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See detailPneumothorax during laparoscopic fundoplication: diagnosis and treatment with positive end-expiratory pressure.
Joris, Jean ULg; Chiche, Jean-Daniel; Lamy, Maurice ULg

in Anesthesia and Analgesia (1995), 81(5), 993-1000

Pneumothorax can develop during laparoscopy, particularly during laparoscopic fundoplication, since the left parietal pleura is exposed and can be torn during dissection in the diaphragmatic hiatus. Such ... [more ▼]

Pneumothorax can develop during laparoscopy, particularly during laparoscopic fundoplication, since the left parietal pleura is exposed and can be torn during dissection in the diaphragmatic hiatus. Such an event will result in specific pathophysiologic changes, since CO2, under pressure in the abdominal cavity, will pass into the pleural space. The aim of this study was to document the pathophysiologic changes induced by pneumothorax, and to evaluate the benefit of positive end-expiratory pressure (PEEP) to treat pneumothorax. Forty-six ASA physical status I and II patients scheduled for laparoscopic fundoplication were monitored extensively; heart rate, mean arterial pressure, end-tidal CO2 (PETCO2), oxygen saturation of hemoglobin (Spo2), minute ventilation, tidal volume, dynamic total lung thorax compliance, and airway pressures were recorded. In 25 patients, oxygen uptake, CO2 elimination and arterial blood gases were also measured. Pneumothorax was diagnosed in seven patients. It resulted in the following pathophysiologic changes: decrease in total lung thorax compliance, increase in airway pressures, and increase in CO2 absorption. Consequently, PACO2 and PETCO2 also increased. Spo2, however, remained normal. The use of PEEP largely corrected these respiratory changes. None of these pneumothoraces required drainage. These data suggest that pneumothorax is common during laparoscopic fundoplication. Early diagnosis is possible by simultaneous monitoring of PETCO2, total lung thorax compliance, and airway pressures. Finally, treatment with PEEP provides an alternative to chest tube placement when pneumothorax is secondary to passage of peritoneal CO2 into the interpleural space. [less ▲]

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See detailAnesthetic management of laparoscopy: new developments
Joris, Jean ULg

in Miller, Ronald D (Ed.) Anesthesia (1995)

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See detailL'hyperthyroïdie sévère associée à la prise d'amodarone: une urgence chirurgicale
Meurisse, Michel ULg; Hamoir, Etienne ULg; Joris, Jean ULg et al

in Revue Française d'Endocrinologie Clinique, Nutrition, et Métabolisme (La) (1995), 36(1), 35-45

L'évolution de certaines thyréotoxicoses associées à la prise d'amiodarone peut être particulièrement grave et rapide, menaçant le pronostic vital. De déclenchement brutal, sans relation avec la durée du ... [more ▼]

L'évolution de certaines thyréotoxicoses associées à la prise d'amiodarone peut être particulièrement grave et rapide, menaçant le pronostic vital. De déclenchement brutal, sans relation avec la durée du traitement par amiodarone, elles peuvent survenir aussi bien chez des sujets porteurs de thyroïdopathies méconnues ou négligées au moment de l'induction du traitement, que chez des patients apparemment indemnes de toute pathologie thyroïdienne pré-existante. Le traitement médical conservateur est le plus souvent inefficace. Dans ces cas, il convient de poser sans hésitation, l'indication d'une thyroïdectomie la plus radicale possible. Ce rapport traite de l'évolution post-opératoire spectaculaire et favorable de 13 cas consécutifs de thyréotoxicose sévère associée à la prise d'amiodarone. La validité de l'approche chirurgicale repose sur la correction rapide et définitive de l'état toxique après exérèse glandulaire. La morbidité quasi nulle liée au geste chirurgical est la seule alternative thérapeutique antithyroïdienne existante qui permette de poursuivre un traitement par amiodarone lorsque celui-ci est indiqué pour contrôler une arytmie menaçante [less ▲]

