Greater than 18-year follow-up after cardiac transplantation: clinical report and pathological findings.
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Aged↗
Biomedical subjects
E Henry
Publications and source records attributed to E Henry.
The National Cancer Prevention Policy: will it sell itself?
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Australia↗
Single dose and multidose analgesic study of ibuprofen and meclofenamate sodium after third molar surgery.
The purpose of this study was to compare the analgesic efficacy and safety of meclofenamate sodium with ibuprofen after dental impaction surgery. This study was double-blind and used a unique methodology. Patients (N = 254) were first randomized into the single dose phase of the study that included placebo, meclofenamate 50 mg, meclofenamate 100 mg, ibuprofen 200 mg, and ibuprofen 400 mg, followed by a 7-day multidose phase in which patients in the placebo group were rerandomized into one of the active treatment cells. In the single dose phase, all active treatments were significantly more efficacious than placebo for every summary analgesic measure. A positive dose-response was seen for both active drugs with meclofenamate 100 mg and ibuprofen 400 mg exhibiting the greatest efficacy for pain relief, pain reduction, time to remedication, and overall evaluation. Side effects were reported by 26 patients. They were evenly distributed among treatment groups with headache and drowsiness being the most common. During the multidose phase, there were only small differences in efficacy measures among active treatment groups. However, meclofenamate produced a higher incidence of stomach cramps and diarrhea than did ibuprofen (8.8% and 7.2% versus 0.8% and 0.8%). This study indicates that higher doses of nonsteroidal anti-inflammatory drugs are most effective immediately after surgery and that lower doses of these drugs can be used after the first postoperative day. The side effect profile of nonsteroidal anti-inflammatory analgesics is best observed with the use of a multidose study design.
Abdominal Pain↗
[Professional responsibility in ambulatory techniques. The individual responsibility of the anesthetist, the surgeon and the facility director].
Ambulatory practice is regulated since October 1992. These regulations do not limit directly the technical choice by surgeons and anaesthetists. However opportunity and feasibility of day care must be estimated separately by the concerned practitioners. Regulations do not affect sensibly the relation with patients though the latter are much more responsible and informed than if hospitalized. Whatever special precautionary measures are taken, aiming at a better risks prevention, they do not reduce at all the usual obligations of anaesthetists and particularly of surgeons, given the ever increasing use of recent methods such as interventional endoscopy.
Ambulatory Care↗
DNA in situ sensitivity to denaturation in bladder cancer and its correlation with tumor stage.
DNA content and sensitivity of DNA in situ to denaturation by acid were analyzed by flow cytometry of cell nuclei freshly isolated from the bladder tumors of 32 patients and were compared with normal urothelium of 8 subjects. DNA sensitivity to denaturation was assessed in RNase treated cells by acridine orange metachromasia following partial denaturation with hydrochloric acid; the extent of denatured DNA is given as an index (alpha t), representing the ratio of single stranded to total DNA per nucleus. Of the low stage tumors (papillomas, Ta, Tis, T1) 11 of 18 (61%) were aneuploid. Of the high stage tumors (T2 and T3a) 11 of 14 (79%) were aneuploid. DNA in nuclei of normal transitional epithelium was very sensitive to denaturation, as was papilloma, characterized by nuclear alpha t indices of 0.73 +/- 0.01 (SD) and 0.73 +/- 0.04, respectively. Nuclear DNA of noninvasive carcinomas (Ta, Tis) was significantly more resistant to denaturation (alpha t = 0.69), and DNA of invasive carcinomas was most resistant, ranging from alpha t = 0.61 (T1 tumors) to alpha t = 0.59 (T2 tumors) to alpha t = 0.57 (T3 tumors). High stage tumors as a group (T2, T3) had significantly different (lower) alpha t values than low stage tumors (Ta, Tis, T1). In model cell culture systems it is known that a decrease in alpha t index, i.e., greater resistance to denaturability, occurs as cells transit from resting phase into the cell cycle. Whether the alpha t index can be used to estimate resting vesus cycling cells of human tumors is still speculative; changes in DNA denaturability also are known to occur with changes in chromatin structure during cell differentiation and in transformation. However, the empirical relationship between alpha t index and tumor stage, of itself, may prove clinically useful in identifying more advanced and perhaps more aggressive tumors.
Biopsy↗
[Acetazolamide: an alternative to shunting in normal pressure hydrocephalus? Preliminary results].
