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Biomedical subjects

R Prêtre

Publications and source records attributed to R Prêtre.

At least 73 records · Page 4Linked to original sources
PubMed1994

Influence of aprotinin on early graft thrombosis in patients undergoing myocardial revascularization.

One hundred sixty-five patients undergoing primary myocardial revascularization were prospectively entered into a randomized, double-blind, placebo-controlled study, in a single institution, in order to determine the influence of high- and low-dose aprotinin application on early coronary artery bypass graft patency. All patients were operated on by the same team and the three treatment groups were comparable in all demographic data and surgical variables. Postoperative chest tube drainage and transfusion requirements were significantly reduced in patients receiving high or low doses of aprotinin. In all patients vein and internal mammary artery graft patency was assessed by control coronary angiograms 4 to 15 days (median 8.2 days) postoperatively. In the high-dose aprotinin group, 140 of 142 vein grafts and in the low-dose aprotinin group all of the 128 vein grafts were patent compared with 138 of 139 in the placebo group. The difference was not statistically significant (P > 0.05). All pedicled internal mammary artery grafts were patent in the three treatment groups. The prevalence of perioperative myocardial infarction was evaluated by serial creatine kinase-myocardial band (CK-MB) isoenzyme measurements and by electrocardiographic recordings. No additional changes that could be attributed to aprotinin were observed. In conclusion, these results suggest that perioperative myocardial infraction secondary to aprotinin-induced native coronary artery or conduit thrombosis is not increased by aprotinin in patients undergoing primary myocardial revascularization.

Aged↗
PubMed1994

Reversed flow in the internal carotid artery after occlusion of the common carotid artery.

Patency of the internal carotid artery in case of common carotid artery occlusion is usually maintained by a flow of blood from the external carotid into the internal carotid artery. A case where a reversed flow of blood was established from the cerebral circulation into the internal carotid artery and eventually into the external carotid artery is presented. Careful reading of the cerebral views of the standard carotid angiogram allowed detection of a retrograde flow into the internal carotid artery. Surgical exploration confirmed the patency of the internal carotid artery; the occluded common carotid artery was bypassed by a prosthesis, which restored an antegrade flow into the internal carotid artery.

Carotid Artery, Common↗
PubMed1994

Dissection of the atrial septum following mitral valve surgery.

Interlayer dissection of the atrial septum resulting in the formation of a cavity developed after an attempted repair of a mitral paraprosthetic leak. Subsequent rupture of the cavity into both atria resulted in a small left-to-right shunt and significant left ventriculoatrial regurgitation. Misplaced stitches, aimed at obliterating the paraprosthetic leak, were the cause of the dissection. This case illustrates a previously unreported complication of mitral valve surgery and stresses the importance of proper exposure and handling of the mitral annulus.

Aged↗
PubMed1994

IVOX in ARDS: respiratory effects and serious complications.

We describe the beneficial effects of an intravenous oxygenator (IVOX) on ventilatory pressure requirement, and also several severe complications related to its use in a young trauma victim developing severe acute respiratory distress syndrome (ARDS). In this patient, adequate systemic oxygenation could not be maintained despite the use of fractional inspired oxygen of 1.0, high level positive end-expiratory pressure (PEEP), and nitric oxide inhalation (30 ppm). The introduction of an intravenous oxygenator improved arterial oxygenation and CO2 elimination, allowing a decrease in minute ventilation and airway pressure. However, hepatic cytolysis, acute renal dysfunction and iliac vein thrombosis developed concomitantly, in spite of full anticoagulation with heparin. These complications resolved rapidly after removal of the IVOX device and the patient made a good recovery.

Adult↗
PubMed1994

[Lesions of the supra-aortic arterial trunks by closed trauma].

Thirteen patients treated for 14 arterial lesions of the supra-aortic trunks from blunt trauma between 1985 and 1993 were retrospectively reviewed. In 2 cases, the lesion was on the innominate artery, in 1 case on the right common carotid artery and in 11 cases on the subclavian artery. It consisted of rupture in 8 cases, pseudoaneurysm in 5 and occlusion from an intimal flap in 1 case. Acute ischemia of the upper limb was present in 5 patients, and severe local hemorrhage in 1 patient. Four patients (5 lesions) did not have symptoms on initial hospitalization. Two later suffered embolisms from a pseudoaneurysm with a fatal outcome from massive cerebral ischemia in one case. Eleven arteries were repaired and two were ligated because of massive associated soft tissue destruction of the shoulder and the arm requiring immediate amputation. In addition to these two amputations, a brachial plexus injury remained disabling for 4 other patients. Blunt injuries of the supra-aortic arterial trunks constitute an immediate challenge in the case of active bleeding and often require combined mediastinal or thoracic and cervical exposure. They carry a heavy morbidity when the subclavian artery is involved due to associated soft tissue or brachial plexus damage. Occult lesions of the arteries supplying the brain are dangerous because of the risk of interference with cerebral blood flow. They should be actively investigated and, if the distal part of the lesion is accessible, they should be treated surgically.

