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Fluck D, Fry CH, Lisk R, Yeong K, Robin J, Han TS. Clinical Characteristics and Mortality of Old and Very Old Patients Hospitalized for Hip Fracture or Acute Medical Conditions. J Frailty Aging 2023; 12:231-235. [PMID: 37493384 DOI: 10.14283/jfa.2022.34] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
BACKGROUND There is increasing interest in healthcare quality and economic implications for hip fracture patients of very old age. However, results are limited by access to comparable control groups. OBJECTIVES We examined healthcare quality measures including mortality and length of stay (LOS) in hospital of adults aged 60-107 years undergoing hip operations, compared to an age-matched group admitted for acute general medical conditions. DESIGN Monocentric cross-sectional study. SETTING Ashford and St Peter's Hospitals NHS Foundation Trust, Surrey, United Kingdom. PARTICIPANTS A total of 3972 consecutive admissions for hip operation from 1st April 2009 to 30th June 2019 (dataset-1) and 6979 for acute general medical conditions from 1st April 2019 to 29th February 2020 (dataset-2). Respective ages, mean (±standard deviation), were 83.5 years (±9.1) and 79.8 years (±9.8). MEASUREMENTS Mortality and LOS were assessed with each group divided into five- year age bands and those ≥95 years. RESULTS There were proportionally more (P <0.001) females admitted for hip operations (72.8%) than for acute general medical conditions (53.8%). Amongst patients admitted with general medical conditions, the frequency of the most serious recorded conditions - including congestive heart failure, stroke, and pneumonia - increased with age. Amongst patients undergoing hip operations, 5.7% died in hospital and 29.3% had a LOS ≥3 weeks. Corresponding values for acute general medical conditions were 10.4% and 11.8%. For those undergoing hip operations in all age categories, the risk of death was lower than for acute general medical group: sex-adjusted odds ratios ranged between 0.27 and 0.67, but the risk of LOS ≥3 weeks was greater: odds ratios ranged between 2.46 and 2.95. CONCLUSIONS Compared to those admitted with acute general medical conditions, patients admitted for hip operations had a lower risk of death, but a longer hospital LOS. .
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Affiliation(s)
- D Fluck
- Dr Thang S Han, Institute of Cardiovascular Research, Royal Holloway, University of London, Egham, Surrey, TW20 0EX, UK. Tel: 01784443807
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Abstract
Ultrasound shock wave therapy is increasingly used for non-invasive surgery. It requires the focusing of very high pressure amplitude in precisely controlled focal spots. In transcostal therapy of the heart or the liver, the high impedance mismatch between the bones and surrounding tissues gives rise to strong aberrations and attenuation of the therapeutic wavefront, with potential risks of injury at the tissue-bone interface. An adaptive propagation of the ultrasonic beam through the intercostal spaces would be required. Several solutions have been developed so far, but they require a prior knowledge of the patient's anatomy or an invasive calibration process, not applicable in clinic. Here, we develop a non-invasive adaptive focusing method for ultrasound therapy through the ribcage using a time reversal cavity (TRC) acting as an ultrasonic beam amplifier. This method is based on ribcage imaging through the TRC and a projection orthogonally to the strongest identified reflectors. The focal pressure of our device was improved by up to 30% using such self-adaptive processing, without degrading the focal spots size and shape. This improvement allowed lesion formation in an Ultracal® phantom through a ribcage without invasive calibration of the device. This adaptive method could be particularly interesting to improve the efficiency and the safety of pulsed cavitational therapy of the heart or the liver.
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Affiliation(s)
- J Robin
- Institut Langevin, ESPCI Paris, Inserm U979, CNRS UMR 7587, Université Paris Diderot, PSL Research University, Paris, France
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Abstract
Time reversal cavities (TRC) have been proposed as an efficient approach for 3D ultrasound therapy. They allow the precise spatio-temporal focusing of high-power ultrasound pulses within a large region of interest with a low number of transducers. Leaky TRCs are usually built by placing a multiple scattering medium, such as a random rod forest, in a reverberating cavity, and the final peak pressure gain of the device only depends on the temporal length of its impulse response. Such multiple scattering in a reverberating cavity is a complex phenomenon, and optimisation of the device's gain is usually a cumbersome process, mostly empirical, and requiring numerical simulations with extremely long computation times. In this paper, we present a semi-analytical model for the fast optimisation of a TRC. This model decouples ultrasound propagation in an empty cavity and multiple scattering in a multiple scattering medium. It was validated numerically and experimentally using a 2D-TRC and numerically using a 3D-TRC. Finally, the model was used to determine rapidly the optimal parameters of the 3D-TRC which had been confirmed by numerical simulations.
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Affiliation(s)
- J Robin
- Institut Langevin, ESPCI Paris, CNRS UMR 7587, INSERM U979, Université Paris Diderot, PSL Research University, Paris, France
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Robin J, Arnal B, Tanter M, Pernot M. A 3D time reversal cavity for the focusing of high-intensity ultrasound pulses over a large volume. Phys Med Biol 2017; 62:810-824. [PMID: 28072572 DOI: 10.1088/1361-6560/aa52ab] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Shock wave ultrasound therapy techniques, increasingly used for non-invasive surgery, require extremely high pressure amplitudes in precise focal spots, and large high-power transducers arranged on a spherical shell are usually used to achieve that. This solution allows limited steering of the beam around the geometrical focus of the device at the cost of a large number of transducer elements, and the treatment of large and moving organs like the heart is challenging or impossible. This paper validates numerically and experimentally the possibility of using a time reversal cavity (TRC) for the same purpose. A 128-element, 1 MHz power transducer combined with different multiple scattering media in a TRC was used. We were able to focus high-power ultrasound pulses over a large volume in a controlled manner, with a limited number of transducer elements. We reached sufficiently high pressure amplitudes to erode an Ultracal® target over a 10 cm2 area.
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Mercer SJ, Khan MA, Hillman CM, Robin J, Matthews JJ. The Maritime Medical Emergency Response Team: what do we really need? J R Nav Med Serv 2017; 103:17-20. [PMID: 30088733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Since 2006, the Defence Medical Services (DMS) pre-hospital care focus has been the Medical Emergency Response Team (MERT), which has enabled the projection of Damage Control Resuscitation (DCR) to the point of wounding as part of consultant- delivered care. Now in a period of contingency operations, the Royal Navy (RN)’s Role 2 medical capability, Role 2 Afloat (R2A) delivers DCR (including surgery) on a maritime platform. This article will focus on the development of the Maritime MERT component of R2A (termed Maritime In Transit Care (MITC) in Maritime Medical Doctrine) and will discuss the requirements based on experience of and preparation for an operation in 2016. Also discussed are the individual competencies and training required to be part of the Maritime MERT; it is hoped that this will simulate debate around this evolving team.
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Matthews JJ, Mercer SJ, Khan MA, Hillman CM, Robin J, Scott TE. Establishing and maintaining a robust Role 2 Afloat organisation within the Royal Naval Medical Services. J R Nav Med Serv 2017; 103:10-13. [PMID: 30088731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In 2009, the Royal Navy (RN) reconfigured the Role 2 maritime medical treatment capability, the Role 2 Afloat (R2A). This capability is now firmly established on a number of platforms in the fleet and was recently externally validated on RFA MOUNTS BAY prior to completion of an operational deployment supporting contingency operations in the Mediterranean. This article outlines the future challenges for R2A and offers suggestions on how to maintain a robust R2A organisation within the Royal Naval Medical Service (RNMS).
