Biomedical subjects

R Barthelemy

Publications and source records attributed to R Barthelemy.

At least 19 recordsLinked to original sources

PubMed2006

[Isolated lesion of the infraspinatus at the myotendinous junction: a new lesion].

PURPOSE: We have identified a previously unpublished lesion of the infraspinatus muscle at the myotendinous junction. We describe its presentation and MRI appearance, notably the absence of other tendinous pathology in the rotator cuff. MATERIALS AND METHODS: We retrospectively reviewed 25 patients with isolated infraspinatus lesions and associated edema identified on the fat-suppressed T2-weighted images of MRI. Imaging exams and medical records collected over a 7-year period were reviewed by a team of radiologists and surgeons specializing in the shoulder. A presentation of the mechanism of injury, radiological analysis of MRI scans and other investigations (arthro-CT and EMG studies) were carried out; all MRI included at least two fat-suppressed T2-weighted (transverse and coronal) sequences and one T1-weighted (transverse) sequence. RESULTS: The lesion was characterized by tearing or delamination at the myotendinous junction, which was accompanied by edema of the infraspinatus muscle in the initial phase. Over time the edema was seen to resolve and muscle atrophy and fatty degeneration became predominant. We identified two groups by the onset of their symptoms. In the "chronic" group (44%), onset was gradual, with these patients frequently having had one or more infiltrations at presentation to us. In the "acute" group (56%), there was an initial traumatic event that was variable in intensity and mechanism. CONCLUSION: This isolated lesion of the infraspinatus at the myotendinous junction has not been previously described. It is recognized by its characteristic MRI appearance and is not generally seen on CT arthrograms as there is no communication with the joint. Its natural history appears to be of a progression from edema to fatty degeneration with or without myotendinous retraction and scarring. Its etiology has not yet been clearly established.

Adult↗

PubMed2004

Laparoscopic treatment of pancreatic pseudocysts.

BACKGROUND: A multicentric study was performed to evaluate the clinical results after laparoscopic treatment of pancreatic pseudocysts (PP). METHODS: We collected the data of 17 patients presenting with PP and operated on by laparoscopy between 1996 and 2001. There were nine men and eight women with a median age of 42 years (range 30-72). In 15 patients the PP developed after acute pancreatitis and the median delay between the acute onset and surgery was 7 months (range: 2-24). In two patients the PP was associated with chronic pancreatitis. All the patients had a single PP with a median diameter of 9 cm (range: 5-20). RESULTS: According to the location of the PP, a cystogastrostomy was performed in 10 patients and a cystojejunostomy in seven patients. The median operative time was 100 min (range: 80-300). Laparoscopic PP surgery was completed successfully in 16 patients and the median size of the cystoenterostomy was 3 cm (range: 2-5). Necrotic debris was present within the PP in 11 patients. The median postoperative hospital stay was 6 days (range: 4-24). No mortality and no immediate morbidity were recorded. However, two patients were readmitted within the first 3 postoperative weeks because of secondary PP infection. The first patient had an early closure of cystogastrostomy and was treated by endoscopic placement of a stent. The second represented with a right retrocolic abscess after cystojejunostomy and was treated by percutaneous drainage. One patient was lost for follow-up 2 months after surgery. The others had regular clinical and radiological controls. With a median follow-up of 12 months (range: 6-36), no recurrence of PP was observed. CONCLUSIONS: The laparoscopic treatment of PP was associated with a low postoperative complication rate and an effective permanent result. That approach avoided some difficulties, particularly bleeding that is classically linked with endoscopic internal drainage.

Adult↗

PubMed2004

[A serious complication of sternal puncture: penetrating injury of the ascending thoracic aorta].

INTRODUCTION: Penetrating thoracic aorta wounds are rare but responsible for a high mortality when medical and surgical management is delayed. OBSERVATION: We report the case of a 71 year-old patient with malignant lymphoma who sustained an accidental penetrating injury of the ascending thoracic aorta while undergoing trephine biopsy of the sternum. He was successfully treated with emergency sternotomy and aortic suture-repair. CONCLUSION: This case report highlights the limits of sternal trephine biopsy, notably in patients whose bones are weakened by a malignant haematological process, and proposes preventive measures in order to avoid accidents.

Aged↗

PubMed2001

[Absorbed dose during helical acquisition CT. Effect of acquisition parameters].

PURPOSE: European directive 97/43 specifies that the dose delivered to the patient during a radiological procedure should be estimated. In order to prepare for implementation of this new regulation, we have studied the dose delivered during spiral CT acquisition. MATERIALS AND METHODS: We have studied the influence of slice thickness, pitch, tube voltage and intensity, and acquisition volume length. We present measurements for single and dual detector CT scanners. We used a pencil ionization chamber to measure air kerma. We measured absorbed dose in water with a waterproof ionization chamber set in a semi-customized phantom filled with water. Chambers were set on the rotation axis of the CT scanners. We studied the dose outside the acquisition volume. RESULTS: We quantified the influence of each parameter on the absorbed dose. We used our measurements to calculate the dose for different acquisition protocols. Also we evaluated the dose to organs distant from the acquisition area. CONCLUSION: This study is one step toward a systematic estimation of the dose delivered to patient during helical CT exams. To use these results in daily practice, we have to develop software using our measurements.

Equipment Design↗

PubMed1998

[The Bimler method in the treatment of sagittal shift of the skeletal base in Class II division 1 malocclusion].