Adolescent↗
PubMed1994

[Sub-adventitial rupture of the external iliac artery in closed traumas of the pelvis. Apropos of 2 cases].

Major vascular injuries in closed fracture of the pelvis occur in approximately 1% of cases. In this setting, subadventitial rupture of the external iliac artery is rare. The lesion is responsible for acute ischemia of the lower limb, and may present diagnostic challenges due to frequently associated major local injuries, delayed disappearance of distal pulses, and concomitant neurological damage. Serial clinical examinations along with the use of arteriography are instrumental in avoiding undue delays.

Adult↗
PubMed1994

Blunt injury to the subclavian or axillary artery.

BACKGROUND: This study is an analysis of our experience with blunt injuries to the subclavian or axillary artery in order to delineate the immediate challenges encountered and to assess immediate and long-term outcome. STUDY DESIGN: A retrospective analysis was performed of 15 consecutive patients treated for a blunt injury to the subclavian or axillary artery in our hospital between 1988 and 1992. RESULTS: Ten patients had multiple injuries, and six were in a state of shock at admission. Bleeding from the artery contributed significantly to shock in three patients. Ischemia of the upper extremity was overt in ten patients. Two patients died as a result of associated injuries. Two patients with extensive tissue destruction underwent immediate amputation, one at shoulder level and one at middle arm. Five patients survived with a denervated limb from brachial plexus damage; in only one was the neurologic injury consistent with a potentially reversible lesion. Arterial repair, performed upon patients not undergoing amputation, was patent at a median time of 33 months in all but one patient. Among the seven patients with extensive disability (two amputated and five denervated extremities), only one patient resumed previous work. CONCLUSIONS: Blunt trauma to a subclavian or axillary artery is associated with significant immediate morbidity and mortality. In the long-term, associated brachial plexus lesions plague most patients, who are left with a severe disability of the upper limb, which complicates their return to society.

Adolescent↗
PubMed1994

Blunt carotid artery injury: difficult therapeutic approaches for an underrecognized entity.

GOALS: To assess the damage inflicted by carotid artery injuries, to attempt to explain some differences between published series, and to summarize the management of different types of lesions. METHOD: Retrospective analysis of patients treated for nonpenetrating injury of the carotid arteries in our hospital from 1985 to 1991. RESULTS: Seven patients (all men, with ages ranging from 19 to 55 years) had eight injuries to the carotid arteries. One patient was asymptomatic; another patient had neurologic symptoms unrelated to the carotid artery injury; severe neurologic deficits developed in the remaining five patients, of whom three died. Symptoms occurred immediately in one patient, after a few days in two patients, and after a few weeks in two patients. Arterial damage included dissection (four cases), pseudoaneurysm (two cases), local contusion (one case), and occlusion (one case). Surgical treatment consisted of aneurysmorraphy and extraintracranial bypass in one patient each. Surgical intervention was not considered in the other patients because of the severity of their neurologic symptoms. Besides collective reviews, very few series pertaining to this pathologic condition exist in the literature; however, some report good overall results. These reports comprise a high proportion of asymptomatic cases; the internal injury is usually only discovered incidentally on thoracic aortograms or by scanning the neck during head computed tomography scans. CONCLUSIONS: Nonpenetrating trauma to the carotid arteries carries significant morbidity and mortality rates. Wide-scale screening for carotid lesions in victims of blunt trauma would be necessary to determine the true incidence and gravity of this pathologic condition. A search for carotid artery injury should be performed in patients with a history of neck or head trauma to detect whether the correction of any lesion would lead to improvement or prevention of neurologic deficits.

Adult↗
PubMed1993

Pathophysiology, recognition and management of pneumoretroperitoneum.