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Samoudi S, Latour D, Robin J, Sabart M, Misson B, Ait Hammou H, Mouhri K, Loudiki M. Horizontal distribution of the cell abundance and toxicity of Microcystis in a hypereutrophic Moroccan reservoir. CONTEMP PROBL ECOL+ 2016. [DOI: 10.1134/s1995425516050139] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Pozzi M, Robin J, Grinberg D, Sebbag L, Boissonnat P, Bochaton T, Sanchez I, Flamens C, Paulus S, Giraud R, Bendjelid K, Meyer P, Licker M, Banfi C, Obadia J, Kirsch M. Very-Low Threshold for Indication of Temporary RVAD Support in LVAD Recipients: Towards a Monoventricular Philosophy? A Multicentre Experience. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Valverde Perez I, Maresca D, Zuercher F, Villemain O, Gomez G, Suarez-Mejias C, Hosseinpour AR, Gonzalez-Calle A, Hazekamp M, Vazquez-Jimenez VJ, El-Rassi I, Hussain T, Gomez-Cia T, Correia M, Villemain O, Ghaleh B, Tanter M, Pernot M, Brugger N, Jahren S, De Marchi SF, Seiler C, Kwiecinski W, Bel A, Robin J, Bruneval P, Arnal B, Tanter M, Pernot M, Messas E. Young Investigator Award session – Basic Science3433D printed models for surgical planning in complex congenital heart disease344Ultrafast doppler imaging of intramyocardial coronary arteries345Quantification of mitral regurgitation with multiple jets: in vitro comparison of two-dimensional PISA techniques346Non-invasive ultrasonic chordal cutting. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Desgranges FP, Desebbe O, Ghazouani A, Gilbert K, Keller G, Chiari P, Robin J, Bastien O, Lehot JJ, Cannesson M. Influence of the site of measurement on the ability of plethysmographic variability index to predict fluid responsiveness. Br J Anaesth 2011; 107:329-35. [PMID: 21680600 DOI: 10.1093/bja/aer165] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Plethysmographic variability index (PVI) is an accurate predictor of fluid responsiveness in mechanically ventilated patients. However, the site of measurement of the plethysmographic waveform impacts its morphology and its respiratory variation. The goal of this study was to investigate the ability of PVI to predict fluid responsiveness at three sites of measurement (the forehead, ear, and finger) in mechanically ventilated patients under general anaesthesia. METHODS We studied 28 subjects after induction of general anaesthesia. Subjects were monitored with a pulmonary artery catheter and three pulse oximeter sensors (the finger, ear, and forehead). Pulse pressure variation, central venous pressure, cardiac index (CI), and PVI measured at the forehead, ear, and finger (PVI(forehead), PVI(ear), and PVI(finger)) were recorded before and after fluid loading (FL). Subjects were responders to volume expansion if CI increased >15% after FL. RESULTS Areas under the receiver-operating curves to predict fluid responsiveness were 0.906, 0.880, and 0.836 for PVI(forehead), PVI(ear), and PVI(finger), respectively (P<0.05). PVI(forehead), PVI(ear), and PVI(finger) had a threshold value to predict fluid responsiveness of 15%, 16%, and 12% with sensitivities of 89%, 74%, and 74% and specificities of 78%, 74%, and 67%, respectively. CONCLUSIONS PVI can predict fluid responsiveness in anaesthetized and ventilated subjects at all three sites of measurement. However, the threshold values for predicting fluid responsiveness differ with the site of measurement. These results support the use of this plethysmographic dynamic index in the cephalic region when the finger is inaccessible or during states of low peripheral perfusion.
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Affiliation(s)
- F-P Desgranges
- Hospices Civils de Lyon, Department of Anesthesiology and Intensive Care, Louis Pradel Hospital, Claude Bernard Lyon 1 University, INSERM ERI 22, Lyon, France
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Leoni S, Benzoni G, Blasi N, Bracco A, Brambilla S, Camera F, Corsi A, Crespi FCL, Mason P, Million B, Montanari D, Pignanelli M, Vigezzi E, Wieland O, Matsuo M, Shimizu YR, Curien D, Duchêne G, Robin J, Bednarczyk P, Castoldi M, Herskind B, Kmiecik M, Maj A, Meczynski W, Styczen J, Zieblinski M, Zuber K, Zucchiatti A. Probing the order-to-chaos region in superdeformed 151Tb and 196Pb nuclei with continuum gamma transitions. Phys Rev Lett 2008; 101:142502. [PMID: 18851522 DOI: 10.1103/physrevlett.101.142502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2008] [Indexed: 05/26/2023]
Abstract
The gamma decay associated with the warm rotation of the superdeformed nuclei 151Tb and 196Pb has been measured with the EUROBALL IV array. Several independent quantities provide a stringent test of the population and decay dynamics in the superdeformed well. A Monte Carlo simulation of the gamma decay based on microscopic calculations gives remarkable agreement with the data only assuming a large enhancement of the B(E1) strength for 1-2 MeV gamma rays, which may be related to the evidence for octupole vibrations in both mass regions.
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Affiliation(s)
- S Leoni
- Dipartimento di Fisica and INFN, Sezione di Milano,Via Celoria 16, 20133 Milano, Italy
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Abstract
There is much debate about the nature and extent of deformities in the proximal femur in children with cerebral palsy. Most authorities accept that increased femoral anteversion is common, but its incidence, severity and clinical significance are less clear. Coxa valga is more controversial and many authorities state that it is a radiological artefact rather than a true deformity. We measured femoral anteversion clinically and the neck-shaft angle radiologically in 292 children with cerebral palsy. This represented 78% of a large, population-based cohort of children with cerebral palsy which included all motor types, topographical distributions and functional levels as determined by the gross motor function classification system. The mean femoral neck anteversion was 36.5° (11° to 67.5°) and the mean neck-shaft angle 147.5° (130° to 178°). These were both increased compared with values in normally developing children. The mean femoral neck anteversion was 30.4° (11° to 50°) at gross motor function classification system level I, 35.5° (8° to 65°) at level II and then plateaued at approximately 40.0° (25° to 67.5°) at levels III, IV and V. The mean neck-shaft angle increased in a step-wise manner from 135.9° (130° to 145°) at gross motor function classification system level I to 163.0° (151° to 178°) at level V. The migration percentage increased in a similar pattern and was closely related to femoral deformity. Based on these findings we believe that displacement of the hip in patients with cerebral palsy can be explained mainly by the abnormal shape of the proximal femur, as a result of delayed walking, limited walking or inability to walk. This has clinical implications for the management of hip displacement in children with cerebral palsy.
