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Biomedical subjects

A Millaire

Publications and source records attributed to A Millaire.

At least 73 records · Page 4Linked to original sources
PubMed1993

Multifocal peripheral and coronary angioplasties.

Multifocal atherosclerotic lesions are frequent. It could thus be expected that multifocal angioplasties (performed in one particular patient on several [iliofemoral, renal, subclavian, mesenteric, coronary] sites) are frequent. To study multifocal angioplasty, we considered the 5344 angioplasties (PTA) (4151 coronary and 1193 peripheral PTA) which had been performed over 10 years in our institution. Eighty PTA (1.5%) were considered as multifocal angioplasty. They were performed in 30 patients who were followed up during 7 to 132 months (mean = 55). In case of primary PTA (72 PTA), the most frequent involved site was the iliofemoral site (47%) followed by renal (35%), coronary (8%), subclavian (7%) and mesenteric sites (3%). Eight PTA were performed after primary failure (3 cases) or after restenosis (5 cases). The 30 patients were divided into 2 groups according to the chronology of multifocal PTA. In group I, 20 patients had multifocal lesions on the first workup and multifocal angiopathy over a short operative period (< 3 months). The 10 patients of group II initially had a single procedure. They subsequently had multifocal angioplasty over a longer period (> 2 years) on different sites of the first PTA. Compared to group I, mean age was lower in group II (46 vs 52 year; ns), primary success rate higher (100 vs 90%; p < 0.05), complications less frequent (3 vs 20%, p < 0.05) and restenosis rate lower (7 vs 21%; p < 0.01). In conclusion, multifocal angioplasty is infrequent. A specific group of patients who had multifocal angioplasty spread over several months or years could be individualized.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon↗
PubMed1993

[French familial multicenter survey of hypertrophic cardiomyopathy. Initial Doppler echocardiographic results].

A French multicentre study of hypertrophic cardiomyopathy has recruited 260 subjects belonging to 18 families. At least 3 persons from each family included had a hypertrophic cardiomyopathy. A Doppler echocardiographic examination was performed in all members of these 18 families. The diagnosis of hypertrophic cardiomyopathy was based on M mode and/or 2D observations of parietal hypertrophy: wall thickness over 13 mm. Asymmetrical forms were distinguished from symmetrical forms by a septum/posterior wall ratio of over 1.3 in M mode or 2D study. The patients had an average age of 40 +/- 18 years, 127 were men and 133 women. One hundred and sixty eight were considered to be normal, 87 had hypertrophic cardiomyopathy and 5 were border line. The maximal diastolic wall thickness on M mode recording of pathological cases was 19.2 +/- 4.8 mm compared with 9.5 +/- 1.9 mm in healthy subjects (p < 0.001). The septum/posterior wall ratio was 1.8 +/- 0.62 in pathological cases and 1.1 +/- 0.8 in normal ones (p < 0.001). Eighty five per cent of the cardiomyopathic cases were asymmetrical (74/87) and only 15% were considered to be symmetrical (13/87) on M mode study whereas 5% were concentric on 2D echocardiography. By Maron's classification, type I hypertrophy was observed in 6% of cases (4/64), type II in 30% (19/64), type III in 58% (37/64), and type IV in 6% (4/64). Signs of obstruction were looked for and systolic anterior motion of the mitral valve was observed in 52% of pathological cases (45/86) and mid-systolic aortic valve closure in 30% (25/83).(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiomyopathy, Hypertrophic↗
PubMed1993

[Evaluation of embolic cerebrovascular complication: contribution of transesophageal echography].

Ischemic cerebrovascular accidents are classically attributed to an embolism of cardiac origin in 15% of cases. This longstanding concept is questioned by trans-esophageal echocardiography (TEE). The incidence of anomalies which could be the origin of a cerebral embolism involves more than 50% of cases in certain series. The superiority of TEE over trans-thoracic echocardiography (TTE) emerges in particular when certain abnormalities such as an intra-atrial thrombus, spontaneous atrial contrast, an intra-aortic atherosclerotic plaque, a patent foramen ovale or an aneurysm of the inter-atrial septum are sought. The high incidence of such abnormalities in a population having sustained an ischemic cerebrovascular accident is not sufficient to establish a cause-and-effect relationship between the abnormality and the cerebral event. Certain abnormalities are commonly associated with each other or with emboligenic arrhythmias (atrial fibrillation). Studies hence remain required to determine the respective responsibilities of these various abnormalities and stratify their embolic risk by defining certain risk factors. While awaiting the result of such studies, it would seem valid to suggest the more routine use of TEE in the investigation of ischemic cerebrovascular accidents in young patients free of clinically obvious heart disease, and this regardless of the result of TTE.

