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Biomedical subjects

J M Constantin

Publications and source records attributed to J M Constantin.

18 recordsLinked to original sources
PubMed2006

Outbreak of colonization and infection with vancomycin-resistant Enterococcus faecium in a French university hospital.

An outbreak of infection with vancomycin-resistant Enterococcus faecium occurred at Hotel-Dieu Hospital (Clermont-Ferrand, France). A case-control study was performed in the infectious diseases and hematology units of the hospital. Urinary catheter use (odds ratio [OR], 12 [95% confidence interval {CI}, 1.5-90]; P<.02), prior exposure to a third-generation cephalosporin (OR, 22 [95% CI, 3-152]; P=.002), and prior exposure to antianaerobials (OR, 11 [95% CI, 1.5-88]; P<.02) were independently predictive of vancomycin-resistant Enterococcus faecium carriage.

Disease Outbreaks↗
PubMed2001

Computed tomography assessment of positive end-expiratory pressure-induced alveolar recruitment in patients with acute respiratory distress syndrome.

Computed tomography (CT) assessment of positive end-expiratory pressure (PEEP)-induced alveolar recruitment is classically achieved by quantifying the decrease in nonaerated lung parenchyma on a single juxtadiaphragmatic section (Gattinoni's method). This approach ignores the alveolar recruitment occurring in poorly aerated lung areas and may not reflect the alveolar recruitment of the entire lung. This study describes a new CT method in which PEEP-induced alveolar recruitment is computed as the volume of gas penetrating in poorly and nonaerated lung regions following PEEP. In 16 patients with acute respiratory distress syndrome a thoracic spiral CT scan was performed in ZEEP and PEEP 15 cm H(2)O. According to the new method, PEEP induced a 119% increase in functional residual capacity (FRC). PEEP-induced alveolar recruitment was 499 +/- 279 ml whereas distension and overdistension of previously aerated lung areas were 395 +/- 382 ml and 28 +/- 6 ml, respectively. The alveolar recruitment according to Gattinoni's method was 26 +/- 24 g and no correlation was found between both methods. A significant correlation was found between PEEP-induced alveolar recruitment and increase in Pa(O(2)) only when recruitment was assessed by the new method (Rho = 0.76, p = 0.003), suggesting that it may be more accurate than Gattinoni's method.

Aged↗
PubMed2000

[Effect of bronchial drainage on the improvement in gas exchange observed in ventral decubitus in ARDS].

OBJECTIVES: A bronchial secretion draining effect is frequently suggested as a mechanism for oxygenation improvement during prone positioning (PP) in patients with acute respiratory distress syndrome (ARDS). Nevertheless, it has never really been evaluated. The aim of this study was to search for an interrelationship between the volume of the bronchial secretion and the improvement of the PaO2/FIO2 ratio during prone positioning, with NO inhalation or not. STUDY DESIGN: Open prospective clinical study. PATIENTS: The study included 15 consecutive patients with severe ARDS (PaO2/FIO2 < 200 after alveolar recruitment, Murray score > 2.5). METHODS: They were returned to the prone position for 4 hours (h0-h4) combined with an inhalation of 5 ppm NO during 1 hour (h2-h3). Tracheal suction were performed hourly between h-2 and h6 and weighed on a precision scale from h-1 to h6. Haemodynamic, blood gas and respiratory compliance were recorded at h0, h2, h3, h4 and h6. RESULTS: No significant haemodynamic changes were observed in the various phases. Compared with the baseline condition at h0, PP and PP + NO respectively improved PaO2/FIO2 by 102 +/- 62% at h2 (P < 0.005) and 156 +/- 79% at h3 (P < 0.005/h0 and < 0.01/h2). 14/15 patients responded to PP and 15/15 to PP + NO (gain in PaO2/FIO2 > 10%). Concerning secretions, we collected 3.0 +/- 7.5 g, 4.4 +/- 6.1 g, 1.7 +/- 1.4 g and 1.7 +/- 1.6 between h-2 and h0, h0 and h2, h2 and h4, h4 and h6. Individual assessments showed no relationship between the PaO2/FIO2 evolution at any time and the quantity of secretions obtained during the first 2 hours in the prone position. Six patients presented secretions of less than 1 g between h0 and h2, and for whom the improvement in oxygenation was higher than average (115 +/- 53% at h2). CONCLUSION: In patients with little or moderate secretions, the improvement observed in oxygenation, with or without NO, does not depend on their volume.

Aged↗
PubMed1997

[Technique and results of cryo-stripping in the treatment of varicose veins of the lower limbs].