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Affiliation(s)
| | | | | | | | - K. Smith
- Clinical Epidemiology and Biostatistics Unit, Murdoch, Children’s Research Institute, Royal Children’s Hospital, Flemington Road, Parkville, Victoria 3052, Australia
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Robin J, Alexander R. Remifentanil obtunds intraocular pressure rises associated with suxamethonium. Br J Anaesth 2008; 101:432; author reply 432-3. [DOI: 10.1093/bja/aen226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Cannesson M, Desebbe O, Rosamel P, Delannoy B, Robin J, Bastien O, Lehot JJ. Pleth variability index to monitor the respiratory variations in the pulse oximeter plethysmographic waveform amplitude and predict fluid responsiveness in the operating theatre. Br J Anaesth 2008; 101:200-6. [DOI: 10.1093/bja/aen133] [Citation(s) in RCA: 252] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Greffe G, Henaine R, Metton O, Nloga J, Wautot P, Robin J, Ninet J, Saroul C, Barthelet M, Derumeaux G, Obadia JF. Choice of echocardiography method for postoperative evaluation of mitral valve replacement with a mechanical prosthesis. Arch Cardiovasc Dis 2008; 101:204-12. [PMID: 18654094 DOI: 10.1016/s1875-2136(08)73694-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECT The French Cardiology Society (SFC) systematically recommends (Class I) transesophageal echocardiography (TEE) after any mitral valve replacement with a mechanical prosthesis (MMVR). Taking into account the increasing workload of echocardiography laboratories, our attitude was to propose that only post-operative transthoracic echocardiography (TTE) is performed. The purpose of this study was to evaluate the possible risks of this simplified procedure. METHODS We performed a precise analysis of one full year of practice of MMVR with exhaustive follow-up for the first 2 years concentrating on thromboembolic complications. RESULTS From January to December 2003, 84 MMVRs (46 after rheumatic fever, 22 degenerative disease, 11 infective endocarditis (IE) and 5 ischemia) were conducted in 45 women and 39 men of average age 61 years. Early mortality (<30 days) concerned 5 patients (5.9%). A control TTE to determine normal prosthetic function was performed 7+/-2 days after surgery and this revealed 2 cases of nonobstructive thrombosis which were treated medically, 3 cases of paraprosthetic regurgitation, and 1 vegetation due to underlying IE. Actuarial survival was 90.5% at 1 year and 83.3% at 2 years. After a mean follow-up of 179.3 patient-years, 5 patients were reoperated (5.9%): 1 for IE, 1 for paravalvular regurgitation, 1 for mitral valve insufficiency with haemolysis, and 2 for obstructive prosthetic valve thromboses. In addition there were 2 cases of prosthetic valve thrombosis, 8 ischemic strokes (2 ministrokes, 6 sequelar strokes), and 1 peripheral embolism. The global thromboembolic complication rate was therefore 6.1 per 100 patient-years (n=11). There were 4 hemorrhagic events, i.e. a rate of 2.2 events per 100 patient-years. 63% of the 1193 INR conducted were within the target range (3-4.5), 26% were below 3 and 11% were greater than 4.5. 35% of patients with thromboembolic complications had an INR<3. CONCLUSION Morbidity and mortality during the first 2 years after MMVR were relatively high but equivalent to the values of comparable series in the literature. These complications would not have been reduced by a more precise screening based on early TEE. Despite the increasingly litigious nature of the doctor-patient relationship, it would probably be excessive to oppose that this guideline was not followed in a dispute; in particular as it is difficult to apply this measure as echocardiography departments are overworked.
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Affiliation(s)
- G Greffe
- Département de chirurgie cardiaque et transplantation, Hôpital Cardiothoracique Louis-Pradel, Lyon-Bron
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Harinstein ME, Flaherty JD, Ansari AH, Robin J, Davidson CJ, Rossi JS, Flamm SL, Blei AT, Bonow RO, Abecassis M, Gheorghiade M. Predictive value of dobutamine stress echocardiography for coronary artery disease detection in liver transplant candidates. Am J Transplant 2008; 8:1523-8. [PMID: 18510630 DOI: 10.1111/j.1600-6143.2008.02276.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Patients with obstructive coronary artery disease (CAD) undergoing orthotopic liver transplantation (OLT) are at increased risk of poor outcomes. The accuracy of dobutamine stress echocardiography (DSE) to detect obstructive CAD is not well established in this population. We retrospectively identified patients with end-stage liver disease who underwent both DSE and coronary angiography as part of risk stratification prior to OLT. One hundred and five patients had both DSE and angiography, of whom 14 had known CAD and 27 failed to reach target heart rate during DSE. Among the remaining 64 patients (45 men; average age 61 +/- 8 years) DSE had a low sensitivity (13%), high specificity (85%), low positive predictive value (PPV) (22%) and intermediate negative predictive value (NPV) (75%) for obstructive CAD. DSE as a screening test for obstructive CAD in OLT candidates has a poor sensitivity. The frequent chronotropic incompetence and low sensitivity in patients who achieve target heart rate, even in those with multiple cardiovascular disease risk factors, suggest that alternative or additional methods of risk stratification are necessary.
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Affiliation(s)
- M E Harinstein
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Tronc F, Robin J, Hanss M, Ninet J. Aortic hemi-arch replacement for acute type A aortic dissection in an Abciximab-treated patient. J Cardiovasc Surg (Torino) 2007; 48:672-673. [PMID: 17989640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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Abstract
The medical admissions unit (MAU) of the Royal Free Hospital, London, should receive all acute accident and emergency (A&E) medical admissions. The unit aims to discharge 60% of patients and to transfer the remainder to a base ward within 48 hours of admission. This study tracked the patient journey from admission to A&E through the MAU during two parallel weeks, one year apart. Key bottlenecks were identified in the first audit and reforms implemented prior to the second. These reforms included improved transfer to base wards, improved weekend work patterns and improved access to investigation, specialist teams and pharmacy. The reforms served to facilitate the patient journey. A greater proportion of acute medical admissions were managed on the MAU and the number of patients exceeding a 48-hour stay fell from 55% to 10%. Both study periods demonstrated a peak in transfer activity from A&E in the 20 minutes before the four-hour target.
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Affiliation(s)
- M Epstein
- Department of Medicine, Royal Free Hospital, London
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Bluth MH, Robin J, Ruditsky M, Norowitz KB, Chice S, Pytlak E, Nowakowski M, Durkin HG, Smith-Norowitz TA. IgE anti-Borrelia burgdorferi components (p18, p31, p34, p41, p45, p60) and increased blood CD8+CD60+ T cells in children with Lyme disease. Scand J Immunol 2007; 65:376-82. [PMID: 17386029 DOI: 10.1111/j.1365-3083.2007.01904.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Immunoglobulin (Ig) E may provide immunity against Borrelia burgdorferi infection (Lyme disease) in children which lasts throughout adulthood. We investigated the presence and persistence of IgE anti-B. burgdorferi antibodies (Abs) in paediatric patients infected with Lyme disease over time. Serum immunoglobulin levels, presence of IgG and IgE anti-B. burgdorferi components, and distributions of blood T, B and natural killer lymphocyte subsets were studied in B. burgdorferi-infected and -uninfected children (nephelometry, UniCAP Total IgE Fluoroenzymeimmunoassay, Western blot, flow cytometry). Total serum IgM, IgG, IgE and IgA levels, and distributions of blood lymphocytes (CD4(+), CD8(+), CD19(+)) of both groups, excluding CD8(+)CD60(+) T cells, were within normal ranges. However, infected, but not uninfected children made IgG anti-B. burgdorferi proteins p18, p31, p34, p41, p45, but not IgG anti-p60, and IgE anti-B. burgdorferi proteins p31, p34, p41, p45, p60, but not IgE anti-p18. These proteins were also detected in an infected child 1 year post-infection. Interestingly, CD8(+)CD60(+) T-cell numbers were significantly increased (fourfold) in infected, compared with uninfected, patients (P=0.001). These results demonstrate that specific IgE anti-B. burgdorferi Abs are generated and persist in children with Lyme disease and that CD8(+)CD60(+) T cells may play an important role in these responses.
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Affiliation(s)
- M H Bluth
- Department of Surgery, S.U.N.Y. Downstate Medical Center, Brooklyn, NY, USA
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Chatelier A, McKenzie DJ, Prinet A, Galois R, Robin J, Zambonino J, Claireaux G. Associations between tissue fatty acid composition and physiological traits of performance and metabolism in the seabass (Dicentrarchus labrax). J Exp Biol 2006; 209:3429-39. [PMID: 16916978 DOI: 10.1242/jeb.02347] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
SUMMARYSeabass were fed for 4 months with diets where the lipid was provided as either canola oil (CO), palm oil (PO) or fish oil (FO), to generate diversity in their tissue fatty acid (FA) composition and investigate how this influenced major traits of exercise performance, cardiac performance and respiratory metabolism. In particular, based upon previous observations, we investigated the hypothesis that enriching the fish tissues with oleic and linoleic acids (OA, 18:1n-9 and LA, 18:2n-6, respectively) from the CO and PO diets would improve maximum exercise and cardiac performance, and increase aerobic metabolic scope. This proved to be the case; exercise respirometry on bass fitted with cardiac flow probes revealed that those fed CO and PO diets had a significantly higher critical swimming speed (Ucrit)than those fed the FO diet. The improved swimming performance in the CO and PO groups was accompanied by a higher maximum cardiac output(Q̇) and net cardiac scope, and a higher active metabolic rate (AMR) and aerobic scope (AS) than in the FO group. Analysis of tissue FA composition revealed that the fish fed the CO and PO diets had accumulated significantly higher levels of OA and LA in their heart and muscle than the fish from the FO group, which had significantly higher levels of highly unsaturated FA of the n-3 series, such as EPA and DHA(20:5n-3 and 22:6n-3, respectively). Principal components analysis revealed significant positive associations between tissue OA and LA content and Ucrit, maximum Q, the increase in Q during exercise, AMR and aerobic scope. There was a negative association between these physiological traits and tissue content of EPA. Therefore, diet composition is an environmental factor that can generate significant phenotypic diversity in major physiological traits of performance and metabolism in the seabass, with increased intake of FAs such as OA and LA leading to improved cardiorespiratory performance.