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See detailHigh-dose aprotinin reduces blood loss in patients undergoing total hip replacement surgery
Janssens, Marc ULg; Joris, Jean ULg; David, Jean-Louis et al

in Anesthesiology (1994), 80

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See detailEpidural anesthesia impairs both central and peripheral thermoregulatory control during general anesthesia.
Joris, Jean ULg; Ozaki, Makoto; Sessler, Daniel I et al

in Anesthesiology (1994), 80(2), 268-77

BACKGROUND: The authors tested the hypotheses that: (1) the vasoconstriction threshold during combined epidural/general anesthesia is less than that during general anesthesia alone; and (2) after ... [more ▼]

BACKGROUND: The authors tested the hypotheses that: (1) the vasoconstriction threshold during combined epidural/general anesthesia is less than that during general anesthesia alone; and (2) after vasoconstriction, core cooling rates during combined epidural/general anesthesia are greater than those during general anesthesia alone. Vasoconstriction thresholds and heat balance were evaluated under controlled circumstances in volunteers, whereas the clinical importance of intraoperative thermoregulatory vasoconstriction was evaluated in patients. METHODS: Five volunteers were each evaluated twice. On one of the randomly ordered days, epidural anesthesia (approximately T9 dermatomal level) was induced and maintained with 2-chloroprocaine. On both study days, general anesthesia was induced and maintained with isoflurane (0.7% end-tidal concentration), and core hypothermia was induced by surface cooling and continued for at least 1 h after fingertip vasoconstriction was observed. Patients undergoing colorectal surgery were randomly assigned to combined epidural/enflurane anesthesia (n = 13) or enflurane alone (n = 13). In appropriate patients, epidural anesthesia was maintained by an infusion of bupivacaine. The core temperature that triggered fingertip vasoconstriction identified the threshold. RESULTS: In the volunteers, the vasoconstriction threshold was 36.0 +/- 0.2 degrees C during isoflurane anesthesia alone, but significantly less, 35.1 +/- 0.7 degrees C, during combined epidural/isoflurane anesthesia. Cutaneous heat loss and the rates of core cooling were similar 30 min before vasoconstriction with and without epidural anesthesia. In the 30 min after vasoconstriction, heat loss decreased 33 +/- 13 W when the volunteers were given isoflurane alone, but only 8 +/- 16 W during combined epidural/isoflurane anesthesia. Similarly, the core cooling rates in the 30 min after vasoconstriction were significantly greater during combined epidural/isoflurane anesthesia (0.8 +/- 0.2 degrees C/h) than during isoflurane alone (0.2 +/- 0.1 degrees C/h). In the patients, end-tidal enflurane concentrations were slightly, but significantly, less in the patients given combined epidural/enflurane anesthesia (0.6 +/- 0.2% vs. 0.8 +/- 0.2%). Nonetheless, the vasoconstriction threshold was 34.5 +/- 0.6 degrees C in the epidural/enflurane group, which was significantly less than that in the other patients, 35.6 +/- 0.8 degrees C. When the study ended after 3 h of anesthesia, patients given combined epidural/enflurane anesthesia were 1.2 degrees C more hypothermic than those given general anesthesia alone. The rate of core cooling during the last hour of the study was 0.4 +/- 0.2 degrees C/h during combined epidural/enflurane anesthesia, but only 0.1 +/- 0.3 degrees C/h during enflurane alone. CONCLUSIONS: These data indicate that epidural anesthesia reduces the vasoconstriction threshold during general anesthesia. Furthermore, the markedly reduced rate of core cooling during general anesthesia alone illustrates the importance of leg vasoconstriction in maintaining core temperature. [less ▲]

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See detailIs aprotinin worth the risk in total hip replacement?
Janssens, Marc ULg; Joris, Jean ULg

in Anesthesiology (1994), 81(2), 518-519

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See detailThe treatment of amiodarone-induced hyperthyroidism. Is there a place for surgery?
Meurisse, Michel ULg; Detroz, Bernard ULg; Messens, D. et al

in Acta Chirurgica Belgica (1994), 94(1), 36-41

In many instances amiodarone-induced hyperthyroidism has been reported as mild, thyroid functions returning to normal after discontinuation of the drug. Nevertheless, life-threatening amiodarone-induced ... [more ▼]

