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Biomedical subjects

P Reynaud

Publications and source records attributed to P Reynaud.

At least 19 recordsLinked to original sources
PubMed2001

The 6-F nitinol TrapEase inferior vena cava filter: results of a prospective multicenter trial.

PURPOSE: The authors report the first results of a new 6-F symmetrically designed permanent nitinol inferior vena cava (IVC) filter, the Cordis TrapEase, evaluated in a multicenter prospective study with 6-months of follow-up. MATERIALS AND METHODS: A total of 65 patients (29 men, 36 women) who ranged in age from 37 to 96 years (mean age, 68 years) and who were at high risk of pulmonary embolism (PE) were enrolled in 12 centers in Europe and Canada. The study was approved by the institutional review boards at all centers. Study objectives were to evaluate filter effectiveness, filter stability, and caval occlusion. Indications for filter placement were deep vein thrombosis with recurrent thromboembolism and/or free-floating thrombus with contraindication to anticoagulation in 37 patients, and complications in achieving adequate anticoagulation in 28 patients. Follow-up included clinical examination, plain film, Doppler ultrasound, CT scan, and nuclear medicine. RESULTS: The analysis of the data revealed a technical success of 95.4% (three filter-system related implantations not at the intended site, no events of filter tilting) and a clinical success of 100% at 6 months (no cases of symptomatic PE), the study primary endpoint. There were no cases (0%) of filter migration, insertion site thrombosis, filter fracture, or vessel wall perforation. During the study period, there were two cases of filter thrombosis: one case of early symptomatic thrombosis that was successfully treated in the hospital, and one case of nonsymptomatic filter thrombosis detected at 1-month follow-up, with spontaneous recanalization at 3 months. In the latter patient, some residual thrombus was still detected at 6 months. Of the study population of 65 patients, there were 23 deaths. These deaths were not related to the device or the implantation procedure but to the underlying disease process. CONCLUSION: This study demonstrates the new nitinol permanent IVC filter to be a safe and an effective device, with a low overall complication rate, for use in patients with thromboembolic disease at high risk of PE.

Aged↗
PubMed2000

Renal tubular dysgenesis-like lesions and hypocalvaria. Report of two cases involving indomethacin.

We describe a case of twins with twin-to-twin transfusion syndrome (TTS) who were found to have renal tubular dysgenesis (TRD)-like lesions and hypocalvaria attributed to indomethacin treatment of the mother for acute polyhydramnios. History of pregnancy, postnatal clinical course, pathological findings of the kidneys, and the skulls are presented and discussed. These findings include incompletely differentiated proximal tubules in the kidneys and hypoplastic calvaria in both twins. The renal tubular lesions were more marked in the donor than in the transfused twin, probably due to the greater degree of ischemia in that twin. This seems to be in favor of a vascular etiology of the renal defects. However, the fact that similar renal lesions and hypocalvaria were also present in the transfused twin seems to indicate that indomethacin played a role in their onset. This so-called kidney-skull connection has never been reported in conjunction with indomethacin therapy.

Adult↗
PubMed2000

Emergency interruption of the inferior vena cava: a debatable issue.

In spite of improvements in the diagnosis and treatment of thromboembolic disease, pulmonary embolism continues to be a major cause of morbidity and mortality. Anticoagulation remains the preferred therapy for deep venous thrombosis; however, this form of treatment is either ineffective or contraindicated for some patients. For these patients, partial interruption of the inferior vena cava via percutaneous filter placement has become the procedure of choice to protect against fatal pulmonary embolism. We described in this paper results obtained with the available permanent filters and complications of these filters described in the literature. We highlighted the interest of temporary filters in patients whose thromboembolic risk is temporary, finally we insist on recognised indications for vena cava filters when anticoagulation is contraindicated or ineffective.

Contraindications↗
PubMed1999

[Histologic comparison between endoscopic axillary lymphadenectomy after lipo-suction and classical surgical technique].