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Affiliation(s)
- A Chatelier
- CNRS-Ifremer UMR 10, Centre de Recherche sur les Ecosystèmes Marins et Aquacoles, Place du Séminaire, BP 5, 17137 L'Houmeau, France.
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Obadia JF, Hénaine R, Bergerot C, Ginon I, Nataf P, Chavanis N, Robin J, André-Fouët X, Ninet J, Raisky O. Monobloc aorto-mitral homograft or mechanical valve replacement: a new surgical option for extensive bivalvular endocarditis. J Thorac Cardiovasc Surg 2006; 131:243-5. [PMID: 16399326 DOI: 10.1016/j.jtcvs.2005.05.058] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2005] [Accepted: 05/26/2005] [Indexed: 11/22/2022]
Affiliation(s)
- J F Obadia
- INSERM, Service de Chirurgie Cardiothoracique et Transplantation, Cardiothoracic Surgery and Transplant Department, Hôpital Cardiothoracique Louis Pradel, Lyon-Bron, France.
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Morais S, Cahu C, Zambonino-Lnfante JL, Robin J, Rønnestad I, Dinis MT, Conceição LEC. Dietary TAG source and level affect performance and lipase expression in larval sea bass (Dicentrarchus labrax). Lipids 2005; 39:449-58. [PMID: 15506240 DOI: 10.1007/s11745-004-1250-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The influence of dietary TAG source (fish oil, triolein, and coconut oil) and level (7.5 and 15% of the diet) on growth, lipase activity, and mRNA level was studied in sea bass larvae, from mouth opening until day 24 and from day 37 to 52. Fish oil and triolein induced better growth in both experiments, this being significant at a higher dietary level. Coconut oil significantly decreased growth at the higher level, possibly as the result of an excessive supply of medium-chain TAG. Growth was not related to lipase specific activity, suggesting a production in excess to dietary needs. Body lipid content was positively related to dietary lipid level and was affected by lipid quality. In addition, larval FA composition generally reflected that of the diet. The source of dietary lipid, but not the quantity, was shown to affect lipase activity significantly. Coconut oil diets induced the highest lipase activity, whereas the effect of fish oil was age dependent-it was similar to coconut oil at day 24 but induced the lowest lipase activity in 52-d-old larvae. The differential lipase response was probably caused by differences in the FA composition of the diet, related to the specificity of lipase toward FA differing in chain length and degree of saturation. No significant differences were found in lipase/glyceraldehyde-3-phosphate dehydrogenase mRNA, which suggests the existence of a posttranscriptional regulation mechanism.
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Affiliation(s)
- S Morais
- Centro de Ciências do Mar (CCMAR), Universidade do Algarve, Campus de Gambelas, 8005-139 Faro, Portugal.
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24
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Robin J, Bluth M, Ruditzky M, Norowitz K, Chice S, Pytlak E, Nowakowski M, Durkin H, Smith-Norowitz T. IgE anti-Borrelia Burgdorferi components (p18, p31, p34, p41, p45, p60) and increased blood CD8+CD60+ T cells in children with lyme disease. J Allergy Clin Immunol 2005. [DOI: 10.1016/j.jaci.2004.12.1033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Obadia JF, Abdullatif Y, Henaine R, Chavanis N, Saroul C, Barthelet M, André-Fouët X, Raisky O, Robin J, Ninet J. [Replacement of the ascending aorta with conservation of the aortic valve. Results of 50 cases using the Tirone David procedure]. Arch Mal Coeur Vaiss 2004; 97:1183-7. [PMID: 15669358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Aortic valve sparing operations are now widely accepted for ascending aortic aneurysm surgery. We herein report our experience of the Tirone David procedure in larger indications. From January 1997 to August 2003, 50 Tirone David procedure have been performed on 36 male and 14 female (mean age: 60 +/- 15). Five patients presented a Marfan disease and 4 acute dissections. Grade III or IV aortic insufficiency was frequent (40%). Aortic diameter was not particularly dilated, ranging from 44 to 78 mm (mean: 57 +/- 10 mm). Mean ejection fraction: 57 +/- 10%. Mean left ventricular end diastolic diameter =63 +/- 7 mm. An associated mitral valve repair and 1 coronary bypass were necessary. Mean cross clamp and bypass times =94 min and 122 +/- 28 min respectively. There was one in-hospital mortality. Secondary mortality affected 2 patients (non-cardiac deaths), for a cumulative follow-up of 946 months. During follow-up continence control was always excellent, only 1 bicuspid valve had an aortic insufficiency >grade II. Tirone David procedure gave satisfactory results as regards both aortic ectasia and aortic regurgitation control. We consider it feasible even in case of aortic dissection but caution is required when facing bicuspid aortic valves.
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Affiliation(s)
- J F Obadia
- Hôpital cardiothoracique Louis Pradel, Lyon-Bron, France.
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26
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Tiongson J, Robin J, Ciaccio C, Quadrini M, Weinberg K, Passman R. 63 FAST VENTRICULAR TACHYCARDIA INDUCED BY PROGRAMMED ELECTRICAL STIMULATION AS A PREDICTOR OF APPROPRIATE IMPLANTABLE CARDIOVERTER DEFIBRILLATOR THERAPY. J Investig Med 2004. [DOI: 10.1136/jim-52-suppl2-63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Robin J, Weinberg K, Tiongson J, Quadrini M, Ciaccio C, Passman R. 52 IMPLANTABLE CARDIAC DEFIBRILLATORS IN RENAL DIALYSIS PATIENTS. J Investig Med 2004. [DOI: 10.1136/jim-52-suppl2-52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Robin J, Bruheim P, Nielsen ML, Noorman H, Nielsen J. Continuous cultivations of a Penicillium chrysogenum strain expressing the expandase gene from Streptomyces clavuligerus: Kinetics of adipoyl-7-aminodeacetoxycephalosporanic acid and byproduct formations. Biotechnol Bioeng 2003; 83:353-60. [PMID: 12783491 DOI: 10.1002/bit.10678] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The production kinetics of a transformed strain of Penicillium chrysogenum expressing the expandase gene from Streptomyces clavuligerus was investigated in chemostat cultivations. The recombinant strain produces adipoyl-7-aminodeacetoxycephalosporanic acid (ad-7-ADCA) as the major product; however, during the cultivations, the appearance of a major unknown and poorly secreted product was observed. Investigations using high-performance liquid chromatography (HPLC) and liquid chromatography-mass spectroscopy (LC-MS) showed that this byproduct has a six-membered dihydrothiazine ring, which is characteristic for cephalosporins. The byproduct may be formed via isopenicillin N by as-yet unknown mechanisms, but involving expandase. It is likely that the unknown compound (UC) is deacetoxycephalosporin C (DAOC). Investigation of the instability of the various beta-lactams produced showed higher instability for compounds with a five-membered thiazolidine ring than those with a six-membered dihydrothiazine ring. Furthermore, secretion of products and byproducts was shown to be quite different. The productivity was studied as a function of the dilution rate in the range 0.015 to 0.090 h(-1). The specific productivity of total beta-lactams was compared with that of the penicillin-G-producing host strain, and it was found to be lower at dilution rates of <0.06 h(-1). Quantification of the fluxes through the pathway leading to ad-7-ADCA showed a decrease in flux toward ad-7-ADCA, and an increase in flux toward UC as the dilution rate increased. Northern analysis of the biosynthetic genes showed that expression of the enzymes involved in the ad-7-ADCA pathway decreased as the dilution rate increased.