The medical records of 15 patients found to have pneumoretroperitoneum in a 10-year period were reviewed. The cause of retroperitoneal emphysema was infection in six patients, trauma in five and iatrogenic in four. Emphysema was confined to the retroperitoneum in 11 patients, and extended to the mediastinum in four and to the soft tissue of the neck in three. Failure to diagnose pneumoretroperitoneum resulted in delayed intervention in two patients. One patient with pneumoretroperitoneum and pneumoperitoneum secondary to a lung lesion underwent unnecessary laparotomy. Outcome was favourable in these three patients. The presence of air in the retroperitoneum is not dangerous but its early recognition and detection of the source are important as septic conditions may be involved.

Adolescent↗
PubMed1993

Relief of severe pulmonary hypertension after closure of a large ventricular septal defect using low dose inhaled nitric oxide.

A 16-month-old girl developed severe pulmonary hypertension after closure of a large ventricular septal defect. All conventional therapeutic measures failed; an attempt to add nitric oxide at a continuous low dose to the inspired gas allowed resolution of pulmonary hypertension and low cardiac output. This report documents that continuous inhalation of low dose nitric oxide is capable of selective resolution of pulmonary hypertension following cardiac surgery for a large septal defect in a child. This suggests that a transient dysfunction in the release of nitric oxide by the pulmonary endothelial cell is responsible for the vasoconstriction.

Administration, Inhalation↗
PubMed1993

Blunt injuries to the innominate artery.

Two patients with aneurysm secondary to blunt traumatic subadventitial rupture of the distal innominate artery (IA) are reported. IA rupture was identified because of a cervical bruit in one patient and detected during thoracic aortography in the other patient. The patients had associated cardiovascular lesions consisting of traumatic aneurysm of the subclavian artery and rupture of the aortic valve, respectively. Both lesions were surgically repaired by resection of the lacerated intima and direct closure of the adventitia. In the patient who underwent repair of the aortic valve with simultaneous cardiopulmonary bypass the IA was approached after cannulation of the right common carotid artery. In the other patient the IA was repaired without use of a shunt under close EEG monitoring. Injury to the IA is rare because the artery is short and relatively well protected by the bony cage. Other cardiovascular lesions may be associated with IA rupture and a routine search should be made.

Adult↗
PubMed1993

Surgical management of aortic valve injury after nonpenetrating trauma.

A case report and a literature review of the patients who underwent surgical repair of an aortic valve injury secondary to nonpenetrating trauma are presented. Thirty-seven patients (32 male and 5 female patients) with a median age of 43 years sustained either blunt chest trauma (34 patients) or muscular strain (3 patients) as a cause of injury. Primary repair was undertaken on 4 patients before 1964 (when the first aortic valve replacement was performed for this condition) and on 6 other patients after 1964. In the former group, 2 patients died because of heart failure and 1 subsequently required a prosthesis. The last patient had an excellent result at 17 years. In the latter group, 1 patient with a complex lesion had persistent moderate aortic regurgitation. The 5 remaining patients had a simple lesion to the valve and showed excellent results on follow-up evaluation (ranging from 6 months to 6 years). Aortic valve replacement successfully corrected the valvular dysfunction in 26 patients. Except for 1 case of hemolytic anemia, specific complications of prosthesis were not encountered, but median follow-up of this review was only 9 months. A modulated approach to this condition is proposed where primary repair is selected for cases with a simple tear or avulsion of one cusp. Intraoperative control of the repair by transesophageal echocardiography increases the safety of this approach. Valve replacement is indicated for more complex lesions or for ineffective primary repair as assessed by intraoperative echocardiography.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Pneumoretroperitoneum: diagnostic and therapeutic approach].

This retrospective study deals with etiology, paths of extension, radiological signs and treatment of pneumoretroperitoneum. The 15 cases presented were seen over a 10-year period. Etiology was infectious in 6 patients, traumatic in 5, and iatrogenic in 4. Treatment applied was surgical in 12 patients, the remaining 3 (who all had their pneumoretroperitoneum secondary to endoscopy) could be handled conservatively. Even though pneumoretroperitoneum is seldom encountered, it should be quickly recognized in order to apply prompt adequate therapy.

Adolescent↗
PubMed1993

Traumatic paramediastinal air cyst: report of two cases and review of the literature.

Two cases of traumatic paramediastinal air cyst are presented with a review of the literature. This rare condition affects young people and usually occurs on the left side of the chest. Its course is spontaneously benign. Although they are usually easily diagnosed on chest roentgenograms, these cysts may sometimes be difficult to differentiate from other more serious traumatic lesions. Computed tomography (or a contrast swallow roentgenogram in some instances) can elucidate doubtful cases.

Adult↗