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Biomedical subjects

T Lochu

Publications and source records attributed to T Lochu.

7 recordsLinked to original sources
PubMed1994

[Mesentric venous thrombosis. Risk factors, treatment and outcome. An analysis of 18 cases].

Eighteen patients with an acute thrombosis of the splanchnic veins were reviewed. Most of apparently idiopathic cases of splanchnic vein thrombosis are related to an increased coagulation related to a congenital or acquired defect of haemostasis. The aim of this study was to assess the effects of a new and effective treatment. Nine male and 9 female patients (range of age: 19 to 81 years) experienced a mesenteric venous thrombosis. There were 14 mesenteric vein thromboses with infarction, two transient mesenteric venous ischaemias without bowel infarction and two acute thromboses of the splanchnic veins without bowel ischaemia. A coagulopathy was detected in seven patients: oral contraception, protein C (PC) or antithrombin III (AT III) congenital deficiencies, acquired deficiency of AT III, PC and protein S (PS), polycythaemia in the post-partum period and primary myeloproliferative disorder. No coagulopathy was associated with thrombosis in eight cases: mesenteric haematoma, splenomegaly, cirrhosis, appendicectomy, cholescytectomy, chronic heart failure, treatment with beta-adrenergic receptor antagonist and digitalis, stenosis of the portal anastomosis after liver transplantation. Twelve patients required surgery: eight intestinal bowel resections with immediate anastomosis, four resections without immediate anastomosis. Only one patient underwent a second look for a repeat bowel resection. No death occurred in the early postoperative period and 17 out of 18 patients were alive after 12 years. An oral anticoagulant therapy was undertaken from two months to seven years. However, three patients suffered a recurrent thrombosis. Two of them required a long-term anticoagulation. Six patients experienced a portal hypertension and oral anticoagulants were discontinued in three of them because of bleeding oesophageal varices. Six patients were treated only by unfractionated heparin (UFH) or low molecular weight heparin (LMWH) followed by oral anticoagulants. After laparotomy, two were only treated with UFH without any bowel resection, as mesenteric venous ischaemia was too extensive. These observations suggest that the choice between an appropriate medical or surgical treatment is important and must be discussed. Since 1989, the therapeutic choice has been modified by ultrasonography and contrast enhanced computed tomographic scan which confirms diagnosis, allows to follow up and check the effects of anticoagulation and to choose the time for surgery. When the diagnosis is established and the patient's risk is low, the IU . kg(-1) . d(-1) to obtain an antifactor Xa activity between 0.3 and 0.6 antiXa IU mL(-1). When the diagnosis is uncertain and the patient's risk if high a laparotomy is required.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1994

[Antibiotic prophylaxis in surgery of the esophagus].

Surgery of oesophagus carcinoma is a long and major procedure. Perioperative radiochemotherapy is often required. Therefore many factors favour the occurrence of local and general postoperative infection, justifying an antibiotic prophylaxis directed against oesophageal and gastric flora. In case of oesophageal stenosis, the oesophageal floral often switches to the fecal type. Antimicrobial agents diffuse to the surgical site and reach there high concentrations for the time of surgery. We recommend, just prior the induction of anaesthesia the intravenous administration of a single dose of a third generation cephalosporin (ceftriaxone 2 g) and nitroimidazole (ornidazole 1 g). The long half-life of these agents allows sufficient concentrations at surgical site to be obtained and the efficacy of this regimen has been demonstrated. Selective decontamination of the digestive tract with systemic antibiotherapy is another approach for the prevention of postoperative complications of surgery of oesophagus carcinoma.

Anti-Bacterial Agents↗
PubMed1993

[Criteria of awakening. Street aptitude].

Recovery period after anaesthesia, even if short in ambulatory surgery, must not be neglected. Most of serious accidents occur in recovery period but recovery assessments are not clearly defined. Different scores exist. Home readiness requires integrity of vital functions. Tests of upper functions also exist but are not commonly and easily used. They don't disclaim physician responsibility and increase his task appreciably.

Ambulatory Surgical Procedures↗
PubMed1990

[Hereditary deficiency of antithrombin III, protein C and protein S. A study of 31 patients from 8 unrelated families].

The families of eight unrelated patients were studied with regard to a hereditary deficiency in antithrombin III (ATIII), protein C, or protein S. These deficiencies were recognized in the course of investigations for deep-vein thrombosis (DVT) in the eight patients. A group of 31 individuals (patients and family members), mostly less than 40-year-old was explored. Two cases of AT III deficiency were discovered, as well as 21 of protein C deficiency, and seven of protein S. Ten of the 30 have had recurrent venous thrombosis at the time of bedrest, trauma, surgery, pregnancy, postpartum or during oral contraceptive treatment. Spontaneous DVT occurred in three cases. Seventeen patients had remained asymptomatic till then. Such patients need antithrombotic treatment during surgery or pregnancy. Prophylactic treatment with enoxaparin in one patient (deficiency in protein C) during her second pregnancy is discussed. It seems that low molecular weight heparin may be a safe alternative to unfractionated heparin. Oral anticoagulants are efficient in preventing reoccurring venous thromboembolism in patients with AT III deficiency. The questions of whether oral anticoagulants should be continued in the long-term in patients with protein C or protein S deficiency who have had a DVT, and whether asymptomatic deficient patients should be given any antithrombotic treatment outside circumstances likely to induce a DVT, remain as yet unanswered.

Adolescent↗