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Affiliation(s)
- J Robin
- Center for Process Biotechnology, BioCentrum-DTU, Building 223, Technical University of Denmark, DK-2800 Lyngby, Denmark
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Robin J, Lettier G, McIntyre M, Noorman H, Nielsen J. Continuous cultivations of a Penicillium chrysogenum strain expressing the expandase gene from Streptomyces clavuligerus: Growth yields and morphological characterization. Biotechnol Bioeng 2003; 83:361-8. [PMID: 12783492 DOI: 10.1002/bit.10677] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The growth stoichiometry of a Penicillium chrysogenum strain expressing the expandase gene from Streptomyces clavuligerus was determined in glucose-limited chemostat cultivations using a chemically defined medium. This strain produces adipoyl-7-aminodeacetoxycephalosporanic acid (ad-7-ADCA) when it is fed with adipic acid. The biomass yield and maintenance coefficients for the strain were similar to those found for penicillin-producing strains of Penicillium chrysogenum. The maximum specific growth rate in the chemostat was found to be 0.11 h(-1). Metabolic degradation of adipate was found to take place in significant amounts only at dilution rates below 0.03 h(-1). After three to five residence times, adipate degradation and ad-7-ADCA production disappeared, and this allowed determination of the biomass yield coefficient on adipate. The morphology was measured at different dilution rates and the mean total hyphal length and mean number of tips both increased with an increase in dilution rate from 0.015 to 0.065 h(-1). Both variables decreased when the dilution rate was increased above 0.065 h(-1). A correlation between mean total hyphal length and productivity of ad-7-ADCA was found.
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Affiliation(s)
- J Robin
- Center for Process Biotechnology, BioCentrum-DTU, Building 223, Technical University of Denmark, DK-2800 Lyngby, Denmark
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30
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Robin J, Bonneau S, Schipper D, Noorman H, Nielsen J. Influence of the adipate and dissolved oxygen concentrations on the beta-lactam production during continuous cultivations of a Penicillium chrysogenum strain expressing the expandase gene from Streptomyces clavuligerus. Metab Eng 2003; 5:42-8. [PMID: 12749843 DOI: 10.1016/s1096-7176(03)00006-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The influence of adipate concentration and dissolved oxygen on production of adipoyl-7-aminodeacetoxycephalosporanic acid (ad-7-ADCA) by a recombinant strain of Penicillium chrysogenum expressing the expandase gene from Streptomyces clavuligerus was studied in glucose-limited continuous cultures. Operating conditions were maintained constant but the adipate and dissolved oxygen concentrations (DOC) were varied separately in a range from 1 to 37.5gl(-1) and from 2% to 125% air saturation (%AS), respectively. The total beta-lactams specific productivity, r(ptotal), was not significantly changed for adipate concentrations from 5 to 25gl(-1), but the flux towards an unknown by-product decreased as the adipate concentration increased. Investigations at different DOC showed that r(ptotal) was stable around 18 micro molgDW(-1)h(-1) for DOC being in the range from 15 to 125%AS. When DOC was decreased from 15 to 7%AS, r(ptotal) increased to 25 micro molgDW(-1)h(-1), mainly due to a two-fold increase in the adipoyl-6-aminopenicillanic acid (ad-6-APA) specific productivity.
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Affiliation(s)
- J Robin
- Center for Process Biotechnology, Technical University of Denmark, BioCentrum-DTU, Building 223, Room 208, DK-2800, Lyngby, Denmark
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Boissonnat P, El Bekkali Y, Salles G, Dumortier J, Roussoulieres A, Sebbag L, Gare J, Robin J, Ninet J, Bastien O. Regression of gastric lymphoma of mucosa associated with lymphoid tissue (MALT) following cardiac transplantation. J Heart Lung Transplant 2002; 21:1044-5. [PMID: 12231377 DOI: 10.1016/s1053-2498(01)00423-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Di Filippo S, Boissonnat P, Sassolas F, Ninet J, Robin J, Champsaur G, Bozio A. Thymoglobuline as induction immunotherapy in pediatric heart transplantation. J Heart Lung Transplant 2002. [DOI: 10.1016/s1053-2498(01)00760-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Panos A, Amahzoune B, Robin J, Champsaur G, Ninet J. Influence of technique of coronary artery implantation on long-term results in composite aortic root replacement. Ann Thorac Surg 2001; 72:1497-501. [PMID: 11722032 DOI: 10.1016/s0003-4975(01)03052-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Long-term results after composite graft aortic root replacement may depend on the insertion technique. The aim of this study is to assess the influence of the technique of coronary artery implantation on long-term results in composite aortic root replacement. METHODS One hundred fifty consecutive patients (mean age, 55 years; 119 men) with different disorders of the ascending aorta who underwent aortic root replacement with a composite graft prosthesis between January 1985 and December 1999 were retrospectively studied. Thirteen patients had previously undergone cardiovascular surgery. The open button technique was performed in 65 patients (43.3%, group 1) and the inclusion technique in 85 patients (56.7%, group 2). Mean follow-up was 70.5 months. Surgery was elective in 110 procedures (73%). RESULTS Global actuarial survival was 76.1% +/- 4.3% for group 1 and 73.7% +/- 3.9% for group 2 at 10 years (p = 0.22). Freedom from reoperation excluding early deaths was 81% +/- 3% for group 1 and 86% +/- 2.2% for group 2 at 10 years (p = 0.62). Group 2 demonstrated a statistically significantly higher occurrence of pseudoaneurysm formation versus group 1 (p = 0.04). CONCLUSIONS Composite graft aortic root replacement is a safe and effective therapy for proximal aortic aneurysm and dissection, resulting in good early and long-term results irrespective of the anastomotic technique. However, the open button technique seems to avoid late false aneurysm formation at the anastomotic sites.
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Affiliation(s)
- A Panos
- Clinic for Cardiovascular Surgery C, Hôpital Cardiologique Louis Pradel, Université Claude Bernard, Lyon, France
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34
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Robin J, Jakobsen M, Beyer M, Noorman H, Nielsen J. Physiological characterisation of Penicillium chrysogenum strains expressing the expandase gene from Streptomyces clavuligerus during batch cultivations. Growth and adipoyl-7-aminodeacetoxycephalosporanic acid production. Appl Microbiol Biotechnol 2001; 57:357-62. [PMID: 11759685 DOI: 10.1007/s002530100787] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The production of adipoyl-7-aminodeacetoxy-cephalosporanic acid (ad-7-ADCA) was studied, using two recombinant strains of Penicillium chrysogenum carrying the expandase gene from Streptomyces clavuligerus. The adipoyl-side chain of this compound may easily be removed using an amidase; and this process therefore represents a new route for the production of 7-ADCA, which serves as a precursor for the production of many semi-synthetic cephalosporins. In this study, one low- and one high-yielding strains were characterised and the specific productivities of ad-7-ADCA and byproducts of the biosynthetic pathway were compared. The fluxes through the biosynthetic pathway were quantified and it was found that there was a 30% higher flux through the expandase in the high-yielding strain. In both strains, there was a significant degradation of adipate. Furthermore, the initial adipate concentration in batch cultures was shown to have a positive effect on the formation of ad-7-ADCA.
