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Biomedical subjects

B Bertrand

Publications and source records attributed to B Bertrand.

At least 109 records · Page 6Linked to original sources
PubMed1993

[Value of the association of normovolemic dilution and hyperbaric oxygenation in the treatment of sudden deafness. A retrospective study].

The multiple treatments of sudden deafness shows how this pathology still remains quite unknown. The authors present a retrospective study of 87 patients treated by normovolemic hemodilution associated to hyperbaric oxygenation. They obtain a total à 60% of significant recovery (ratio between hearing gain and initial hearing loss, above 25%) and in severe hearing loss (threshold between 70 and 90 dB) 60% of good results (ratio above 50%). The importance of the initial form of audiogram and the presence of dizziness as prognostic factors is not confirmed. On the other hand, the evolution of tinnitus is correlated with the deafness and it is a supplementary means to evaluate the therapeutic efficiency. Moreover the persistence of tinnitus represents an important after effect. Sudden deafness still remains a medical emergency and the delay for carrying out any treatment should be as short as possible. On the other hand it is possible to reduce hospital stay by two sessions of hyperbaric oxygenation per day.

Adolescent↗
PubMed1993

[Mid-term follow-up after transluminal coronary angioplasty. Clinical results, mortality, morbidity apropos of 500 consecutive procedures].

The aim of this study was evaluation of mid-term results, with a mean follow-up of 23 months (range: 6 months to 6 years), in 449 patients undergoing 500 consecutive angioplasty procedures before 1989. All of these 449 patients underwent primary angioplasty, and not dilatation after restenosis. Data processing of information, based upon a questionnaire filled out by the patient's own cardiologist, enabled 100 per cent follow-up. In these patients with a mean age of 56 (range: 32-83), angioplasty was single in 93 per cent of cases. The indication was unstable angina (45%), following a myocardial infarction (44%) or, more rarely, stable angina (10%). The anterior interventricular was dilated more often than the right coronary and circumflex (56%, 31% and 22% respectively). The cardiac survival rate of 41 months was 94.3 per cent, 78 per cent of patients not having experienced any serious coronary events at the time of last available information. 65 (sixty five) per cent of patients were asymptomatic and the Thallium stress test was normal in 67 per cent of them. Angina recurred in 17 per cent of patients, twice as often in women (p < 0.02). 14 (fourteen) per cent had undergone a bypass procedure and 14 per cent had been redilated. Comparisons by the Kaplan-Meier method showed less good results after the age of 57: higher mortality (p < 0.01), more frequent recurrences of angina (p < 0.05), more frequent aorto-coronary bypasses (p < 0.001). Aorto-coronary bypasses were commoner after dilatation of the anterior interventricular (p < 0.005), after multiple dilatations (p < 0.03) or after unstable angina (p < 0.05).

Angina Pectoris↗
PubMed1992

Relationship of chronic ethmoidal sinusitis, maxillary sinusitis, and ostial permeability controlled by sinusomanometry: statistical study.

Three hundred sixty-seven successive patients suffering from chronic maxillary sinusitis (CMS) were thoroughly examined by means of maxillary sinusoscopy, a CT scan of the facial sinuses, and sinusomanometry (SMM). Ninety-eight cases of unilateral CMS, 269 cases of bilateral CMS, and 444 chronic ethmoidal sinusitis (CES) cases were evaluated. According to SMM, the maxillary ostia were divided into two groups: 1. maxillary ostium patency (MOP) group and 2. the maxillary ostium nonpatency (MONP) group. The unilateral and bilateral pathologies were separately analyzed so as to minimize the effects of general or systemic causes on the results. MONP is, in both bilateral and unilateral groups, significantly linked with the presence of ethmoidal sinusitis (P < 10(-6); P = .026), while the correlation between MOP and the ethmoid status does not appear to be significant in either group. Thus, there seems to be a close relationship between CES and maxillary ostial dyspermeability in cases of CMS.

Belgium↗
PubMed1992

[Our experience with percutaneous endoscopic gastrostomy in pharyngo-laryngeal surgery].

Percutaneous endoscopic gastrostomy (PEG), is an enteral feeding procedure, easy to tolerate and simple to perform. PEG appears to be an alternative to surgical gastrostomy. Used in ten patients with E.N.T. cancer, we only observe two minor complications. Advisable in a first time for the feeding of patients with palliative treatment, we propose PEG for patients in position to have a long and difficult rehabilitation of swallowing.

Adult↗
PubMed1992

[Measurement of cardiac output by invasive methods: methods and variability].

