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Biomedical subjects

O Goëau-Brissonnière

Publications and source records attributed to O Goëau-Brissonnière.

At least 19 recordsLinked to original sources
PubMed2005

Total laparoscopic aortic surgery: transperitoneal direct approach.

OBJECTIVE: We describe the laparoscopic transperitoneal direct approach to the abdominal aorta. OPERATIVE TECHNIQUE: The patient is placed in the right lateral decubitus position, which allows dropping of the small bowel into right side of the abdomen. Anatomical exposure of the abdominal aorta follows the same steps as in open surgery. DISCUSSION: Laparoscopic transperitoneal direct approach allows a reproducible exposure of the abdominal aorta. This technique was useful when retrocolic and/or retrorenal approaches were not possible because of previous left nephrectomy.

Aorta, Abdominal↗
PubMed2005

Undiagnosed aorto-caval fistula during total laparoscopic abdominal aortic aneurysm repair: a cause of conversion.

Total laparoscopic aortic repair is evolving and is now the technique of choice for the treatment of infrarenal abdominal aortic aneurysms (AAA) in our department. With growing experience, surgeons will be confronted with the same peroperative situations than open surgery. We report a case of total laparoscopic AAA repair with peroperative diagnosis of aorto-caval fistula (ACF).

Aged↗
PubMed2005

Experimental development of an endovascular graft for thoraco-abdominal aortic aneurysm repair.

AIM: Current treatment of thoraco-abdominal aortic aneurysms is surgical. Despite significant advances in surgical technique and anesthetic management, significant morbidity and mortality remain associated with their repair. In compliance with principles of reducing postoperative morbidity, we developed a thoraco-abdominal endovascular graft in experimental models of type III and type IV thoraco-abdominal aortic aneurysm. This device had to preserve the vascularization of the visceral arteries while ensuring full aneurysmal exclusion. METHODS: Six implantations of the endovascular graft were performed. This graft was a modular system, made of: 1) a custom made main body containing 4 prosthetic visceral branches, 2) 4 self-expandable stent-grafts connecting prosthetic visceral branches with visceral arteries, 3) a custom made tubular endovascular graft connecting the main body with one of the iliac arteries. RESULTS: On angiographic controls, full aneurysmal exclusion was achieved while maintaining visceral artery perfusion. At the end of each procedure, the experimental model was opened. Macroscopic examination showed harmonious thoraco-abdominal endovascular graft deployments, without abnormal component constraint or kinking. There was no discordance between macroscopic and angiographic RESULTS CONCLUSIONS: Our experimental work led to the development of a thoraco-abdominal endovascular graft, demonstrating feasibility of thoraco-abdominal aneurysm endoluminal treatment on an in vitro model close to the anatomical conditions observed in human pathology.

Angioplasty↗
PubMed2002

Laparoscopic resection of a retroperitoneal schwannoma.

We report a case of a successfully resected retroperitoneal benign schwannoma using laparoscopic surgery. A 62-year-old woman presented with an asymptomatic retroperitoneal mass. Computed tomography (CT) scan revealed a solid tumor compressing the inferior vena cava (IVC). First, we performed an intraoperative biopsy analysis, which revealed a benign neurologic tumor. We then proceeded with the complete laparoscopic resection of the tumor. Pathology revealed a benign schwannoma 8 x 5 cm in size. To our knowledge, only three other cases of the laparoscopic resection of retroperitoneal schwannoma have been reported. In our case, despite the large size of the tumor and the high level of compression of the IVC, a totally laparoscopic resection was feasible.

Female↗
PubMed2001

Experimental treatment of vascular graft infection due to Staphylococcus epidermidis by in situ replacement with a rifampin-bonded polyester graft.

