PubMed Health⌕ Search

Biomedical subjects

L Dontigny

Publications and source records attributed to L Dontigny.

At least 37 records · Page 2Linked to original sources
PubMed1983

Major mediastinal vascular injuries.

Surgical repair was carried out in 37 patients who had rupture of the thoracic aorta or major branches. The survival rate was 90% (33 of 37). Three deaths occurred in the acute phase, giving a survival rate of 87% (19 of 22). Two patients had severe coexisting brain trauma and the other had profuse intrathoracic hemorrhage before thoracotomy could be carried out. One death occurred in a chronic case (an arch aneurysm) for a survival rate of 94% (14 of 15). A massive air embolism to the brain caused this fatal outcome. There were no instances of left heart failure or renal shutdown in our series. One case of paraplegia occurred because a shunt was inserted erroneously in the distended adventitia from an enormous surrounding hematoma. The distal end of the shunt was not in the aortic lumen so there was no distal perfusion during the period of aortic clamping.

Accidents, Traffic↗
PubMed1981

Aneurysms of the descending thoracic aorta: treatment with the Gott shunt.

In the repair of aneurysms of the descending thoracic aorta, interruption of aortic flow has usually been accomplished by cardiopulmonary bypass, which has been associated with excessive bleeding due to the systemic heparinization required. To avoid this problem, the authors have used an external (Gott aneurysm) shunt, which does not require systemic heparinization. In 50 patients with an aneurysm of the descending thoracic aorta a Gott aneurysm shunt was used as an external bypass. The shunt is a flexible, transparent, polyvinyl chloride tube and its heparin-coated wall prevents clotting. Forty-two (84%) patients survived the operation. Thirty-two patients had surgical repair of a traumatic rupture of the descending aorta; 29 (91%) survived. Of 18 patients operated on for an arteriosclerotic aneurysm or a DeBakey type III dissection 13 (72%) survived. Most of the deaths occurred early in the series; among the last 14 patients treated for an arteriosclerotic aneurysm or dissection 13 (93%) survived. Paraplegia occurred once (2%) because a shunt was accidentally introduced outside the lumen of the descending aorta and therefore did not function. Another patient with an acutely transected aorta and bleeding had rapid cross-clamping of the aorta without a shunt but suffered a cardiac arrest due to postclamping acidosis. He was successfully resuscitated. No heart failure, paraplegia or renal failure occurred in the 48 patients properly protected with the Gott aneurysm shunt. Regardless of their etiology, thoracic aneurysms are unpredictable and the authors recommend surgical treatment in most patients, using this external bypass technique as a method of organ protection.

Adolescent↗
PubMed1980

Determinants of mortality following coronary bypass surgery.

Factors related to early and late mortality were studied in 663 consecutive patients who had coronary bypass operations. There were 18 operative deaths (2.7%) and 15 late deaths (2.3%). Patients who died were slightly older than surviving patients. Operative mortality was higher (5.3%) in those with congestive heart failure; this correlated directly with the degree of abnormal wall motion shown on left ventriculograms. Preoperative end-diastolic pressure of the left ventricle was not a good predictor of death. While operative mortality was 1.5% in those with stable angina, it increased to 4.2% in patients with unstable angina and to 25% in patients with evolving myocardial infarction. In those with stenosis of the left main coronary artery, early mortality was 12.3%. Although early mortality was unaffected by the extent of coronary disease or by the degree of correction, it increased significantly (P less than 0.05) with the number of grafts inserted and when other cardiac procedures were also performed. Perioperative myocardial infarction was associated with a 28% mortality, but was unrelated to graft failure in 60% of the cases. Late mortality was related only to the number of diseased coronary arteries. Thus, left ventricular function, severity of angina and extent of coronary obstruction appear to be the main determinants of survival following coronary artery operation.

Adult↗
PubMed1980

[25 cases of traumatic rupture of the thoracic aorta: current diagnostic elements].

Traumatic rupture of the descending thoracic aorta is lethal within 3 weeks in 95% of patients who do not undergo operation. In this series of 25 patients who were operated on, 84% have survived for 6 years and there have been no cases of paraplegia. The mechanism of injury is most important in the investigation of patients with traumatic injuries and must be sought either from the patient or from witnesses. A history of rapid deceleration (more than 60 km/h) following a highway collision was present in all our cases. Failure to wear seat-belts resulted in 70% of patients being ejected from a vehicle. A side-on collision resulting in lateral deceleration caused trauma to the intrathoracic aorta in 45% of cases. Vertical deceleration resulted from falls from great heights (bridge, overpass) in 25% of cases. Clinical signs of diagnostic importance were: arterial hypertension (60%), systolic murmur (35%) and the pseudocoarctation syndrome (25%). Pertinent signs on chest roentgenograms were present in 95% of cases and included widening of the mediastinum and blunting of the aortic knob. The authors conclude thoracic aortography should be carried out in trauma patients when two or more of the following are present: (a) history of rapid deceleration, ejection from a vehicle or lateral collision, (b) hypertension and (c) blunting or modification of the aortic knob. The presence of a pseudocoarctation syndrome is an absolute indication for aortography.

