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E Marchand

Publications and source records attributed to E Marchand.

At least 19 recordsLinked to original sources
PubMed1999

Physiological basis of improvement after lung volume reduction surgery for severe emphysema: where are we?

Lung volume reduction surgery has become an accepted therapeutic option to relieve the symptoms of selected patients with severe emphysema. In a majority of these patients, it causes objective as well as subjective functional improvement. A proper understanding of the physiological determinants underlying these beneficial effects appears very important in order to better select patients for the procedure that is currently largely carried out on an empirical basis. Lung volume reduction surgery has two distinct effects. Firstly, it causes an increased elastic recoil, which at least partially explains the enhanced maximal expiratory flow. Secondly, it is associated with a reduction of hyperinflation which allows for an increase in global inspiratory muscle strength and in diaphragmatic contribution to tidal volume as well as a decrease in the inspiratory elastic load imposed by the chest wall. Taken together, these effects result in a reduced work of breathing and in an enhanced maximal ventilation which both contribute to the increased exercise capacity and reduced dyspnoea after surgery. The improved lung recoil and the reduced hyperinflation after volume reduction surgery were the primary postulates upon which the usual selection criteria for the procedure were based. It is now likely that these are correct. Nevertheless, some patients do not benefit from lung volume reduction surgery and the current literature does not allow for a refinement of the selection process from a physiological point of view. The exact mechanisms underlying the improvement in lung recoil, lung mechanics, and respiratory muscle function remain incompletely understood. Moreover, the effects of lung volume reduction surgery on gas exchange and pulmonary haemodynamics still need to be more fully investigated. An analysis of the characteristics of patients who do not benefit from the procedure and the development of an animal model for lung volume reduction surgery would probably help address these important issues.

Exercise Tolerance↗
PubMed1998

[Down the claws!].

Explore the source record for details and available documents.

Bartonella henselae↗
PubMed1998

Optimal coronary balloon angioplasty with provisional stenting versus primary stent (OCBAS): immediate and long-term follow-up results.

OBJECTIVE: This study sought to compare two strategies of revascularization in patients obtaining a good immediate angiographic result after percutaneous transluminal coronary angioplasty (PTCA): elective stenting versus optimal PTCA. A good immediate angiographic result with provisional stenting was considered to occur only if early loss in minimal luminal diameter (MLD) was documented at 30 min post-PTCA angiography. BACKGROUND: Coronary stenting reduces restenosis in lesions exhibiting early deterioration (>0.3 mm) in MLD within the first 24 hours (early loss) after successful PTCA. Lesions with no early loss after PTCA have a low restenosis rate. METHODS: To compare angiographic restenosis and target vessel revascularization (TVR) of lesions treated with coronary stenting versus those treated with optimal PTCA, 116 patients were randomized to stent (n=57) or to optimal PTCA (n=59). After randomization in the PTCA group, 13.5% of the patients crossed over to stent due to early loss (provisional stenting). RESULTS: Baseline demographic and angiographic characteristics were similar in both groups of patients. At 7.6 months, 96.6% of the entire population had a follow-up angiographic study: 98.2% in the stent and 94.9% in the PTCA group. Immediate and follow-up angiographic data showed that acute gain was significantly higher in the stent than in the PTCA group (1.95 vs. 1.5 mm; p < 0.03). However, late loss was significantly higher in the stent than the PTCA group (0.63+/-0.59 vs. 0.26+/-0.44, respectively; p=0.01). Hence, net gain with both techniques was similar (1.32< or =0.3 vs. 1.24+/-0.29 mm for the stent and the PTCA groups, respectively; p=NS). Angiographic restenosis rate at follow-up (19.2% in stent vs. 16.4% in PTCA; p=NS) and TVR (17.5% in stent vs. 13.5% in PTCA; p=NS) were similar. Furthermore, event-free survival was 80.8% in the stent versus 83.1% in the PTCA group (p=NS). Overall costs (hospital and follow-up) were US $591,740 in the stent versus US $398,480 in the PTCA group (p < 0.02). CONCLUSIONS: The strategy of PTCA with delay angiogram and provisional stent if early loss occurs had similar restenosis rate and TVR, but lower cost than primary stenting after PTCA.