In situ prosthetic graft replacement (ISPGR) of an infected prosthesis raises the risk of recurrent infection in the new graft, especially in cases involving drug-resistant microorganisms. The purpose of this animal study was to evaluate in situ replacement of a vascular graft infected by a highly rifampin-resistant strain of Staphylococcus epidermidis with the use of a rifampin-bonded polyester graft. Antibiotic bonding was obtained by soaking grafts in a high dose of rifampin solution (60 mg/mL). The infrarenal abdominal aorta of 20 dogs was replaced using a polyester prosthesis infected with a highly rifampin-resistant strain of Staphylococcus epidermidis. One week later, the 18 surviving animals were randomized into three groups. Group I (n = 6) did not undergo reoperation. Group II (n = 6) underwent ISPGR using a rifampin-bonded prosthesis. Group III (n = 6) underwent ISPGR using an untreated prosthesis. All surviving animals were killed 28 days after the first procedure. Infectious signs were noted and bacteriological study was carried out on explanted prostheses and various tissue samples. The findings of this experimental study show that soaking a polyester prosthesis in a high-dose rifampin solution can prevent reinfection after in situ replacement of a prosthesis infected by a highly rifampin-resistant Staphylococcus epidermidis.

Anastomosis, Surgical↗
PubMed2001

Retrograde aortomesenteric bypass with tunneling behind the left renal pedicle.

This report describes a new technique for revascularization of the superior mesenteric artery (SMA) which creates a retrograde bypass tunneled behind the left renal pedicle. The procedure can be performed by the left retroperitoneal or transperitoneal route, alone or in association with reconstruction of the infrarenal aorta. Proximal anastomosis is retrograde on the left side of the infrarenal aorta or aortic prosthesis. The course of the bypass runs first in the back and top of the retrorenal dissection plane, then loops behind and over the left renal pedicle, and finally turns downward and forward to the SMA. Distal anastomosis can be made either end-to-end or end-to-side. This large, loop-shaped course not only reduces the risk of kinking but also gives the bypass enough length to adapt to movements of the SMA. This technique has been performed in association with reconstruction of the infrarenal aorta in three patients. Postoperative control using Doppler ultrasound, arteriography, and helical CT scan showed no kinking or other abnormality. One patient died a month after the procedure from myocardial infarction. Follow-up Doppler ultrasound in the two surviving patients showed bypass patency with no stenosis at 19 and 30 months.

Anastomosis, Surgical↗
PubMed2000

Embolic risk of the different stages of carotid bifurcation balloon angioplasty: an experimental study.

PURPOSE: Embolic events during carotid angioplasty are a challenging problem. This experimental study was undertaken to determine the embolic risk after each stage of carotid angioplasty procedure. METHODS: Five ex vivo carotid artery balloon angioplasties were performed on fresh carotid specimens. The carotid specimens were obtained from five patients who underwent an internal carotid artery bypass for stenosis >75%. Before the endovascular maneuvers and after each stage of the procedures, the specimens were flushed with 20 mL of saline solution. Small particulate emboli (diameter, <60 microm) were searched in all the effluents according to the Coulter technique. After this procedure, each effluent was also submitted to scanning electron microscopy. RESULTS: When the stenosis was crossed with the guidewire or the balloon catheter, the number and the mean diameter of embolic particles did not change with three plaques (CP1, CP2, and CP3) and were increased with two plaques (CP4 and CP5). The maximal size of particles was 220 microm (CP5). After balloon angioplasty, the number and the mean diameter of particles increased with CP1, CP2, and CP3. With CP4 and CP5, the number of particles decreased, but their size increased. The maximal size of particles was 1100 microm (CP4). CONCLUSION: Carotid balloon angioplasty generates embolic particles after each stage of the procedure. Techniques of prevention should then be effective from the initial step of the angioplasty procedure, and the selection of patients for carotid angioplasty remains crucial.

Angioplasty, Balloon↗
PubMed1999

Resistance of antibiotic-bonded gelatin-coated polymer meshes to Staphylococcus aureus in a rabbit subcutaneous pouch model.

