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P Y Carry

Publications and source records attributed to P Y Carry.

At least 19 recordsLinked to original sources
PubMed1997

[Correction to the airflow measurement in the presence of a leak between the trachea and endotracheal tube].

PURPOSE: To estimate the leak between the endotracheal tube and the trachea in newborns in order to compensate for errors in airflow measurement and to monitor mechanical variables from pressure and flow signals. METHODS: Assuming that the leak resistance (Rf) is constant during a respiratory cycle, the resistive properties of the endotracheal tube were evaluated. The method was validated in the intensive care unit with a mechanical test lung and assessed on recordings of three newborns during mechanical ventilation for RDS. We have used a least squares method for the estimation of positive end expiratory pressure (PEEP) on both newborns and simulated data. RESULTS: Direct measurements of simulated leak resistances on the mechanical lung are in agreement with our estimation of leak resistances. In newborns, the success of flow correction is evidenced on end inspiratory pauses: corrected flow drops to zero while raw data show a constant nonzero flow. On the simulated lung, the PEEP underestimation with uncorrected flow ranges from 10 to 20 cm H20 while the corresponding, underestimation with corrected flow is less than 2 cm H2O. In newborns, the flow correction shifts the estimated PEEP from negative values (-0.3 +/- 1.3 cm H2O before correction) to positive values (3.6 +/- 0.7 cm H2O after correction) higher than the imposed PEEP (2 cm H2O). CONCLUSIONS: The efficiency of this simple method has been demonstrated. It could be used successfully on adult patients, as there will not be flow correction in the absence of leaks.

Humans↗
PubMed1997

Evaluation of respiratory inductive plethysmography: accuracy for analysis of respiratory waveforms.

OBJECTIVE: To assess the accuracy of respiratory inductive plethysmography (RIP) waveforms to those obtained with whole body plethysmograph (BP) as this device gives a plethysmographic signal and a pneumotachograph (PNT). DESIGN: Randomized controlled trial. SETTING: Physiologic laboratory in a university hospital. PARTICIPANTS: Eleven subjects from the laboratory staff. INTERVENTIONS: This study was achieved during four consecutive periods in subjects breathing spontaneously and through different added resistive loads. Using the least square method calibration, two RIP waveforms, VRIP.BP(t) and VRIP.PNT(t), were simultaneously calculated with coefficients obtained from BP and from PNT volume waveforms, respectively VBP(t) and VPNT(t). For each recording, to compare volume waveforms, we calculated their differences in term of distances, DRIP-BP and DRIP-PNT, between the normalized RIP volume signal (respectively, VRIP.BP[t] and VRIP.PNT[t]) and its normalized reference (respectively, VBP[t] and VPNT[t]). We also calculated the distance DPNT-BP between the two normalized references VBP(t) and VPNT(t). RESULTS: No significant effect of load or time on the distance occurred. Including all the recordings, the mean distance DRIP-BP (3.4+/-1.1%) appears significantly lower than both the mean distance DRIP-PNT (4.5+/-1.3%; p<0.04) and the mean distance DPNT-BP (4.6+/-0.9%; p<0.008). For each period or load level, DRIP-BP appears to be lower than DRIP-PNT and DPNT-BP. CONCLUSION: The RIP seems reasonably accurate for analysis of respiratory waveform while subjects subsequently breathe against resistive loads.

Adult↗
PubMed1996

[Do corticotherapy and hemodilution decrease postoperative inflammation after maxillofacial surgery?].

OBJECTIVE: To assess the efficiency of corticosteroids and preoperative acute normovolaemic haemodilution (PANHD) in reducing postoperative inflammation after maxillofacial surgery. STUDY DESIGN: Randomized clinical trial. PATIENTS: Thirty-two patients scheduled to undergo maxillary osteotomy for facial dysmorphia were randomized into four groups of eight (PANHD or not; corticosteroids or not). METHODS: PANHD decreased haematocrit to 30%. In the corticosteroid groups, methylprednisolone 1.5 mg.kg-1 was given intravenously at the beginning of surgery (after PANHD in haemodiluted group), and after surgery, 1.5 mg.kg-1 iv daily for three days. Postoperative inflammation was assessed with an X-Ray technique (radiotelemetry) providing data on tissue thickness (extent of facial oedema), and by measurement of plasma concentrations of four acute phase proteins during the first postoperative week. RESULTS: No change in facial oedema and in acute phase proteins occurred with PANHD. Corticosteroids decreased postoperative oedema and acute phase proteins. CONCLUSION: Corticosteroids decrease postoperative inflammation after maxillofacial surgery but not PANHD.

