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Biomedical subjects

J Cron

Publications and source records attributed to J Cron.

At least 19 recordsLinked to original sources
PubMed2003

[Aortofemoral bypass: gold-standard or outdated?].

Although aorto-bifemoral bypass procedures have proven efficacy for the treatment of aortoiliac occlusion, complications have led to a preference for less invasive interventions. A precise knowledge of this morbidity is thus necessary to evaluate and compare outcome with alternative techniques. The purpose of this study was to analyze the course of complications observed in a large group of patients who recently underwent aorto-bifemoral bypass performed by the same team. Between 1975 and 1996, 720 patients underwent aorto-bifemoral bypass procedures for occlusion. Indication for surgery was invalidating claudication in 68%, pain at rest in 28% and trophic disorders in 4%. Mean follow-up was 9.6 years. Twenty-three patients were lost to follow-up. One hundred sixty cases of prosthesis complications were recorded (21.3% of patients): ten infections (1.3%), 14 false aortic aneurysms (2%), 40 false femoral aneurysms (5.5%), 82 prosthetic thrombotic events (11.2%), and 14 femoral anastomotic strictures (1.9%). These complications led to death in nine patients (1.2%) and amputation in 23 (3.2%). Analysis of the results show that late mortality attributable to the prosthesis was minimal compare with other causes of death. Numerous complications occur late after prosthetic repair but their impact on mortality and amputations is limited. Aorto-bifemoral bypass is a safe technique that remains the gold standard for evaluation of other revascularization methods.

Adult↗
PubMed2002

Late reoperations after surgical and endovascular lower limb revascularisation.

OBJECTIVES: to evaluate the rate of late reoperations after primary lower limb revascularisation. METHODS: a prospectively collected database of 639 consecutive patients, undergoing 763 primary arterial reconstruction for lower limb occlusive disease during the five-year period 1989 through 1993, was analysed with regard to the rates and locations of late (after 30 days) re-operation. The reconstruction was supra-inguinal in 527 (69%) cases, surgical in 391 (Group IA) and endovascular in 136 (Group IB). Infra-inguinal reconstruction had been performed in 236 (31%) cases, surgical in 160 (Group IIA) and endovascular in 76 (Group IIB). The 499 men and 140 women were followed during an average of 32 (range 1-122) months. RESULTS: the 5-year cumulative reoperation rates were 25% after supra-inguinal surgery and 28% after supra-inguinal angioplasty, respectively (NS). The rates were 47% and 33% after infra-inguinal surgery and angioplasty, respectively ( p=0.04). CONCLUSION: limbs treated for occlusive arterial disease carry a high risk of late reoperation whether the initial procedure is open surgery or angioplasty. Reoperations were twice as common for infra-inguinal procedures.

Actuarial Analysis↗
PubMed2000

[Surgery of the internal carotid: locoregional or general anesthesia?].

AIM OF THE STUDY: The aim of this retrospective study was to assess the advantages of regional anesthesia over general anesthesia in carotid artery surgery. PATIENTS AND METHOD: From January 1989 to December 1998, 670 patients with severe internal carotid artery stenosis were operated in the same center and were classified into two groups according to the type of anesthesia: group I, general anesthesia (n = 312) and group II, regional anesthesia (n = 358). Characteristics of the two groups were almost similar except for a higher rate of unstable heart disease in group I and bypass grafts in group II. RESULTS: A shunt was used in 16.3% of cases in group I and in 8.4% in group II. Complications resulting from the use of a shunt and intraoperative complications observed with regional anesthesia were reported. There was a conversion from regional to general anesthesia in 6 patients. Median duration of clamping was longer in group II (30 min vs 25 min). Cardiac complication rates were similar in the two groups, particularly cardiac mortality (0.6%). There were more pulmonary and miscellaneous complications in group I. Neurological complications were more frequent in group I, particularly fatal strokes (1% versus 0%). Neurological mortality and morbidity cumulative rates were 3.1% and 1.5%, respectively, not significantly different. CONCLUSION: These results, in agreement with those of the literature, confirm that carotid artery endarterectomy is associated with a low rate of neurological mortality and morbidity. Although regional anesthesia was associated with a lower rate of complications, we are not allowed to conclude to its superiority, as the present study was retrospective and the difference was not statistically significant.

Aged↗
PubMed2000

Endothelial nitric oxide synthase function in pig lung after chronic pulmonary artery obstruction.