In many instances amiodarone-induced hyperthyroidism has been reported as mild, thyroid functions returning to normal after discontinuation of the drug. Nevertheless, life-threatening amiodarone-induced thyrotoxicosis has also been described. Conventional treatments such as with antithyroid drugs (Thionamide) and corticosteroids are essentially ineffective or fail to stop the dramatic course of the thyroid crisis. This limited efficacy of medical therapy, particularly in patients with previously--neglected or unknown--thyroid disease, prompted us to intervene surgically. We report a series of six patients who underwent total or nearly total thyroidectomy as first line therapy for four of them. Surgery resulted in rapid resolution of thyrotoxicosis with an uneventful postoperative course. This approach has the advantage of immediate and safe efficacy, low risk of relapse and finally, appears to be the only antithyroid treatment that permits continued therapy with amiodarone. [less ▲]

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See detailLaparoscopic adrenalectomy in pheochromocytoma and Cushing's syndrome. Reflections about two case reports.
Meurisse, Michel ULg; Joris, Jean ULg; Hamoir, Etienne ULg et al

in Acta Chirurgica Belgica (1994), 94(6), 301-6

Laparoscopic adrenalectomy is possible as well on the left as on the right side using a percutaneous transabdominal approach. The exposure of the glands seems better than it could be achieved with an open ... [more ▼]

Laparoscopic adrenalectomy is possible as well on the left as on the right side using a percutaneous transabdominal approach. The exposure of the glands seems better than it could be achieved with an open method. In combination with intraoperative infusion of nicardipine, a calcium-channel blocker, the laparoscopic removal of a pheochromocytoma was performed safely and under stable conditions. In case of Cushing's syndrome, the laparoscopic approach reduces the problems related to poor healing. In all cases of laparoscopic adrenalectomy, this approach could offer the clear advantages of smaller incisions, reduced postoperative pain and incisional discomfort as well as complications related to large and invasive procedure and finally allows quicker recovery. Moreover, conversion to open surgery remains always possible, if needed. [less ▲]

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See detailThe peripheral analgesic effects of opiods
Joris, Jean ULg; Hargreaves, Kenneth M

in APS Journal (1993), 2(1), 51-59

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See detailHemodynamic changes during laparoscopic cholecystectomy.
Joris, Jean ULg; Noirot, Didier P; Legrand, Marc ULg et al

in Anesthesia and Analgesia (1993), 76(5), 1067-71

Hemodynamics during laparoscopic cholecystectomy under general anesthesia (isoflurane in N2O/O2 (50%)) were investigated in 15 nonobese ASA Class I patients by using invasive hemodynamic monitoring ... [more ▼]

Hemodynamics during laparoscopic cholecystectomy under general anesthesia (isoflurane in N2O/O2 (50%)) were investigated in 15 nonobese ASA Class I patients by using invasive hemodynamic monitoring including a flow-directed pulmonary artery catheter. During surgery, intraabdominal pressure was maintained automatically at 14 mm Hg by a CO2 insufflator, and minute ventilation was controlled and adjusted to avoid hypercapnia. Hemodynamics were measured before anesthesia, after the induction of anesthesia, after tilting into 10 degrees head-up position, 5 min, 15 min, and 30 min after peritoneal insufflation, and 30 min after exsufflation. Induction of anesthesia decreased significantly mean arterial pressure and cardiac index (CI). Tilting the patient to the head-up position reduced cardiac preload and caused further reduction of CI. Peritoneal insufflation resulted in a significant increase (+/- 35%) of mean arterial pressure, a significant reduction (+/- 20%) of CI, and a significant increase of systemic (+/- 65%) and pulmonary (+/- 90%) vascular resistances. The combined effect of anesthesia, head-up tilt, and peritoneal insufflation produced a 50% decrease in CI. Administration of increasing concentrations of isoflurane, via its vasodilatory activity, may have partially blunted these hemodynamic changes. These results demonstrate that laparoscopy for cholecystectomy in head-up position results in significant hemodynamic changes in healthy patients, particularly at the induction of pneumoperitoneum. [less ▲]

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See detailTotal intravenous anesthesia in South-African genetic porphyria (variegate porphyria)
Bichel, Th; Joris, Jean ULg; Jacquet, N. et al

in Acta Anaesthesiologica Belgica (1993), 44(1), 25-29

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See detailAnalgésie médullaire. Association anesthésiques locaux - opiacés: modalités d'utilisation
Joris, Jean ULg

in Analgésie péri-opératoire (1993)