Inadequate sagittal development of the mandible (class II, division 1 malocclusion), is one of the most frequent in dentofacial malformations. We present the Bimler "gebissformer", removable and functional appliance and its tridimensional action. The treatment can be started during the deciduous dentition or in mixed dentition. Therapeutic results, increase of SNB angle, maxillary expansion, and reduction of the deep bite are presented. While therapeutic failure is observed in 30% of the cases (by absence of tissular response or poor patient compliance), the stability of the results in 70% of the remaining cases and its total inocuity make this appliance an interesting method of treatment.

Age Factors↗

PubMed1995

Closed loop control of PaCO2 during ECC.

A prototype for the control of blood gases during extracorporeal circulation (ECC) has been built. It is composed of a CDI300 continuous gas blood analyzer, a programmable gas blender and an IBM PC. The air blender is composed of three mass flow controllers (air, oxygen and total flow rate). The microcomputer commands these controllers in order to obtain the desired mixture of air and oxygen. The system acquires the data sent by the blood gas analyzer every 6 seconds and commands the gas blender in order to maintain the desired arterial dioxide partial pressure (PaCO2) in the arterial line. The first experimental results on sheep show that if blood gas parameters are stable when beginning the closed loop control, then the desired PaCO2 value may be obtained. Otherwise, the value of PaCO2 under control is slightly different but a stable value is obtained after 10 minutes. More experiments must be done in order to establish the real limits of such a system and optimize the gain of the control system.

Animals↗

PubMed1994

Evaluation of a cardiopulmonary preservation method for heart-lung transplantation.

This study was designed to examine whether concomitant administration of anti-free radicals with donorcore cooling on cardiopulmonary bypass (CPB) and hypothermic storage of the heart and lung, could provide successful extended cardiopulmonary preservation. Fourteen sheep heart-lung blocks harvested after core-cooling and cardioplegic arrest were preserved at 4 degrees C for 8.5 hr. Before and during CPB, the animals were perfused with Prostaglandin E1 (PGE1), superoxide dismutase (SOD), catalase (CAT) and deferoxamine (DEF). Cardioplegic arrest was induced with St. Thomas' Hospital solution (Plegisol) to which SOD, CAT and DEF had been added. The preservation solution consisted of Plegisol modified by the addition of K-lactobionate, raffinose, mannitol, SOD, CAT, DEF, a phosphate buffer and penicillin. Histological examination performed on 3 donor heart-lung blocks before and after CPB and cardioplegia, then immediately following cold storage, produced no clear evidence of structural damage in cardiac myocytes and lung parenchyma. Eleven donor organs were therefore transplanted in size-matched recipients with a total mean ischemic time of 12 hr. The combined administration of SOD, CAT, DEF, insulin and glucose during the initial period of reperfusion had no beneficial effect on cardiopulmonary performance. A progressive fall in Pa O2 and mean aortic pressure was observed post-operatively in the 7 animals that were weaned from CPB. Five of them died within 3 to 5 hr after CPB weaning, the remaining 2 animals died of cardiac arrest within the fourth hour. The results of this experiment seem to indicate that: 1. better organ function and improved survival could have been obtained if the duration of anti-radical treatment had been prolonged after reperfusion and, 2. physical manipulation of the donor grafts during harvesting and transplantation may have been partly responsible for the poor post-transplantation cardiopulmonary performance.

Animals↗

PubMed1991

[Heart-lung preservation: historical evolution and current research data].

Over the past decade, combined, heart-lung transplantation has been established as a therapeutic modality for many patients with end stage cardiopulmonary disease. However, the scarcity of suitable donors and the lack of a reliable and simple technique for distant organ procurement have somewhat limited its practice. The normothermic autoperfusion preparation has been utilized in a few satisfactory distant heart-lung preservation and subsequent transplantation, but this method is rather cumbersome. Single cold flush perfusion of the pulmonary artery with infusion of prostaglandin E1, a powerful vasodilator of the pulmonary bed, has been used successfully in heart-lung preservation for transplantation. Donor core-cooling through cardiopulmonary bypass without pulmonary artery flush perfusion appears to provide longer and better graft protection since it improves its function. The production of oxygen radicals after reperfusion of ischemic tissues has important implications in organ preservation and transplantation. Recent studies in the prevention of reperfusion injury indicate that enzymatic scavenger and iron chelator therapy may play an important role in the reduction of reperfusion injury in the clinical setting of heart-lung transplantation.

Cryopreservation↗

PubMed1990

Automatic modules for extracorporeal circulation control.

Maintenance of a constant level in the oxygenator during surgical extracorporeal circulation (ECC) is of paramount importance. We propose a device able to regulate the pump speed accordingly to the level in the oxygenator, and an automatic clamp to control venous return from the patient. The level regulator permits pump speed control and also stops the pump when a prefixed low level is reached (during ECC). Linearization of the level sensor has been made in order to optimize the PI regulator. Simulation results are presented and the regulator is evaluated in a clinical environment. The automatic clamp provides a good solution for reproducible and easy transitions in venous return. When coupled with the level regulator, the pump speed will increase automatically from zero to the correct equilibrium speed, with variable duration (from 30 seconds to 5 minutes) chosen by the operator. The same technique is used for stopping the ECC. These two devices are, in fact, modules, making up part of an evolutive device for ECC automation. The modules can exchange data with a supervising microcomputer.

Automation↗

PubMed1986