UNLABELLED: Stripping of varicose veins, a reference method, causes postoperative pain and sometimes dysesthesia due to saphenous nerve damage. Ankle wound healing is sometimes painful and often unaesthetic. Invaginated stripping eliminates some of the drawbacks, but keeps the lower wound and must be left in the case of recurrent saphenous rupture. Those two techniques do not allow total saphenous resection in the case of infected ulcers. Cryosurgery can be used regardless of the state of the ankle skin. It allows a complete invaginated stripping without ankle wound. METHODS: Over a 9-year period, 6157 limbs (3255 patients) underwent cryosurgery for varicose veins. The indication in 88% of cases was based on functional or aesthetic reasons and in 7% of the cases, hypodermitis, in 3% ulcerations and in 2% superficial venous thrombosis. RESULTS: Postoperatively, a single case of sural phlebitis was observed. Frequency and intensity of pain and hematomas are decreased. Thanks to this technique, the lower incision can be avoided thus giving better aesthetic results. CONCLUSION: Cryosurgery for varicose veins can be used in any circumstances. It has a similar efficacy to the stripping technique. Aesthetic and functional results are better. It is an important improvement especially in case of ulceration.

Cryosurgery↗
PubMed1996

[Computers in a private surgeon's office. "Do it yourself" or "one is never served better than by oneself"].

In an attempt to minimise the administrative work involved in private surgical practice, the author naturally considered the use of computers. After studying the medical software market, he was convinced that most software was better adapted to general practice than to surgery. He concluded that the best person to design a surgical software would be the surgeon himself, provided he was prepared to spend some of his leisure time to develop a computer application. The software developed is a large integrated application facilitating all of the functions necessary to good functioning of the surgical office. It therefore ensures filing of medical records, correspondence, accounts, management of salaries, and appointments, as all of these sectors are related to the surgical activity itself. This approach led to the design of an application, and its functioning and the possibilities provided are described.

Humans↗
PubMed1996

[Non-deployment of branches of a vena cava filter. Elements of prevention].

Non-deployment of an L.G.M. percutaneous vena cava filter is rare. The aim of this paper is to report a new case of this complication. A second filter was inserted between the non-deployed filter and the renal veins to prevent proximal migration of the transvenous interruption device to the pulmonary artery or the right side of the heart, and to guarantee an effective prophylaxis of further pulmonary embolization. Two years later, the vena cava was still patent. The best way to avoid this accident is a perfect insertion technique: after a preoperative cavography to check diameter and patency of the vena cava, the filter must be deployed by retracting the introducer sheath while maintaining the position of the inner canula, and not pushing the filter out of the introducer sheath. A second filter must always be available in the operating room in case of incomplete opening of the filter. The use of vena cava filter is not devoid of risks. Restricted indications are therefore recommended.

Aged↗
PubMed1995

[Cryo-stripping: an advance in the treatment of varicose veins. 3811 operated limbs].

OBJECTIVES: Stripping varicose veins can cause invalidating durable dysaesthesia in 25% of the cases due to saphenous vein damage. Postoperative varicosis is also frequently encountered. Cicatrization may be inaesthetic at the ankle and the operation may even be impossible due to infected ulcerations. Alternative methods are therefore needed. Cryosurgery using a freezing probe can be used to remove the entire saphenous vein via the inguinal incision alone. METHODS: Over a 6 year period, 2,009 patients (3,811 members) underwent cryosurgery for varicose veins. The indication in 88% of the cases was based on functional or aesthetic reasons and in 7% hypodermitis, in 3% ulcerations resistant to medical treatment and in 2% superficial venous thrombosis. RESULTS: Postoperatively, a single case of sural phlebitis was observed (0.02%). Dysaesthesia occurred in the saphenous nerve territory in 2% of the cases and resolved in a few months. Functional signs present preoperatively had disappeared within one month of surgery in 98%. The aesthetic result was excellent since there is no scar tissue on the limb excepting the inguinal incision and since postoperative varicosis was rare (0.1%). All varicose ulcerations had healed in less than 3 months of surgery and no case of deep vein failure was observed. CONCLUSION: Cryosurgery for varicose veins is as effective as the stripping procedure and avoids certain complications. The aesthetic result and functional results are better. Cryosurgery is an important progress in the treatment of varicose veins of the lower limbs, especially in case of ulcerations.

Adolescent↗
PubMed1995

[Varicose liposclerosis amd ulcers: importance of cryo-stripping].

Varicose veins stripping is often a difficult procedure when lipodermatosclerosis or ulcers are present, because malleolar incision is impossible. On the contrary, cryo-stripping is performed by a single incision of the groin or the popliteal fossa. A cryroprobe is inserted into the vein lumen, after ligating and interrupting the sapheno-femoral or popliteal junction. The lower saphenous extremity is frozen. The vein is broken and returned inside-out by removing the cryo-probe upwards. Upon 3,811 legs operated on from 1988 to 1994, there were 265 liposclerosis and 114 ulcers. Deep venous insufficiency was associated 43 times. In less than three months, all but six ulcers were healed. These six patients suffered from post phlebitic syndrome. Cryo-stripping is an efficient method in the treatment of unhealing infected ulcers or severe venous lipodermatosclerosis.

Adult↗
PubMed1991

[Early prognostic factors of the surgery of aneurysms of the abdominal aorta with renal artery clamping].