This study examines the efficacy of the bonding of rifampicin, vancomycin or gentamicin to gelatin-coated knitted polymer meshes to prevent perioperative infection. Antibiotic bonding was obtained by soaking the meshes for 15 min in a solution containing 20 mg ml(-1) of rifampicin or 10 mg ml(-1) of vancomycin or gentamicin. A polymer mesh was implanted in a subcutaneous pouch in 16 rabbits: four received a rifampicin-soaked mesh, four received a vancomycin-soaked mesh, four received a gentamicin-soaked mesh, and four received an untreated mesh (control group). At the time of implantation, all the meshes were contaminated locally with 10(8) colony forming units of Staphylococcus aureus. Meshes were harvested one week later and submitted to bacterial counts. At the time of explantation, none of the antibiotic-soaked meshes were infected, whereas all the untreated meshes were infected. These results show that antibiotic soaking evidently prevents perioperative infection of gelatin-coated knitted polymer meshes in this model.

Animals↗
PubMed1998

Treatment of vascular graft infection by in situ replacement with cryopreserved aortic allografts: an experimental study.

PURPOSE: The purposes of this study were to prove the efficacy of cryopreserved aortic allografts to treat an established vascular graft infection by in situ replacement in an animal model and to evaluate the role of the antibiotics normally used to decontaminate the allografts. METHODS: Twenty-three dogs underwent infrarenal aortic replacement with a gelatin-sealed knitted polyester graft contaminated in vitro by Staphylococcus epidermidis RP-62. One week later, the 18 surviving animals underwent reoperation for graft removal and were randomized into three groups for in situ replacement: group I (control, n = 6) received a new gelatin-sealed graft; group II (n = 6) received a non-antibiotic-treated cryopreserved allograft; and group III (n = 6) received an antibiotic-treated cryopreserved allograft. Control grafts and allografts were removed 4 weeks after the initial intervention for quantitative bacteriologic analysis and histologic analysis. Bacteriologic results were expressed as colony-forming units per square centimeter of graft material. Qualitative bacteriologic analysis was also obtained from perigraft fluid and tissue. RESULTS: All of the initially implanted grafts and all of the control grafts (group I) were infected at the time of removal. In group II, three out of six allografts were not totally incorporated, whereas in group III incorporation was always complete, with a significantly decreased inflammatory reaction. All of the antibiotic-treated allografts were sterile, whereas three untreated allografts grew bacteria. CONCLUSIONS: In this model, cryopreserved aortic allografts were more resistant to reinfection than synthetic grafts after in situ replacement of an infected prosthetic graft. However, the antibiotic loading of the cryopreserved aortic allograft appears to be essential to obtain optimal therapeutic effects.

Animals↗
PubMed1997

Acute upper extremity ischemia during concomitant use of ergotamine tartrate and ampicillin.

Individual hypersensitivity to the vasoconstrictor effects of ergotamine tartrate has been observed even at doses within recommended limits. Hypersensitivity can be induced by concomitant use with other drugs. The best-documented example of drug-induced hypersensitivity to ergotamine tartrate involves antibiotics of the macrolides class. The mechanism underlying this interaction appears to be interference with metabolism of ergotamine tartrate by the liver. In the present report we describe a case of upper extremity ischemia during concomitant use of ergotamine tartrate and ampicillin. The fact that the effect was not dose-dependent, disappeared when administration of ampicillin was discontinued, and reappeared when administration of ampicillin was resumed suggests that the underlying mechanism in our patient was immunologic. Since immunologic hypersensitivity to the vasoconstrictor effects of ergotamine tartrate is unpredictable, great caution and close surveillance is advisable when ergotamine tartrate is used in association with other drugs.

Ampicillin↗
PubMed1996

[Rupture to the skin of atheromatous aneurysm on a femoropopliteal venous bypass using an in situ vein].

Atheromatous aneurysmal degeneration of a venous bypass graft is a rare and late event after venous bypass grafting. We report the case of a 49-year-old man in whom a large aneurysm of a saphenous graft implanted 10 years earlier ruptured to the skin. Amputation was required. Graft degeneration can lead to complications which may be life or limb-threatening due to graft rupture, graft thrombosis or distal embolization. Close follow-up after arterial reconstruction using a vein graft is therefore highly warranted for early detection and correction of any abnormalities before onset of complications.