Angioplasty, Balloon, Coronary↗
PubMed1998

Idiopathic chronic eosinophilic pneumonia. A clinical and follow-up study of 62 cases. The Groupe d'Etudes et de Recherche sur les Maladies "Orphelines" Pulmonaires (GERM"O"P).

Idiopathic chronic eosinophilic pneumonia (CEP) is a rare disorder of unknown cause with nonspecific respiratory and systemic symptoms but rather characteristic peripheral alveolar infiltrates on imaging, developing mainly in women and in atopic subjects. The disorder is highly responsive to oral corticosteroid therapy, but relapses are frequent on reducing or stopping treatment. The long-term course of the disease and data regarding outcome, particularly the need for prolonged oral corticosteroid therapy and the development of severe asthma, are somewhat contradictory. A multicentric retrospective study was conducted in an attempt to describe better the initial features and, above all, the later course of CEP in a large homogeneous series of 62 stringently selected patients of whom 46 were followed for more than 1 year. The prevalence of smokers was low (6.5%) and about half of our patients (51.6%) had a previous, and often prolonged, history of asthma. The clinical and roentgenographic features were in keeping with previous studies, but we found that computed tomography could disclose ground glass opacities not detected by X-ray, and that migratory infiltrates before treatment were more frequent (25.5%) than reported previously. The bronchoalveolar lavage cellular count always showed a striking eosinophilic pattern, thus allowing distinction between CEP and cryptogenic organizing pneumonia, both syndromes sharing many common clinical and imaging features. About two-thirds of the patients (68%) showed a ventilatory defect in pulmonary function tests, with about one-half of these presenting with an obstructive pattern, sometimes without previous asthma. Along with the submucosal eosinophilic infiltration noted in 2 patients without ventilatory defect, this is strong evidence to confirm that CEP is not only an alveolointerstitial but also an airway disease. The dramatic response to oral corticosteroid therapy was observed in all treated patients. Although only 1 patient initially treated for less than 6 months did not relapse, longer oral corticosteroid therapy in no way provided protection from further relapses. We thus propose to try to wean oral corticosteroid therapy after 6 months in patients without severe asthma, because recurrences remain responsive to oral steroids. However, prolonged oral corticosteroid therapy was necessary in the majority of patients, with 68.9% of those followed for more than 1 year still on oral corticosteroid therapy at the last follow-up, either because of relapse or because of severe asthma.

Adolescent↗
PubMed1998

Granulomatous bronchiolitis associated with Crohn's disease.

Symptomatic bronchopulmonary disorders have been only occasionally reported in Crohn's disease, although several studies have documented the possibility of latent involvement of the respiratory tract. We report the case of a patient with long-standing Crohn's disease who presented with acute transient chest pain and a recent history of mild dyspnea and nonproductive cough. Chest radiographs were normal, while high-resolution computed tomography demonstrated a mosaic pattern of attenuation that was consistent with a bronchiolar disorder. Pulmonary function tests showed mild airway obstruction and normal diffusion indices. Thoracoscopic lung biopsy demonstrated focal infiltration of the bronchiolar walls by mononuclear cells and non-necrotizing granulomas. To our knowledge, this is the first account of isolated granulomatous bronchiolitis in Crohn's disease. These findings suggest that a granulomatous inflammatory process of the bronchioles could be involved in the development of airway obstruction in patients with Crohn's disease.

Adult↗
PubMed1994

TaqI restriction fragment length polymorphisms for growth hormone in bovine breeds and their association with quantitative traits.

The objectives of the present study were (1) to reveal GH-TaqI RFLPs in different bovine breeds and (2) to look for association between quantitative traits and GH-TaqI RFLPs in bulls highly selected for growth and meat production. Blood was sampled from 269 Holstein heifers, 48 Italian and 45 Hungarian Simmental heifers, 30 Normande heifers and 41 bulls and 13 heifers of the double-muscled Belgian White Blue breed. Bulls were weighed from 7 until 13 months of age and the average daily gain, the feed efficiency, the height and the phenotypic index were determined at the end of the experiment. GH-TaqI RFLPs revealed 4 DNA fragments of 6 (A), 5.2 (B), 4.4 (C) and 4.2 (D) kbp. The distribution of genotypes was different between Normande and the other breeds (P < 0.001) and between Belgian White Blue and Holstein (P < 0.001) or Hungarian Simmental breed (P < 0.005). The Normande heifers were also characterized by a high frequency of the AB genotype (53%) compared with other experimental breeds (range values: 7-24%). In the statistical analysis of the relationships between quantitative traits and GH-TaqI RFLPs in double-muscled Belgian White Blue bulls, the AC genotypic class was not used because of its low distribution. The AA class showed greater records of weight at 7 (P < 0.07) and 13 (P < 0.06) months of age than the AB class. In conclusion, this study has shown a correlation between the GH-TaqI RFLPs and weight at 7 and 13 months of age in Belgian White Blue bulls.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1987