Because long-term pulmonary artery (PA) obstruction is associated with expansion of the systemic blood supply to the lung, chronic ischemia may not occur, and endothelium nitric oxide synthase (eNOS) function may be preserved in postobstructive pulmonary arteries. To test this hypothesis, we studied piglets 2 d or 5 wk after left PA ligation or a sham operation. We measured left lung ATP and lactate lung concentrations; calcium-dependent and calcium-independent NOS activities and eNOS protein; and left PA relaxations in response to acetylcholine, calcium ionophore, and sodium nitroprusside. Decreases in ATP and increases in lactate concentrations were significantly attenuated after 5 wk PA occlusion (p < 0.05 versus sham and 2-d ligation). Compared with sham and 2-d PA occlusion, calcium-dependent NOS activity and eNOS protein were lower in the long-term PA occlusion group. Calcium-independent NOS activity was unchanged. Acetylcholine and calcium ionophore relaxations were impaired after 5 wk, whereas only acetylcholine relaxation was impaired after 2-d PA occlusion. Relaxation to sodium nitroprusside remained unchanged. In conclusion, despite relative conservation of lung energy metabolism, prolonged PA occlusion decreased eNOS function and protein in postobstructive pulmonary arteries.

Adenosine Triphosphate↗
PubMed2000

[Radiation-induced aorto-ilio-femoral arterial arteritis. Mediocrity of the long-term results after conventional surgery].

OBJECTIVES: To assess long-term outcome after surgical cure of radiation-induced aorto-ilio-femoral arterial occlusion and to deduce therapeutic indications. PATIENTS AND METHODS: Over a 20-year period, 15 patients were treated for occlusion of the aorto-ilio-femoral vessels 4 to 28 years after receiving radiotherapy. Primary treatment was medical (n=1), balloon dilatation (n=5), anatomic revascularization (n=5), and extra-anatomic bypass (n=4). Mean follow-up was 6.8 years. RESULTS: Among the 5 balloon dilatations, there was one failure requiring right axillofemoral bypass that was followed shortly by fatal septic shock; the 4 others have remained patent at 2 to 15 years, one having required stent dilatation at 6 months. Among the 5 patients who had anatomic revascularization, excepting on patient who died shortly after surgery from her cancer, all have required revision; 2 patients died of infection at 9 and 10 years; the two others are alive at 5 and 18 years. Among the 4 patients with extra-anatomic bypass (one aortothoracic-bifemoral bypass, two axillofemoral bypasses and one cross-over bypass), 2 died with prosthetic sepsis at 3 and 7 years and 2 others have had a bypass replacement. Overall, at last follow-up, half of the operated patients have died from infection (n=5) or cancer (n=2). DISCUSSION: In reports in the literature, revision and infection after conventional surgery is frequent. There is less risk with the endovascular approach, but it can be only applied for short occlusions. CONCLUSION: Excepting easily accessible occlusions with an apparent minimal risk for percutaneous balloon dilatation, irradiated arteries should be operated on only in case of severe ischemia. Patients with claudication should be treated conservatively because of the high risk of complications for prosthesis implantation with irradiated arteries.

Adult↗
PubMed1999

Indications and benefits of simultaneous endoluminal balloon angioplasty and open surgery during elective lower limb revascularization.

Combined balloon angioplasty and conventional revascularization are occasionally performed but some points are still controversial: which patients are eligible for this associated procedure?; should the procedures be performed simultaneously or successively?; and in case of simultaneous procedure, which one should be performed first? To answer these questions, the notes of 64 patients consecutively submitted to this procedure at the Henri Mondor hospital were reviewed. Arterial dilatation was performed on the iliac artery, superficial femoral artery, popliteal artery or tibioperoneal trunk in 31, 26, four and four patients, respectively. Reasons for simultaneous procedures were multiple occlusive lesions in 67% of patients and inflow improvement in 14%. The others reasons included iliac obstruction in poor risk patients, unilateral failure of planned bilateral iliac balloon angioplasty, outflow improvement, local contraindication to arterial approach, shortness of vein graft, clamp injury during open surgery and inadequate patient position for both procedures. Complications were rare. One patient died of recurrent sepsis of the femoro-femoral bypass. The 5-year limb salvage rate was 91%. In this study, simultaneous procedures were associated with three advantages: the risk of septic complications associated with graft implantations in a previously punctured site was decreased, anticoagulant and/or antiplatelet therapy did not need to be modified before the second procedure, hospital length of stay and cost appeared to be lower. On a simultaneous procedure, it is recommended that the balloon angioplasty be performed after the conventional procedure in order to avoid clamping a recently dilated artery when performing the bypass.