Acute-Phase Proteins↗
PubMed1996

[Morbidity of lateral loop ileostomy].

The aim of this retrospective study was to assess the morbidity of twisted loop ileostomy (TLI). Between 1985 and 1994, 83 TLI were performed in 79 patients. Before TLI closure, 13 patients (16%) presented complications, requiring surgery in 5 cases. Small bowel obstruction (7 cases: 8%) and high stoma output (4 cases: 5%) were the commonest complications. After stoma closure (performed in 76 cases), 8 patients (10.5%) presented complications, requiring surgery in 3 cases. The most commonest complication was enteric fistula (4 cases: 5.3%) requiring reoperation in 2 cases. This procedure adds a separate set of postoperative complications, which tend to be minor in nature without any permanent sequelae and which can be minimized by a meticulous surgical technique. This technique remains a safe and effective procedure for fecal diversion.

Adolescent↗
PubMed1995

Acute normovolaemic haemodilution does not reduce the inflammatory process induced by facial surgery.

The place of preoperative acute normovolaemic haemodilution (haematocrit = 28%-32%) in reducing postoperative inflammation was evaluated after facial surgery. Thirty-two patients scheduled for mandibular osteotomy were randomized to a nonhaemodiluted group or to a haemodiluted group. The degree of postoperative inflammation was evaluated: first by an x-ray technique (radiotelemetry) providing measurements of the tissue thickness (quantitation of facial oedema), and second by the measurement of four acute phase protein plasma concentrations during the first postoperative week. Throughout the study, no changes in facial oedema or in variation of acute phase proteins were detected after haemodilution. It is concluded that acute normovolaemic haemodilution has no effect on the intensity of facial oedema and the biological inflammation process after facial surgery.

Acute-Phase Proteins↗
PubMed1995

A computer program for automatic measurement of respiratory mechanics in artificially ventilated patients.

A program for automatic and periodic determination of respiratory mechanics in artificially ventilated patients is described. Airway pressure and flow signals are obtained from the ventilator in the controlled ventilation mode with constant flow inflation and end-inspiratory pause. Periodically, the program records both signals for a given time and it delimits a ventilatory cycle and its components out of this record. Then, four mechanical parameters of the respiratory system are calculated: (1) Rinit, the resistance obtained with the end-inflation occlusion technique; (2) Ers, the elastance (inspiratory) calculated from the slope of the airway pressure profile during inflation; (3) tau, the expiratory time constant; (4) PEEP, the global positive end expiratory pressure. All parameter measurements have been evaluated in experimental conditions, and are in good agreement with reference values. The complete software includes the display of the signals and of the trends together with automatic disk file backups. An additional program allows one to display the trends again and to create table text files containing all the recorded data for further analysis. The system proved to work in ICU and anaesthesia patients with various ventilators.

Adult↗
PubMed1994

[Intra-abdominal pressure].

The abdominal pressure is a hydrostatic one, which can be measured in the bladder, the rectum and the stomach. In physiologic conditions, the abdominal pressure is variable, with peaks as high as 100 to 200 mmHg at the time of defecation, cough. The increase in abdominal pressure elicited by abdominal distension or compression acts directly on the abdominal compartment, indirectly on the thoracic compartment, and modifies the circulation and the ventilation. Venous return is decreased as the inferior vena cava is compressed. The systemic resistances are also increased as the abdominal vessels are compressed. Therefore the circulation is mainly distributed to the superior part of the body. Although the cardiac output is decreased, the usual haemodynamic parameters remain in the normal range: arterial pressure is increased, heart rate is unchanged, central venous pressure is increased, cardiac failure is unusual. The abdominal distension is also responsible for a restrictive respiratory syndrome, mainly due to the ascension of the diaphragm. The compression of the abdominal content explains renal effects and the decreased diuresis. A sustained increase in abdominal pressure occurs in several clinical conditions. During coelioscopy, abdominal pressure is a under control and the cardiovascular effects are minor. Insufflation with CO2 carries the risk of hypercapnia, gas embolism and pneumothorax. During abdominal tamponade, anuria is directly related to the level of pressures. At an abdominal pressure over 25 mmHg, anuria is common and decompression becomes essential. The G suit increases arterial pressure either by elevating vascular resistances or increasing blood content in the upper part of the body. Therefore cardiac tolerance can be decreased especially in cardiac patients. The adverse effects of abdominal pressure can also be observed in case of peritoneal dialysis and ascites. The risk of regurgitation associated with an increased abdominal pressure must also be kept in mind. The abdominal pressure plays an important role in anaesthesia as well as in surgery. Therefore its measurement, which is easy, should become a routine.