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Affiliation(s)
- J Robin
- Centre for Process Biotechnology, Biocentrum-DTU, Technical University of Denmark, Lyngby
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35
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Robin J, Bompard D, Tronc F, Beaune J, Wahid F, Champsaur G. Bilateral internal thoracic artery harvesting under robotic video-assistance. Surg Endosc 2001; 15:755-6. [PMID: 11591984 DOI: 10.1007/s004640010044] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/1999] [Accepted: 06/08/1999] [Indexed: 10/28/2022]
Abstract
BACKGROUND Following upon the recent development of minimally invasive coronary robotic surgery, we set out to evaluate the feasibility of bilateral internal mammary artery (IMA) harvesting using the voice-controlled AESOP 2000 video assisted robot. METHODS The robot is placed on the right side of the patient. The left IMA is first totally video-harvested, with the arm of the robot crossing over the patient to reach the left chest. The voice-controlled movement of the arm allows the surgeon to obtain the best video image of the artery. After completion of the dissection, the arm is positioned on the right part of the chest. The right IMA is then harvested using the same technique. RESULTS Two patients underwent harvest of a bilateral IMA using this technique. The time of dissection was 52 min and 86 min, respectively. CONCLUSION This technique allows a more precise, faster, tremor-free dissection, as compared to a conventional thoracoscopic harvesting.
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Affiliation(s)
- J Robin
- Department of Cardiovascular Surgery, Hôpital Cardiologique and Claude Bernard University, 59 Boulevard Pinel, 69003 Lyon, France.
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Ginon I, Mestrallet C, Barthelet M, Robin J, André-Fouët X. A closed interatrial septum aneurysm, filled with blood, mimicking a tumour in the right atrium. Eur J Echocardiogr 2000; 1:289-90. [PMID: 11916608 DOI: 10.1053/euje.2000.0046] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We report the case of a 70-year-old woman with rheumatic mitral stenosis and a transient ischaemic attack. Transoesophageal echocardiography revealed a cystic mass in the right atrium, hanging to the interatrial septum by a pedicle, not circulating. The mass was heterogeneous and suggested a tumour (myxoma) or a thrombus. Surgical resection showed it was an interatrial septal aneurysm, closed on itself, filled with blood. The usual causes of cardiac tumours and pathogeny of large interatrial aneurysms are discussed.
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Affiliation(s)
- I Ginon
- Service de Cardiologie, Hôpital Cardio-Vasculaire Louis Pradel, BP Lyon-Montchat, 69394 Lyon Cedex 3, France
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Vedrinne C, Tronc F, Martinot S, Robin J, Allevard AM, Vincent M, Lehot JJ, Franck M, Champsaur G. Better preservation of endothelial function and decreased activation of the fetal renin-angiotensin pathway with the use of pulsatile flow during experimental fetal bypass. J Thorac Cardiovasc Surg 2000; 120:770-7. [PMID: 11003761 DOI: 10.1067/mtc.2000.108902] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Pulsatile flow was shown to overcome the progressive rise in peripheral and placental vascular resistances observed during steady-flow bypass, this rise being counteracted by inhibition of nitric oxide synthase. This study quantifies the release of endothelial vasoactive substances during a 60-minute in utero model of fetal bypass. METHODS Fetuses were randomly allocated into 1 of 2 groups (steady flow, n = 8, or pulsatile flow, n = 13) and subjected to bypass through central cannulation and perfusion with either a centrifugal or pulsatile (125 beats x min(-1)) blood pump. RESULTS Lactate concentration was high, starting at fetal exteriorization and increasing during fetal preparation in the 2 groups. Once bypass was established, the rise was significant only in the steady-flow group. Plasma nitric oxide metabolites, similar before bypass, reached higher levels during pulsatile flow at the end of bypass (99+/-9 vs. 82+/-23 micromol x L(-1); P =.037). Levels of urinary nitric oxide metabolites were significantly higher in the pulsatile-flow than in the steady-flow group (764+/-143 vs. 508+/-240 micromol x L(-1); P =.005). Plasma cyclic guanosine monophosphate levels increased after 30 minutes of bypass in the pulsatile-flow group (25+/-18 vs. 12+/-8 pmol x mL(-1); P =.004), and urinary cyclic guanosine monophosphate excretion was higher in the pulsatile-flow group (517+/-450 vs. 118+/-78 pmol x mL(-1); P =.024). Plasma endothelin-1 levels increased in the 2 groups and were higher in the steady-flow group at 30 minutes (27+/-5 vs. 23+/-2 pg x mL(-1); P =.04) and 60 minutes of bypass (39+/-7 vs 32 +/- 6 pg x mL(-1); P =.04). Plasma renin concentration increased significantly during bypass only in the steady-flow group (26+/-10 vs. 57+/-42 in ng A1 x mL(-1) x h(-1); P =.04). CONCLUSIONS Improved placental and peripheral perfusion during fetal pulsatile-flow bypass may be mediated by preservation of fetal/maternal endothelial nitric oxide biosynthetic mechanisms and/or decreased activation of the fetal renin-angiotensin pathway.
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Affiliation(s)
- C Vedrinne
- Department of Anesthesia and Intensive Care Medicine in Cardiovascular Surgery, Louis Pradel Cardiologic Hospital, Lyon, France.
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Abstract
A patient presenting with a pacemaker lead infection and tricuspid regurgitation underwent a minimally invasive video-assisted tricuspid valve replacement. The valve was approached through a right anterior mini thoracotomy. Under thoracoscopic vision and peripheral cardiopulmonary bypass, a catheter was placed on the ascending aorta for antegrade cardioplegia delivery. A transthoracic aortic cross-clamp was introduced through the third right intercostal space. Tricuspid valve replacement added to the pacemaker leads ablation was exclusively performed under thoracoscopic vision, providing an excellent video-image in this reduced operative field. After 22 months of follow up, the patient is asymptomatic, the echocardiography showing a normally functioning valve.
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Affiliation(s)
- J Robin
- Department of Cardiovascular Surgery, Hôpital Cardiologique, Lyon, France.
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Affiliation(s)
- P Yiu
- Cardiothoracic Surgical Unit and Departments of Intensive Care and Clinical Pharmacology, University College and Middlesex Hospitals, London, United Kingdom
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41
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Champsaur G, Robin J, Curtil A, Tronc F, Vedrinne C, Sassolas F, Bozio A, Ninet J. Long-term clinical and hemodynamic evaluation of porcine valved conduits implanted from the right ventricle to the pulmonary artery. J Thorac Cardiovasc Surg 1998; 116:793-804. [PMID: 9806386 DOI: 10.1016/s0022-5223(98)00443-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This retrospective study was initiated to evaluate the long-term results of valved prosthetic conduits implanted in the right ventricular outflow tract in patients with complex ventricular-pulmonary discontinuity. METHODS A cohort of 103 patients out of 127 (24 early deaths, 19%) operated on between 1973 and 1996 with porcine valved conduits was available for evaluation, with a follow-up ranging from 1 to 21.6 years (mean follow-up 8.4 +/- 6 years). A total of 74 hemodynamic studies were performed after the operation, 50 patients having undergone at least 1 cardiac catheterization during the follow-up period. RESULTS There were 16 late deaths, and the actuarial survivals, including early mortality, were 72.9% +/- 4% at 5 years, 63.1% +/- 5% at 10 years, and 58.2% +/- 5% at 15 years, at which time 20 patients were still available for review and exposed to the risk of dying. The mean peak systolic gradient across the right ventricular outflow tract was plotted as a function of time, showing a gradual increase and a significant step-up after the eighth year, from 43 +/- 36 to 69 +/- 19 mm Hg (P < .005). Reoperation was required for progressive conduit obstruction between 1.1 and 17.7 years after implantation (mean 7.4 +/- 4.8 years) in 25 patients (24%, 70% CL 15%-33%), with generally very few symptoms, or for residual ventricular septal defect in 3 patients. Freedom from reoperation was 79.5% +/- 5% at 10 years and 65.8% +/- 7% at 15 years. CONCLUSIONS Porcine conduits may represent a valuable alternative to biologic substitutes with similar long-term results. Given the few symptoms, progressive conduit stenosis after the eighth postoperative year imposes a yearly noninvasive patient evaluation during the follow-up.