Suzanne recently described a new technique of axillary lymphadenectomy in breast cancer to reduce post surgical morbidity. It combines liposuction and endoscopic dissection. To determine whether this technique induces lymph node alterations, we examined retrospectively 111 lymphadenectomies done by this new method and compared them to 41 lymphadenectomies performed by conventional surgery. The percentage of altered lymph nodes, with or without metastasis, was approximately the same with both techniques (about 19%). Lymph nodes removed by conventional surgical lymphadenectomy had a detached capsule more frequently. Cellular crush was more frequent after liposuction and endoscopic dissection. Liposuction altered more frequently large lymph nodes, which represented, however, the minority of the lymph nodes removed by this technique. No specific alteration was detected in relation to either of the two technics.

Axilla↗
PubMed1998

[Toward a medical approach to the evaluation of activity in a physician-staffed mobile intensive care unit].

OBJECTIVE: To test the ability of various medical criteria for classifying the patients in a physician-staffed mobile intensive care unit (MICU) by referring to intervention times. STUDY DESIGN: Prospective, open study. PATIENTS AND METHODS: For all the on-scene interventions of the MICUs over a 10-month period, the following data were prospectively collected: pre-hospital diagnosis, initial severity score, medical care score, immediate outcome and three intervention times: on-scene time (OS), time spent with the patient by the MICU team (MT), total duration of intervention (TD). RESULTS: A total of 3,672 MICU interventions were included. Median times were 45 min (32-59) for OS, 66 min (41-91) for MT and 85 min (61-116) for TD. The amount of interventions in a city was correlated with the population (R = 0.95; P < 0.001). The medical care score was greater than one in more than half of the patients. It defined five groups of patients which were different for the three intervention times (P < or = 0.001). A third of the patients were directly transported by the MICU to an ICU. For the median test, immediate outcome groups were different for the three intervention times (P < 0.001). After exclusion of patients with initial cardiac arrest, initial severity score defined five groups of patients which were different for the three intervention times (P < 0.002). Initial severity score and medical care score were correlated (R = 0.37; P < 0.001). CONCLUSION: A classification of the patients based on immediate outcome would be a more accurate indicator of the variability in medical care and consumption of resources in a physician-staffed MICU. In addition, a medical intervention score should be developed to better characterise this medical activity.

Adult↗
PubMed1998

[Cervical ganglioneuroma. Review, apropos of a case].

We describe a case of cervical ganglioneuroma, an uncommon benign tumor which develops slowly, predominantly in females and infants. Ganglioneuromas have a neuroectodermic origin and are localized along the sympathetic trunk. Most are unmasked fortuitously by palpation or by high serum catecholamine levels proportional to tumor size. After radiographic exploration and surgical excision, a pathologic study of the surgical specimen is required to identify this very differentiated tumor stemming from the neural crest.

Catecholamines↗
PubMed1997

The Tempofilter: a multicenter study of a new temporary caval filter implantable for up to six weeks.

A multicenter study was conducted to evaluate a new temporary caval filter (Tempofilter) designed to be implanted for up to 6 weeks. A total of 66 patients with a mean age of 51.8 years were enrolled in the study. All had documented high risk of pulmonary embolism: severe deep venous thrombosis in 89.5% of cases and previous symptomatic pulmonary embolism in 65% of cases. Filter placement was performed in association with a surgical or obstetrical procedure in 68.5% of cases. The indication for filter placement was contraindication to or failure of anticoagulant therapy in 85% of the cases. The mean duration of implantation was 29.9 days. Pulmonary embolism was not observed during the implantation period. Partial thrombosis of the filter was observed in 15% of cases due to trapping of clots by the filter. Thrombosis did not hinder filter removal when attempted. Filter-related complications were minor. Filter migration occurred in only 7.5% of cases. Migration never led to complications and did not hinder filter removal. In all cases migration was due to specific, preventable causes. The results of this study show that the Tempofilter is not only safe and easy to use but also effective in preventing pulmonary embolism. A significantly longer maximum implantation time is a major advantage of the Tempofilter over conventional temporary filters. We believe that this filter can be used for temporary protection against the risk of pulmonary embolism particularly in young patients and in a surgical setting.

Adult↗
PubMed1997

[Tracheal intubation in prehospital resuscitation: importance of rapid-sequence induction anesthesia].

