Vascular complications after liver transplantation are relatively rare. Thrombosis of the host-tr... more Vascular complications after liver transplantation are relatively rare. Thrombosis of the host-transplant arterial anastomosis is the most frequently encountered vascular complication whereas only a few observations of infected anastomotic aneurysms, often leading to death by massive bleeding or loss of the transplant, have been reported. We report herein the case of a patient with an infected false anastomotic aneurysm of the hepatic artery associated with dissection of the celiac artery following orthotopic liver transplantation in a 35-year-old man who had received a liver transplantation for end-stage liver disease secondary to posthepatitis cirrhosis in March 1989. Starting at day 30, he had signs of infection associated with hemocultures positive for Staphylococcus aureus. A subhepatic collection was found on sonography and CT scan and also cultured positive for the same germ. Arteriograms demonstrated a celiac artery dissection associated with a false anastomotic aneurysm of the hepatic artery. Surgical treatment consisted of arterial reconstruction using a saphenous vein graft between the right renal artery and the hepatic artery of the transplant, followed by resection of the hepatic artery aneurysm and the celiac artery. Hepatic ischemia was 12 min. The immediate postoperative course was uneventful and postoperative angiograms showed that the reconstruction was patent at 5 years.
Critical ischemia is defined by continuous pain, impending sleep, with ankle pressure less than 5... more Critical ischemia is defined by continuous pain, impending sleep, with ankle pressure less than 50mm Hg, and/or first toe pressure less than 30 mm Hg (Dormandy et Rutherford, 2000; Norgren et al., 2007). Treatment of patients aged over 80 requires specific knowledge of arteriopathy at this age and an evaluation of co-morbidity factors (diabetes mellitus, renal failure, ischemic cardiopathy). Assessment should include: the degree of ischemia, the extension of arterial disease, the co-morbidity factors, and the diffusion of the atherosclerotic disease. A transatlantic consensus conference has enabled a classification of arterial lesions determining therapeutic indications. Aorto-iliac lesions may be treated by surgery or angioplasty. Femoro-popliteal or crural lesions may be treated by surgery or angioplasty. Type C or D lesions should be treated by femoro-popliteal or crural bypass. Bypass to the ankle or foot are done on high peripheral resistances. These bypasses require a venous g...
We report the case of a 38-year old man who developed erythroderma during treatment with teicopla... more We report the case of a 38-year old man who developed erythroderma during treatment with teicoplanin for staphylococcal septicaemia. The clinical symptoms, which included high fever, shock and erythroderma, were suggestive of staphylococcal toxic shock. After teicoplanin was withdrawn and replaced by vancomycin the disease followed a favourable course. The reintroduction test was positive. This case illustrates the problems associated with the diagnosis of erythroderma in intensive care patients and confirms that it is possible to prescribe vancomycin in cases with allergic reaction to teicoplanin.
In 45 young dogs an enlargement angioplasty of the left pulmonary artery was performed using patc... more In 45 young dogs an enlargement angioplasty of the left pulmonary artery was performed using patches made from one of three autologous materials (jugular vein, unmodified pericardium, and glycerolized pericardium) or from two heterologous materials (lyophilized human dura mater and modified bovine carotid artery). Catheterization and angiographic studies performed 5 to 6 months after the operation showed that all patched vessels had remained patent, except in three dogs which had received heterologous implants. The animals were killed 5-24 months after operation (mean weight increase: 84%), and the implants were studied by optical microscopy and morphometry, scanning and transmission electron microscopy, and indirect immunofluorescence with antidog Factor VIII rabbit antiserum. The two heterologous tissues exhibited limited biocompatibility, as estimated from 10 criteria obtained at histologic studies. Conversely, all three autologous biomaterials were characterized by infiltration of noninflammatory cells, near-complete endothelialization, and neosynthesis of structural proteins; infectious foci were very rare or absent. These results suggest that autologous tissues, although deendothelialized at the time of implantation, constitute the most suitable material for patch angioplasty, as far as endothelial triggering, cellularity and resistance to infection are concerned.
The bronchodilator properties of RU 42173, a new beta-adrenergic stimulant with an original struc... more The bronchodilator properties of RU 42173, a new beta-adrenergic stimulant with an original structure, as a cyclic analogue of an arylethanolamine, have been evaluated on different in vitro and in vivo models and compared with those of salbutamol and isoprenaline. RU 42173 equipotently inhibited histamine-, acetylcholine-, and KCl-induced contractions in isolated guinea pig trachea or small bronchus and in isolated human bronchus. When administered to guinea pigs by the IV or aerosol route, RU 42173 dose-dependently inhibited bronchospasm induced by histamine, acetylcholine, and methacholine. It also inhibited PAF-induced bronchoconstriction and PAF-induced hyperreactivity to histamine. Moreover, RU 42173 had a rapid onset and prolonged duration of action. The potency of RU 42173 was similar to that of salbutamol.
