Conrad Pelletier - Academia.edu (original) (raw)

Papers by Conrad Pelletier

The Annals of Thoracic Surgery, 1986

, 102 patients aged 70 years or more underwent isolated aortocoronary bypass surgery. They were c... more , 102 patients aged 70 years or more underwent isolated aortocoronary bypass surgery. They were compared with a group of 100 consecutive patients of less than 70 years of age who underwent the same surgical procedure in 1983. The older group was consistently more diseased in regard to clinical incapacity, unstable angina, the number of coronary arteries involved, and the number of coronary bypasses performed. The incidence of substantial stenosis of the left main coronary artery among the older patients was twice that in the younger ones. There were 7 early deaths in the older group and none in the younger patients. The cause of death was cardiac in 3 patients and noncardiac in 4. A total of 54 complications occurred in 39 older patients and 32 in 27 younger patients. The incidence of cardiac complications was similar in both groups (18 in the older and 17 in the younger). However, noncardiac complica-

The Annals of Thoracic Surgery, Jan 31, 1990

The Annals of Thoracic Surgery, 1997

The objective of this study was to evaluate the value of retrograde blood cardioplegia in coronar... more The objective of this study was to evaluate the value of retrograde blood cardioplegia in coronary artery bypass grafting. In 1994 and 1995, 224 patients undergoing first-time isolated coronary artery bypass grafting were randomized to antegrade (112 patients, group 1) or retrograde (112 patients, group 2) administration of blood cardioplegia. In group 1, 76 patients were given warm cardioplegia (at 33 degrees C) and 36 had cold cardioplegia (< 20 degrees C), whereas in group 2 cardioplegia was warm in 77 patients and cold in 35. The two randomization groups had similar demographic and angiographic characteristics. The number of grafted coronary arteries averaged 2.9 +/- 0.7 in group 1 and 2.8 +/- 0.7 in group 2. Total duration of cardiopulmonary bypass (78 +/- 23 and 75 +/- 21 minutes) and of aortic cross-clamping (47 +/- 16 and 46 +/- 16 minutes), total volume of infusion of the crystalloid component of cardioplegia (988 +/- 297 and 1016 +/- 595 mL), and total duration of infusion of cardioplegia (23 +/- 10 and 22 +/- 11 minutes) were similar (p > 0.05). There was no death in group 1 and one in group 2 as a result of a pulmonary embolus, for a global early mortality of 0.45%. The numbers of perioperative myocardial infarction (5 versus 3), congestive heart failure (4 versus 5), postoperative hemorrhage (4 versus 4), and stroke (1 versus 2) were also similar (p > 0.05). Release curves of total creatine kinase, creatine kinase-MB by serum activity and mass concentration, and troponin T were not significantly different (p > 0.05) between the two groups. For the 216 patients without perioperative myocardial infarction, peak enzyme release of creatine kinase-MB at 24 hours averaged 23 +/- 22 and 20 +/- 18 IU/L, and that of troponin T averaged 1.1 +/- 1.1 and 1.3 +/- 1.5 micrograms/L at 6 hours for the antegrade and the retrograde groups, respectively (p > 0.05). Our results indicate no evidence that the retrograde method of cardioplegic infusion improves myocardial protection during first operation for isolated coronary revascularization compared with the usual antegrade route.

The Annals of Thoracic Surgery, 1996

Background. The release of nitric oxide is decreased after myocardial ischemia and reperfusion. W... more Background. The release of nitric oxide is decreased after myocardial ischemia and reperfusion. Whereas the precursor L-arginine can stimulate the release of nitric oxide, its effect on metabolic recovery after myocardial ischemia is unknown.

