PubMed Health⌕ Search

Biomedical subjects

R Lemaire

Publications and source records attributed to R Lemaire.

At least 19 recordsLinked to original sources
PubMed1994

High-dose aprotinin reduces blood loss in patients undergoing total hip replacement surgery.

BACKGROUND: Aprotinin, a proteinase inhibitor, has been reported to reduce blood loss significantly during cardiac surgery. The mechanisms of this effect remain unclear. We studied the effect of aprotinin on blood loss and transfusion requirement during total hip replacement. Potential mechanisms of action and side effects also were investigated. METHODS: Forty patients scheduled for primary total hip replacement were randomized to receive, in double-blind fashion, either aprotinin given as a bolus of 2 x 10(6) kallikrein inactivator units (KIU) followed by an infusion of 5 x 10(5) KIU/h until the end of surgery or an equivalent volume of normal saline. Anesthesia and surgical techniques were standardized and systematic deep venous thrombosis prophylaxis was used. Peri- and postoperative blood loss and transfusion were measured. Fibrinolysis, coagulation pathways, and platelet function were assessed. Renal and hepatic function as well as the incidence of deep venous thrombosis also were assessed. RESULTS: Aprotinin reduced total blood loss from 1,943 +/- 700 ml to 1,446 +/- 514 ml (P < 0.05). This reduction of blood loss occurred during surgery (P < 0.05) and postoperatively (P < 0.001). Total amounts of blood transfused were 3.4 +/- 1.3 units/patient in the control group and 1.8 +/- 1.2 units/patient in the aprotinin group (P < 0.001). The activated partial thromboplastin time was significantly prolonged by aprotinin immediately after surgery, at 50.6 +/- 12.4 versus 32.3 +/- 4.6 s in control patients (P < 0.001), but results of the other coagulation tests were not different between the two groups. No side effects were observed in the aprotinin group. The incidence of deep venous thrombosis in the two groups was not significantly different. CONCLUSIONS: The use of high-dose aprotinin during total hip replacement results in a reduction in both blood loss and the amount of blood transfused. Aprotinin's mode of action, however, remains to be elucidated.

Aged↗
PubMed1992

[Digestive lymphomatous polyposis].

We report 7 prospectively followed cases of lymphomatous polyposis of the gastrointestinal tract. They were characterized by multiple polypoid lesions affecting several segments of the gastrointestinal tract always involving the colon and the rectum. An ileocecal mass was present in 4 cases. Regional lymph node involvement was constant. Peripheral lymphadenopathy was frequent (5 cases out of 7), as was other extra-digestive extension to the bone marrow (4 cases out of 7) and cavum (3 cases out of 7). The histopathological aspect was that of a small cleaved cells (working formulation) or centrocytic (Kiel classification) non-Hodgkin's lymphoma. The peculiar morphology and phenotype of the tumoral B-lymphocytes suggest their possible follicle marginal zone origin. Lymphomatous polyposis bore a rapidly fatal prognosis in every case (mean survival 20 months). This study of seven patients together with the 20 well-documented cases of the literature confirms the existence of lymphomatous polyposis as a distinctive clinicopathological entity among gastrointestinal non-Hodgkin's lymphoma.

Adult↗
PubMed1991

[Venous blood flow in the lower limbs during pregnancy].

From the standpoint of vascular mechanics, the distribution of total circulating blood volume, increased during pregnancy occurs to the advantage of the uterine circulation and the detriment of the venous circulation of the lower limbs. Varicose veins, often found in the legs, are due to compression by the pregnant uterus and changes in hormonal secretions. Many clinical findings still remain unexplained.

Blood Circulation↗
PubMed1990

[Current role of the osteoplastic shelf in the treatment of sequelae of hip dislocation in adults].

This operation, first described by König at the end of the 19th century, continues to have some indications. This simple operation should be performed with a very precise technique: the new shelf is placed at the rim of the acetabulum on the capsule; the shelf should be solid and well-fitting, making any secondary displacement impossible, even when the patient is walking. The hip should be covered anteriorly and superiorly. The main indication is a dysplastic acetabulum, especially with a vertical roof. The best results are seen after operation on dysplastic hips without osteoarthritis; when osteoarthritis is present, the results are less good. The procedure is generally indicated only in patients younger than 45 years and it is relatively contraindicated in patients over 50 years old. It is very important to discuss the indication for this operation with the patient; it is a prophylactic measure performed on a hip with normal mobility and little pain.

Acetabulum↗
PubMed1989

[Morphology of the tibial tuberosity].