From a series of 15 consecutive patients with a normal-pressure hydrocephalus examined over 2 years. 10 showed frank improvement with oral acetazolamide. The drug was a first-choice treatment in 5 cases and was given up after a spinal tap in 5 cases. Clinical response occurred even in the most severe cases, although it was slightly less impressive for intellectual impairment than for gait or bladder disturbances. Tolerance was excellent with a daily dose of 250 to 500 mg. The benefit remained stable on a more than 1 year follow-up in 8 cases. We suggest that acetazolamide should be tried in patients with normal pressure hydrocephalus prior to considering shunting.
Acetazolamide↗
Loss of motivation for speaking with bilateral lacunes in the anterior limb of the internal capsule.
A 76-year-old man suddenly presented with loss of motivation for speaking. He had no aphasia, depression or dementia, but he did not want to speak with other people. CT scan showed hypodensities, presumably lacunes, mainly in the anterior limb of the two internal capsules. Global behavioral changes with loss of self psychic activation have been reported, but in our patient the disturbance was restricted to oral language. The role of activating cortico-subcortical loops is discussed.
Aged↗
[Giant thrombosed aneurysm of the left vertebral artery developing in the fourth ventricle].
A case of giant, thrombosed, non haemorrhagic aneurysm of the distal portion of the left vertebral artery is reported. The patient came to medical attention with an acute cervical pain after a minimal cervical traumatism and a diagnosis of torticollis from rheumatologic cause was made. In fact, a few weeks before, he had suffered three episodes of right homonymous hemianopsia. Subsequently, hiccup, vomiting, orthostatic dizziness with postural hypotension appeared, suggesting a medullary lesion. CT scan showed a round, heterogeneous high-density lesion near the fourth ventricle. Angiography was normal. MRI showed an oval mass in the fourth ventricle, between the medulla and the cerebellum. Surgery found an aneurysm of the end of the left vertebral artery.
Adult↗
[Clinical history and anatomic findings following the longest survival after cardiac transplantation].
The authors report the case history of the first patient in the world to have survived 18 and a half years with a heart transplant. This survival was marked by several episodes of rejection during the early years and various other incidents. The pathology encountered was primarily iatrogenic: diffuse osteoporosis sometimes limited the patient's activity. Two skin cancers and a lung cancer were diagnosed and treated. The patient died from progressive respiratory failure with pulmonary hypertension and signs of right ventricular failure. Pathological examination revealed a subnormal myocardium with a certain amount of overloading of the coronary arteries, confirmed the lung cancer and pulmonary hypertension and, most importantly, revealed the presence of nodular regenerative hepatic cirrhosis responsible for ascites during the last few months of life and a renal adenocarcinoma. These last two lesions are observed in immunosuppressed patients. The authors pay tribute to this patient who led an active and devoted life in the service of others.
Carcinoma, Bronchogenic↗
[Primary failure of pericardial valvular heterografts].
From July 1981 to October 1984, 79 Hancock pericardial valves were implanted in 74 patients surviving the hospital period and with a mean age of 64.2 years. Fifty-two patients underwent aortic valve replacement, 16 had mitral valve replacement, 5 bad a double replacement and 19 associated procedures were performed. The mean survival is 48 months. Until 1st June 1987, 11 primary failures have required reoperation (14.9%), 4 in the mitral position (4.6% patient-years), 7 in the aortic position (3.01% patient-years). The time to reoperation was 48.4 months for the aortic orifice and 36.5 months for the mitral orifice. The lesions most frequently encountered were tears (7 cases), calcifications (5 cases) and stretching of valvular tissue (2 cases); two patients died during the postoperative phase of this operation. Despite the small number of patients followed, this series demonstrates of high incidence of dysfunction due to primary tissue degeneration as, after the 5th year, the actuarial rate of absence of primary lesion is 85.3 +/- 8% with no significant difference between the aortic and the mitral orifices, although dysfunction appears to occur more rapidly in mitral prostheses. These results are much less favourable than those obtained with Ionescu bioprostheses in the aortic position of those obtained with porcine bioprostheses in either position. This justifies very regular clinical and echocardiographic follow-up of patients with Hancock pericardial valvular heterografts.
Actuarial Analysis↗
[18 and one-half years' survival after cardiac graft. Clinical course and anatomical findings].
Operated upon in November, 1968, the last survivor of heart transplant recipients in those times has died on May 11, 1987, having survived 18 years and 6 months. The active life of this patient, however, was marred by episodes of graft rejection during the first post-operative years and by various incidents. It was mainly the complications of the immunosuppressive treatment that hampered his activities (osteoporosis) and provoked his death. Post-mortem examination confirmed that the heart was in good condition, found an active bronchial epithelioma and revealed iatrogenic lesions, namely adenomas, adenocarcinoma of the kidney and "regenerative" nodular hyperplasia of the liver with portal hypertension. Such lesions are observed in patients under long-term treatment with immunosuppressants. A "sleep apnoea" syndrome might have accounted for the formation of pulmonary hypertension lesions. The authors wish to pay their respects to this man who devoted himself to the service of other men.