Abdomen↗
PubMed1994

Regional chemotherapy (with mitomycin C) and intra-operative hyperthermia for digestive cancers with peritoneal carcinomatosis.

Intraperitoneal chemo-hyperthermia with mitomycin C was used to treat 28 patients with far advanced digestive adenocarcinoma and histologically confirmed peritoneal carcinomatosis. Surgical resection of the primary tumor was possible in 17 cases. After closure of the abdominal wall, intraperitoneal chemo-hyperthermia was performed for 90 to 120 minutes under general anesthesia and 32 degrees C hypothermia, through 3 intraperitoneal drains forming a closed circuit, using 10 mg/l of mitomycin C in 6 liters of peritoneal dialysate heated to an inflow temperature of 46-49 degrees C. No mortality occurred, and there were 2 post-operative complications, with transitory biological side effects. In 9 out of 10 patients with preoperative malignant ascites, the ascites cleared after treatment. One-year survival rate was 54.2%. These encouraging preliminary results show that intraperitoneal chemohyperthermia with mitomycin C is a safe and reliable treatment for peritoneal carcinomatosis in far advanced digestive cancers.

Adenocarcinoma↗
PubMed1994

[Effect of fibrin glue on lymphostasis during lymph node excisions. Prospective randomized study in 40 patients].

To evaluate the efficacy of fibrin glue for lymphostasis during axillary and inguinal lymph node removal, we conducted a prospective randomized study including 40 patients. Post-operative mortality and morbidity rates were not different throughout the 2 groups. However they were significant decreasement in drainage duration, in drainage quantity and in hospital duration in the group "with" fibrin when compared with the group "without".

Adenocarcinoma↗
PubMed1993

[Cancers of the stomach and peritoneal carcinoses: will hyperthermia be a new therapeutic approach?].

Overall survival rate of gastric adenocarcinoma is poor whatever the therapeutic is. Main reasons for this poor prognosis are regional failure and local recurrences. Using hyperthermia could be of interest in peritoneal carcinomatosis during gastric carcinoma: in vitro cytotoxic effect of hyperthermia is well known. Using hyperthermia in combination with intra peritoneal chemotherapy could improve local control. Preliminary results of pilot studies treating peritoneal carcinomatosis with intra peritoneal chemohyperthermia are reported.

Antineoplastic Agents↗
PubMed1993

[Intraperitoneal chemo-hyperthermia in the treatment of peritoneal carcinomatosis of ovarian origin. Initial cases, physiopathologic data].

The authors report the first results using intraperitoneal hyperthermic chemotherapy with mitomycin C or cisplatinum with protective hypothermia up to 32 degrees C in four cases of peritoneal carcinomatosis secondary to cancer of the ovary which was resistant to conventional treatment. They were stage III and IV in the FIGO classification. There were no post-operative complications. Two patients are still alive 4 and 6 months after intraperitoneal hyper-chemotherapy. Hypothermia has its own action of destroying tumour cells and potentiates the effects of chemotherapy. We have, following the work of the japanese, devised a therapeutic regime combining chemotherapy and intraperitoneal hyperthermia.

Aged↗
PubMed1992

Treatment of malignant peritoneal effusion in digestive and ovarian cancer.

Intra Peritoneal Chemo Hyperthermia (IPCH) with Mitomycin C (MMC) or Cisplatinum (CP) was used to treat 32 patients with far advanced digestive or ovarian cancers and peritoneal carcinomatosis. Surgical resection of the primary tumor has been possible in 18 cases. After closure of the abdominal wall, a 90 minutes IPCH as performed under general anaesthesia and 32 degrees C general hypothermia, through 3 intraperitoneal drainages realizing a closed circuit, using 10 mg/l of MMC or 15 to 25 mg/l of CP in 6 l of peritoneal dialysate heated at the inflow temperature of 46 to 49 degrees C. The mortality rate was 3% and the morbidity rate was 3%. In 11 out of 12 patients with preoperative malignant ascites, no more ascites could be found after IPCH. For peritoneal carcinomatosis from digestive origin, median survival was 11.2 months and 1 year survival rate was 46.9%. These encouraging preliminary results show that IPCH is a safe and reliable treatment for peritoneal carcinomatosis in far advanced digestive or ovarian cancers.