The Journal of Thoracic and Cardiovascular Surgery, Jun 30, 2001

described in numerous cardiovascular disorders, such as myocardial infarction, 1 systemic hyperte... more described in numerous cardiovascular disorders, such as myocardial infarction, 1 systemic hypertension, 2 coronary artery spasm, 3 heart failure, 4 and pulmonary hypertension. The human lung is an important site of metabolism for various circulating vasoactive amines and peptides, including ET-1. Reduced clearance or increased production by the pulmonary circulation could contribute to increased circulating ET-1 levels in different cardiovascular diseases. The plasma concentration of ET-1 increases progressively during cardiopulmonary bypass (CPB). 7 It is suggested that ET-1 could act as a mediator of perioperative vasospasm. 8 In an experimental model, postbypass E ndothelin 1 (ET-1) is an endothelium-derived peptide with strong vasoconstrictive and proliferative actions. Increased circulating ET-1 levels have been Background: Coronary artery bypass operations are associated with increased circulating levels of the powerful vasoconstrictor endothelin 1. The pulmonary circulation is an important site for both production and clearance of endothelin 1. Lung endothelial injury resulting from cardiopulmonary bypass could modify pulmonary endothelin 1 metabolism through an increase in production, a reduction in removal, or a combination of both.

Canadian Journal of Surgery Journal Canadien De Chirurgie, Feb 1, 2001

Chest Journal, Oct 1, 1982

ABSTRACT

Rev Med Interne, 1985

Actinobactillus actinomycetemcomitans a 6t6 isol$ chez 2 malades souffrant d'endocardite infectie... more Actinobactillus actinomycetemcomitans a 6t6 isol$ chez 2 malades souffrant d'endocardite infectieuse. La presentation clinique est conforme aux donn6es de la litt6rature : pr6dominance du sexe masculin; survenue chez des sujets de plus de 40 ans porteurs d'une cardiopathie pr~disposante; pas de porte d'entr6e et aspect subaigu du syndrome. Parmi les particularit6s not6es dans les 2 observations rappor-t6es, mentionnons l'excellente r6ponse ~ une mono-antibioth6rapie et l'absence de ph~nom6ne embolique. Cependant, l'approche th6rapeutique optimale n'est pas encore d6finie. Le spectre des bact6ries impliqu6es dans l'6tiologie de l'endocardite infectieuse a ~t6 consid6rablement 61argi au cours des derni6res ann6es, le pr6sent travail refl~te ce changement.

Amer J Ophthalmol, 1998

PURPOSE: To report a case of chronic, progressive unilateral blepharoptosis in a 73-year-old woma... more PURPOSE: To report a case of chronic, progressive unilateral blepharoptosis in a 73-year-old woman with Waldenström’s macroglobulinemia.METHOD: Case report. A biopsy was performed on a thickened and indurated tarsal plate that we believed had resulted in mechanical blepharoptosis.RESULTS: Histologic and immunohistochemistry studies of the biopsy specimen demonstrated a lymphoplasmacytoid cell infiltrate with monoclonal antibodies consistent with Waldenström’s macroglobulinemia.CONCLUSION: Involvement of the tarsal conjunctiva and tarsus in Waldenström’s macroglobulinemia is a newly recognized cause of eyelid thickening and ptosis.

Ophthalmic Plastic and Reconstructive Surgery, Jun 1, 1998

The hydroxyapatite implant (Bio-Eye, Intergrated Orbital Implant, Inc., San Diego, CA, U.S.A.) ha... more The hydroxyapatite implant (Bio-Eye, Intergrated Orbital Implant, Inc., San Diego, CA, U.S.A.) has gained increasing popularity as an orbital implant in recent years. Several complications may occur, including infection, exposure, extrusion, and various peg problems. Exposure of the implant appears to be the most common complication, ranging up to 21.6%. Many techniques, including nonsurgical and surgical approaches, have been described to manage these exposures. When surgery is indicated, a patch graft may be required to cover the defect. We report our experience and technique with autogenous temporalis fascia as a patch graft. Autografts such as temporalis fascia are easily obtained, bring about no immunological reaction, and have no risk of infectious transmission.

