Biomedical subjects

F Clement

Publications and source records attributed to F Clement.

At least 19 recordsLinked to original sources

PubMed2000

Preoperative quality of life as a predictive factor of 3-year survival after open heart operations.

BACKGROUND: The aim of this prospective study was twofold: to determine the evolution of quality of life in heart surgery patients through the first 3 postoperative years using the Nottingham Health Profile questionnaire and to determine whether preoperative quality of life influences 3-year survival. METHODS: From January to July 1994, 215 patients underwent elective open heart operation in our department. Patients filled in the Nottingham Health Profile questionnaire five times: preoperatively, postoperatively at month 3, and at each anniversary of their operation for 3 years. The evolution of quality of life scores through time were compared using analysis of covariance with repeated measures. Analysis of 3-year survival prognostic factors was achieved using the Cox proportional hazards model. RESULTS: Quality of life scores varied through time, but not significantly. Multivariate analysis showed two independent risk factors to influence 3-year survival: dyspnea class (III-IV versus I-II, relative risk = 2.80, 95% confidence interval = 1.2 to 6.5) and the energy section of the Nottingham Health Profile questionnaire (relative risk = 1.02 by unit, 95% confidence interval = 1.01 to 1.03). CONCLUSIONS: Our study shows quality of life scores to be stable for the first 3 years after operation and the preoperative energy score to be predictive of 3-year survival.

Aged↗

PubMed2000

Intermediate lukewarm (20 degrees c) antegrade intermittent blood cardioplegia compared with cold and warm blood cardioplegia.

BACKGROUND: In the field of intermittent antegrade blood cardioplegia, 3 levels of temperature are commonly used: (1) cold (8 degrees C); (2) tepid (29 degrees C); and (3) warm (37 degrees C). Given the 21 degrees C spread and the metabolic changes that can occur between cold (8 degrees C) and tepid (29 degrees C) cardioplegia, we thought it worthwhile to test a temperature halfway between the cold and tepid levels. The aim of this study was to test the quality of myocardial protection provided by intermediate lukewarm (20 degrees C) cardioplegia by comparing it with cold and warm cardioplegia. Protection was assessed by measuring cardiac troponin I release. METHODS: One hundred thirty-five patients undergoing coronary artery bypass grafting were enrolled in a prospective randomized trial comparing cold (8 degrees C), intermediate lukewarm (20 degrees C), and warm (37 degrees C) antegrade intermittent blood cardioplegia. Cardiac troponin I concentrations were measured in serial venous blood samples. RESULTS: The total amount of cardiac troponin I released was significantly higher in the cold group (4.7 +/- 2.3 microg) than in the intermediate lukewarm (3.4 +/- 2.0 microg) or the warm (3.1 +/- 2.7 microg) groups. The cardiac troponin I concentration was significantly higher at hour 6 in the intermediate lukewarm group (1. 23 +/- 0.55 microg/L) than in the warm group (0.89 +/- 0.50 microg/L). CONCLUSIONS: Intermittent antegrade intermediate lukewarm blood cardioplegia is appropriate and clinically safe. Cardiac troponin I release suggests that intermediate lukewarm cardioplegia is better than cold cardioplegia but less effective than warm cardioplegia in low-risk patients. We therefore recommend the use of warm cardioplegia in low-risk patients.

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PubMed2000

Perceived health status in patients over 70 before and after open-heart operations.

AIM: to evaluate improvement and predictors of improvement in patients' perceived health status after cardiac surgery in older patients. METHODS: three hundred and seventy-seven patients from three different departments of cardiac surgery completed the Nottingham Health Profile questionnaire before and 1 and 2 years after open-heart surgery. We analysed pre- and postoperative data and pre- and postoperative Nottingham Health Profile scores. RESULTS: the mean age was 74+/-3 years. The comparison between pre- and postoperative scores showed an improvement in all but the social isolation section. Logistic regression showed that the predictors of patients who became worse after surgery were (i) in the energy section: age over 75 [odds ratio (OR) = 1.8, 95% confidence interval (CI) = 1.02-3.2], coronary artery disease (OR = 2.4, 95% CI = 1.04-3.6) and postoperative events (OR = 1.9, 95% CI = 1.01-3.7); (ii) in the physical mobility section: diabetes mellitus (OR = 2.4, 95% CI = 1.2-4.7); and (iii) in the social isolation section: physical mobility impairment (OR = 3.4, 95% CI = 1.3-8.7). CONCLUSIONS: cardiac surgery improves perceived health status in patients over 70. This improvement is better for those undergoing aortic valve replacement than for those undergoing coronary artery bypass surgery. Comparison with reference scores for a standard population shows that, even when successful, cardiac surgery results in fatigue and persistent sleep disturbance in older patients.