Adult↗
PubMed1998

Some popliteal aneurysms are congenital.

Although the majority of popliteal aneurysms are of atherosclerotic origin and are discovered in patients aged more than 50, the aetiology of a small minority may be attributed to arterial trauma, septic disruption, Behcet's disease, a medial fibromuscular dysplasia, or popliteal entrapment. The aim of this study was to propose a possible congenital origin for popliteal aneurysms without evidence of any other aetiology. A retrospective review of five younger patients (aged 20-45 years) with seven non-atherosclerotic popliteal aneurysms was performed. In patient nos 1 and 2, histological examination showed that the arterial wall had been replaced by an abundant collagenic tissue. After replacement by a saphenous bypass graft, these patients did well with a follow-up ranging from 1 to 15 years. Patient no. 3 was not operated on because of a symptomless occlusion of the tibial and peroneal arteries, and remains well 10 years later. Patients nos 4 and 5 were treated with a saphenous bypass graft. The last patient also had associated bilateral congenital anomalies of the division of the popliteal arteries. In the absence of any evidence of any classical aetiology, particularly fibromuscular dysplasia and popliteal entrapment, a congenital aetiology is proposed in aneurysms diagnosed in younger patients. The complex composition of the popliteal artery, being composed by an association of three original segments, may induce a fragility of the arterial wall that may be responsible for aneurysmal deterioration as well as abnormal branching or popliteal artery entrapment. These aneurysms are associated with the same risk of thrombosis as atherosclerotic aneurysms and therefore, they should be subjected to the same therapeutic considerations.

Adult↗
PubMed1998

[Long-term results of aorto-bifemoral prostheses in the surgery for atheromatous stenosis of the aortic bifurcation].

Seven hundred patients operated consecutively by the same surgical team for atheromatous stenosis of the aortic bifurcation were followed up for 20 years with only 5 patients lost to follow-up. There were 94.5% of men with a mean age of 58 years. The operative mortality was 2.7% with few deaths due to true cardiovascular causes (0.7% of patients). The secondary mortality was very high with two main causes: cancer (39% of patients) and cardiovascular diseases (37%). Other causes were responsible for only 24% of deaths. The principal complications of the prostheses were: infection (0.6% of operated patients), thrombosis (6.7%), pseudo-aneurysm of the aorta (1.57%) and pseudo-aneurysm of Scarpa's triangle (4%). The benefits of surgery are unquestionable both on terms of survival, as amputation, bed confinement and invalidity are avoided, and in terms of function, as amputation was avoided in 84% of the 32% of patients in Stages III or IV before surgery. Only 5% of patients were amputed during the observation period. Moreover, 79% of survivors had a good functional result at 15 years. Improvement of results depends on better hygienic measures, systematic screening for high risk cancers and a better management of the arterial disease with early treatment of other arterial diseases (coronary, carotid) in order to reduce postoperative and mostly medium- and long-term cardiovascular mortality.

Aged↗
PubMed1998

[Atherosclerotic lesions of the subclavian artery. Indications for subclavian carotid transposition].

PURPOSE: To analyze the clinical and anatomical outcome after subclavian carotid transposition and to compare the results with other surgical procedures. METHODS: The hospital records of 51 patients undergoing subclavian carotid transposition were reviewed retrospectively for preoperative symptoms, Doppler and arteriography findings, preoperative details and postoperative complications. Long-term patency and symptoms were determined by physical and Doppler examination during the follow-up. RESULTS: The indications for subclavian transposition were: vertebrobasilar ischemia (24%), ischemia of the upper limb (45%), asymptomatic occlusion or non-specific symptoms (31%). Subclavian artery transposition was associated with vertebral revascularization (7 cases), and homolateral carotid surgery (11 cases). There were no deaths. Early occlusions occurred in two cases, one required reoperation. Minor complications were observed in 21% of the patients with no permanent morbidity. Overall patency after a mean 54 months follow-up was 96%. CONCLUSION: Subclavian carotid transposition is a good method for the treatment of proximal subclavian occlusive disease. Long-term patency can be achieved. Carotido-subclavian bypass should be limited to cases with extensive occlusive lesions as patency rate is lower.

Adult↗
PubMed1997

Simultaneous endoluminal dilatation and conventional surgery. Importance of programmed revascularization of the legs.