The influence of anterior projection of the tibial tuberosity in the pathogenesis of anterior knee pain syndromes has been given relatively little attention. This point has been investigated by performing a morphological study of 77 knee-joints with a standard radiological method. The knees fell into two groups: one of them included typical patellar syndromes, the other group included knees presenting with some other conditions, mostly meniscal. A subjective evaluation of the shape of the tuberosity was made and correlated with clinical status. An objective rating was attempted by measuring the anterior projection of the tuberosity, in order to eliminate the influence of skeletal size, it was expressed as a ratio between two values. Subjective evaluation of the shapes of the tuberosities was found unreliable. The individual values for the calculated index of anterior projection were found to be scattered for every morphological type. It appeared difficult to conclude that there is a definite proven relationship between hypoplasia of the tuberosity and overloading of the femoro-patellar joint. Evaluation of the anterior projection of the tuberosity should take into account the position of the tuberosity in the coronal plane.

Adolescent↗
PubMed1989

[Transposition of the tibial tuberosity in recurrent dislocations and painful femoro-patellar syndromes. Study of a continuous series of 140 operated knees].

Surgical displacement of the tibial tuberosity has been performed in 140 cases over a 10-year period. Medial displacement with or without ventralization of the tuberosity gave excellent results in all 11 cases presenting with recurrent patellar dislocation. Anterior displacement of the tuberosity using a modified Maquet procedure was performed in 129 knees presenting with femoro-patellar pain (chondromalacia patellae, femoro-patellar osteoarthritis). Indication for surgery was intractable femoropatellar pain. Surgical technique (isolated anterior translocation or anterior and internal translocation of the tuberosity) was selected according to clinical and radiological examination. Results were very good in 50% of cases, good in 30%, poor in 20%. No patient was made worse after the procedure. The complication rate was acceptably low, due to meticulous surgical technique. The overall good results in this series are related to strict selection of patients.

Adolescent↗
PubMed1989

[The motor structures responsible for venous flow].

There are numerous forces which propel the blood within the veins: --At tissue venule level the residual arteriolar pressure especially intervenes. --At peripheral vein level, the dominant forces are those which lower the transmural pressure, either by decreasing intravascular pressure (gravity, aspiration from neighbouring veins), or by increasing the extravascular pressure creating a compression effect by squeezing of the flexible vessel between muscles and a rigid aponeurosis. --At central vein level, the principal role is ensured by the thoraco-abdominal mechanics, whereby contraction of the diaphragm produces compression and aspiration. The right heart intervenes, when required, and directs blood towards the pulmonary circulation. The result of the simultaneous, successive application of these forces, differs depending on the organ. In addition, the flexibility of the vessel varies according to neuro-hormonal control. Finally, the rheological properties of the fluid and the degree of backflow must be taken into account. Thus, one gets a double flow (hydraulic transfer, propagated waves) which varies according to requirements. The energy expenditure due to flow is a function of the characteristics and volume of the liquid displaced. The complexity of such a flow has the advantage of adaptability but the inconvenience of fragility.

Blood Circulation↗
PubMed1987

Parent-to-child transplantation with cyclosporine immunosuppression.

The use of cyclosporine, a fungal endecapeptide immunosuppressive agent, has greatly improved the outcome of haploidentical transplantation in adults, but less impressively improved the result of parent to child transplantation. The incidence of allograft loss and treated rejection episodes was much greater in pediatric than in adult recipients, and the evidences of nephrotoxicity lessened. Although resistance of the child's immune system to the effects of the drug cannot be excluded, it appears more likely that this relates to the rapid clearance of the agent in the pediatric age group (39.6 mL/min/kg) versus in adults (12.3 mL/min/kg), thereby reducing the area under the serum concentration curve from 765 +/- 593 to 386 +/- 277 ng/mL/hr per mg/kg (mean +/- SD). This effect caused trough serum levels measured by radioimmunoassay to be below the putative threshold. These findings demonstrate the need for higher cyclosporine doses and frequency in pediatric compared with adult patients.

Adolescent↗
PubMed1983

[Surgery in the octogenarian (introduction). Results of a national survey].

Presentation of the results of a national, multicentric and retrospective study regarding the surgery of the octogenarian. The series counts 7,407 patients accepted for surgery, and which can be divided into 4,581 women (61.8%) and 2,826 men (38.2%) of an average age of 84.4 years old (extremities 80-101 years old). The global mortality of this population of elderly (whether operated on or not) amounts to 16.7%. The postoperative mortality of the 4,177 operated patients is 18.2% with different rates according to the surgical disciplines: 34.7% for surgery of the colon, 23.2% for bone surgery, 22.4% for vascular surgery, 15.3% for biliary surgery, 8.7% for urologic surgery and 5.6% for cardiac surgery.

Age Factors↗