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Biomedical subjects

C Dubost

Publications and source records attributed to C Dubost.

At least 91 records · Page 5Linked to original sources
PubMed1983

[Severe postoperative heart blocks appearing late. 16 cases].

Sixteen patients, aged 4 to 42 years, operated for congenital heart disease, presented, months or years after surgery, complete atrioventricular (11 cases) or sinoatrial block (5 cases). Six patients had transient complete atrioventricular block in the immediate postoperative period, the maximum duration of which was less than 30 days. The late postoperative period was defined as at least 6 months after surgery. The period between surgery and the implantation of a pacemaker varied from 9 months to 19 years, average 6,3 years. Analysis of long term electrocardiographic studies distinguished three types of progression: --group I: alternation of sinus rhythm and conduction defect until definitive block, sometimes presenting with syncope; --group II: sudden, severe conduction defect after a long period of sinus rhythm; --group III: progressive lengthening of the PR interval. Seven patients developed syncope; 4 had dizziness, 2 were short of breath; only 3 were asymptomatic. All underwent permanent pacing. The incidence of late conduction defects appears to be 1 to 2% of operated patients. The causes include progressive fibrosis, slow sclerosis extending over conduction pathways which are congenitally fragile. Most late blocks are of an advanced degree. Some may be responsible for unexplained sudden death. It is therefore desirable to avoid this complication by the judicious and considered implantation of a cardiac pacemaker. Some authors mention the following factors in deciding on the indications for pacing: --complete, transient atrioventricular block during the operation or the immediate postoperative period; --ECG appearances of right bundle branch block and left anterior hemiblock, or trifascicular block; --His bundle studies.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1983

Secondary hyperparathyroidism in chronic haemodialysis patients: a clinico-pathological study.

Fifty-eight patients on intermittent haemodialysis underwent parathyroidectomy because of severe secondary hyperparathyroidism. Mean individual parathyroid gland weight was 689 +/- 62 (SEM) mg. Mean total gland weight per patient was between two and three grams. Increasing nodule formation within hyperplastic glands appeared to develop with increasing time of duration of hyperparathyroidism. Patients with chronic pyelonephritis had a higher gland weight than those with chronic glomerulonephritis. A direct relationship was found between gland weight and circulating immunoreactive parathyroid hormone, but an inverse relationship between gland weight and plasma aluminium concentration. The higher the parathyroid gland aluminium, the higher was the bone aluminium concentration.

Adolescent↗
PubMed1982

[Unexpected generalized amyloidosis discovered on biopsies. Value of Wright's method for etiologic diagnosis. Three case-reports].

Three cases are reported in which unexpected generalized amyloïdosis was disclosed by biopsies. The authors emphasize the value of precise analysis of the deposits and particularly of Wright's method for studying their staining properties. This method can guide investigations towards one of the two main etiologies of amyloïdosis (immunoglobulinic or AA).

Aged↗
PubMed1982

[Primary hyperparathyroidism. A retrospective study of 500 cases (author's transl)].

A retrospective study of more than 500 case-records of primary hyperparathyroidism was undertaken with the view of elucidating a number of problems raised in recent years: incidence of the disease, new clinical features, diagnostic methods and possible associations with other pathologies. The authors summarize the operative findings and the immediate or long-term results of surgical treatment, which on the whole are satisfactory and of long duration.

Humans↗
PubMed1982

[Clinical study of prostacyclin in extracorporeal circulation. Effects on hemodynamics and coagulation].

The effects of prostacycline (PGI2), the most powerful known platelet antiaggregant on platelet count and function during cardiopulmonary bypass, were assessed in a double blind study. One group of 13 patients received 2,5 mg/Kg of Heparin with an infusion of 25 ng/Kg/min of prostacycline instituted 15 minutes before the Heparin, continued at the beginning of cardiopulmonary bypass at a dose of 50 ng/Kg/min and terminated at the end of bypass. A second group of 15 patients were studied by the same protocol with a placebo infusion. The platelet count was significantly higher at the end of cardiopulmonary bypass in the Prostacycline group. Platelet aggregation was reduced by comparison with the control group from the beginning of Prostacycline infusion. The active thrombin time was significantly longer in the Prostacycline group. However, blood loss did not differ significantly between the two groups although it was less in the study group. The platelet count and function during cardiopulmonary bypass with Prostacycline was therefore increased and resulted in a reduction in Heparin consumption.