Invasive techniques for the measurement of cardiac output include the Fick method, the marker dilution method and radiological ventriculography. The principles, methods and accuracy of these techniques are described. The reference method remains that of Fick, despite its being less widely used now because of its complicated nature and its technical limitations (need for strict baseline conditions, precision of sampling). The thermodilution method is often performed. It is easy and provides reliable results, except in conditions of low cardiac output or when there is severe tricuspid insufficiency. Radiological ventriculography is used less for the measurement of cardiac output, since it is heavily dependent upon heart rate and theoretical geometrical models. It remains valuable for the quantification of mitral and aortic regurgitation.

Cardiac Output↗
PubMed1992

[Evaluation of cardiac output by Doppler echocardiography. Basic principles and practice].

The measurement of cardiac output by the Doppler-echocardiography method is of considerable interest since, in contrast to other available techniques, it offers the possibility of the measurement of output at each valve orifice, thus providing a quantitative approach to valve regurgitation. The 4 basic data items required are: the surface area of the valve orifice, trans-valvular Doppler velocity spectrum, duration of ejection and of filling, and heart rate. A large number of studies have analysed the various investigation techniques and have shown their excellent correlation with reference invasive methods. In the light of experience acquired in our Echocardiography Laboratory, we recommend, in accordance with data from the literature, the exclusive use of pulsed Doppler and measurement of valve orifices by two-dimensional imaging at the point of insertion of the aortic and sigmoid cusps as well as at the mitral ring. A simplified method for the measurement of mitral surface area on the basis of TM records is suggested.

Cardiac Output↗
PubMed1992

[Evaluation of cardiac output by Doppler echocardiography. Correlation of aortic, pulmonary and mitral ring flow rates. Study of 103 subjects free of valve leak].

Measurement by Doppler-echocardiography of blood flow rates has the advantage over techniques for the measurement of cardiac output of determining the latter for each valve orifice, and of opening up an approach to the quantification of aortic and mitral regurgitation. This prospective study involving 103 subjects free of any valve leak showed the absence of an significant difference between aortic, pulmonary and mitral ring flow rates in a given individual. Correlations between results obtained at the three measurement sites were: r = 0.92 between aorta and pulmonary artery, r = 0.90 between aorta and mitral ring and r = 0.90 between pulmonary artery and mitral ring. These results support the validation of this technique and would justify its use in the evaluation, quantification and monitoring of mitral and aortic valve leaks.

Adolescent↗
PubMed1992

[Quantification by transthoracic Doppler of tricuspid valve insufficiencies].

Various methods are available today for the quantification of regurgitation by transthoracic Doppler. The present review deals with their respective usefulness in tricuspid insufficiency (TI). Despite their contribution in the domain of mitral and aortic insufficiency, precise quantification methods remain of very limited value regarding the tricuspid orifice, and this because of practical difficulties of application. Evaluations of the severity of TI is based, essentially, on a semiquantitative approach. Cartography of the regurgitation stream, by colour Doppler, is the chief method, despite its limitations which are clearly emphasised by the effects of the contrast test. The discovery, by pulsed Doppler, of laminar systolic flow is a sign of capital importance. It is indicative of massive TI and of particular anatomical and hemodynamic conditions, but it is uncommon. Systolic reversal of flow in the inferior vena cava is a good sign of severity but lacks specificity. In contrast, measurement of maximum velocities of TI, while essential for the evaluation of pulmonary pressures, is of no value in terms of the quantification of regurgitation. Transthoracic Doppler data must be taken together with those of transthoracic echocardiography, the esophageal approach offering nothing special, being essentially useful in lesion evaluation. The quantification of TI, by transthoracic Doppler, has derived only very little benefit from the current orientation of Doppler methods.

Animals↗
PubMed1992

[Clinical evaluation after myocardial infarction. Its role, date and methods].

Although global mortality in the year following myocardial infarction is about 10%, this figure varies from less than 1% to more than 50% in some very high risk cases. The principal objective of clinical evaluation during the acute phase is to establish a prognosis and propose a rational strategy for myocardial revascularisation (by bypass grafting or angioplasty) in patients with a poor prognosis. An essential feature of this evaluation is to reduce health care costs and hospital stay to a minimum. Coronary angiography is the only investigation which allows assessment of the coronary circulation and is probably the best method of evaluating global and regional left ventricular function, two essential prognostic factors: on the other hand, it does not provide information about the presence of residual ischaemia or persistent myocardial viability in the infarcted territory. Some very high risk patients should undergo systematic coronary angiography to determine the possibilities for myocardial revascularisation: early post-infarction angina, left ventricular failure, chronic angina, elderly but valid patients... The indications of coronary angiography should also extend to patients with non-Q wave infarction, to young patients with myocardial infarction on thrombolysed infarcts: results of coronary angiography should then be compared with those of standard exercise stress testing. It is only in other situations, concerning a minority of patients, in which two attitudes may be considered: the first, to perform coronary angiography very early (within 24-48 hours of admission) allowing early discharge from hospital of many cases, completed later by standard exercise stress testing: any revascularisation procedure is considered at that time and requires a second hospital admission. The second attitude consists in performing coronary angiography between the 7th and 10th day only if some paraclinical changes are present: exercise stress testing then has an essential role; to improve its negative predictive value for absence of long-term coronary events it should be associated with radionuclide investigation of myocardial perfusion (thallium, MIBI) or with an evaluation or residual myocardial viability (labelled fatty acids, cyclotron). This attitude also allows early identification of "good candidates" for myocardial revascularisation.

