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Biomedical subjects

B Iung

Publications and source records attributed to B Iung.

64 records · Page 4Linked to original sources
PubMed1991

[Long-term results of surgical valvuloplasty for non-ischemic mitral insufficiency. Apropos of 155 cases].

One hundred and fifty-five patients with isolated mitral regurgitation were referred from our Department of Cardiology for mitral valve repair between 1972 and 1990. Men were in the majority (59%), the mean age was 51 years and 61% of the patients were in NYHA class III or IV. Degenerative or dystrophic etiologies predominated, followed by rheumatic origins (17%) and bacterial endocarditis (14%). Surgical repair was performed using Carpentier's techniques: insertion of a prosthetic ring (87%) valvular resection (73%), valvular mobilization (11%), closure of a perforation (4,5%) and resection of vegetations (4,5%). Two patients died during surgery and 7 were lost to follow-up; the others were followed for an average of 4 years, i.e., a cumulative follow-up of 584 years/patients. The overall results at 11.5 years were satisfactory: 84.5% survival rate and 64.5% with good valvular function. The linearized rates of endocarditis, thromboemboli, hemorrhagic complications (51 patients were taking anticoagulants) and repeated interventions were, respectively: 0.35, 1.54, 0.17 and 2.05%/patient-year. Residual mitral regurgitation was sought by clinical and Doppler examinations: 55.5% of the patients had none, 26% had mild, 10.3% had moderate and 8.2% had severe regurgitation. Analysis of the latter two groups identified 3 influencing factors: rheumatic origin of the regurgitation, surgery on the anterior cusp and the year surgery was performed (the post-surgical incidence has decreased in recent years). Other, less-well-known complications were also found: left ventricular outflow tract obstruction, progressive evolution towards mitral stenosis, development of aortic regurgitation (usually discreet) and formation of left atrial thrombi.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1991

[Bilateral renal embolism during thrombolytic therapy with tissue-type plasminogen activator in a patient with thrombosis of the left ventricle].

The authors report a case of bilateral renal embolism during thrombolytic treatment in the acute phase of myocardial infarction in a 77 year old patient in whom echocardiography had shown a left ventricular thrombus. After reviewing the literature, the risk of embolic complications of thrombolytic therapy would seem difficult to evaluate because of the difficulty of diagnosis, but they exist irrespective of the type of thrombolytic agent used.

Aged↗
PubMed1991

Degenerative aortic regurgitation.

In view of the growing incidence of degenerative origin among the aetiologies of aortic regurgitation, we felt it interesting to report our experience of the surgical treatment of such patients. Out of 313 patients operated on for isolated chronic aortic regurgitation between 1974 and 1989, 102 (32.6%) had aortic regurgitation of degenerative origin and form the basis of this study. The patients were divided into group I (n = 48) without aneurysm of the ascending aorta and group II (54 patients) with anulo-aortic ectasia. The first group was further subdivided according to the diameter of the ascending aorta: in group Ia (23 patients) the aorta was normal with a root diameter of less than 40 mm, while in group Ib (25 patients) the aorta was enlarged (root diameter between 40 and 54 mm). There was no statistically significant difference between the pre-operative and operative parameters of patients in groups Ia and Ib. All underwent aortic valve replacement without associated surgery of the ascending aorta. During a mean follow-up of 58 months, five patients from group Ib had aortic dissection and in another three, an ascending aorta aneurysm developed. Reoperation was performed in six cases. No such complications occurred in group Ia. At 6 years, the proportion of patients free from complications related to the ascending aorta was 100% in group Ia vs 63 +/- 6% in group Ib (P less than 0.05). In group II, all the patients underwent aortic valve replacement. The modalities of repair of the ascending aorta differed with time.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Dystrophic aortic valve insufficiency].

Although dystrophic aortic regurgitation is considered to be a rare condition, if aortic regurgitation due to cystic media-necrosis which usually presents with annulo-aortic ectasia and regurgitation due to dystrophic aortic valves are included, it becomes a relatively common cause of aortic regurgitation. In the authors' experience of 313 patients operated for pure chronic aortic regurgitation, approximately 30% had dystrophic lesions and this was the second most common cause of aortic regurgitation after acute rheumatic fever. The clinical presentation is variable: excluding annulo-aortic ectasia, the other features of dystrophic aortic regurgitation are less well known. Eighty-nine cases without aneurysm of the ascending thoracic aorta were recensed and analysed in a French Cooperative study. They were divided into two groups with respect to the diameter of the ascending aorta measured by echocardiography. The incidence of late postoperative complications of the ascending aorta was higher in patients with a dilated aorta. The diagnosis of dystrophic aortic regurgitation is easy in patients with an aneurysm of the ascending aorta: in other cases, transoesophageal echocardiography is very useful for evaluating the valvular lesions. Surgical treatment of pure dystrophic aortic regurgitation with an aneurysm of the ascending aorta is well established but the best management of aortic regurgitation associated with only mildly dilated aorta is debatable.