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PubMed1999

[Hearing tests in a specialized practice].

The purpose of the study was to evaluate the quality of examinations performed in ENT-practice as preparation for hearing aid (HA) fitting. The material comprises 113 referrals to an audiological department from the Eastern Danish area including an audiogram. The referrals were evaluated concerning information relevant for HA fitting. A comparison between the pure tone air conduction hearing thresholds measured in the ENT-practice and in the audiological department was also performed. Only one referral contained information about all relevant examinations. Pure tone air conduction thresholds measured in ENT-practice deviated significantly at 250 Hz-4 kHz from the hearing thresholds measured in the audiological department, and indicated poorer hearing at all frequencies. Only 53% of the air conduction hearing thresholds evaluated for the average of 0.5-4 kHz corresponded with the thresholds measured in the audiological department within the repeatability of the test (i.e. +/- 10 dB). In conclusion, the audiometries in the referrals should only be considered as screening.

Adult↗

PubMed1999

Heteroarotinoids inhibit head and neck cancer cell lines in vitro and in vivo through both RAR and RXR retinoic acid receptors.

A class of less toxic retinoids, called heteroarotinoids, was evaluated for their molecular mechanism of growth inhibition of two head and neck squamous cell carcinoma (HNSCC) cell lines SCC-2 and SCC-38. A series of 14 heteroarotinoids were screened for growth inhibition activity in vitro. The two most active compounds, one that contained an oxygen heteroatom (6) and the other a sulfur heteroatom (16), were evaluated in a xenograph model of tumor establishment in nude mice. Five days after subcutaneous injection of 10(7) SCC-38 cells, groups of 5 nu/nu mice were gavaged daily (5 days/week for 4 weeks) with 20 mg/kg/day of all-trans-retinoic acid (t-RA, 1), 10 mg/kg/day of 6, 10 mg/kg/day of 16, or sesame oil. After a few days, the dose of t-RA (1) was decreased to 10 mg/kg/day to alleviate the side effects of eczema and bone fracture. No significant toxic effects were observed in the heteroarotinoid groups. All three retinoids caused a statistically significant reduction in tumor size as determined by the Student t-test (P < 0. 05). Complete tumor regression was noted in 3 of 5 mice treated with t-RA (1), 4 of 5 mice treated with 16, 1 of 5 mice treated with 6, and 1 of 5 mice treated with sesame oil. Reverse transcriptase polymerase chain reaction (RT-PCR) was used to determine that the expression levels of RARalpha, RXRalpha, and RXRbeta were similar in the two cell lines, while RARbeta expression was higher in SCC-2 over SCC-38, and RARgamma expression was higher in SCC-38 over SCC-2. Receptor cotransfection assays in CV-1 cells demonstrated that 16 was a potent activator of both RAR and RXR receptors, while 6 was selective for the RXR receptors. Transient cotransfection assays in CV-1 cells using an AP-1 responsive reporter plasmid demonstrated that t-RA (1), 6, and 16 each inhibited AP-1-driven transcription in this cell line. In conclusion, the growth inhibition activity of the RXR-selective 6 and the more potent growth inhibition activity of the RAR/RXR pan-agonist 16 implicate both RARs and RXRs in the molecular mechanism of retinoid growth inhibition. Moreover, the chemoprevention activity and the lack of toxicity of heteroarotinoids demonstrate their clinical potential in head and neck cancer chemoprevention.

Animals↗

PubMed1999

[A 7-year experience with goiter surgery in an otorhinolaryngologic department. A retrospective study of the the period 1990-1996].

The aim of this study was quality assurance and to analyse the frequency of complications following thyroid surgery. The most dreaded surgical complications are permanent injury to the recurrent laryngeal nerve or persistent hypocalcaemia. Our surgical procedure included the use of the surgical microscope in connection with thyroid grand surgery. Our materiel includes 122 patients who underwent surgery for benign thyroid diseases in our department from 1990-1996. In nearly 50% of all cases a lobectomy was performed, reserving resections and subtotal thyroidectomy to special cases. Resections were primarily done in the beginning of the period. The surgical microscope was used as a standard procedure to identify and expose the recurrent laryngeal nerve and the parathyroid glands. Primary thyroid grand surgery in benign disease resulted in permanent unilateral laryngeal nerve palsy in one case or in 0.83% of the patients. When calculated as nerves at risk, the complication rate was reduced to 0.67%. In benign completion surgery the complication rate was 0%. No patient developed persistent hypocalcaemia.

Adult↗

PubMed1999

[Stridor caused by laryngeal rheumatoid arthritis].

A 71-year old man who had had severe rheumatoid arthritis for many years involving all the joints suddenly developed stridor caused by immobilisation of both the vocal cords. Arthritis of the cricoarytenoid joints of the larynx was suspected, and the patient was successfully treated with prednisolone.