OBJECTIVE: To investigate complications of emergency endotracheal intubation (EEI), possibly facilitated by rapid-sequence induction, in the prehospital critical care setting: 1) the difficulty of intubation; 2) the cardiorespiratory consequences of intubation; 3) the relationship between the occurrence of complications and prognosis. STUDY DESIGN: Prospective non randomized, open study. PATIENTS: All patients treated over a 5-month period by a physician-manned ambulance service and requiring EEI. METHODS: Patients were allocated either in with cardiac arrest (CA) group or a group with maintained spontaneous circulation (SC). Difficulty of intubation was assessed by the number of attempts. RESULTS: Two hundred and twenty-four consecutive EEI were carried out by physicians (46%) and residents (38%) not trained in anaesthesia, anaesthetists (8%), or nurse anaesthetists (7%). Trachea was intubated after a maximum of three attempts in all patients. Success rate at the first attempt was 91%. It was 92% in CA patients (n = 76) and 90% in SC patients (P = 0.59). Anaesthetic induction, with (n = 112) or without (n = 12) succinylcholine, was used to facilitate 84% of intubations in SC patients. Complications occurred in 30 patients (20%). There was no relationship between the latter and hospital mortality, duration of ventilatory support, duration of stay in the intensive care unit. CONCLUSION: In this study, EEI in SC patients was frequently facilitated by rapid sequence induction and was associated with a high success rate at the first attempt, as in CA patients. Morbidity was low. All physicians involved in emergency airway management should be skilled in this technique.

Adolescent↗
PubMed1996

End-tidal carbon dioxide during cardiopulmonary resuscitation in humans presenting mostly with asystole: a predictor of outcome.

OBJECTIVE: To determine whether continuous semiquantitative assessment of end-tidal CO2 could provide a highly sensitive predictor of return of spontaneous circulation during cardiopulmonary resuscitation (CPR). DESIGN: Prospective, clinical study. SETTING: Prehospital CPR. PATIENTS: One hundred twenty patients, during nontraumatic cardiac arrest. INTERVENTIONS: End-tidal CO2 values were measured continuously after tracheal intubation, and were categorized as the initial value, and as minimal and maximal values during the first 20 mins. MEASUREMENTS AND MAIN RESULTS: Presenting rhythm was asystole in 22 of the first 24 patients. Return of spontaneous circulation occurred in eight patients. Initial, minimal, and maximal end-tidal CO2 values were significantly (p < .01) higher in these patients than in the patients without return of spontaneous circulation. Cutoff values providing a 100% sensitivity and the highest specificity in predicting return of spontaneous circulation were found to be 10 torr for initial and maximal end-tidal CO2 values, and 2 torr for the minimal end-tidal CO2 value. The number of patients required to reject (with a risk error of <.05) the hypothesis of an actual sensitivity of < or = 90% for an observed sensitivity of 100% was found to be 95. In the second part of the study, this hypothesis was prospectively tested for initial and maximal end-tidal CO2 values in the subsequent 96 patients. Presenting cardiac rhythm was asystole in 87 patients. Return of spontaneous circulation was obtained in 30 patients. The cutoff value of 10 torr for maximal end-tidal CO2 during the first 20 mins after tracheal intubation provided an observed sensitivity of 100% in predicting return of spontaneous circulation with a specificity of 67%. This result allows rejection of the hypothesis of an actual sensitivity of < or = 90% (p = .042). By contrast, the observed sensitivity of initial end-tidal CO2 was only 87%. CONCLUSIONS: End-tidal CO2 represents a valuable tool for monitoring patients presenting with asystole during prehospital CPR. Fluctuations in end-tidal CO2 during CPR and the utility of end-tidal CO2 in detecting return of spontaneous circulation justify its continuous measurement. In addition, a high sensitivity (>90%) in predicting return of spontaneous circulation is prospectively demonstrated using the maximal end-tidal CO2 during the first 20 mins after tracheal intubation, with a cutoff value of 10 torr. Such a prognostic indicator could be used for a more rational approach to prolonged CPR.

