Biomedical subjects

P Branche

Publications and source records attributed to P Branche.

5 recordsLinked to original sources

PubMed2006

Effects of increased intra-abdominal pressure on central circulation.

BACKGROUND: In an experimental model we investigated the effects of a gradual increase in intra-abdominal pressure (IAP) on the central circulation. METHODS: Seven pigs were anaesthetized, mechanically ventilated and instrumented. IAP was gradually increased by 5 mm Hg up to 30 mm Hg by abdominal banding in normovolaemic animals, and then they were made hypovolaemic after blood withdrawal. Right atrial pressure (RAP) and left ventricular end-diastolic pressure (LVEDP) at each step and aortic, femoral and inferior vena cava blood flows were measured. Left ventricular end-diastolic area (LVEDA) was determined using epicardial echocardiography. RESULTS: Cardiac output maintained at mild IAP was reduced to 76 (24)% of the initial value at 30 mm Hg IAP [mean (sd)] in normovolaemic animals, and 72 (22)% (P<0.001) in hypovolaemic animals. In normovolaemic animals the LVEDA and LVEDP were significantly increased at an IAP of 10 and 15 mm Hg by 26 (24)% and 38 (23)%, respectively. At these IAP values, the difference between the RAP and IAP was positive. When this gradient became negative, that is beyond 15 mm Hg in normovolaemia and for all IAP values in hypovolaemic animals, the LVEDA declined, reaching 78 (16)% and 62 (22)% (P<0.05) of the initial values in normovolaemic and hypovolaemic groups at the highest IAP value. CONCLUSIONS: These results showed that a gradual increase in IAP led to a redistribution of abdominal blood volume towards the thoracic compartment, at IAP lower than 15 mm Hg in normovolaemia, and at its expense at higher values of IAP. In hypovolaemia there was no thoracic compartment gain. Whereas the absolute or transmural RAPs were not informative of the direction of this blood shift, an RAP greater than IAP was associated with an intrathoracic compartment gain.

Abdomen↗

PubMed2004

Amniotic fluid embolism during caesarean section.

Amniotic fluid embolism occurs rarely but is a leading cause of maternal mortality. A high index of clinical suspicion is necessary to make an early diagnosis to reduce morbidity and mortality. We report a non-fatal case of amniotic fluid embolism occurring during a caesarean section, with special emphasis on the mode of development and diagnosis. The initial presentation of this syndrome was a coagulopathy, followed by the usual complications of massive bleeding. Although non-specific, the diagnosis of amniotic fluid embolism was supported by the observation of amniotic fluid in the central venous blood as well as in the broncho-alveolar fluid.

Adult↗

PubMed2000

[Liver transplantation in infants and children. Evaluation of the first 40 cases (March 1991-March 1997)].

BACKGROUND: Liver transplantation (LT) is the treatment of end-stage liver disease in children. We report our experience with LT using grafts from living related (LRD) and cadaver donors (CD). POPULATION: From March 1991 to March 1997, 40 children and infants received a total of 42 liver grafts. A reduced-size liver was used in 28 cases. We studied pre-transplantation status, survival rate, and medical and surgical complications in these patients. RESULTS: The survival rate in our series was respectively 85 and 80% at 1 and 7 years after LT. Low weight infants required a prolonged ventilatory assistance. Five of the six deaths noticed during the first three months after LT occurred in children weighing less than 12 kg. One year after LT, no significant difference in the incidence of rejection was found, neither between low-weight children and the others, nor between patients transplanted from CD or LRD. Biliary tract stricture was the major surgical complication. CONCLUSION: This series consisted of a majority of low-weight children. The survival rate in the patients weighting less than 12 kg is lower than in the others. This may be explained by the nutritional status of these patients and early postsurgical complications. The use of grafts from living donors offers more flexibility since the operation is performed electively, but it did not seem to modify the incidence of acute rejections and surgical complications.

Adolescent↗

PubMed1999

[Orthotopic liver transplantation from a living adult donor to an adult using the right hepatic lobe].

STUDY AIM: In children, living donor liver transplantation has been shown to be efficient in treating end-stage liver diseases when the left lateral segment is harvested. In adults, more liver mass is needed to provide adequate hepatic function. The aim of this study is to report 2 successful cases of living donor liver transplantation using a right hepatic lobe from adult. PATIENTS AND METHODS: In 2 sons, the right hepatic lobe was harvested without the middle hepatic vein for transplantation in their fathers who were suffering from end-stage liver cirrhosis. Hepatectomy was done without vascular inflow occlusion after dissection of vascular and biliary structures, itself strictly restricted to the right side. In recipients, the graft was implanted orthotopically with preservation of the native inferior vena cava and after temporary porto-caval shunt. RESULTS: The duration of donors procedures was 7 h and 11 h 45 min; intra-operative transfusions comprised of 700 mL from cell-saver in the first case, and 1300 mL plus 1 autologous red blood cell unit in the second case. Graft weights were 770 g and 1100 g. None of the donors experienced liver failure and both were able to leave the hospital 9 days after the operation. In recipients, initial graft function was excellent in the first case and correct in the second case, despite the necessity to redo intra-operatively the hepatic vein anastomosis secondary to a twisting. Patients were discharged 20 and 40 days respectively following transplantation. CONCLUSION: Adult living donor liver transplantation using a right hepatic lobe is efficient and safe. This option could contribute to reducing the mortality of patients on the waiting list.

Adolescent↗

PubMed1998

Myocardial effects of isoflurane in healthy infants and small children. Assessment by continuous oesophageal aortic blood flow echo-Doppler.

BACKGROUND: In paediatric healthy patients and in real peroperative conditions, the cardiovascular effects of isoflurane have been poorly described. METHODS: We have evaluated the myocardial effects of 1% end-expired concentration (EEC) of isoflurane in 25 healthy infants or small children undergoing superficial surgical therapy for small burns with a continuous aortic blood flow echo-Doppler device. Aortic blood flow (ABF) was measured with a small oesophageal probe specially designed for infants. The aortic flowmeter was connected with satellite devices to visualize the haemodynamic profile variations during the isoflurane inhalation period. RESULTS: Isoflurane significantly decreased ABF and increased pre-ejection period/left ventricular ejection time (PEP/LVET), when compared with control values previously recorded 5 min after induction with halothane-fentanyl and atracurium (respectively, 80 +/- 7%, mean +/- SD; P < 0.001 and 111 +/- 11%; P = 0.017, 5 min after EEC of isoflurane reached 1%, then respectively, 75 +/- 12%; P < 0.001 and 119 +/- 16%; P < 0.001, at the end of the isoflurane inhalation period). These variations reversed to a great extent when isoflurane was switched off (97 +/- 17% for ABF; P = 0.08 and 105 +/- 12% for PEP/LVET; P = 0.75). Among the usual parameters, 1% EEC of isoflurane caused no significant changes in heart rate, moderately decreased mean arterial pressure (successively, 88 +/- 12%; P = 0.045 and 87 +/- 19%; P = 0.049), but belatedly decreased end-tidal CO2 pressure (87 +/- 11% at the end of the inhalation period (P < 0.001) which persisted 5 min after isoflurane was turned off (90 +/- 11%; P < 0.001)). CONCLUSIONS: These findings suggest that isoflurane can transiently depress cardiac function in healthy infants.

Anesthetics, Inhalation↗