Endomyocardial Fibrosis↗
[Dexamethasone suppression test in psychiatric pathology].
The dexamethasone suppression test (DST) has been used in psychiatric pathology for about 10 years. Carroll et al. consider this test to be specific of endogenous depression. According to these, and many other authors, approximately 55% of patients with endogenous depression show a positive response to the test, whereas a positive response is observed in only 4% of normal subjects or patients with psychiatric disorders other than major depressive disorders. The DST was performed in 162 psychiatric inpatients (5 with organic disease, 28 with schizophrenic disorders, 17 with major affective disorders, 5 with obsessive compulsive disorders, 103 with dysthymic disorders and 4 unclassified). Dexamethasone (1 mg) was administered orally at 11 p.m., and plasma cortisol concentration was measured the following day at 16 p.m. Response to the test was positive in 53% of patients with major affective disorders, 25% of those with schizophrenic disorders, 60% with obsessive compulsive disorders and 18% with dysthymic disorders. There was no statistical difference in the results according to age, sex ratio, family history of depression or duration of the disorders. Only two variables were close to the P less than 0.05 level of statistical significance: severity of the disorders and early morning awakening. DST sensitivity, therefore, would appear to be about 50% in major affective disorders, but this test is not specific as it may also be positive in other psychiatric disorders. A positive dexamethasone suppression test may be regarded as a sign of severity of psychiatric disorders.
Depressive Disorder↗
[Occurrence of tardive dyskinesia during neuroleptic treatment].
The incidence of tardive dyskinesia under neuroleptic treatment is diversely estimated. The effectiveness of anticholinergics in its prevention is under discussion. Among 52 patients treated with neuroleptics for more than 5 years (mean: 9 years) only 2 developed tardive dyskinesia, and the disorder was transient in each case. The low doses of neuroleptic drugs administered and their systematic association with anticholinergics seem to be partly responsible for this low incidence of tardive dyskinesia.
Adult↗
Leak of driving gas from Air-Shields ventilator.
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Anesthesiology↗
[Intracranial meningioma disclosed by isolated elevated cerebrospinal fluid protein levels].
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Aged↗
[Spatial delusion: sign of lesions of the non-dominant hemisphere].
Two cases with respectively an ischemic and a tumoral lesion of the right hemisphere showing a striking and isolated delusional belief to be relocated elsewhere are reported. Delusion had the remarkable intrinsic coherence of a paranoid delirium but was limited to the localization in space. In contrast these patients had no mental clouding or hallucinations and were well orientated for time and persons. Associated findings were a misrepresentation of space in drawing in the first case, and a left hemiparesis, a left sensory extinction, a left hemianopsia, a left visual neglect, a constructional apraxia and a misrepresentation of space in the second case. Such a spatial delirium has been described after severe head injury but rarely after unilateral cerebral lesions. The latter involve constantly the right hemisphere, either in the frontal, temporo-parietal or thalamic region. Usual neurobehavioral correlates in these cases were a disorder of visual memory, a topographical disorientation, a lack of representation and use of visuospatial data, and an anosognosia. The putative role of a 'release' of the left hemisphere is discussed.
Aged↗
[Plea for monoamine oxidase inhibitors. Retrospective study of 350 cases].
The case-records of 350 outpatients treated with monoamine oxidase inhibitors have been reviewed. All patients presented with depression, obsessions or phobias. About two-thirds benefited from the drugs, particularly after other treatments (including psychotropic drugs, seismotherapy, psychotherapy and internment) had failed. With the moderate doses administered (iproniazide: 50 mg/day; nialamide: 100 mg/day) side-effects were uncommon and mild and no incident was noted in 32 general anaesthesias given for surgical operations. These findings should help in lifting the ban on this category of drugs. Monoamine oxidase inhibitors are effective, useful and sometimes indispensable after failure of other antidepressants.
Adult↗
[Parkinson's disease. Retrospective study of 302 clinical case records].
This retrospective study of the case-records of 302 patients with Parkinson's disease shows that the condition begins earlier in males and that loss of weight during the first years of the disease is of poor prognosis. It also provides some arguments in favour of low-dosage L-dopa and suggests that no time should be wasted in administering this treatment.
Female↗