[Integration of digital angiography, magnetic resonance, x-ray computed tomography and positron emission tomography in stereotaxy].

Consecutively to drastic changes which occurred in cerebral imagery techniques, we have developed a stereotactic apparatus and system based on the integration of several new techniques allowing visualisation of the brain: tomodensitometry (TDM), digital subtraction angiography (DSA), magnetic resonance (MR) and positron emission tomography (PET). TDM, DSA and MR can be performed in stereotactic conditions with the apparatus in situ. They give the computer the anatomic references necessary for all calculations. MR and PET images obtained without stereotactic apparatus can also be integrated into the stereotactic study at the condition that DSA was formerly performed in stereotactic conditions, i.e. with the apparatus in situ. The visualisation of the corpus callosum makes this integration possible. An optimal definition of cerebral tumors or target-structures for intracerebral electrode recording is thus obtained.

Brain Diseases↗
PubMed1987

Magnetic resonance imaging stereotaxy: recognition and utilization of the commissures.

Magnetic Resonance Imaging (MRI) offers a non-invasive method to visualize the intracerebral structures. Coupled to a compatible stereotactic frame and software, MRI can be used to determine the coordinates of intracranial targets. Coordinates of the anterior commissure, posterior commissure, targets and intercommissural distance were obtained from positive contrast ventriculography and by MRI in 6 patients undergoing stereotactic localization prior to the implantation of stimulating thalamic electrodes for pain control. The correlation of coordinates and measurements obtained with ventriculography and MRI is +/- 1 mm in most measurements, but up to 3 mm in 2 cases. Magnetic resonance stereotaxy allows non-invasive and precise localization of intracerebral targets, but does not yet allow its routine use with confidence. Further understanding of distortion and artifacts and corrections of these is mandatory.

Brain↗
PubMed1986

Usefulness of anticoagulant therapy in the prevention of embolic complications of atrial fibrillation.

The medical records of 254 patients with atrial fibrillation were reviewed to determine the incidence of embolic events in relation to type of cardiovascular disease, duration of atrial fibrillation, and use of anticoagulants. During a total follow-up of 833 patient-years in atrial fibrillation, there were 32 instances of systemic embolism: 21 involved the cerebral circulation and 11 were extracerebral. Thirty of these events occurred during 549 patient-years of follow-up without anticoagulation therapy (5.46 of 100 patient-years), while only two embolic events occurred during 284 patient-years on anticoagulants (0.7 of 100 patient-years). Thus, the incidence of embolism was eight times more frequent during the unanticoagulated period of observation in atrial fibrillation (p less than 0.002). The incidence of embolism during follow-up without anticoagulants was the same regardless of the presence or absence of mitral valve disease and regardless of whether atrial fibrillation was chronic or paroxysmal. The rate of serious hemorrhagic complications on anticoagulants was acceptably low (2.11 of 100 patient-years). We conclude that in this study population anticoagulant therapy reduced the risk of embolic complications of atrial fibrillation. The results also indicate that the use of anticoagulants should not be limited to patients with atrial fibrillation due to mitral valve disease.

Adult↗
PubMed1986

Long-term reproducibility and significance of provokable ventricular arrhythmias after myocardial infarction.