The aneurysms of the abdominal aorta requiring suprarenal clamping are rare. Suprarenal clamping was required for only 43 of 544 aneurysms operated electively from 1981 to 1989. Twenty-five patients had a juxtarenal aneurysm, without any normal aortic segment under the renal arteries, and suprarenal clamping was therefore necessary while the upper anastomosis was being established (group I). Eighteen patients had an aneurysm enclosing the root of at least one renal artery (group II). Several prognostic factors have been assessed: patient's age, presence of preoperative renal insufficiency, of arterial hypertension or of coronary insufficiency, and revascularization method. Five patients died. Four of them belonged to group II and were over 75 years old. All presented with a preoperative renal insufficiency. Two of these deaths were caused by mesenteric infarction. Four cases of regressive postoperative renal insufficiency were observed in patients for whom renal clamping had lasted longer than 45 minutes. This study allowed outlining three prognostic factors: the patient's age, preoperative renal insufficiency, a period of renal ischemia exceeding 40 minutes. On the other hand, the severity of hypertension had no predictive value. Coronary insufficiency requires a strict hemodynamic surveillance, but is not a contraindication for revascularization.

Age Factors↗
PubMed1989

[Probable side effects caused by plethoryl. Common acute hepatitis, anicteric hepatitis, cirrhosis due to hypervitaminosis A, inflammatory arthralgias].

Plethoryl is a combination of triatricol, cyclovalone and vitamin A normally prescribed in the treatment of hypercholesterolaemia. Four cases of side-effects most probably caused by this product are reported. They include: 1) a case of common acute hepatitis, 23 cases of which have already been published, with aggravation and reduced time-lapse after reintroduction; 2) a case of clinically silent but biochemically classical hepatitis; 3) a case of cirrhosis due to vitamin A toxicity; 4) a case of inflammatory arthralgias recurring after the same time-lag when the drug was reintroduced despite double doses and without clinical evidence of hepatitis. The last three side-effects have never been previously reported. The adverse reactions to Plethoryl almost always occur in the unofficial indications of the product, notably in the "treatment" of obesity.

Acute Disease↗
PubMed1986

[Revascularization of the 2 lower limbs from the descending thoracic aorta without laparotomy].

Arterial bypass of the lower limbs from the thoracic aorta approached through a thoracic or abdominal route has already been described. The technique reported here is original in that the descending thoracic aorta is exposed through thoracotomy, and the prosthesis is passed behind the left kidney, then, for the right leg bifurcation, through Retzius' space without laparotomy. Two patients were operated upon with this technique which is described in detail, together with its potential indications, advantages and disadvantages.

Aged↗
PubMed1985

[Urologic manifestations of aortocaval fistulas].

The authors report two cases of aortocaval fistula, resulting from the rupture of an abdominal aneurysm, and revealed by lumbar pains and hematuria. In both cases, the left kidney was mute, and was possibly responsible for the hematuria.

Aged↗
PubMed1984

[66% glucose, a safe sclerosant. Experimental study].

Although accidents due to the intra-arterial injection of detergent sclerosant are very rarely observed, they are dramatic in their effects and often result in amputations, a risk accepted with difficulty for a treatment with a functional aim. To avoid these incidents, which may occur even when treatment is applied by the most experienced surgeons, the authors have used 66% glucose solution without accident since 1948. To confirm efficacy of the method, an experimental study compared 66% glucose (66 G) with a very commonly used product, 1% sodium tetradecyl sulfate (STD), in the rabbit. Except when enormous doses of 66 G are employed, the only effect noted was eosinophilic necrosis of the vessel wall without clinical symptoms, whereas doses eight times lower of STD produced an irreversible ischemia from obliterating endarteritis of the branches of the vascular tree injected. The 66% glucose solution appears to be a very safe, gently acting sclerosant, and the product of choice for peri- and post-operative sclerosis, particularly in regions where accidental arterial puncture is anatomically possible.

Animals↗
PubMedDate not supplied

Decreased susceptibility to extended-spectrum cephalosporins of a penicillin-susceptible Streptococcus pneumoniae in meningitis.

A 69-year-old woman was admitted to the hospital with meningitis due to Streptococcus pneumoniae. The strain was susceptible to penicillin but intermediate to cefotaxime. In Europe the decrease of susceptibility generally pertains more to penicillin than to cefotaxime. Such a strain is perhaps a forewarning of the existence of high-level cephalosporin-resistant strains. Despite the possible detection of the resistance by oxacillin disk, it underlines the need to determine the MICs of different beta-lactams without delay and to choose the most efficient treatment.

Aged↗
PubMedDate not supplied

[Revascularization of supra-aortic trunks from the femoral artery].

A seventy-year-old woman had an occlusion of the left sub-clavian and left primitive, internal and external carotid arteries, combined with a pre-thrombotic stenosis of the brachiocephalic trunk. Lesions were so diffused that a cross extra-anatomic bypass was impossible at the cervical level. There was contraindication for the implantation of a prosthesis on the aortic arch, due to a much extended calcified atheroma which did not allow clamping. Supra-aortic trunk revascularization was done through right femoral-axillary bypass without any post-operative complication. After a four year follow-up, the bypass is still patent. The purpose of this report is to emphasize that such r revascularization, which is rarely reported, must be better known since the implantation of the bypass on the femoral artery leads to patent and durable results.

Aged↗