PubMed Health⌕ Search

Biomedical subjects

J M Lefebvre

Publications and source records attributed to J M Lefebvre.

At least 19 recordsLinked to original sources
PubMed2001

A new vascular sealant (Sealgel) to achieve rapid hemostasis after percutaneous angioplasty in anticoagulated patients: clinical feasibility and preliminary results.

The aim of this study was to assess the feasibility of a new vascular sealant (Sealgel) to provide rapid hemostasis in anticoagulated patients after percutaneous transluminal angioplasty (PTA). Sealgel was designed with ancrod (10 mg) and tranexamic acid (80 mg) dissolved in a hyaluronic acid gel (3 ml). Fifty anticoagulated patients (heparin, aspirin, ticlopidin) who underwent PTA of coronary artery were enrolled in the study. Sealgel (3 ml) was delivered under manual compression through a 9-F cannula at the arterial puncture site after the introducer sheath removal at the end of PTA procedure. Hemostasis time as well as complications were recorded. Sealgel was successfully delivered in 98 % of patients. Hemostasis occurred within 15 mn of manual compression in 82 % of patients, within 25 mn in 98 %, and failed in 1 patient (2 %). Hematoma (6-cm diameter) was observed in 1 patient and late bleeding in another one. There were no clinical signs of embolism, inflammatory swelling, local infection, vascular fistula, or pseudoaneurysm. No surgery or blood transfusion was required. Sealgel application after PTA in anticoagulated patient is feasible and secure. Preliminary results suggest that the Sealgel brought about rapid hemostasis; however further studies are needed to determine its clinical efficacy.

Aged↗
PubMed1995

Treatment of an ilio-caval thrombosis by mechanical thrombolysis.

In proximal deep vein thrombosis, thrombolytic treatment is more effective than heparin from a recanalization point of view but with a failure rate of 20%. We describe an interventional therapeutic procedure that may be effective in these cases. Mechanical thrombolysis with the thrombolizer (Angiocor, Lille Hellemmes, France) has been tried in 2 cases of deep vein thrombosis, when systemic thrombolysis alone had failed.

Adult↗
PubMed1992

Inoue balloon usefulness in case of failure to stabilize bifoil catheter balloons during percutaneous mitral valvotomy.

A new bifoil balloon catheter has been used in the last 120 percutaneous mitral valvotomies carried out in our institution. The shaft segment between the two balloons of the bifoil catheter has been adjusted to the guide-wire diameter, allowing its introduction through a 14F sheath. This thinner shaft does not always offer enough back up to the balloons during inflation. An Inoue balloon replaced an unstable bifoil balloon in 5 cases of mitral dilatation failure due to balloon instability, regularly providing firm stability until full balloon inflation.

Adult↗
PubMed1992

[Electric stimulation of the spinal cord in arterial diseases of the legs. A multicenter study of 244 patients].

From January 1985 through January 1990, 244 patients (168 males, 76 females, mean age: 69 +/- 14 years) received epidural spinal cord stimulation for the treatment of advanced, nonreconstructable, peripheral vascular disease of the lower limbs due to atherosclerosis in 180 patients, atherosclerosis and/or diabetes in 49, and thromboangiitis obliterans in 15 patients: previous surgery included 101 bypass-grafts in 70 patients, 51% of which below the knee, and 117 sympathectomies in 113 patients as the last resource in face of distal peripheral vascular disease of the lower limbs. Mean ankle-to brachial systolic pressure ratio was .31 +/- .34 on symptomatic limbs; due to pain and advanced disease, walking capacity was assessed in only 151 patients, either on treadmill in 25, or in a metered corridor in 126; angiogram of the lower limbs was performed in every patient unless one not older than three months was readily available; pain at rest was assessed after an analogical scale; partial transcutaneous oxygen tension was measured on the dorsum of the fore-foot of 77 symptomatic limbs (mean: 13.35 +/- 14 mmHg). According to clinical and functional evaluation, 18 patients had exertional ischemia (group I), 87 had permanent ischemia with pain at rest and no tissue loss (group II), and 139 had chronic tissue loss (group III), including 93 ischemic ulcers (mean surface: 3.7 cm2, mean duration: 3.5 months) in 88 patients, 27 limited gangrene, and 24 previous limited non-healing distal amputation. After temporary spinal cord stimulation at T12-L1 level (mean duration: 9 +/- 4 days) with a percutaneous quadripolar electrode lead had allowed for selection of responders, 212 patients received an implantable neurostimulator.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Peripheral laser angioplasty with sapphire tip.