Anticoagulants↗
PubMed1982

[Treatment of single ventricle by direct atriopulmonary anastomosis without tube or valve. Apropos of a case operated on].

A case of single ventricle with pulmonary stenosis operated at 20 years of age by direct atrio-pulmonary anastamosis is presented. This procedure in contrast to classical techniques does not use an intraventricular patch or a valved ventriculo-pulmonary conduit. It is an adaptation of the Fontan technique initially proposed for tricuspid atresia. The operation consisted of closing the right atrioventricular orifice with a piece of Dacron, suturing the pulmonary valves (which were stenosed) and connecting the right atrium and pulmonary artery by a direct anastamosis using the auricle. The clinical result remains satisfactory one year after surgery: the cyanosis has regressed, the functional tolerance is perfect, there is no hepatomegaly and the patient is in sinus rhythm. The technique is very simple and involves less risk to the His bundle than intraventricular septalisation. It should be reserved to cases of single ventricle with low pulmonary pressures and resistance without cardiac failure. The long-term prognosis depends on the tolerance of the right atrium and is, at present, unknown.

Adult↗
PubMed1982

Hemodynamic and metabolic effects of prostacyclin after coronary bypass surgery.

The hemodynamic and metabolic effects of prostacyclin (PGI2) were assessed in 12 patients who underwent coronary bypass surgery. PGI2 were injected intravenously at a rate of 2.5 ng/kg/min for 10 minutes, followed by three consecutive 10-minute injections of 5, 10 and 20 ng/kg/min. PGI2 infusion decreased systolic and diastolic arterial pressures by 17% (p less than 0.001) and increased cardiac index by 17% (p less than 0.001) without changing the heart rate. Right atrial, pulmonary arterial and pulmonary wedge pressures remained essentially unchanged. Total vascular resistance decreased by 37% (p less than 0.001). Rate-pressure product, an index of myocardial oxygen consumption, decreased by 13% (p less than 0.01), while stroke work index did not change. A 36% decrease in arterial PO2 (p less than 0.001) was the most consistent metabolic effect induced by PGI2 infusion. However, oxygen transport increased by 11% (p less than 0.05), suggesting that no decrease in peripheral oxygen supply was produced. Thus, PGI2 improved cardiac function and performance by a predominant effect on total vascular resistance. It may be valuable in the management of patients who undergo coronary artery surgery.

Adult↗
PubMed1982

[Familial hypocalciuric hypercalcemia: two case reports (author's transl)].

Two cases of familial hypocalciuric hypercalcemia (FHH) are reported with a review of the literature. Both cases had hypercalcemia, hypophosphatemia, variable parathormone (PTH) levels and hypocalciuria. The parathyroid glands were only slightly hyperplastic and subtotal parathyroidectomy did not reduce the hypercalcemia. FHH is an autosomal dominant congenital disease with high penetrance. It is characterised by hypocalcemia. This contradictory biological finding should alert the physician to the diagnosis and initiate a familial enquiry. The serum PTH and urinary cyclical-AMP levels do not distinguish FHH from primary hyperparathyroidism. Surgery is usually contraindicated because it is ineffective and because the disease is usually benign. Semi-quantitative bone histology in a patient with a high PTH level was normal. The value of bone biopsy in these cases is discussed.

Adolescent↗
PubMed1982

[High ectopia of a parathyroid adenomas of the "parathymus". 2 cases].

The third brachial pouch gives rise to the thymus and antero-inferior part of the parathyroid gland (P3). A P3 gland can develop in any region of the migration pathway of the thymus from the angle of the jaw to the pericardium. Rare high ectopia of a parathyroid adenoma of the "parathymus" was detected in two patients during repeat operations for primary hyperparathyroidism.

Adenoma↗
PubMed1981

[Oesophagectomy without thoracotomy. 5 cases (author's transl)].

The authors describe an original technique of excision in severe caustic burns of the upper digestive tract: oesophagectomy without thoracotomy. The new procedure avoids the wide pleural opening of the thoracic approach, which leads to frequent and often fatal respiratory and infectious complications, whereas extrapleural drainage of the mediastinum has always proved effective and safe. Five technically successful operations were performed in one year. One patient died on the 10th post-operative day of tracheal necrosis related of the burn and 4 patients survived. These preliminary results are encouraging.

Abdomen↗