Adenocarcinoma↗
PubMed1992

Hemodynamic and hormonal responses to hypothermic and normothermic cardiopulmonary bypass.

Normothermic cardiopulmonary bypass (CPB) is used in cardiac surgery at some institutions. To compare hemodynamic and hormonal responses to hypothermic (29 degrees C) and normothermic nonpulsatile CPB, 20 adults undergoing coronary artery bypass graft and/or aortic valve replacement were studied. Hemodynamic measurements and plasma hormone concentrations were obtained from preinduction to the third postoperative hour. The two groups were given similar amounts of anesthetics and vasodilators. Systemic vascular resistance increased only during hypothermic CPB, and heart rate was higher at the end of hypothermic CPB. Postoperative central venous pressure and pulmonary capillary wedge pressure were lower after hypothermic CPB. Oxygen consumption decreased by 45% during hypothermic CPB, did not change during normothermic CPB, but increased similarly in the two groups after surgery; mixed venous oxygen saturation (SvO2) was significantly lower during normothermic CPB. Urine output and composition were similar in the two groups. In both groups, plasma epinephrine, norepinephrine, renin activity, and arginine vasopressin concentrations increased during and after CPB. However, epinephrine, norepinephrine, and dopamine were 200%, 202%, and 165% higher during normothermic CPB than during hypothermic CPB, respectively. Dopamine and prolactin increased significantly during normothermic but not hypothermic CPB. Atrial natriuretic peptide increased at the end of CPB and total thyroxine decreased during and after CPB, with no difference between groups. This study suggests that higher systemic vascular resistance during hypothermic CPB is not caused by hormonal changes, but might be caused by other factors such as greater blood viscosity. A higher perfusion index during normothermic CPB might have allowed higher SvO2.

Aortic Valve↗
PubMed1990

[Treatment of peritoneal carcinomatosis by intraperitoneal chemo-hyperthermia with mitomycin C. Initial experience].

Intra-peritoneal chemo-hyperthermia with mitomycin C was used to treat 9 patients with very advanced gastrointestinal cancers with peritoneal seedings. Resection of the primary tumor was possible in 3 cases. After temporary of closure of the abdominal wall, 90 to 120 minutes of intra-peritoneal chemo-hyperthermia was performed under general anaesthesia with 32 degrees C of systemic hypothermia, via 3 intra-peritoneal drains forming a closed circuit, using 10 mg/l of mitomycin C in 61 of peritoneal dialysate warmed at the inflow temperature of 46 to 49 degrees C. We observed no mortality or morbidity. There were only minor and temporary laboratory side effects and for 6 patients, no malignant cells could be found in the ascitic fluid after intra-peritoneal chemo-hyperthermia. In six patients, we conserved an improvement in the Karnofsky index 3 to 7 months after intra-peritoneal chemo-hyperthermia. These results show that intraperitoneal chemo-hyperthermia with mitomycin C is a safe and reliable treatment for peritoneal seedings in severely advanced gastrointestinal cancers and encourage us to proceed with this new therapeutic modality.

Adult↗
PubMed1990

[Post-traumatic hemobilia caused by arteriobiliary fistula. A case report and review of the literature].

One new case of post-traumatic hematobilia due to an arteriobilary fistula is reported. This etiology is relatively rare, and its diagnosis is sometimes difficult if the three signs: pain, bleeding and jaundice are not observed. The most effective paraclinical examination still is selective arteriogrpahy, which makes the diagnosis possible, accurately locates the fistula and sometimes allows hyperselective embolization, as it did in this case. The use of embolization for the treatment of post-traumatic hematobilia due to an arteriobiliary fistula reduces operative mortality for this disease, which still has a poor prognosis.

Adult↗
PubMed1990

[Intraperitoneal hyperthermic chemotherapy in the treatment of peritoneal carcinosis of digestive origin. A case report and physiopathology].

The authors describe their first experience of IP hyperthermochemiotherapy using mitomycin C under hypothermic coverage at 32 degrees C, in a female patient with peritoneal carcinosis secondary to stomach cancer. Postoperative complications were not observed. Tested mitomycin blood levels evidenced good absorption via the peritoneal route. 4 months later, the patient is doing well and the authors are propounding the method be started in a series of patients, in order to assess its long-term efficacy.

Adult↗