UNLABELLED: To improve the result of peripheral laser recanalization (less perforation with wider tunnels of vaporization), we used the technique of sapphire laser angioplasty. A Nd:YAG laser with continuous emission was connected to a catheter with a 600 mum fiber and a sapphire probe to its extremity (1.8-3 mm in diameter). Treatment was performed on 127 patients with severe stenosis or occlusion of peripheral arteries (iliac, femoral, or popliteal arteries). Recanalization was obtained in 102 cases (80%) and was further embellished by balloon dilatation. The rate of success decreased proportionally with the length of occlusions (93% for 3 cm, 33% for 15 cm and more). Most failures were due to wall perforation or wall entry of the probe; passage of the sapphire tip was rarely blocked by the occlusion. At follow-up, 26.4% of arteries were reoccluded after 2 months. IN CONCLUSION: laser angioplasty with a sapphire tip can totally recanalize occluded arteries with low rate of failure and complications.

Adult↗
PubMed1988

Percutaneous transvenous caval interruption with the "LGM" filter: early results of a multicenter trial.

From September 1985 to December 1986, 100 patients undergoing percutaneous placement of a transvenous "LGM" caval filter were included in a multicenter prospective trial. Peripheral venograms completed by pulmonary arteriography or scintigraphy were obtained for all patients. Eighty-five patients had experienced pulmonary embolism, 59 had iliocaval thrombosis, while 40 had venous thrombosis confined to the lower limbs. In two instances, insertion or passage of the catheter was impossible. Ninety-eight "LGM" filters were placed percutaneously through the internal jugular vein, 82 of which were correctly positioned in the infrarenal inferior vena cava. Eight filters were positioned with a tilt of more than 15 degrees with respect to the vertical axis, five failed to open correctly, and three were incompletely open and tilted. No postoperative deaths were observed; there were two recurrent embolisms, and seven caval thromboses occurred during the year that followed insertion of the filter. The "user-friendliness" and efficacy of this percutaneous filter makes it a treatment of choice in the partial interruption of the inferior vena cava.

Aged↗
PubMed1988

[Treatment of femoro-popliteal thrombosis by peripheral angioplasty. Value of the laser].

In a series of 197 dilatations of the peripheral arteries performed over a 5-year period (1980-1985), 38 concerned complete thrombosis (less than 12 cm long) of the femoral and popliteal arteries. While in patients with femoral stenosis (n = 49) the primary success rate was 95 p. 100 with an annual recurrence rate of 8 p. 100, in patients with complete thrombosis the primary success rate was only 52 p. 100, and the recurrence rate was 30 p. 100 at 6 months. Such results would justify the use of new therapeutic methods. Percutaneous laser thermal angioplasty is now being evaluated, and it appears that the primary success rate is considerably increased by combined laser and balloon angioplasty. Recurrences raise a much more complex problem and require a multifactorial management with improved dilatation techniques, anti-platelet or anticoagulant treatment, abstention from smoking and close surveillance.

Angioplasty, Balloon↗
PubMed1987

Are physical properties of totally implanted systems modified by long-term chemotherapy? Preliminary results.

The physical properties of totally implanted systems for long term chemotherapy were tested before and after in vitro and in vivo chemotherapy. The results show that the drugs used (Cisplatin, Vinblastine and Bleomycin) did not alter the mechanical and microscopic properties of the catheter walls. Although the results cannot be extrapolate to others antineoplastic agents, they confirm the usefulness of the systems for long-term chemotherapy.

Adsorption↗
PubMed1982

[Early detection of myocardial alterations in mitral insufficiency with the angiotensin test].

Left ventricular function was assessed at rest and after increasing systemic arterial resistance by angiotensin in 40 patients with isolated mitral insufficiency. Angiotensin was administered intravenously at a dose of 0,4 micrograms/mn until the systolic blood pressure rose by at least 30 mm Hg. Left ventricular and aortic pressures, cardiac index and left ventriculography in the 30 degree right anterior oblique projection (50 frames per second) were recorded before and during angiotensin infusion. The mean rise in systolic left ventricular pressure was 40 +/- 2,8 mm Hg; the heart rate increased slightly but significantly; left ventricular and diastolic pressure rose from 12,0 +/- 1,0 to 24,0 +/- 1,2 mmHg. The systolic index (Fick's method) was significantly decreased (37 +/- 1,6 ml/m2 to 26 +/- 1,6 ml/m2) though the angiographic systolic index remained unchanged. This is explained by an increase in the regurgitant fraction (51 +/- 2,5% ao 65 +/- 3%). The end diastolic volume index was unchanged; the ejection fraction was significantly decreased. The resting hemodynamic status was only slightly disturbed in 29 patients (mean capillary pressure less than 15 mm Hg, 8,8 +/- 0,52 mmHg). The left ventricular function curves with angiotensin distinguished two groups of patients: Group A (20 patients) with left ventricular dysfunction induced by angiotensin, Group B (9 patients) who maintained the systolic index despite the increase in left ventricular end diastolic pressure. These results suggest that the angiotensin test may be useful for detecting early left ventricular dysfunction in patients with isolated mitral insufficiency and virtually normal resting hemodynamic parameters.

