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Biomedical subjects

D Bonnet

Publications and source records attributed to D Bonnet.

288 records · Page 16Linked to original sources
PubMedDate not supplied

Right ventricular myocardial sinusoidal-coronary artery connections in critical pulmonary valve stenosis.

Ventriculo-coronary arterial connections are frequently observed in pulmonary atresia with intact interventricular septum. Sustained right ventricular hypertension during cardiac morphogenesis is thought to be responsible for persistence of myocardial sinusoidal-coronary artery connections. Considering an unusual observation of ventriculo-coronary arterial connections in a patient with critical pulmonary valve stenosis, we speculate that sinusoidal connections in pulmonary atresia with intact ventricular septum occur not only because it is the only exit for blood from the blind right ventricle, but also because of intrinsic altered morphogenesis of the right ventricle myocardium.

Abnormalities, Multiple↗
PubMedDate not supplied

[Arterial rigidity and endothelial dysfunction in obese children].

Obesity is a cardiovascular risk factor in adults. Poorly is known about effect of obesity on cardiovascular system in children. Mechanical properties of a great elastic trunk, the common carotid artery (CCA) and endothelium function of the brachial artery were studied in 130 obese children (age: 12 +/- 3 years, body mass index (BMI): 29 +/- 5.5 kg/m2, without hypertension (115 +/- 19/58 +/- 8 mmHg). These patients had a vascular high resolution echographical analysis. Cross sectional compliance (CSC), cross sectional distensibility (CSD) and incremental elastic modulus (Einc) were analysed at the CCA site. The brachial artery dilation was measured after hyperthemia (flow mediated dilation, FMD), an endothelium dependent function and after sublingually glyceryl trinitrate (GTNMD), an independent endothelium function. Fat mass composition and distribution were assessed by dual-energy X-ray absorptiometry in 70 patients. In 50 obese patients an oral glucose tolerance test was done to determine insulin resistance. The obese children had significantly lower CSC and CSD than the healthy controls (respectively 0.12 +/- 0.04 vs 0.14 +/- 0.05 mm2.mmHg-1; p < 0.05 and 0.5 +/- 0.2 vs 0.8 +/- 0.4 mmHg(-1).10(-2); p < 0.001). Obese children had higher value than the controls for Einc (2.4 +/- 0.4 vs 1 +/- 0.24 mmHg.10(3); p < 0.001) that correlated poorly with fasting insulin concentrations (r = 0.34; p < 0.06) and BMI (r = 0.34; p < 0.01). FMD was significantly lower in obese children than in controls (6 +/- 3 vs 8 +/- 4%, p < 0.01) without modification of GTNMD (17 +/- 6 vs 18 +/- 7%, NS). These two parameters were respectively correlated with the android fat distribution (r = 0.36; p < 0.01; r = 0.49; p < 0.001). The CCA stiffness of obese children is linked to the amount of the overweight and to insulin resistance. The android fat distribution is related to endothelium dysfunction.

Adolescent↗
PubMedDate not supplied

[Aortic arch shape and flow dynamics].

Post-operative deformation of the aortic arch architecture is associated with an increased risk of hypertension following correction of coarctation. In addition to morphological analysis, MRI allows a functional analysis of the thoracic aorta. We report three examples which illustrate the direct relationship between aortic arch morphology and blood flow in the thoracic aorta.

Adolescent↗
PubMedDate not supplied

[Relationship between aortic arch shape and blood pressure response after coarctation repair].

The mechanisms of secondary hypertension after repair of coarctation of the aorta are not well understood. Abnormalities of the architecture of the aortic arch and their consequences on blood pressure have not been studied. In order to study the relationship between abnormalities or aortic arch architecture and resting blood pressure ninety-four patients without re-coarctation were followed up prospectively from 1997 to 2004 (mean age 16.9 +/- 8.1 years; mean weight 57.5 +/- 18.3 Kg; interval since surgery 16.3 +/- 5.4 years). All underwent MRI angiography of the thoracic aorta which enabled the abnormalities to be classified in 3 groups: gothic arch, crenellated arch and roman arch. Twenty-four patients (25.5%) were hypertensive and 70 (74.4%) normotensive. There were 40 gothic arches (42.5%). 14 crenellated arches (15%) and 40 roman arches (42.5%). Gothic arches were more commonly observed in the hypertensive patients (18/40, [45%, 95% CI 31-62]) than the crenellated arches (4/14, [28.5%, 95% CI 7-48]) or the roman arches (2/40, [5%, 95% CI 2-12]). Only the gothic arch was independently correlated with hypertension on multivariate analysis. The authors conclude that gothic deformation of the aortic arch is an independent predictive factor of hypertension in patients operated for coarctation with an excellent result on the isthmic region. Patients with a gothic appearance of their aortic arch should be followed up closely.

Adolescent↗
PubMedDate not supplied

[Tyrer's Brief Scale for Anxiety used with outpatients. First validation in the French language].