... JR BOISSIER *, JF GIUDICELLI, J. FICHELLE, H. SCHMITT and Mme H. SCHMITT Chaires de Pharrrnac... more ... JR BOISSIER *, JF GIUDICELLI, J. FICHELLE, H. SCHMITT and Mme H. SCHMITT Chaires de Pharrrnacologie, Facult~ de M~decine de Paris, 15, rue de l'Ecole de MOdecine, 75, Paris (6), France Accepted 15 January 1968 JR BOISSIER, JFGIUDICELLI, J. FICHELLE, H ...
Hand-assisted laparoscopic donor nephrectomy (HLDN) may have advantages over laparoscopic donor n... more Hand-assisted laparoscopic donor nephrectomy (HLDN) may have advantages over laparoscopic donor nephrectomy, such as shorter learning curve, operation and warm ischaemia times. The aim of this study was to evaluate the feasibility and safety of HLDN. Between January 2000 and October 2002, 50 consecutive HLDN procedures were performed through a low transverse abdominal incision, 23 right sided and 27 left sided. The median age of the donors was 44 years. No HLDN required conversion to an open procedure. The median operating time for HLDN was 153 min. The median warm ischaemia time was 3 (range 1.0-4.5) min and the median blood loss was 50 (range 20-500) ml in both left- and right-sided procedures. Eight patients suffered ten minor complications during their admission. The duration of hospital stay was 5 days for donors. Three recipients developed graft failure owing to acute rejection, renal vein thrombosis and ischaemic necrosis. Both left- and right-sided HLDN procedures were feasible and safe through a low transverse abdominal incision.
Femoro-distal bypasses are not always feasible or indicated in patients presenting with &quot... more Femoro-distal bypasses are not always feasible or indicated in patients presenting with "critical" chronic ischemia. The results of nutrient flaps carried out over a 2-year period are analyzed. 12 patients had extensive gangrene compromising limb salvage (heel, dorsal or lateral aspect of foot or ankle at high risk of tendon or joint sepsis). Coverage of tissue loss was provided by a latissimus dorsi flap in 8 patients, a radial artery free flap in 1 patient, a supra-malleolar flap in 3 patients. The hospital mortality rate was 8.3%. The cumulative patency and limb salvage rates are respectively 58% and 67% at 6 months, 44% and 67% at 12 months. The challenge of inframalleolar reconstruction in patients presenting with critical ischemia is not always amenable to surgical revascularization to the foot, due to the lack of a suitable artery for bypass implantation or due to the lack of run-off, when arteriosclerosis of the plantar arch, or when distal embolisms are present. Some patients present with extensive gangrene, and in most of cases infection of the foot, and carry a high risk of arthritis: they are not likely to heal properly if surgical bypass alone to a foot artery is done. Bypass surgery is not indicated in diabetic patients with extensive foot infection, in whom no significant macroangiopathy is present. These 3 situations are a good indication for flaps, in order to cover the tissue loss, to fight the infection, and to provide a vascular supply to the foot. When conventional therapies cannot face critical ischemia, nutrient flaps can provide a fair limb salvage rate.
Femoro-tibial bypasses are not always feasible in patients presenting with "critical&... more Femoro-tibial bypasses are not always feasible in patients presenting with "critical" chronic ischemia. The results of endovascular therapies carried out over a 2-year period are analyzed. Twenty-three patients with critical ischemia (rest pain 13%, gangrene 87%) had 25 procedures on 29 leg arteries: percutaneous transluminal angioplasty in 17 arteries, rotational atherectomy in 10 arteries, laser recanalization (1 artery), directional atherectomy (1 artery). The hospital mortality rate was 4.3%. The cumulative patency and limb salvage rates were respectively 51% and 77% at 6 months, 34% and 71% at 12 months. Candidates for tibial-peroneal endovascular techniques should have a threatened limb, as long as the consequences of failed procedures on patients presenting with claudication can be disastrous, and as long as mid-term patency rates reported in the literature are not fair enough. In localized stenosis or short occlusions with adequate runoff, endovascular techniques are a good alternative to femorotibial bypasses for limb salvage. In diffuse lesions with no possibility of bypass, endovascular techniques can facilitate limb salvage, even if the mid-term arterial patency rate is poor. When conventional therapies cannot face critical ischemia, endovascular therapies can provide a fair limb salvage rate.