Heart Diseases↗
PubMed1993

[Rhabdomyolysis caused by pravastatin and type 1 macrocreatine kinase].

The authors report a case of rhabdomyolysis which occurred in a 61 year old woman who was receiving pravastatin and who was also found to present with type 1 macrocreatine kinase. Drug induced rhabdomyolysis is common, particularly with HMG Coenzyme A reductase inhibitors. The authors describe the onset of an adverse effect of this type with pravastatin, a recently marketed drug, as has been previously described for lovastatin and simvastatin. The concomitant detection of macrocreatine kinase, the incidence of which is estimated to be between 2 and 5% in the population, raises the question of whether rhabdomyolysis of this type may occur preferentially in patients with this biological anomaly.

Creatine Kinase↗
PubMed1993

[Angioplasty of the subclavian arteries. Immediate and mid-term results].

The authors report the immediate and mid-term results of a retrospective study concerning 30 attempted angioplasties in 30 patients with tight stenosis of the subclavian artery. The cohort consisted of 23 men with a mean age of 57.5 and 7 women with a mean age of 57.7. Twenty three patients had symptoms and 7 were asymptomatic. There were 2 technical failures related to impossibility of passage through the stenosis. There were two complications during the immediate postoperative period in the form of obstruction at the arterial puncture site with no long term functional consequences. Clinical evaluation after a mean follow-up of 32.5 months showed that 25 (89.2%) of 28 patients with a good primary result were improved from a clinical and/or blood pressure after a mean follow-up of 34.5 months in 19 (82.6%) of the 23 patients undergoing this investigation. This study confirms the satisfactory efficacy of subclavian angioplasty with a low complication rate. It would seem legitimate to suggest angioplasty as first line treatment of stenosis of the subclavian artery and to reserve surgery for failures or contraindications to the technique.

Adult↗
PubMed1992

Malignant pericardial effusions: usefulness of pericardioscopy.

In cases of malignant pericardial effusion, surgical subxiphoid biopsy sometimes fails to prove malignancy. To assess the usefulness of pericardioscopy, which allows an endoscopic investigation of the pericardial cavity, this technique was systematically performed during surgical drainage procedures that were performed on 40 patients who had pericardial effusions of suspected malignant origin. Twenty-six patients had a history of neoplasm, 10 had a history of hematologic malignancy, and four had recent tumors or lymphadenopathies that were suspected to be of malignant origin. Classical tests that are usually performed during a conventional surgical drainage procedure (fluid studies and subxiphoid biopsy) were combined with direct visualization of the pericardial surfaces and guided biopsies of suspicious areas. The follow-up period after pericardioscopy was at least 12 months. Two early deaths occurred after pericardioscopy, but no death was directly related to the endoscopy. According to all of the tests that were performed, diagnoses were malignant pericardial effusion in 15 of 40 patients (group I, 37%) and nonmalignant pericardial effusion in 25 of 40 patients (group II, 73%). In 3 of 13 patients (23%) in group I, the diagnosis was obtained only by pericardioscopy (results of cytologic studies and subxiphoid biopsy were negative). In two patients in group I, pericardioscopy could not be completed, but the diagnosis of malignant pericardial effusion was obtained by pericardiocentesis. In group II, effusion was considered to be postradiation pericarditis in five cases, infectious pericarditis in three cases (bacterial in one and tuberculous in two), hemopericardium induced by coagulation disturbances in three cases, and idiopathic pericarditis in 14 cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Biopsy↗
PubMed1992

[Left intraventricular gradients measured by Doppler echocardiography at rest, during exercise and during isoproterenol test in hypertrophic cardiomyopathy].