Anastomosis, Surgical↗
PubMed1996

[Reliability of needle biopsy of solitary thyroid nodules in view of surgical indications].

To evaluate the accuracy of fine-needle biopsy in the management of the solitary thyroid nodules, 320 biopsies without aspiration were performed in 212 patients, iteratively in 91 cases. Among the 212 initial biopsies, 93 smears were found presumably benign (43.9%), 6 malignant (2.8%), 49 benign implying cytologic control (23.1%), 24 suspicious with decision to operate (11.3%), 40 inadequate (18.9%). On 67 surgical indications (malignant or suspicious cytology, or clinical data), 59 operations were performed. The 11 diagnosed cancers (5.2% of the patients; 18.6% of the operations) correspond to six malignant and five suspicious cytologies at the first or second biopsy. On 145 cases without decision to operate, 125 were clinically surveyed, with sometimes another biopsy (mean survey: 27.6 months; range: 6-80 months), and it was never necessary to modify the initial expectancy attitude. Our results, rather similar to those related by most of the previous publications, confirm that the fine-needle biopsy is a reliable and effective means for the etiologic diagnosis of thyroid nodules and the indications for operative intervention. It spares many patients from a useless operation and is worthy to take a leading place in exploring these nodules.

Biopsy, Needle↗
PubMed1996

Arteries from human beings are less infectible by Staphylococcus aureus than polytetrafluoroethylene in an aortic dog model.

PURPOSE: Treatment of aortoiliac prosthetic graft infections includes the removal of the infected material and repeat revascularization if necessary. The risk of infection of the graft material used for the repeat revascularization has been the drawback of its use in situ except with autografts. Good results were obtained in this setting by use of in situ arterial allografts. The purpose of our study was to compare in vivo the infectibility of arteries used as allografts to the infectibility of commercially available prostheses. METHODS: Twelve dogs underwent thoracoabdominal aortic bypass with use of either an artery from a human being (n=6) or an expanded polytetrafluoroethylene (ePTFE) graft (n=6). One month later, bacteremia was produced with Staphylococcus aureus. One week after bacterial challenge, the animals were killed to recover the grafts. Each graft then underwent bacterial study. RESULTS: None of the arterial grafts grew bacteria, whereas four of the six ePTFE grafts (p < 0.05) did. In addition, none of the fragments of the arterial grafts grew bacteria, whereas 24 of the 60 ePTFE fragments (p < 0.01) did. CONCLUSION: Nonautologous arteries are less infectible than ePTFE in vivo. This decreased infectibility makes the arterial allograft an appealing material when revascularization must be performed in a contaminated field.

Animals↗
PubMed1996

Rifampicin loading of vascular grafts.

Antibiotic-bound arterial prostheses may contribute to the management of prosthetic infections. The in-vitro absorption and release of rifampicin was measured in four different polyester arterial prostheses, including unsealed VP 1200, gelatin-sealed Gelsoft, collagen-impregnated Hemashield and gelatin-sealed Unigraft. Gelsoft grafts bound more rifampicin than unsealed VP 1200. Rifampicin concentrations with the gelatin sealed to Gelsoft grafts reached a threshold when the rifampicin concentrations of the soaking solution were 10 mg/mL or more. Rifampicin adsorption plateaued after 15 min of soaking VP 1200, and peaked after 25 min of soaking Gelsoft. pH variations did not significantly influence antibiotic binding. Prosthesis-bound rifampicin concentrations decreased rapidly after soaking, but a significant portion of the antibiotic remained associated with the material after 7 days. Release was slower with Gelsoft than with VP 1200 during the first 3 h, but after 24 h, the amounts of rifampicin released were similar in the two materials. Other experiments were performed in dogs receiving sealed grafts as infrarenal aortic bypass after soaking the material in a 1 mg/mL solution of rifampicin in normal saline. After 3 days of implantation, the amount of rifampicin in explanted grafts was higher in Gelsoft and Hemashield than in Unigraft. This study confirms that rifampicin bonding to prosthetic material occurs and is enhanced by sealed collagen or gelatin.

Absorption↗