Coronary Angiography↗
PubMed1991

Comparative effects of APSAC and rt-PA on infarct size and left ventricular function in acute myocardial infarction. A multicenter randomized study.

BACKGROUND: Recombinant tissue-type plasminogen activator (rt-PA or alteplase) and anisoylated plasminogen streptokinase activator complex (APSAC or anistreplase) have been demonstrated to limit infarct size significantly and to preserve left ventricular function when injected soon after acute myocardial infarction. However, as yet, the efficacy and safety of these two thrombolytic agents have not been directly compared in one trial; this was the aim of this study. METHODS AND RESULTS: One hundred eighty-three patients suffering from a first acute myocardial infarction were randomly allocated to either APSAC (30 units over 5 minutes) or single-chain rt-PA (100 mg over a 3-hour period) within 4 hours of the onset of symptoms. Global and regional left ventricular function were assessed from contrast angiography an average of 5.3 +/- 2.3 days after initial therapy. Radionuclide angiography and thallium-201 single-photon emission computerized tomography were performed before hospital discharge. Infarct size was assessed by single-photon emission computerized tomography and expressed in percentage of the total myocardial volume. Ninety patients received APSAC and 93 received rt-PA within a mean period of 172 +/- 52 minutes after the onset of symptoms. The two groups were similar in age, location of the acute myocardial infarction, Killip class, and time of randomization. The patency rate of the infarct-related artery was 72% in the APSAC group and 76% in the rt-PA group (NS). Initial and predischarge left ventricular ejection fraction as well as infarct size were similar in both therapeutic groups (0.50 +/- 0.14 versus 0.52 +/- 0.12 for initial and 0.48 +/- 0.10 versus 0.47 +/- 0.10 for predischarge ejection fraction, 11 +/- 7% versus 9 +/- 7% for infarct size, respectively, for APSAC- and rt-PA-treated patients). Bleeding complications requiring blood transfusion occurred in one APSAC patient and in two rt-PA patients. One patient in the rt-PA group died of a massive intracranial hemorrhage. At the end of the 3-week follow-up period, five APSAC patients (5.5%) and seven rt-PA patients (7.5%) had died. CONCLUSIONS: The early infusion of APSAC or rt-PA in acute myocardial infarction produced a similar patency rate, limitation of infarct size, and preservation of left ventricular systolic function with an equivalent rate of bleeding complications.

Anistreplase↗
PubMed1991

Regulation of adipose cell differentiation. I. Fatty acids are inducers of the aP2 gene expression.

The regulation of the expression of adipose-related genes, i.e., aP2, adipsin, and glycerophosphate dehydrogenase (GPDH) by growth hormone (GH) and polyamines, as well as the role of fatty acids, have been investigated in polyamine-dependent Ob1754 cells and Ob1771 preadipose cells. Growth hormone acts as an obligatory hormone for adipsin and GPDH gene expression but its presence is not required for the expression of the aP2 gene. In fully differentiated Ob1771 cells, impairment of fatty acid synthesis by glucose deprivation leads to an inhibition of the aP2 gene expression, whereas the expression of adipsin and GPDH genes remains unaffected. Supplementation of the culture medium with fatty acids prevents the decrease of aP2 gene expression, and this effect appears primarily due to an increase in the transcriptional level of aP2 gene. The induction of aP2 gene has been examined in early committed, lipid-free Ob1771 cells in which fatty acid synthesis is very low despite glucose supplementation. Long-chain fatty acids (greater than or equal to C12) are able to activate the aP2 gene. It is concluded that fatty acids or fatty acid metabolites activate the aP2 gene and subsequently modulate its expression.

Adipose Tissue↗
PubMed1991

[Microsurgical approach to the lacrimal ducts. Technical aspects--indications--reasons for failure].