Vascular complications after liver transplantation are relatively rare. Thrombosis of the host-tr... more Vascular complications after liver transplantation are relatively rare. Thrombosis of the host-transplant arterial anastomosis is the most frequently encountered vascular complication whereas only a few observations of infected anastomotic aneurysms, often leading to death by massive bleeding or loss of the transplant, have been reported. We report herein the case of a patient with an infected false anastomotic aneurysm of the hepatic artery associated with dissection of the celiac artery following orthotopic liver transplantation in a 35-year-old man who had received a liver transplantation for end-stage liver disease secondary to posthepatitis cirrhosis in March 1989. Starting at day 30, he had signs of infection associated with hemocultures positive for Staphylococcus aureus. A subhepatic collection was found on sonography and CT scan and also cultured positive for the same germ. Arteriograms demonstrated a celiac artery dissection associated with a false anastomotic aneurysm of the hepatic artery. Surgical treatment consisted of arterial reconstruction using a saphenous vein graft between the right renal artery and the hepatic artery of the transplant, followed by resection of the hepatic artery aneurysm and the celiac artery. Hepatic ischemia was 12 min. The immediate postoperative course was uneventful and postoperative angiograms showed that the reconstruction was patent at 5 years.
Critical ischemia is defined by continuous pain, impending sleep, with ankle pressure less than 5... more Critical ischemia is defined by continuous pain, impending sleep, with ankle pressure less than 50mm Hg, and/or first toe pressure less than 30 mm Hg (Dormandy et Rutherford, 2000; Norgren et al., 2007). Treatment of patients aged over 80 requires specific knowledge of arteriopathy at this age and an evaluation of co-morbidity factors (diabetes mellitus, renal failure, ischemic cardiopathy). Assessment should include: the degree of ischemia, the extension of arterial disease, the co-morbidity factors, and the diffusion of the atherosclerotic disease. A transatlantic consensus conference has enabled a classification of arterial lesions determining therapeutic indications. Aorto-iliac lesions may be treated by surgery or angioplasty. Femoro-popliteal or crural lesions may be treated by surgery or angioplasty. Type C or D lesions should be treated by femoro-popliteal or crural bypass. Bypass to the ankle or foot are done on high peripheral resistances. These bypasses require a venous g...
We report the case of a 38-year old man who developed erythroderma during treatment with teicopla... more We report the case of a 38-year old man who developed erythroderma during treatment with teicoplanin for staphylococcal septicaemia. The clinical symptoms, which included high fever, shock and erythroderma, were suggestive of staphylococcal toxic shock. After teicoplanin was withdrawn and replaced by vancomycin the disease followed a favourable course. The reintroduction test was positive. This case illustrates the problems associated with the diagnosis of erythroderma in intensive care patients and confirms that it is possible to prescribe vancomycin in cases with allergic reaction to teicoplanin.
In 45 young dogs an enlargement angioplasty of the left pulmonary artery was performed using patc... more In 45 young dogs an enlargement angioplasty of the left pulmonary artery was performed using patches made from one of three autologous materials (jugular vein, unmodified pericardium, and glycerolized pericardium) or from two heterologous materials (lyophilized human dura mater and modified bovine carotid artery). Catheterization and angiographic studies performed 5 to 6 months after the operation showed that all patched vessels had remained patent, except in three dogs which had received heterologous implants. The animals were killed 5-24 months after operation (mean weight increase: 84%), and the implants were studied by optical microscopy and morphometry, scanning and transmission electron microscopy, and indirect immunofluorescence with antidog Factor VIII rabbit antiserum. The two heterologous tissues exhibited limited biocompatibility, as estimated from 10 criteria obtained at histologic studies. Conversely, all three autologous biomaterials were characterized by infiltration of noninflammatory cells, near-complete endothelialization, and neosynthesis of structural proteins; infectious foci were very rare or absent. These results suggest that autologous tissues, although deendothelialized at the time of implantation, constitute the most suitable material for patch angioplasty, as far as endothelial triggering, cellularity and resistance to infection are concerned.
The bronchodilator properties of RU 42173, a new beta-adrenergic stimulant with an original struc... more The bronchodilator properties of RU 42173, a new beta-adrenergic stimulant with an original structure, as a cyclic analogue of an arylethanolamine, have been evaluated on different in vitro and in vivo models and compared with those of salbutamol and isoprenaline. RU 42173 equipotently inhibited histamine-, acetylcholine-, and KCl-induced contractions in isolated guinea pig trachea or small bronchus and in isolated human bronchus. When administered to guinea pigs by the IV or aerosol route, RU 42173 dose-dependently inhibited bronchospasm induced by histamine, acetylcholine, and methacholine. It also inhibited PAF-induced bronchoconstriction and PAF-induced hyperreactivity to histamine. Moreover, RU 42173 had a rapid onset and prolonged duration of action. The potency of RU 42173 was similar to that of salbutamol.