Aged↗

PubMed1998

Warm reperfusion and myocardial protection.

BACKGROUND: The aim of this study was to determine whether warm reperfusion improves myocardial protection with cardiac troponin I as the criteria for evaluating the adequacy of myocardial protection. METHODS: One hundred five patients undergoing first-time elective coronary bypass surgery were randomized to one of three cardioplegic strategies of either (1) cold crystalloid cardioplegia followed by warm reperfusion, (2) cold blood cardioplegia followed by warm reperfusion, or (3) cold blood cardioplegia with no reperfusion. RESULTS: The total amount of cardiac troponin I released tended to be higher in the cold blood cardioplegia with no reperfusion group (3.9+/-5.7 microg) than in the cold blood cardioplegia followed by warm reperfusion group (2.8+/-2.7 microg) or the cold crystalloid cardioplegia followed by warm reperfusion group (2.8+/-2.2 microg), but not significantly so. Cardiac troponin I concentration did not differ for any sample in any of the three groups. CONCLUSIONS: Our study showed that the addition of warm reperfusion to cold blood cardioplegia offers no advantage in a low-risk patient group.

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PubMed1997

Crystalloid versus cold blood cardioplegia and cardiac troponin I release.

BACKGROUND: Cardiac troponin I (CTnI) has been shown to be a marker of myocardial injury. The aim of this study was to compare antegrade crystalloid cardioplegia with antegrade cold blood cardioplegia with warm reperfusion using CTnI release as the criteria for evaluating the adequacy of myocardial protection. METHODS AND RESULTS: Seventy patients were randomly assigned to receive crystalloid or blood cardioplegia. CTnI concentrations were measured in serial venous blood samples drawn just before cardiopulmonary bypass and after aortic unclamping at 6, 9, 12, and 24 hours and daily thereafter for 5 days. ANOVA with repeated measures was performed to test the effect of the type of cardioplegia on CTnI release. The total amount of CTnI released was higher in the crystalloid cardioplegia group than in the blood cardioplegia group (11.2 +/- 8.9 versus 7.8 +/- 8.6 micrograms, P < .02). CTnI concentration was significantly higher in the crystalloid group than in the blood group in the samples drawn at hours 9 and 12. Three patients in each group had ECG evidence of perioperative myocardial infarction. Eight patients in the crystalloid group and five patients in the blood group had CTnI evidence of perioperative myocardial infarction. CTnI release was significantly lower in patients requiring no electrical defibrillation after aortic unclamping. CONCLUSIONS: Cold blood cardioplegia followed by warm reperfusion is beneficial in an unselected group of patients with a preserved left ventricular function undergoing an elective first coronary artery bypass grafting. CTnI allowed the diagnosis of small perioperative necrotic myocardial areas. The need for electrical defibrillation after aortic unclamping was related to a higher release of CTnI. A further study is necessary to determine whether this technique was beneficial because of cold blood cardioplegia, warm reperfusion, or both.

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PubMed1996

Prospective study of quality of life before and after open heart operations.

BACKGROUND: The aim of this prospective study, with completion of questionnaires before and 3 months after open heart operations, was to evaluate the improvement of quality of life brought about by these operations and the predictors of this improvement. METHODS: The Nottingham health profile questionnaire contains 38 subjective statements divided into six sections: energy, physical mobility, emotional reaction, pain, sleep, and social isolation. Factors influencing quality of life scores were determined by analysis of covariance. Factors influencing the status of the patients (improved or worsened) were determined by logistic regression. RESULTS: From January to July 1994, 215 consecutive patients underwent elective open heart operations. The comparison between mean preoperative and postoperative scores showed an improvement in all sections of quality of life. An average of 80% of patients were improved by their operations. Independent predictors of less improvement of quality of life scores were as follows: for the energy section, age over 70 and New York Heart Association functional class III or IV; for sleep, age over 70; for physical mobility, New York Heart Association functional class III or IV; for social isolation, female gender; and for pain, age over 70 and abnormal segmental wall motion. Independent predictors of patients worsened by operation were as follows: New York Heart Association functional class III or IV in the energy section (odds ratio = 3.7, 95% confidence interval 1.4 to 9.8) and in the physical mobility section (odds ratio = 2.4, 95% confidence interval 1.02 to 5.5), female gender in the social isolation section (odds ratio = 2.8, 95% confidence interval 1.03 to 7.7), and presence of at least one comorbid disease in the emotional reaction section (odds ratio = 2.5, 95% confidence interval 1.17 to 5.2). CONCLUSIONS: Cardiac operations improve quality of life in patients. The improvement is similar for patients undergoing coronary artery bypass grafting versus valve replacement, and for patients with no postoperative events versus those with nonlethal postoperative complications. The strongest predictive factors for quality of life are age and New York Heart Association functional class.