Canadian Medical Association Journal

To assess the effect of the waiting period before elective open-heart surgery on patient outcomes... more To assess the effect of the waiting period before elective open-heart surgery on patient outcomes. Retrospective analysis. The Montreal Heart Institute, a referral centre in cardiology and cardiac surgery. All 568 patients who underwent open-heart surgery on an elective basis or following urgent admission or interhospital transfer between October 1991 and February 1992. In-hospital death rate, incidence of postoperative complications, length of stay in the intensive care unit (ICU) and total length of hospital stay. A total of 206 patients (151 men and 55 women with an average age of 59.0 [standard error of the mean (SEM) 1] years) underwent elective surgery, and 362 patients (264 men and 98 women with an average age of 62.0 [SEM 1] years) underwent urgent surgery. The mean wait for elective surgery was 2.8 (SEM 0.2) months. There was no significant difference between the two groups in the in-hospital death rate (4% v. 4%), the average length of stay in the ICU (4.4 [SEM 0.2] days v. 5.8 [SEM 1] days) or the average total length of hospital stay (9.0 [SEM 0.4] days v. 9.1 [SEM 1] days). As would be expected, postoperative complications developed in significantly more patients in the urgent group (27%) than the elective group (18%) (p = 0.02). Eight patients were admitted on an urgent basis for surgery owing to worsening symptoms or acute myocardial infarction after a mean wait of 4.6 months. One patient died suddenly at home 1 month after medical investigation while awaiting repeat coronary artery bypass grafting. Among the 206 patients who underwent elective surgery there was no relation between waiting time and adverse clinical outcomes after surgery. The results suggest that the wait before elective open-heart surgery had no effect on patient outcome after surgery in our institution. A policy of a short waiting period before elective open-heart surgery for patients whose condition is stable is safe and acceptable only if rapid access to medical and surgical treatment is available should it become necessary.

The Journal of Trauma: Injury, Infection, and Critical Care, 1998

We reviewed the real and potential ocular problems in all head and neck injuries at a tertiary ca... more We reviewed the real and potential ocular problems in all head and neck injuries at a tertiary care and regional trauma center from April of 1994 to March of 1995. Through a retrospective study, 127 charts were reviewed, specifically looking at the mechanism of injury, types of injury, whether there was any ocular trauma noted in the chart, and whether there was a consultation to the ophthalmology department. Forty-one of these patients were seen by an ophthalmologist as the initial consultant for ocular and orbital injuries recognized by the emergency staff. In the 86 remaining patients, signs of potential ocular injury were recorded in the chart in 62 (72%) of these patients, yet an ophthalmology consultation was requested for only 23 of them (37%). This survey reveals the lack of awareness in a regional trauma center of certain ocular and periocular signs that may be indicative of more serious ocular injuries. It is the purpose of this article to highlight these concerns to the various health professionals involved with head and neck trauma patients in the hope that the patients will, in the end, benefit from a more thorough and complete assessment of the potential ocular and periocular injuries.

Transplantation, 1993

The effects of cold storage and type of preservation solution on coronary endothelial function ar... more The effects of cold storage and type of preservation solution on coronary endothelial function are not well understood. Experiments were designed to evaluate coronary endothelial-dependent relaxation after a 4-hr cold (4 degrees C) storage in different preservation solutions. Isolated rat hearts were studied in the Langendorff apparatus for coronary endothelial function. After 30 min of stabilization, hearts were arrested with a 10-min perfusion of 4 degrees C crystalloid hyperkalemic cardioplegic solution (CHCS) containing 24 mmol/L of KCl and stored for 4 hr in the following preservation solutions: CHCS, Krebs-Ringer's solution (KR), 0.9% NaCl (NS), and University of Wisconsin solution (UW). A fifth group was perfused and stored in UW solution. Endothelial-dependent and independent coronary artery vasorelaxation were tested, respectively, by infusing 5-hydroxytryptamine (5-HT) (1 x 10(-6) mol/L) and sodium nitroprusside (SNP) (1 x 10(-5) mol/L) before and 30 min after the storage period. In hearts stored in CHCS and KR, the coronary artery flow increase to 5-HT and SNP infusion were not significantly affected. However, in hearts preserved with NS and UW solutions, 5-HT coronary response was significantly decreased, indicating endothelial dysfunction. In addition to these findings, coronary flow increase to SNP infusion was decreased in the group perfused and stored with UW, suggesting smooth muscle damage. These experiments suggest that 4-hr cold storage in NS or UW impairs endothelial-dependent coronary relaxation in the isolated rat heart model.