Aorta, Thoracic↗
PubMed1989

[Combination of theophylline and beta-adrenergic agonists in the treatment of asthma: efficacy and tolerance. Review of the literature].

Theophylline and beta 2-mimetic agents have long been used concomitantly in the treatment of asthma, but divergent opinions are lingering on concerning the safety and effectiveness of this combination in both chronic and acute asthma. In this article, the effectiveness and safety of the combined treatment are reviewed on the basis of published experimental studies and controlled clinical trials. Altogether, these publications demonstrate that the combination is more effective in chronic asthma than either of the two drugs taken separately, but the results obtained are more discordant in acute asthma. Concerning the cardiovascular system, some experimental and epidemiological data have probably led to overestimate the cardiotoxicity of the combined treatment. In clinical studies the incidence of severe arrhythmia is low and certainly not higher than with a single drug therapy in both chronic and acute asthma. Owing to its safety, the theophylline-beta 2-mimetic combination can be prescribed widely in order to improve the treatment of the different forms of asthma.

Acute Disease↗
PubMed1988

Cardiac arrhythmias during the combined use of intravenous aminophylline and terbutaline in status asthmaticus.

The purpose of this study was to evaluate prospectively the occurrence of cardiac arrhythmias during the combined therapy with intravenous aminophylline and terbutaline in 29 consecutive patients with status asthmaticus. The 24-hour Holter recordings were performed during continuous intravenous infusions of aminophylline (0.56 +/- 0.20 mg/kg/h) and terbutaline (0.034 +/- 0.014 microgram/kg/min). Serum theophylline concentration was 12.1 +/- 3.8 micrograms/ml and never reached the toxic level (greater than 20 micrograms/ml). Premature ventricular contractions (PVCs) were absent in 35 percent of patients and 48 percent had rare unifocal PVCs (less than 10/h). Only 17 percent of patients (five of 29) exhibited severe ventricular arrhythmias: PVCs greater than 10/h (n = 3), multifocal PVCs (n = 1); and a short run of ventricular tachycardia (n = 1). Serious supraventricular arrhythmias occurred in only 7 percent of patients (two of 29) who developed sustained runs of atrial tachycardia. These arrhythmias were always clinically well tolerated and spontaneously resolved without any antiarrhythmic treatment. We conclude that severe arrhythmias are rarely observed during combined therapy with aminophylline and terbutaline in status asthmaticus.

Adult↗
PubMed1986

[Postpartum myocardial infarction with normal coronary arteries. Apropos of a case].

A case of painless anteroseptal and high lateral wall infarction presenting as cardiogenic shock with pulmonary oedema 24 hours after childbirth complicated by severe post partum haemorrhage with a coagulation defect, is reported. Coronary angiography performed one month later was normal, with a negative ergometrine provocation test. The authors review five previous reports in the medical literature, and discuss the possible physiopathological mechanisms which, alone or in association could have operated in the reported case.

Adult↗
PubMedDate not supplied

[Jejunal perforation by cholesterol embolus: a case treated surgically].

A case of ischaemic jejunal perforation which could be attributed to mesenteric cholesterol emboli is reported. The jejunal pathology had been preceded by other, more classical sites of systemic cholesterol embolization that occurred immediately after arterial catheterization in this male patient with aneurysm of the abdominal aorta. Emergency segmental resection of the jejunum was performed with satisfactory immediate results. Histological examination of the operative specimen confirmed that the perforation was caused by cholesterol emboli. Cholesterol embolization of the intestine may have various clinical consequences which are reviewed by the authors.

Aortic Aneurysm, Abdominal↗
PubMedDate not supplied

Fetal and obstetrical impact of percutaneous balloon mitral commissurotomy during pregnancy.

Since 1984 percutaneous mitral balloon commissurotomy (PMC) has replaced closed mitral commissurotomy in most of its indications. However the application of this technique to pregnant women had raised considerable concern essentially because of the risk of fetal distress and irradiation. Of 1,017 PMC performed between March 1986 and December 1992, 11 were carried out during pregnancy. At the time of the procedure gestational time ranged from 24 to 34 weeks of amenorrhea. PMC resulted in immediate hemodynamic improvement and there were no major maternal complications. Maternal abdominal radiation was always less than 0.2 mSv. Fetal heart rate was monitored during the procedure and showed only minor abnormalities. The outcomes of these 11 pregnancies were: 4 vaginal deliveries after 37 weeks, 5 cesarean sections after 37 weeks and 1 at 29 weeks. All newborn children were normotrophic and without malformation.

Adult↗