... JR BOISSIER *, JF GIUDICELLI, J. FICHELLE, H. SCHMITT and Mme H. SCHMITT Chaires de Pharrrnac... more ... JR BOISSIER *, JF GIUDICELLI, J. FICHELLE, H. SCHMITT and Mme H. SCHMITT Chaires de Pharrrnacologie, Facult~ de M~decine de Paris, 15, rue de l'Ecole de MOdecine, 75, Paris (6), France Accepted 15 January 1968 JR BOISSIER, JFGIUDICELLI, J. FICHELLE, H ...
Hand-assisted laparoscopic donor nephrectomy (HLDN) may have advantages over laparoscopic donor n... more Hand-assisted laparoscopic donor nephrectomy (HLDN) may have advantages over laparoscopic donor nephrectomy, such as shorter learning curve, operation and warm ischaemia times. The aim of this study was to evaluate the feasibility and safety of HLDN. Between January 2000 and October 2002, 50 consecutive HLDN procedures were performed through a low transverse abdominal incision, 23 right sided and 27 left sided. The median age of the donors was 44 years. No HLDN required conversion to an open procedure. The median operating time for HLDN was 153 min. The median warm ischaemia time was 3 (range 1.0-4.5) min and the median blood loss was 50 (range 20-500) ml in both left- and right-sided procedures. Eight patients suffered ten minor complications during their admission. The duration of hospital stay was 5 days for donors. Three recipients developed graft failure owing to acute rejection, renal vein thrombosis and ischaemic necrosis. Both left- and right-sided HLDN procedures were feasible and safe through a low transverse abdominal incision.
Femoro-distal bypasses are not always feasible or indicated in patients presenting with &quot... more Femoro-distal bypasses are not always feasible or indicated in patients presenting with "critical" chronic ischemia. The results of nutrient flaps carried out over a 2-year period are analyzed. 12 patients had extensive gangrene compromising limb salvage (heel, dorsal or lateral aspect of foot or ankle at high risk of tendon or joint sepsis). Coverage of tissue loss was provided by a latissimus dorsi flap in 8 patients, a radial artery free flap in 1 patient, a supra-malleolar flap in 3 patients. The hospital mortality rate was 8.3%. The cumulative patency and limb salvage rates are respectively 58% and 67% at 6 months, 44% and 67% at 12 months. The challenge of inframalleolar reconstruction in patients presenting with critical ischemia is not always amenable to surgical revascularization to the foot, due to the lack of a suitable artery for bypass implantation or due to the lack of run-off, when arteriosclerosis of the plantar arch, or when distal embolisms are present. Some patients present with extensive gangrene, and in most of cases infection of the foot, and carry a high risk of arthritis: they are not likely to heal properly if surgical bypass alone to a foot artery is done. Bypass surgery is not indicated in diabetic patients with extensive foot infection, in whom no significant macroangiopathy is present. These 3 situations are a good indication for flaps, in order to cover the tissue loss, to fight the infection, and to provide a vascular supply to the foot. When conventional therapies cannot face critical ischemia, nutrient flaps can provide a fair limb salvage rate.
Femoro-tibial bypasses are not always feasible in patients presenting with "critical&... more Femoro-tibial bypasses are not always feasible in patients presenting with "critical" chronic ischemia. The results of endovascular therapies carried out over a 2-year period are analyzed. Twenty-three patients with critical ischemia (rest pain 13%, gangrene 87%) had 25 procedures on 29 leg arteries: percutaneous transluminal angioplasty in 17 arteries, rotational atherectomy in 10 arteries, laser recanalization (1 artery), directional atherectomy (1 artery). The hospital mortality rate was 4.3%. The cumulative patency and limb salvage rates were respectively 51% and 77% at 6 months, 34% and 71% at 12 months. Candidates for tibial-peroneal endovascular techniques should have a threatened limb, as long as the consequences of failed procedures on patients presenting with claudication can be disastrous, and as long as mid-term patency rates reported in the literature are not fair enough. In localized stenosis or short occlusions with adequate runoff, endovascular techniques are a good alternative to femorotibial bypasses for limb salvage. In diffuse lesions with no possibility of bypass, endovascular techniques can facilitate limb salvage, even if the mid-term arterial patency rate is poor. When conventional therapies cannot face critical ischemia, endovascular therapies can provide a fair limb salvage rate.
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Papers by J. Fichelle