Angiotensin II↗
PubMed1979

Coronary arteriography in acute transmural myocardial infarction.

Coronary arteriography was performed 16 +/- 3 days (range 7 to 21 days) in 106 patients with acute transmural myocardial infarction (61 posterior infarct, 45 anterior infarct). Coronary arteriography was performed without serious complications. Only 44% of patients with anterior infarct had total occlusion of the left anterior descending artery while a significant stenosis of the vessel was observed in the others -27% had a single vessel disease, 49% had two lesions and 22% had three lesions; one patient had angiographically normal coronary arteries. Among the patients with posterior infarction, 21% had one vessel disease and double or triple lesions accounted for 39% of each. Sixty per cent of patients with anterior infarction and 45% with posterior infarction had no collateral vessels. In the others patients collateral circulation had a protective effect only in anterior infarction. Age has no effect on the distribution and number of lesions nor on the development of a collateral circulation. The location and severity of the lesions were not different in patients who presented with arrythmias and those who did not.

Acute Disease↗
PubMed1978

Left ventricular compliance in acute transmural myocardial infarction in man.

130 patients with recent transmural myocardial infarction were studied in order to evaluate changes in left ventricular compliance. Left heart catheterization and cineangiographic left ventriculography were performed. The modulus of chamber stiffness (K) was determined from the slope of the linear relation between volume stiffness (dP/dv) and pressure; the modulus of muscle stiffness was evaluated by the Laird index (asymptotic slope of logP vs log V). Patients were divided in 3 groups: Group A included 5 patients studied before and after myocardial infarction who experienced an increase in the modulus of chamber and muscle stiffness after infarction. Group B included 10 patients who were studied at the onset of infarct and 15 days later: this group demonstrated changes in LV compliance with, most often a rightwardshift of P-V curve in anterior infarct and inversely a leftward shift in posterior infarction. The 115 patients of Group B are roughly equally distributed in the areas of normal, increased or decreased compliance. Any correlation was found between the extent of asynergy and changes in modulus of chamber stiffness. However, ejection fraction or VCF were higher in patients with a reduction of compliance than in patients with an increase of compliance.

Cardiac Catheterization↗
PubMed1977

[Coronary arteriography in recent myocardial infarct].

Sixty patients with a recent transmural acute myocardial infarction had seletive coronary arteriography carried out between the 7th and the 29th day (mean 17 +/- 2 days) after the onset of the condition. The anterior infarction (n = 25 cases) had a total obliteration in 36% of cases, and most often (64%) a stenosis of the anterior descending artery with an excellent distal bed (80%). The collateral circulation is often zero (76% of cases); 80% have adjacent lesions on the right coronary or circumflex artery, but 7 patients out of 25 would have been able to have a preventive bypass operation. The posterior infae lesions are often sited electively at the level of the artery of the S/A node or in the middle of the second vertical segment in the region of the right ventricular branch. Thus the infarct is the result of a complex lesion of the right coronary and circumflex arteries, because the latter is affected in three cases out of four. 63% of patients with a postero-inferior infarction have diffuse lesions, and 13 out of 35 could have had a preventive bypass procedure. This study shows: 1. That this investigation is well-tolerated after a recent infarction; 2. The high incidence (43%) of stenoses at the edge of the area of necrosed myocardium; 3. The importance of this investigation in finding the nearby lesions which are very frequently associated: in 33% of cases, preventive bypass would have possible.

Acute Disease↗
PubMed1977

[Coronary artery spasms].

In a series of 2000 coronary arteriographies, spasm of the coronary artery was found in 52 cases, which were divided into three groups: 41 cases of "iatrogenic" spasm caused by stimulating the ostium of the coronary artery (usually the right) with the tip of the catheter; 8 cases of spasm on top of an organic fixed lesion; 4 cases of coronary spasm on a coronary artery which was reported as "radiologically normal". The study includes a review of the circumstances which favour or impede discovery of coronary spasm, as well as a provocation test using methyl ergometrine. This test seems to be specific in that it only produced coronary spasm in patients with Prinzmetal's syndrome, and excluded the cases of angina with normal coronary arteriography. The patients with spasm on top of a fixed organic lesion underwent a successful aorto-coronary bypass graft together with resection of the pre- and sub-aortic nerve plexus. Patients with a spasm in an artery which was "arteriographically normal" were treated medically by nitrate compounds and vaso-dilators. Three of these patients had an excellent result with medical treatment. Treatment failed in the fourth patient, who then obtained benefit from straight-forward resection of the pre- and sub-aortic nerve plexus with an excellent result which has been maintained for over six months.

Adult↗