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Affiliation(s)
- G Champsaur
- Department of Cardiovascular Surgery, Hôpital Cardiologique Louis Pradel, and Claude Bernard University, Lyon, France
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Vedrinne C, Tronc F, Martinot S, Robin J, Garhib C, Ninet J, Lehot JJ, Franck M, Champsaur G. Effects of various flow types on maternal hemodynamics during fetal bypass: is there nitric oxide release during pulsatile perfusion? J Thorac Cardiovasc Surg 1998; 116:432-9. [PMID: 9731785 DOI: 10.1016/s0022-5223(98)70009-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE This study investigates the role of various flow conditions on maternal hemodynamics during fetal cardiopulmonary bypass. METHODS Normothermic fetal bypass was conducted under pulsatile, or steady flow, for a 60-minute period. Fetal lamb preparations were randomly assigned to 1 of the 3 groups: steady flow (n=7), pulsatile flow (n=7), or pulsatile blocked flow bypass (n=7), where fetuses were perfused with Nomega-nitro-L-arginine after the first 30 minutes of pulsatile flow to assess the potential role of endothelial autacoids. RESULTS Maternal oximetry and pressures remained unchanged throughout the procedure. Under fetal pulsatile flow, maternal cardiac output increased after 20 minutes of bypass and remained significantly higher than under steady flow at minute 30 (8.8+/-0.7 L x min(-1) vs 5.9+/-0.5 L x min(-1), P=.02). Maternal cardiac output in the pulsatile group also remained higher than in both steady and pulsatile blocked flow groups, reaching respectively 8.7+/-0.9 L x min(-1) vs 5.8+/-0.4 L x min(-1) (P=.02) and 5.9+/-0.3 L min(-1) (P=.01) at minute 60. Maternal systemic vascular resistances were significantly lower under pulsatile than under steady flow after 30 minutes and until the end of bypass (respectively, 9.1+/-0.6 IU vs 12.7+/-1.1 IU, P=.02 and 8.9+/-0.5 IU vs 12.9+/-1.2 IU, P=.01). Infusion of Nomega-nitro-L-arginine was followed by an increase in systemic vascular resistances from 9.3+/-0.7 IU, similar to that of the pulsatile group, to 13.5+/-1 IU at 60 minutes, similar to that of the steady flow group. CONCLUSIONS Maternal hemodynamic changes observed under fetal pulsatile flow are counteracted after infusion of Nomega-nitro-L-arginine, suggesting nitric oxide release from the fetoplacental unit under pulsatile fetal flow conditions.
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Affiliation(s)
- C Vedrinne
- Department of Anesthesia and Intensive Care Medicine in Cardiovascular Surgery, Louis Pradel Cardiologic Hospital, Lyon, France
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Bonnefoy E, Filley S, Kirkorian G, Guidollet J, Roriz R, Robin J, Touboul P. Troponin I, troponin T, or creatine kinase-MB to detect perioperative myocardial damage after coronary artery bypass surgery. Chest 1998; 114:482-6. [PMID: 9726734 DOI: 10.1378/chest.114.2.482] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES To compare cardiac troponin I (cTnI), cardiac troponin T (cTnT), and creatine kinase MB (CKMB mass) in patients with and without new Q wave on the ECG following coronary artery bypass graft (CABG) surgery. PATIENTS After ethic committee's approval and informed consent, 82 patients, mean age 63+/-10 years, scheduled for CABG were included. INTERVENTIONS Arterial blood samples were drawn during cardiopulmonary bypass, before, and 6, 12, 24, and 48 h after aortic cross-clamp release. cTnI, cTnT, and CKMB mass were measured. The appearance of new Q wave on the ECG performed preoperatively and 24 h postoperatively was used to assess myocardial lesion independently of biological markers. RESULTS There were 69 patients without new Q wave on the ECG (group 1) and 13 with (group 2). In group 1, cTnI reached a peak of 2.1 microg/L (median, interquartile range [IQ]=2.4) at 12 h, cTnT increased progressively with a peak of 0.22 microg/L (IQ=0.2) at 48 h, and CKMB presented an earlier peak of 10 microg/L (IQ=6.2) at 6 h. Starting with the same median value, group 2 patients presented significantly higher peaks: cTnI: 17 microg/L (IQ=16) at 12 h; cTnT: 1.4 microg/L (IQ=2.3) at 12 h; and CKMB mass: 74 microg/L (IQ=61) at 6 h. Receiver operating characteristic (ROC) curves were constructed. The area under the curve was 0.90 for cTnI, 0.84 for CKMB, and 0.81 for cTnT (not significant). The best cutoff values to discriminate between group 1 and group 2 patients were determined with the ROC curves: cTnI=5 microg/L; CKMB mass=20 microg/L; cTnT=0.3 microg/L. Sensitivity, specificity, and positive and negative values for cTnI (5 microg/L) were 91%, 82%, 53%, and 98%, respectively. CONCLUSIONS There was little differences among cTnI, cTnT, and CKMB after CABG to diagnose myocardial damage as assessed by new Q wave on the ECG. There was a trend of cTnI to be a better discriminator than cTnT, but it did not reach statistical significance.
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Affiliation(s)
- E Bonnefoy
- Intensive Care Unit, Hopital Cardiovasculaire et Pneumologique Louis Pradel, Lyon, France
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Vedrinne JM, Curtil A, Martinot S, Vedrinne C, Robin J, Franck M, Champsaur G. The hemodynamic effects of hypoxemia in anesthetized pigs: a comparison between right heart catheter and echocardiography. Anesth Analg 1998; 87:21-6. [PMID: 9661539 DOI: 10.1097/00000539-199807000-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED During hypoxemia, hypoxic pulmonary vasoconstriction and tachycardia are often observed in association with increases in pulmonary artery pressure and cardiac output. Nevertheless, the hemodynamic consequences of hypoxemia have never been evaluated by echocardiography and simultaneously compared with invasive hemodynamic variables. Fourteen open-chest, anesthetized piglets (weight 29-36 kg) were submitted to progressive hypoxemia and reoxygenation. Usual invasive hemodynamic variables were obtained from peripheral and central heart catheters. Direct epicardial echocardiography was used to measure right and left ventricular areas on a short-axis view at mid-papillary level. The mean pulmonary artery pressure (MPAP) increased with pulmonary vascular resistance in a dose-related manner as the fraction of inspired oxygen (FIO2) declined from 0.5 to 0.12. The MPAP correlated with right ventricular end-diastolic area (RVEDA) only at FIO2 0.08. There was a 49% reduction in left ventricular end systolic wall stress (LVESWS) between FIO2 0.5 and 0.08. Left ventricular ejection fraction area (LVEFA) increased by 33% above baseline and correlated with the decrease in LVESWS. No correlation was observed between left ventricular end-diastolic area and pulmonary artery occlusion pressure or left atrial pressure and between cardiac output and LVEFA. Systemic vascular resistance underestimates the magnitude of changes in LVESWS but overestimates the afterload compared with LVESWS. This study demonstrates that, for the lowest FIO2 (0.08), changes in MPAP correlated with changes in RVEDA but not in pulmonary vascular resistance. Moreover, LVESWS decreases significantly in a dose-related manner under progressive hypoxemia and normalizes immediately after reoxygenation. This study also shows that, under hypoxemic conditions, echocardiography enhances understanding of hemodynamic changes compared with right heart catheterization alone. IMPLICATIONS Acute hypoxemia in pigs is responsible for pulmonary vasoconstriction-induced pulmonary hypertension (which is restricted by the right ventricular failure), as well as a PaO2-dependent decrease in left ventricular afterload. These changes are better displayed by echocardiography than by right heart catheter.