The dacryocystorhinostomy is an operation that connects directly the lacrymal sac to the nasal cavity. In 1904, Toti described the external approach but one had to wait until the development of the sinus surgery to have a new interest in the endonasal approach. It appears to be a safe, efficacious and a less traumatizing procedure preserving the lacrymal function without skin incision. It allows a procedure in a non-scarred field. A good relationship between the ENT and the ophthalmologist is required.

Child, Preschool↗
PubMed1991

[Electromyography of the larynx in the diagnosis of spontaneous or post-thyroidectomy laryngeal paralysis].

Electromyographic assessment (EMG) of the larynx is very important for diagnostic and prognostic in cases of unmoving larynx: definition that authors like better than larynx palsie or recurrent nerve palsie because it is impossible to know why the larynx do not move in many cases (15f for 20 cases in the experience of the authors). EMG must be realized on several muscles and not only on the vocal fold muscle. It is necessary to realize several EMG to have a good follow up. If we have the proof that it is a case of definitive recurrent palsie the authors think that it is now, indication of nervous selective anastomosis by micro-surgery.

Electromyography↗
PubMed1990

Expression and regulation of pOb24 and lipoprotein lipase genes during adipose conversion.

Lipoprotein lipase (LPL) and pOb24 mRNAs are known to be early markers of adipose cell differentiation. Comparative studies of the expression of pOb24 and LPL genes during adipose conversion of Ob1771 preadipocyte cells and in mouse adipose tissue have shown the following: 1) the expression of both genes takes place at confluence; this event can also be triggered by growth arrest of exponentially growing cells at the G1/S stage of the cell cycle; 2) In contrast to glycerol-3-phosphate dehydrogenase mRNA, the emergence of pOb24 and lipoprotein lipase mRNAs requires neither growth hormone or tri-iodothyronine as obligatory hormones nor insulin as a modulating hormone; 3) in mouse adipose tissue, pOb24 mRNA is present at a high level in stromal-vascular cells and at a low level in mature adipocytes, and in contrast LPL mRNAs are preferentially expressed in mature adipocytes. Thus, these two genes do not appear to be regulated in a similar manner, as also shown by the differential inhibition of their expression by tumor necrosis factor (TNF) and transforming growth factor-beta (TGF-beta).

Adipose Tissue↗
PubMed1990

The adipocyte: relationships between proliferation and adipose cell differentiation.

The differentiation of adipose precursor cells can be divided into early and late events. Growth arrest at the G1/S boundary triggers the activation of early genes, i.e., pOb24 and lipoprotein lipase; the expression of both genes is primarily regulated at a transcriptional level. The expression of late markers, which lead to terminal differentiation and accumulation of neutral lipids, takes place after a limited number of mitoses of early-marker-expressing cells. Only terminal differentiation requires the presence of growth hormone and triiodothyronine as obligatory hormones and insulin as a modulating hormone, and results in the formation of triacylglycerol-filled, non-dividing cells. It appears that terminal differentiation involves the cyclic AMP pathway, the diacylglycerol pathway, and a third pathway triggered by insulinlike growth factor-I and insulin. It is thus proposed that a combination of mitogenic-adipogenic signals is required to trigger terminal differentiation of preadipose cells.

Adipose Tissue↗
PubMed1990

Correction of glottic insufficiency by collagen injection.

Thirty-nine patients were treated with GAX collagen for vocal fold augmentation. The objective results were evaluated by measurement of the maximum phonation time, the phonatory quotient, vocal frequency analysis, and laryngostroboscopy. These results are as good as those with Zyderm Collagen II (ZCI). Avoidance of useless overcorrection, better resistance to collagenase, and less induced hypersensitivity differentiate GAX from ZCI.

Adolescent↗
PubMed1990

The use of injectable collagen to correct velopharyngeal insufficiency.

The use of Gax collagen is proposed for correcting velopharyngeal insufficiency with posterior pharyngeal wall augmentation. The indications for this procedure are velopharyngeal insufficiency that remains after surgery and treatment by a speech pathologist. The procedure is also valuable after velum paralysis. Collagen (2.5-5cc) is injected through a device designed for vocal-fold and laryngeal rehabilitation. Several injection points are necessary to raise a good Passavant's ridge. The muscular activity of the posterior pharyngeal wall models the collagen pad for the first 3 weeks; afterwards, the collagen shape remains unchanged due to its integration in the host tissues. At this time, five patients have been injected with Gax collagen and have improved. The oldest case dates from 28 months ago; the most recent dates from 8 months ago. There were no adverse reactions, and the results remain stable at the present time.

Adolescent↗