Doppler echocardiography has been shown to be an accurate method of assessing left ventricular outflow obstruction in hypertrophic cardiomyopathy (HCM). One of the characteristics of this pressure gradient is its variability and, therefore, we measured this parameter during dynamic exercise testing in 33 patients. The results were compared with those recorded during isoproterenol infusion, the reference stress test for patients with HCM. Submaximal exercise in the recumbent position is usually well tolerated and resulted in a 43% increase in heart rate and a 47% increase in pressure gradient. There was a significant correlation between resting and exercise outflow obstruction (r = 0.90; p = 0.001). Moreover, exercise echo revealed obstruction in 26% of patients without resting pressure gradients (latent obstruction). The interpretation of results obtained with isoproterenol infusion is more difficult: this test resulted in an important increase in the left ventricular pressure gradient (231%) and "revealed" obstruction in 84% of cases. Therefore, we believe that exercise is more physiological and better tolerated than isoproterenol stress infusion and should be adopted as the investigation of choice in HCM even without obstruction at rest. If it is not possible to perform the exercise or no outflow tract obstruction can be demonstrated, an isoproterenol infusion may be used but this is not always well tolerated and the results should be interpreted with caution.

Cardiomyopathy, Hypertrophic↗
PubMed1992

Congenital high flow coronary cameral fistula in an 81-year-old woman: management problems.

An 81-year-old woman presenting with severe congestive heart failure was found to have a congenital right coronary fistula draining into the superior vena cava. The diagnosis was suspected on transthoracic two-dimensional echo-Doppler study and confirmed with coronary angiography. Transesophageal echocardiography and magnetic resonance imaging were nondiagnostic. An attempt to close the fistula with transcatheter embolization using a detachable latex balloon was unsuccessful because of the very large size of the fistula. Follow-up showed a favorable outcome with medical therapy. Despite the advent of more recent diagnostic and therapeutic techniques, management of such large fistulae remains unresolved.

Aged↗
PubMed1992

[Pericardioscopy: techniques, indications and results. Apropos of an experience with 70 cases].

Pericardoscopy (PCS) is an original method of examination of the pericardial cavity. Its principle is derived from pleuroscopy and the apparatus is derived from mediastinoscopy. The main indication for this technique is the diagnosis of pericardial effusions. Sixty-five PCS were performed for this purpose, allowing an accurate etiological diagnosis in 35 cases. The etiological diagnosis was based on the clinical and paraclinical context in 4 other effusions, considered to be idiopathic after PCS. In 23 cases, the etiology remained uncertain, but a tuberculous or neoplastic etiology was ruled out after PCS. Three false negative results were obtained. Complete cleaning of the pericardial cavity allowed favorable immediate and mid a term outcome, avoiding possible constriction. Finally, PCS established the operability of two bronchial cancers, located in the hilar area and suspected of intrapericardial extension (PCS was performed in these cases in absence of pericardial effusion).

Acute Disease↗
PubMed1991

[Dissecting aneurysm of the left iliac artery disclosing Marfan's disease].

Marfan's syndrome only very rarely presents as a peripheral arterial complication. In the case described, dissection of the left iliac artery in a 52-year-old man presented as intermittent claudication of sudden onset and enabled the diagnosis of previously unrecognised Marfan's syndrome on the basis of great height, a dorsal kyphoscoliosis, a positive family history and aortic abnormalities. Treatment based upon vasodilators and platelet antiaggregation enabled a favourable outcome with frequent monitoring.

Aortic Dissection↗
PubMed1991

[Isolated tricuspid endocarditis. Apropos of a case caused by Streptococcus D bovis and faecalis occurring after coloscopy].

A 59-year-old chronic alcoholic male, with no cardiac past history, was hospitalised with septicemia 5 months after the endoscopic removal of 2 benign intestinal polyps. The diagnosis of tricuspid endocarditis was possible only 2 months later on the basis of echocardiography requested because of the onset of a tricuspid systolic murmur. Blood cultures revealed the presence in succession of streptococcus D fecalis then bovis. Antibiotics, changed several times because of the onset of complications (allergy, agranulocytosis), failed to deal with the problem of infection as shown by the development of several septic pulmonary emboli which finally resulted in total tricuspidectomy with neither immediate nor secondary valve replacement. The authors use this clinical case to review the characteristics of tricuspid endocarditis, the incidence of which is on the increase in certain etiological contexts (staphylococcal endocarditis in drug addicts or secondary to central vascular lines). They stress that the clinical picture is often confusing since the murmur of tricuspid incompetence is absent in 2/3 of cases. Echocardiography must therefore be requested routinely in all septicemias, thus enabling earlier diagnosis and assessment of the risk of pulmonary embolism (risk if vegetation greater than 10 mm). The nature of the organism responsible may be suggestive of certain etiologies. Thus malignant disease of the colon should be sought if the bacterium is a streptococcus D bovis. Apart from antibiotics, treatment must include effective anticoagulation to decrease the risk of embolic recurrence.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