The long-term reproducibility and significance of inducible ventricular arrhythmias were assessed in 21 survivors of a myocardial infarction. Programmed ventricular stimulation performed a mean of 12 +/- 2 days (range 8 to 18) after infarction provoked ventricular fibrillation in 2 patients, sustained monomorphic ventricular tachycardia in 8 and nonsustained ventricular tachycardia in 11. Patients were restudied using the same protocol a mean of 8 +/- 2 months (range 4 to 11) after infarction. All patients underwent programmed ventricular stimulation studies in the absence of antiarrhythmic drug treatment. Ventricular tachyarrhythmias could be reinitiated in 16 patients (76%): ventricular fibrillation in 2, sustained ventricular tachycardia in 5 (monomorphic in 4) and nonsustained ventricular tachycardia in 9. A preponderance of inferior infarction was observed among patients with reinducible tachycardias (9 of 16 patients versus 0 of 5 with noninducible tachycardias) (p less than 0.05). No significant difference existed between patients with and without reinducible arrhythmias with respect to severity of coronary artery disease, degree of left ventricular dysfunction, occurrence of ventricular fibrillation in the acute phase of infarction and ventricular arrhythmias detected by 24 hour ambulatory electrocardiographic (Holter) monitoring. There was no significant difference between patients with and without a positive late study in stimulation thresholds, ventricular refractory periods, time interval between initial and repeat testing and use of beta-adrenergic blocking agents. During a mean follow-up period of 17 months (range 10 to 23) one patient with inducible sustained monomorphic ventricular tachycardia at both studies died suddenly. The remaining patients have survived follow-up without experiencing an arrhythmic event.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Programmed ventricular stimulation in survivors of an acute myocardial infarction.

The prognostic significance of programmed ventricular stimulation and its usefulness in relation to other forms of invasive and noninvasive testing was evaluated in 150 survivors of acute myocardial infarction. Ventricular tachyarrhythmias of 6 beats or more were induced in 35 (23%) patients. No significant differences existed between patients with inducible ventricular tachyarrhythmias and those without inducible ventricular tachycardia with respect to occurrence of spontaneous ventricular arrhythmias in the acute and early recovery phase of infarction or predischarge exercise-induced ischemia or arrhythmias, severity of coronary artery disease, or degree of left ventricular dysfunction. A higher incidence of inferior myocardial infarction was observed in patients with inducible ventricular tachycardia when compared with those without inducible ventricular tachycardia (66% vs 41%, p less than .01). During a mean follow-up of 10 +/- 5 months (range 2 to 19), there were two sudden deaths, three nonsudden deaths, and two additional patients developed sustained ventricular tachyarrhythmias. There was no significant difference between patients with and those without inducible ventricular tachyarrhythmias with respect to the occurrence of these events. In this study population, a lower mean ejection fraction (p less than .01), the presence of a ventricular aneurysm (p less than .05), and exercise-induced ventricular premature contractions (p less than .05) were predictors of sudden death and of spontaneous ventricular tachycardia. Thus, the findings of this study do not support the hypothesis that the induction of ventricular tachyarrhythmias in patients recovering from acute myocardial infarction identifies a group at high risk for sudden cardiac death.

Acute Disease↗
PubMedDate not supplied

Comparison of plasma glucose and plasma free insulin during CSII and intensified conventional insulin therapy.

The plasma glucose and plasma free insulin profiles of six totally insulin-dependent diabetic patients were compared during periods of 4 days in hospital under a conventional insulin therapy (ICIT) comprising 4 daily injections of regular insulin and under continuous subcutaneous insulin infusion (CSII). Two profiles of prandial insulin administration with CSII were compared: a rectangular (R) and an exponential wave (E) in which 50% of the dose was given rapidly followed by an exponential decrease. In both cases, the basal infusion rate was increased by 30-50% between 5 a.m. and 8 a.m. Mean circadian blood glucose was equally good with ICIT: R and E: 7.0 +/- 0.9, 7.3 +/- 1.0, and 7.1 +/- 1.0 mmol/L, respectively. In five patients, fasting plasma glucose was higher with ICIT than with R and E (12.7 +/- 1.8 versus 6.9 +/- 1.0 and 6.8 +/- 0.8 mmol/L, respectively; t test: P less than 0.05; Wilcoxon: P = 0.06). Mean plasma free insulin level was significantly higher (t test: P less than 0.005; Wilcoxon: P less than 0.05) with ICIT (0.46 +/- 0.04 nmol/L) than with R (0.37 +/- 0.04 nmol/L) or E (0.36 +/- 0.05 nmol/L), although the daily doses were similar. In conclusion, CSII leads to a better glycemic control than ICIT, since it appears to prevent the morning rise of blood glucose.

Adult↗