi (n = 29). All lesions except one were endoscopically confirmed to be noninflammatory. Immediately after implantation, radiologic and endoscopic studies verified reestablishment of a satisfactory airway diameter in all patients. At a mean follow-up of 10.35 (range, 3-27) months, improvement in the respiratory status of 49 of the 55 patients (89%) was maintained and tolerance of the device was excellent. For the Wallstent endoprosthesis, the six complications observed at endoscopy were successfully treated. The Gianturco stent, however, led to a high rate of complications: 30% of cases had migration and/or rupture of the metallic mesh, potentially leading to obstruction or wall perforation; one case of respiratory distress was fatal. This procedure offers rapid epithelialization and incorporation of the device into the tracheobronchial wall.

Adult↗
PubMed1993

[Treatment of hemorrhages by rupture of cardio-tuberous varices with transjugular intrahepatic portasystemic shunt].

Twelve consecutive patients admitted for bleeding from ruptured gastric varices were treated with transjugular intrahepatic portosystemic shunts and followed for a mean of 6 +/- 3 months (range: 8-293 days). The shunt was performed successfully in all 12 patients. The shunt occluded in 3 patients (respectively 19, 101 and 103 days after insertion) of whom one remained asymptomatic and two experienced rebleeding. Four patients presented with acute encephalopathy, spontaneously in two and after rebleeding in two. Three patients died, two after rebleeding and one of septic shock secondary to pneumonia. Overall, 9 patients survived a mean of 211 +/- 92 days with no rebleeding, 8 of whom have not yet experienced any complications. These results suggest that transjugular intrahepatic portosystemic shunts could be useful in treating hemorrhages from ruptured gastric varices and in preventing their recurrence.

Adult↗
PubMed1992

Lumbar and cervical stenosis. Frequency of the association, role of the ankylosing hyperostosis.

The authors report a study of 47 patients admitted for cervical myelopathy (N = 17) or symptomatic lumbar spinal stenosis (N = 30). Nine patients had clinical evidence of coexisting cervical myelopathy and lumbar spinal stenosis. Ten out of the 17 patients having cervical myelopathy had lumbar spinal stenosis as evidenced by sagittal tomography and/or computerized tomography. Nine out of the 30 patients admitted for symptomatic lumbar spinal stenosis had coexisting cervical canal stenosis as evidenced by sagittal tomography. Thirteen out of these 19 patients with both cervical and lumbar canal stenosis had also ankylosing spinal hyperostosis.

Humans↗
PubMed1992

[Evaluation of efficacy and tolerability of ioversol in intravenous urography. A comparative double-blind study versus iopamidol].

The efficacy and safety of Optiray (ioversol), a new low osmolar non-ionic contrast agent were compared with Iopamiron in a double-blind randomized trial for intravenous pyelography. Concerning the diagnostic efficacy, Optiray 300 was equivalent to Iopamiron 370 for identical injection volumes. Significantly less reinjections were necessary with Optiray. Tolerability was found to be excellent, equivalent to the reference product. Optiray was found to be both well tolerated and of satisfactory diagnostic value.

Adolescent↗
PubMed1991

Chlamydia trachomatis cervical infection: prevalence and determinants among women presenting for routine gynecologic examination.

OBJECTIVE: To determine the prevalence of and risk indicators for Chlamydia trachomatis cervical infection among women presenting for a periodic medical examination. DESIGN: Prevalence study. SETTING: Centre local de services communautaires (CLSC) Saint-Louis du Parc, Montreal. PATIENTS: All women presenting for a routine gynecologic examination from May 1985 to July 1986. Of the 773 (99%) who agreed to participate 56 were excluded because of inadequate diagnostic tests (34), antibiotic intake in the preceding 6 weeks (19) or loss to follow-up after the initial visit (3). OUTCOME MEASURES: Culture was the diagnostic standard, but rapid diagnostic tests were also used. From the identified cases logistic regression analysis was used to evaluate the following risk indicators: age, place of residence, use of oral contraceptives, sexual partners and frequency, history of sexually transmitted disease (STD) and abnormalities found on genital examination. MAIN RESULTS: Fifty-one of the women were found to have C. trachomatis infection, for a prevalence rate of 7.1%; 32 (63%) were completely asymptomatic. Three independent indicators were found: age of 25 years or less (odds ratio [OR] 3.2, 95% confidence limits [CL] 1.8 and 5.9), cervical erythema, contact bleeding or mucopurulent exudate (OR 2.5, 95% CL 1.4 and 4.5) and residency in the CLSC area (OR 2.3, 95% CL 1.1 and 5.1). A history of STD or vaginitis had a significant protective effect in women 30 years of age or more (OR 0.2). CONCLUSIONS: Case-finding for chlamydial infection could be an effective public health measure among women 25 years of age or less and among those with signs of cervicitis when they present for a Papanicolaou test.

Adolescent↗
PubMed1991

Early postoperative sternal approximation after ITA harvesting: computed tomographic evaluation.

Between November 1989 and February 1990, 66 randomized sternotomized patients underwent aortocoronary bypass and were subjected to a sternal scanner in the early postoperative period. Each examination included a manubrial and a sternal body print. At each level, we studied the occurrence of spacing or misalignment of the sternal layers. The 66 patients were subdivided into four groups according to the type of conduit harvested (single left internal thoracic artery or saphenous vein) and the type of material used for the sternal closure (steel wires or nylon yarns). In all cases, adequate early sternal approximation, which is represented by a good alignment as well as by an excellent contact of the sternal layers, was infrequently demonstrated. Moreover, the two abnormalities most often observed were manubrial spacing and sternal body misalignment. The sternal closure technique and internal thoracic artery harvesting had no significant effect on the sternal approximation. To minimize manubrial spacing and sternal body misalignment, we propose that the surgeon should apply three threads through the manubrium, withdraw the shoulder roll beforehand, elevate both of the patient's shoulders, and maintain the two xyphoid layers in the same plane and in fairly close contact during the tightening of the wires.

Aged↗
PubMed1991

Iliac artery stenosis or obstruction after unsuccessful balloon angioplasty: treatment with a self-expandable stent.

Obstruction or stenosis of the iliac artery was treated by placement of a self-expandable stent in 91 patients. A total of 100 lesions was treated. All patients had had poor results of balloon angioplasty including residual stenosis, iliac occlusion, and dissection. The stent used in all cases was a self-expandable stainless steel endoprosthesis mounted on a 7- or 9-French catheter and covered by an invaginated tubular rolling membrane. The diameter of the expanded stent varied from 7 to 12 mm. A total of 129 stents was placed. Technical success was 97%. Thromboses occurred immediately after placement in two patients and within the first month in six; these were mainly due to residual obstruction. Eighty-two (93%) of 88 patients with a follow-up longer than 3 months had no recurrent symptoms. Restenosis caused by intimal hyperplasia inside the stent occurred in 10 patients; these required repeated intervention in only four cases. In the remaining six patients, no further complications occurred. Our results show that self-expanding endoprostheses are of value for improving the results of inadequate percutaneous transluminal angioplasty.

Adult↗