Biomedical subjects
Publications and source records attributed to A Perrin.
Bacterial meningitis following operation for ablation of acoustic neurinoma is a rare but always possible complication. Of 350 cases of neurinoma operated upon between 1965 and 1982, this postoperative lesion was reported in eleven patients (3.4 p. 100). Recovery occurred in all cases without sequelae. Mode of onset, symptoms and signs, curative therapy and preventive factors are discussed.
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Sclerodermic cardiomyopathy is the commonest cardiac lesion in this collagen disorder. The picture is a common-place one of left ventricular failure with moderate cardiomegaly (unless there is an associated chronic pericardial effusion). There are no characteristic features on the ECG. The prognosis is particularly poor, with death within one or two years. Clinical presentation of the cardiomyopathy may be preceded by isolated ECG changes occuring over one or two years. The myocardial disorder, which is often associated with latent pericardial and endocardial lesions, is peculiar to scleroderma out of all the collagen disorders, but presents no difficulty in differential diagnosis because of the other features of the disease of which it is a part.
Of 340 patients undergoing aorto-coronary surgery over a period of 6 years, the 136 cases in which there was a minimum follow-up of more than 4 years were analysed from the standpoint of the results. Overall amount annual postoperative mortality was low, less than 2,5%, even though the majority of patients undergoing surgery suffered from rest angina and had double or triple coronary stenoses. Analysis of prognostic parameters reveals the importance of the quality of the left ventricule, whilst age, sex, risk factors, the site of the bypass, the number of stenoses and the type of angina had little or no statistical influence on postoperative mortality. Six years after operation, there remained 66% of excellent results and 60% of the patients were able to work. One hundred and forty eight follow-up coronary arteriograms were carried out (including 33 repeated). During the first year after operation (184 by-passes examined) the percentage of permeability of the grafts was 84,8%. Later (86 bypasses examined) this fell significantly to 74,4% but 86,3% still had at least one permeable by-pass. Repeat late studies after four years showed the stability of the result. Investigation into the causes of postoperative infarctions ans analysis of the results in terms of the number of by-passes carried out in relation to the number of coronary stenoses, indicate that multiple by-passes should be avoided when technical conditions are difficult, with a narrowed coronary network and of little functional value.
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Cultures have been made from explants of thoracic aortas to study the growth pattern of aortic mediacytes. Explants from aortas of eight rats, aged between seven to eight weeks, were seeded. Three parameters were measured weekly from the second to the nineth week: the surface of the culture (S); the relative increment of this surface (delta S/S) and the number of 3H-thymidine labelled cells by the unit surface (n chi S-1) after autoradiography. The surface of primary culture, in relation to time, has roughly the shape of a sigmoidal curve. Growth is continuous until the fifth week and reaches a plateau beyond that time. The two other parameters decreased regularly during the first phase to attain a minimum at the beginning of the plateau-period; however new cells in the S-phase are still found in this second period.
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Progress in surgical technique and decreased early and late postoperative risk should lead to a modification in the indications for aortic valve replacement, before irreversible myocardial changes have definitively compromised the result of surgery. One hundred and seventy aortic valve replacements (100 pure or predominant aortic stenoses, 70 cases of aortic insufficiency) were carried out by the same surgeon over a period of 4 years with a minimum follow-up of one year and average of 25.4 months, using à Bjork prosthesis or a homograft. Early postoperative mortality was 5.3%, not differing from that associated with other types of valve replacement (mitral, polyvalvular). It is related more directly to surgical technique than to preoperative prognostic factors. Late mortality was 8.1%. Almost one third of these late deaths were related to the surgical technique or to the model of aortic prosthesis used. Stage IV cardiac failure plays a pejorative role in this late mortality, whilst no prognostic role could be demonstrated with respect to angina, meancardiac surface, Sokolow index, mean pulmonary artery pressure or diastolic pressure in the left ventricule. One year after surgery there was found to be a significantly important decrease in the Sokolow index and a modest decrease in mean radiological cardiac surface area. Beyond one year, no further improvement was seen. The majority of the patients surviving surgery had a good functional result since only 1% of the aortic stenosis patients and 7% of the aortic insufficiency group remained in stage III or IV cardiac failure. 78% of the patients who were working before operation were able to resume their professional activity after an average period of 6.2 months. However only 40% of the patients with stage IV failure who underwent surgery could return to work.
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On a series of 170 aortic valve replacement - 100 aortic stenoses (AS) and 70 aortic regurgitations (AR) - with an early post operative death rate of 5.3% and a late one of 8% (with a minimum follow up of 1 year and an average one of 25.4 months, two electrocardiographic and radiological checks could be done on 123 patients, 12 months on an average after the operation, and again for 116 patients, 21 months after the operation. After a year there was a significant and substantial decrease of the left ventricular hypertrophy (LVH) and a moderate one of the radiological heart area (HA). The decrease of LVH (Sokolow's index and AVL) tended to be more marked for the AS group and that of HA for the AR. At the second check no further significant change of LVH or HA was noted for either group, and the average HA of the patients remained high. The mean post-operative decrease of LVH and HA was all the greater as the pre-operative value was higher; but it was independent of the stage of heart failure and of the pre-operative hemodynamic data. There was no correlation demonstrated between the amplitude of post-operative variations of HA or LVH and the main operative stages (aortic clamping, ventricular fibrillation, coronary infusion). There was no significant difference between the mean values of LVH or HA of the survivors and those of the early post-operative deaths. The mean value of pre-operative HA was higher in the patients who were to die late than in the survivors, but the difference was not statistically significant after 25.4 months. The mean pre-operative values of HA and LVH did not influence the quality of the post-operative functional result.
In a patient with a primary cardiomyopathy, anatomical investigation allowed us to find a total old organised thrombosis of the coronary sinus associated with the presence of a right ventricular stimulator of a pacemaker. A brief review of the literature reveals that cardiac thombosis is a surpising and rare complication of a residual intracavitary pacemaker, even if it is located in the coronary sinus.
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The study concerns the clinical, haematological, serological, radiological and histocompatibility antigenic status of eleven in-patients suffering from long-standing sero-positive rheumatoid arthritis at the Royal Hospital and Home for Incurables in London. The study revealed a striking degree of widespread bony ankylosis affecting the peripheral joints and cervical spine. In large part, this bony ankylosis accounted for the disability but it is considered that the cervical spine ankylosis may protect the spinal cord from damage. The absence of the histocompatability antigen HLA 27 is a useful pointer in the exclusion of Ankylosing Spondylitis. Despite the clinical impression that the disease was inactive, the elevated sedimentation rate (23-66, mean 41 mm) suggests that the rheumatoid process remains active.
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