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See detailUne salle d'analgésie postopératoire: une alternative à l'Acute Pain Service
Joris, Jean ULg; Lamy, Maurice ULg

in Douleur et analgésie (1993), 2

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See detailLes morphinomimétiques en réanimation
Lamy, Maurice ULg; Joris, Jean ULg; Damas, Pierre ULg et al

in Réan urg (1993), 2(4bis), 488-494

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See detailClonidine and ketanserin both are effective treatment for postanesthetic shivering.
Joris, Jean ULg; Banache, Maryse; Bonnet, Francis et al

in Anesthesiology (1993), 79(3), 532-9

BACKGROUND: Although meperidine is an effective treatment of postanesthetic shivering, its mechanism of action remains unknown. Investigation of other drugs might help clarify the mechanisms by which ... [more ▼]

BACKGROUND: Although meperidine is an effective treatment of postanesthetic shivering, its mechanism of action remains unknown. Investigation of other drugs might help clarify the mechanisms by which shivering can be controlled. Accordingly, we investigated the efficacy of clonidine, an alpha 2-adrenergic agonist, and ketanserin, a 5-hydroxytryptamine antagonist, in treating postanesthetic shivering. METHODS: First, 54 patients shivering after general anesthesia were allocated randomly to receive an intravenous bolus of saline, 150 micrograms clonidine, or 10 mg ketanserin. A second study explored the dose-dependence of clonidine. Forty shivering patients were given saline or clonidine, 37.5, 75, or 150 micrograms. RESULTS: The duration of shivering was significantly shorter in those given clonidine (2.1 +/- 0.9 min) than in the other two groups and shorter in the ketanserin group (4.3 +/- 0.9 min) than in the saline group (12.0 +/- 1.6 min). Clonidine and ketanserin significantly decreased systolic arterial blood pressure when compared to saline. Core rewarming was significantly slower in the clonidine group. In the second study, 37.5 micrograms clonidine was no more effective than saline. Two minutes after treatment, 150 micrograms obliterated shivering in all patients. Five minutes after treatment, all patients given 75 micrograms had stopped shivering. Systolic arterial pressure and heart rate decreased significantly in patients given 75 and 150 micrograms clonidine. CONCLUSIONS: Clonidine (150 micrograms) and ketanserin (10 mg) both are effective treatment for postanesthetic shivering. The effect of clonidine on shivering is dose-dependent: whereas 37.5 micrograms had no effect, 75 micrograms clonidine stopped shivering within 5 min. [less ▲]

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See detailLaparoscopy, urology, and gynaecology
Joris, Jean ULg

in Current Opinion in Anaesthesiology (1993), 6

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See detailAnalgésie postopératoire après thoracotomie
Joris, Jean ULg

in Conférences d'actualisation 1993 (1993)

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See detailAnalgésie postopératoire par analgésie péridurale autocontrôlée
Joris, Jean ULg

in Douleur et analgésie (1993), 4

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See detailAmiodarone-induced thyrotoxicosis: is there a place for surgery?
Meurisse, Michel ULg; Hamoir, Etienne ULg; D'Silva, Milbhor et al

in World Journal of Surgery (1993), 17(5), 622-6627

Amiodarone-induced hyperthyroidism has on most instances been reported as mild, and thyroid functions return to normal after discontinuation of the drug. Nevertheless, life-threatening amiodarone-induced ... [more ▼]

Amiodarone-induced hyperthyroidism has on most instances been reported as mild, and thyroid functions return to normal after discontinuation of the drug. Nevertheless, life-threatening amiodarone-induced thyrotoxicosis has also been described. Conventional treatments such as antithyroid drugs (thionamide) and corticosteroids are essentially ineffective or fail to alter the dramatic course of the thyroid crisis. This limited effectiveness of medical therapy, particularly in patients with previously neglected or unknown thyroid disease, prompted us to intervene surgically. We report a series of nine patients who underwent total or near-total thyroidectomy as a first-line therapy for five of them. Surgery resulted in rapid resolution of thyrotoxicosis with an uneventful postoperative course. This approach has the advantage of immediate effectivity, low risk of relapse, and appears to be the only treatment that permits continued therapy with amiodarone when the drug appears needed to control a life-threatening arrhythmia. [less ▲]

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