Aged↗
PubMed1996

[Rôle of growth hormone therapy in the genesis of slipped capital femoral epiphysis].

The authors report two cases of children treated with growth hormone who had a secondary slipped capital femoral epiphysis. Endocrine disease, radiotherapy are some well-known etiological factors reported in literature, but growth hormone influence is still discussed. This hormone could have an indirect incidence on this pathology because of its effects on growth cartilage. The increased number of treatment with growth hormone is certainly a risk factor for slipped capital femoral epiphysis. Regular checking from "France Hypophyse" allows an early diagnosis of epiphysis and surgical fixation can be made immediately. Systematic controlateral side fixation it still discussed but allowed to continue the treatment with the same posology.

Adolescent↗
PubMed1995

The LGM Vena-Tech caval filter: results of a multicenter study.

Caval filters have proved essential to the progress being made in the prevention of recurrent pulmonary embolism. A prospective multicenter study was conducted to evaluate the efficacy and possible complications relating to the LGM Vena-Tech percutaneous caval filter, which has been used in Europe since 1989. A total of 222 patients who had undergone LGM Vena-Tech filter placement between September 1989 and December 1991 were included in this study. Two hundred twenty caval filters were positioned via the percutaneous route: 154 of them via the jugular or subclavian vein and 66 via the femoral vein. Two filters could not be implanted. The in-hospital mortality rate was 1.7% (four patients), which included one patient who died of intraoperative recurrent pulmonary embolism. Mean follow-up was 15 months. Forty-one patients died during follow-up (actuarial survival 65.4% +/- 6% at 30 months). There were five cases of recurrent pulmonary embolism (cumulative freedom from pulmonary embolism 93.2% +/- 3.8% at 30 months). Ten patients had thrombosis of the inferior vena cava (actuarial caval patency 94% +/- 3.6% at 30 months). Eight filters (3.6%) migrated over distances that were less than the height of one vertebra. Shifting did not lead to any cases of thrombosis or recurrent pulmonary embolism. Ten filters tilted between 15 and 25 degrees in relation to the inferior vena cava axis. Recurrent pulmonary embolism never occurred concurrently with filter tilting. The LGM Vena-Tech caval filter ensures satisfactory prevention of pulmonary embolism with a low rate of complications. However, because its long-term fate is not known, its use should be restricted to cases in which heparin treatment has failed or is contraindicated.

Adult↗
PubMed1995

Arterial vascularization of the gastrointestinal tract in Macaca fascicularis (cynomologus monkey).

We describe the origin, course, and distribution of the arteries responsible for vascularization of the subdiaphragmatic gastrointestinal tract of Macaca fascicularis as well as the characteristics of the celiac trunk and the superior and inferior mesenteric arteries, studied in a series of 50 animals. Detailed knowledge of these systems is an essential requirement if experimental surgery is to be successfully performed in these laboratory animals.

Angiography↗
PubMed1995

Site-directed bronchoalveolar lavage and transbronchial biopsy in HIV-infected patients with pneumonia.

We have assessed the diagnostic value of site-directed bronchoalveolar lavage (BAL) and combined transbronchial biopsy (TBB) in 29 HIV-infected patients with localized pneumonia, in whom a previous BAL was nondiagnostic and in whom improvement did not occur with empiric antibiotic therapy. All patients but three had a CD4 cell count < 100/microliters. A definite diagnosis could be reached in 26 of 29 (90%) individuals, including 24 pathogens. Neither the radiologic pattern nor the type of Pneumocystis carinii (PC) prophylaxis could predict the positivity of either one of these two diagnostic procedures. Site-directed BAL alone allowed a diagnosis in infection in eight (28%) cases. TBB alone led to diagnosis in eight (28%) cases, including three PC and two toxoplasma gondii, undiagnosed by the site-directed BAL. Both techniques were positive and in agreement in 10 (34%) cases. The majority of the diagnosis led to a specific treatment. Therefore, the patients' survival was positively altered by the procedure. In conclusion, the performance of site-directed BAL and combined TBB markedly optimizes the diagnostic yield of each of these procedures performed separately in HIV-infected patients with localized pneumonia.

Adult↗