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Affiliation(s)
- J M Vedrinne
- Department of Anesthesiology, Hôpital Edouard Herriot, Lyon, France
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Robin J, Martinot S, Curtil A, Vedrinne C, Tronc F, Franck M, Champsaur G. Experimental right ventricle to pulmonary artery discontinuity: outcome of polyurethane valved conduits. J Thorac Cardiovasc Surg 1998; 115:898-903. [PMID: 9576227 DOI: 10.1016/s0022-5223(98)70372-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The ideal substitute for the treatment of ventricle-pulmonary artery discontinuity remains a topic of controversy, because of calcifications and degeneration of biologic substitutes leading to subsequent reoperations. Because polyurethane valves used in ventricular assist devices show a satisfactory biocompatibility, the aim of this study was to evaluate a valved conduit composed of a Dacron graft incorporating a trileaflet 25 mm polyurethane valve. METHODS The conduit was implanted between the right ventricle and the main pulmonary artery in adult sheep, with ligation of the proximal pulmonary artery. The animals received no medications. Serial hemodynamic data were collected at the time of implantation and at postoperative intervals of 6 and 12 months. RESULTS The peak pressure gradient across the valve increased significantly between implantation (0.17 +/- 5.6 mm Hg) and 6 months after operation (7.3 +/- 3 mm Hg, p = 0.0007) and remained stable thereafter (6.7 +/- 3 mm Hg at 12 months), whereas the cardiac output remained unchanged (4.6 +/- 0.6 L/min at implantation, 4 +/- 0.6 L/min at 6 months, and 3.9 +/- 1.1 L/min at 12 months). At the completion of the study, valve samples were processed and vapor coated with carbon for microscopic examination. There was one instance of nonadherent thrombus formation inside a cusp but no structural failures. The other valves were free of calcium deposits and no significant amounts of phosphorus could be detected by scanning electron microscopy and energy dispersive spectrometry. CONCLUSIONS These data demonstrate the good hemodynamic performance, low thrombogenicity, and acceptable durability of the polyurethane valves implanted in the right side of the heart in a chronic sheep model.
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Affiliation(s)
- J Robin
- Claude Bernard University and Hôpital Cardiologique, Lyon, France
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Ninet J, Tronc F, Robin J, Curtil A, Aleksic I, Champsaur G. Mechanical versus biological isolated aortic valvular replacement after the age of 70: equivalent long-term results. Eur J Cardiothorac Surg 1998; 13:84-9. [PMID: 9504735 DOI: 10.1016/s1010-7940(97)00306-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE In order to evaluate the long-term outcome of valvular substitutes in the elderly, we retrospectively analyzed two comparative groups of patients consecutively operated on by the same team for an isolated valvular aortic replacement using either a mechanical or a pericardial prosthesis. METHODS From 1982 to 1996, 206 patients over 70 years (mean 76.5+/-4.4) underwent an isolated aortic valvular replacement using either a St. Jude Medical (Group I, n = 93) or a Mitroflow (Group II, n= 113) prosthesis depending on the surgeon's preference at the time of surgery. Both groups matched for the following pre-operative variables: sex ratio, type of aortic valve disease, NYHA status, cardiac rhythm, mean pulmonary arterial pressure, left ventricular end-diastolic pressure, LV-AO gradient, cardiac index and ejection fraction. RESULTS Given an early mortality rate of 6.4% in Group I and 4.4% in Group II (NS), follow-up (mean 4.4+/-3.7 years in Group I and 5.3+/-3.1 years in Group II) was 100% complete. Actuarial survival was 69.9+/-6 and 70.2+/-4.6% at 5 years for Group I and Group II, respectively, and 49.6+/-7.7 vs. 51.4+/-6.3% at 10 years (NS). Freedom from valve-related death was 86.5+/-4.8% in Group I vs. 82.7+/-4% in Group II at 5 years (NS) and 66.7+/-8.7 vs. 66.3+/-7% at 10 years (NS). There were no anticoagulant-related deaths or severe accidents in Group 1. A secondary valvular replacement was necessary in 4 patients in Group II vs. none in Group I. CONCLUSION The study shows a similar late survival in both groups, with a strikingly low incidence of anticoagulant-related deaths in this population. Given a higher rate of reoperation after biological valve replacement, the use of mechanical valve in this aging population seems to be a valid option.
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Affiliation(s)
- J Ninet
- Service de Chirurgie thoracique et cardiovasculaire C, Hôpital Cardiovasculaire Louis Pradel, Lyon-Monchat, Lyon, France
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Tronc F, Curtil A, Robin J, Ninet J, Champsaur G. [Coarctation of the aorta and its surgical treatment]. Arch Mal Coeur Vaiss 1997; 90:1729-36. [PMID: 9587458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Coarctation or isthmic stenosis of the aorta is defined as an abnormal obstruction situated at the junction of the aortic arch and the descending aorta near the site of ligamentus arteriosus. It is a common malformation representing 5 to 7.5% of all congenital heart diseases. Coarctation of the aorta is 2 to 3 times commoner in boys than in girls. Two clinical forms may be distinguished: asymptomatic isolated coarctation of childhood, the surgical treatment of which was first performed by Crafoord in 1944, and coarctation of the neonate and infant associated in over 2/3 of cases with other cardiovascular malformations, especially tubular hypoplasia of the aortic arch. The surgical correction of isolated coarctation is best performed between 6 months and 1 year of age in other to limit the incidence of residual hypertension. A modified Crafoord technique decreases the risk of restenosis and enables treatment of associated hypoplasia of the aortic arch in the same surgical procedure.
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Affiliation(s)
- F Tronc
- Service de chirurgie cardiovasculaire et thoracique C, hôpital cardiovasculaire et pneumologique, Lyon-Montchat
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Champsaur G, Vedrinne C, Martinot S, Tronc F, Robin J, Ninet J, Franck M. Flow-induced release of endothelium-derived relaxing factor during pulsatile bypass: experimental study in the fetal lamb. J Thorac Cardiovasc Surg 1997; 114:738-44; discussion 744-5. [PMID: 9375603 DOI: 10.1016/s0022-5223(97)70077-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study was initiated to test the hypothesis that fetal hemodynamic changes observed under pulsatile flow bypass might be related to the release of endothelium-derived relaxing factor through oscillating shear stress. METHODS Normothermic bypass was instituted in utero in 21 preterm fetal lambs for a 1-hour period through the right atrium and main pulmonary artery. Ultrasonic flowmeters were positioned around the descending aorta and the umbilical artery. The circuit consisted of an oxygenator and a pump set to either continuous flow (n = 7) or pulsatile flow (n = 7) and adjusted to maintain a fetal main arterial pressure of 50 mm Hg. In seven other animals, endothelium-derived relaxing factor was blocked by a continuous infusion of N omega-nitro-L-arginine after 30 minutes of pulsatile flow. RESULTS During the first 30 minutes of bypass, pump flows were significantly lower in the continuous-flow group than in the pulsatile-flow or blocked-flow groups (respectively, 612 +/- 144, 907 +/- 153 and 987 +/- 228 ml/min), with similar changes in aortic and umbilical flows. Systemic vascular resistances were significantly lower in the pulsatile-flow and blocked-flow groups than in the continuous-flow group (550 +/- 106 vs 821 +/- 212 dynes/sec/cm-5). However, after blockade of endothelium-derived relaxing factor, resistances increased gradually in the blocked-flow group to reach the level of that of the continuous-flow group at the end of bypass (943 +/- 77 vs 556 +/- 143 dynes/sec/cm-5 in the pulsatile-flow group). CONCLUSIONS Blockade of endothelium-derived relaxing factor after 30 minutes of pulsatile flow returns fetal hemodynamics to continuous flow conditions. The specific inhibitor of endothelium-derived relaxing factor used in this experiment suggests that nitric oxide may be released by fetal endothelium during pulsatile bypass.
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Affiliation(s)
- G Champsaur
- Department of Cardiovascular Surgery, Hôpital Cardiologique, Lyon, France
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Robin J, Tronc F, Curtil A, Vedrinne C, Finet G, Champsaur G. Extravascular aortic clamping for minimally invasive coronary artery bypass surgery. J Thorac Cardiovasc Surg 1997; 114:868-9. [PMID: 9375626 DOI: 10.1016/s0022-5223(97)70101-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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