Accidents, Traffic↗
PubMed1979

[Early and late outcome after aortocoronary bypass: experience in 500 cases].

Between 1971 and 1976, 500 patients underwent aortocoronary bypass surgery. There were 15 operative deaths (3%) and the total frequency of perioperative infarction was 7%. The operative mortality was 7.4% in unstable angina, as compared with 1.1% in stable angina (P less than 0.01). The proportion of grafts patent at 2 weeks was 92% and at 18 months 87.6%. Postoperative follow-up was complete for 99% of the patients. There were 15 late deaths (3%) and the rates of survival at 2 and 4 years were 94.4% and 92.1% respectively. The actuarial curve of survival after surgery was not significantly different from that of the general population. After a mean follow-up of 27 months 73% of the patients were completely free of angina and 19% were markedly improved. The rate of recurrence of angina averaged 10% per year and the annual infarction rate was 0.7%. Fourteen patients (3%) underwent reoperation during the follow-up period. Thus, coronary revascularization surgery offers effective and sustained relief of incapacitating angina and might also improve survival if the operative mortality is low.

Adult↗
PubMed1978

Management of critical emergencies in chest trauma.

Critical emergency cases of chest trauma are of three types: those caused by blunt trauma, thoracoabdominal injuries and penetrating injuries. The author describes the management of the most commonly encountered lesions in each of these three categories. All lesions resulting from chest trauma should be considered as a critical emergency until proven otherwise.

Abdominal Injuries↗
PubMed1977

Left atrial thrombosis complicating mitral stenosis: results of surgical treatment.

In 343 patients treated surgically for mitral valve disease, there was thrombosis of the left atrium in 40. Massive atrial thrombosis was present in 32 of them, yet the diagnosis was suspected or established preoperatively in only 12, because of insufficient clinical signs. A transventricular mitral commissurotomy was performed in 32 patients and mitral valve replacement in the remaining 8. Surgical mortality was 23% in the patients with atrial thrombosis compared with 7% in the trombus-free patients: 66% of the deaths were due to cerebral embolism. Systemic embolism occurred in 17% of the patients who had a closed approach initially and in 27% following a planned open procedure. Among the survivors, 65% were asymptomatic or markedly improved; the average follow-up was 42 months. Atrial thrombosis increases the surgical risk because of the high incidence of operative embolism, a complication that is not avoided by the use of open procedures, but that could be prevented by earlier surgical treatment of mitral stenosis, before atrial thrombi develop.

Adult↗
PubMed1976

Outpatient management of intercostal tube drainage in spontaneous pneumothorax.

In a series of 226 patients with spontaneous pneumothorax, 167 (74%) were managed successfully on an outpatient basis by observation (20%) or by intercostal tube drainage and a flutter valve (54%). Only 59 patients (26%) were hospitalized, and 42 of these were treated surgically (18.6%). Outpatient management with a flutter valve has proved to be safe, efficient, and economical.

Adolescent↗
PubMed1976

[An unusual case of hydatid cyst].

A hydatid cyst of the spleen developed in a Greek-Canadian woman who had lived on a sheep farm. The cyst extended through the diaphragm to the left lower lobe. Splenectomy and left lower lobectomy and excision of contiguous diaphragm were performed. Histopathologic examination confirmed the presence of hydatid cysts in both spleen and lung. Postoperative course was uneventful. In Canada hydatid disease is rare and its occurrence sporadic. It is commoner among Canadian Indians and immigrants than native Canadians. Treatment is surgical; en bloc excision of tissue eliminates the possibility of anaphylaxis of dissemimination of scolices.

Echinococcosis↗
PubMed1976

[Unusual traumatic rupture of the thoracic aorta with avulsion of the left subclavian artery].

Of the many cases of traumatic rupture of the aorta diagnosed each year at l"Hôpital du Sacré-Coeur, Montreal, most patients are already in irreversible shock when seen. However, during the period Oct. 1, 1974 to Sept. 30, 1975, prompt surgical treatment saved six patients. One of these six patients had a complete trans-section of the aortic arch between the left carotid and left subclavian arteries with avulsion and slight retraction of the left subclavian artery. Repair of the aortic arch and left subclavian artery was accomplished without extracorporeal circulation. A sutureless temporary bypass shunt was created by (a) cannulating the ascending and descending aorta, the cannulas being secured with purse-string sutures and joined by a 3/8-inch (94-mm) polyvinyl chloride (PVC) tube connected to a "double T" adapter, and (b) joining two small PVC tubes from the adapter with two straight cannulas, a no. 14 being inserted into the innominate artery and a no. 12 being inserted into the left carotid artery. With this temporary bypass created, the ascending and descending aorta and aortic arch vessels were all clamped. Aortic continuity was re-established with a tubular Dacron graft (diameter, 19 mm) to which was anastomosed a side-arm of knitted Dacron (diameter, 10 mm) to repair the left subclavian artery. Throughout the temporary perfusion the brain, spinal cord and all abdominal viscera were well protected. No sign of ventricular distension was detected. This report is the first in which complete transsection of the aortic arch has been managed by a sutureless bypass shunt allowing perfusion of all aortic arch vessels without extracorporeal circulation.

Adult↗