The brief scale for anxiety of Tyrer is a subdivision of the comprehensive psychopathological scale. We studied a serie of 105 anxious outpatients treated for chronic or reactive anxiety, without depressive or psychotic symptoms. We confirm its sensitivity to change, prove its concurrent validity in regard to the Hamilton anxiety rating scale and demonstrate that the brief scale for anxiety is a reliable instrument to assess anxiety with outpatients. Nevertheless the assessment of its internal validity raises the question of the item's selection at the time of the elaboration of the rating scales according to the scale's purpose. Indeed, must we attempt to register all the symptoms of the anxious syndrome, with the risk of including less specific items? Or must we choose the most characteristic and specific items with the risk of obtaining a more reductionist inventory, but more reliable in a "transnosographic" perspective?

Adult↗
PubMedDate not supplied

[The eosinophilic lung].

Infiltration of the pulmonary parenchyma by eosinophils is revealed in bronchoalveolar washings. Associated with pulmonary biopsy, this technique has renewed the approach to a classical syndrome. Pulmonary infiltration eosinophilia has multiple etiologies: some are well characterized (parasitic or medicinal), some others pose some nosological or etiopathogenic problems not yet clarified (chronic pulmonary infiltration eosinophilia, vasculitis of the lung). In such difficult cases, use of surgical pulmonary biopsies has to be envisaged.

Biopsy↗
PubMedDate not supplied

[Capgras syndrome in adolescence: a review apropos of one case].

The author report a case of Capgras' syndrome in a 12-years-old girl, who had been hospitalized for attacks of abdominal pain. These symptoms had gone on for two years and led twice to surgical interventions which did not find any organic etiology. Interviews with the girl showed that the abdominal pains were related to symptoms of typical panic attacks which lasted about 20 minutes. In some on them, she experienced multiple autoscopy and the "illusion des sosies", described by Capgras. Long-term evolution showed that Capgras' syndrome disappeared with improvement of the panic attacks, but ten years later the patient is still suffering from generalized anxiety. To our knowledge, no case, even in adult patients, was previously described in the context of panic attacks. Furthermore, Capgras' syndrome is particularly rare at adolescence. Our review of literature exhibits only 19 cases under 18. Diagnosis was available in 16 cases, and consisted of schizophrenia or schizophreniform psychosis in 62.5% of the cases. The others involved acute psychosis (2 cases), post-partum psychosis (1 case), drug-induced-psychosis (1 case), psychotic major depression (1 case), and post-varicella encephalitis (1 case). The doubles (out of the 15 cases where relevant detail is available) included at least a parent in 92.9% of patients, a brother or sister in 35.7%, a member of the medical team in 21.4% and a grand-parent in 14.3%.

Abdominal Pain↗
PubMedDate not supplied

[Psychopharmacology of autism].

Results of recent studies in pharmacotherapy in autism are presented. Haloperidol, fenfluramine and naltrexone have been the most extensively studied drugs in systematic research. Haloperidol appeared to decrease levels of hyperactivity, stereotypies, emotional lability but also abnormal object relations and social withdrawal. However, the therapeutic effect was generally modest and long term administration was associated with dyskinesias in autistic children. The frequent hyperserotonemia in autism has suggested the use of fenfluramine, an antiserotoninergic agent. Although the initial reports were optimistic, more recent carefully designed studies often failed to show that fenfluramine was superior to placebo. Naltrexone, a potent opiate antagonist, was explored following the opioid hypothesis based on the similarity between autistic symptomatology and abnormal behaviors observed in opiate addicts and in laboratory animals administered opiates and on the abnormalities of endogenous opioids that exit in a subgroup of autistic children. However, the current studies do not concur and no definite conclusions can be made of the efficacy of naltrexone at present time. Low doses of amisulpride which have been shown to improve negative symptoms in schizophrenia and serotoninergic antidepressants, which have proven effective in repetitive and ritualized behaviors, have recently began to be evaluated in controlled studies. At present time, no medication has shown to alter the course or the symptoms of autism, but some seem to be effective in reducing severe aberrant behaviors.

Adolescent↗
PubMedDate not supplied

[Acquired aphasia in a child with epilepsy (Landau-Kleffner syndrome). Comments apropos of a case with 1-year follow-up].

Authors report a case of Landau-Kleffner syndrome in a 6 year old boy. Landau-Kleffner syndrome is a rare disorder characterized by the combination of acquired aphasia and epileptic abnormalities like diffuse spikes-and-waves in sleep EEG. Seizures are associated in 50 to 80% of cases and generally disappear at puberty. Behavior disorder ranges from minor psychomotor disturbances to psychotic-like features. Onset appears at an age between 3 to 7 years. The relationship between aphasia and epilepsy remains unclear, even if language improvement frequently follows EEG improvement. The hypothesis of an underlying encephalitis could explain the whole syndrome but is not yet validated. Therapy should associate antiepileptic drugs, corticosteroid treatment and speech therapy, but no controlled study is available to confirm this protocol. Aphasia recovery is generally incomplete. The evolution of behavior disorder is not well documented. In the reported case, one year after onset, sleep EEG again became normal, behavior disturbances had disappeared, but spoken language was still absent.

Cerebral Cortex↗