OBJECTIVE: evaluate the benefit of synchronous arterial reconstruction and endoluminal balloon dilatation for occlusive arterial disease during non-urgent procedures. METHOD: late results of forty arterial reconstructions combining open surgery with simultaneous endoluminal dilatation have been reviewed. Balloon dilatation was performed on iliac (N = 18), femoral (N = 18), popliteal (N = 3) and infra-popliteal arteries (N = 2). Reasons were rapidity in 31 cases, local reasons in five cases (such as brievity of available vein for bypass), heavy operative risk in two cases and partial failure of transluminal angioplasty in two cases. RESULTS: during the first post-operative month, there were one death (due to sepsis) and two reocclusions (one of the dilated artery and the other of the bypass). They were successfully reoperated. At the moment of the study, the mean follow-up being thirty months, seven patients are deceaded (six of them from intercurrent disease), one has been amputated, three suffer intermittent claudication and twenty-nine are cured (but eight of them have been reoperated). CONCLUSION: synchronous arterial reconstruction and transluminal dilatation are a good option in case of multiple arterial occlusive disease particularly in poor risk patients and when inflow or outflow of bypasses should be improved. Associated balloon dilatation is very useful in case of too short vein graft or arterial stenosis due to a clamp injury. Nowadays in our department, these combined procedures are more and more frequent One stage procedure is associated with less complications, shorter length of hospitalization and lower cost.

Angioplasty↗
PubMed1981

Role of phagocytic cells in cancer.

Partial manifestations of the anti-tumor defence in the organism will sometimes lead to surprising changes in the clinical picture of the disease. This must be taken into consideration and, if possible, such therapeutical procedures must be chosen which do not interfere with the course of defence reactions. Therefore, the study of the organism's anti-tumor defence mechanisms is of theoretical as well as of practical value. In Hodgkin's disease a significant increase in phagocytic activity could be observed when the disease was in progress; during clinical remission the values returned to normal ones [181]. The phagocytic activity may be supposed to reflect the dynamic situation between the host and the tumor in man [196]. The determination of phagocytic activity may be useful as an indicator of the extent or activity of the disease [181]. Phagocytic function may be affected by a surgical intervention [46], radiotherapy [179, 183] and by anti-tumor chemotherapy [3, 209]. On stimulating MPS during the course of radiotherapy, improved clinical results have been observed [115]. When examining patients in the course of treatment and after it, a need was felt for methods that can easily be applied and that enable the state of the defence capacity of the organism to be taken into account. The measurement of the phagocytic activity of MPS in clinical practice by using the 131I labelled aggregated human albumin [115] can only be used at selected workplaces. Today, however, drugs and therapeutical procedures with immunosuppressive effects are virtually used in all workplaces where there are patients with malignant tumors. Therefore, an original method of phagocytosis of latex particles in vitro has been elaborated. This method is primarily aimed at orientation, but it may be employed in every hematological laboratory. It determines the intensity of phagocytic activity of leukocytes. The differences between the values obtained in cancer and those obtained in healthy subjects and patients with non-malignant disorders are highly significant. This statement has been made on the basis of 363 examinations performed in clinically healthy subjects, in patients with cancer and in patients with non-malignant disorders. The results were analyzed statistically and it has been found out that the phagocytic capacity of leukocytes is significantly activated in the presence of a pathological process in the organism. This activation is mush more evident in cancer patients than in patients with non-malignant disorders. Strikingly low values were observed in the terminal stage of the disease when the defence capacity of the organism has broken down. These findings induced us to consider the suitability of this kind of examination. It can be used alone or in combination with other methods for estimating the defence capacity of the organism, or for choosing the right therapeutical measures...

Anaerobiosis↗
PubMed1975

Phagocytic activity of leukocytes in tumors (clinical studies).

1. A method of evaluating in vitro phagocytic activity of leukocytes, using inert latex particles has been described. 2. 363 investigations have been carried out according to the method in clinically healthy donors, in patients with and without malignant disorders. The subjects have been divide into groups according to nature of the disease (operable and inoperable tumors, non-malignant, acute anc chronic disorders). 3. A statistical evaluation of the results revealed that the phagocytic capacity of leukocytes is significantly activated in the presence of a pathological process in the organism and this to a considerably higher degree in tumorous disorders than in non-malignant affections. The degree of activation of the phagocytic capacity of leukocytes can be measured by this method and the latter can be used in every haematological laboratory.

Adult↗