Activities of Daily Living↗

PubMed1996

Effects of myocardial ischemia on the release of cardiac troponin I in isolated rat hearts.

BACKGROUND: The twofold aim of this experimental study was (1) to verify the correlation between the duration of ischemia and concentration of cardiac troponin I and (2) to compare the release of cardiac troponin I with histologic findings. METHODS: Experiments were done on 18 rat hearts, which were perfused according to the Langendorff method, immediately after excision in group I (control group) and after immersion for 3 hours (group II) and 6 hours (group III) in St. Thomas' Hospital solution at 4 degrees C. During reperfusion, the release of cardiac troponin I, creatine kinase isoenzyme MB, and lactate dehydrogenase, the recovery of left ventricular pressure, and heart rates were compared among the three groups. After the experiment, three samples of myocardium (left ventricle, right ventricle, and septum) were taken for histologic examination. RESULTS: Cardiac troponin I concentration was significantly higher in group III than in groups I and II and in group II compared with group I. Cardiac troponin I concentration increased as the ischemic period increased. The relation between cardiac troponin I release and ischemic duration tended to be linear. Creatine kinase MB and lactate dehydrogenase concentrations did not differ from one group to the other. Left ventricular pressure was not significantly different among the groups. In the control group, no heart had more than 10% of the myocytes affected. One of six hearts in group II and three of six in group III had more than 10% of myocytes affected. CONCLUSION: This experimental study showed (1) that cardiac troponin I is an early marker of ischemic injury and (2) that cardiac troponin I concentration increases as the ischemic period increases. Early cardiac troponin I release appears to correlate with the extent of ischemic injury in rats undergoing buffer perfusion.

Animals↗

PubMed1996

Inter-observer reliability in the interpretation of coronary angiograms.

The interpretation of coronary angiograms is indispensable in determining procedure in coronary surgery. The aim of this study was to measure the overall reliability of a group of surgeons in the interpretation of coronary angiograms, surgical procedure and the evaluation of operative risk. Ten coronary angiograms were interpreted by eight cardiac surgeons at four different medical centers. Evaluation of coding discrepancies, in this case of multiple raters applying an ordinal-scale classification scheme (0, 1, 2) with no expert yardstick available for coding, was explored by a two-way random factor analysis of variance. Reliability was substantial for the assessment of stenosis irrespective of the artery (intraclass correlation coefficient (ICC) ranging from 0.92 to 1), and good for the distal part of the artery (ICC ranging from 0.83 to 0.86) as well as for the collateral provision (ICC ranging from 0.75 to 0.94). Agreement between surgeons was good with respect to the number of bypasses to be performed (ICC = 0.88). The number of bypass per patient varied from 2.6 to 3.2 depending on the surgeon. Agreement as to whether or not to bypass was substantial for the right coronary artery (ICC = 0.92), good for the marginal artery (ICC = 0.87) and fair for the left anterior descending artery (ICC = 0.60) and the circumflex artery (ICC = 0.60). There was a higher rate of agreement concerning inferior wall motion (ICC = 0.98) than of the anterior wall motion (ICC = 0.78). Agreement was substantial for ejection fraction (ICC = 0.93), operative risk (ICC = 0.93) and the type of coronary tree (ICC = 0.85). With respect to the overall set of items, no one surgeon disagreed significantly with the rest of the group. Some disagreement regarding anatomy suitable for revascularization exists between surgeons. Surgical assessment of risk is similar. Cardiac surgeons quickly learn to assess risk in a similar manner, even though they might not always graft the same anatomic vessels or assess regional wall motion similarly.

Coronary Angiography↗

PubMed1996

Mediastinitis-a rare complication of a peritonsillar abscess.

We report a case of mediastinitis, in an otherwise healthy 25-year-old man, resulting from a peritonsillar abscess with extension through the parapharyngeal and retropharyngeal spaces. In our case the patient was primarily treated with needle aspiration, a method described in many publications as a safe alternative to incision and drainage. We emphasize that for peritonsillar abscesses a tonsillectomy or wide incision and drainage, instead of needle aspiration, might prevent the extension of the condition, thus preventing serious complications.

Adult↗

PubMed1996

Quality of life after open-heart surgery in patients over 75 years old.

In a postal study we used the Nottingham Health Profile questionnaire to assess the quality of life of elderly survivors of open-heart surgery. From January 1984 to October 1993, 146 patients over 75 years of age underwent open-heart surgery in the Department of Cardiovascular Surgery at Beasançon (France). Eleven patients (7. 5%) died in the immediate post-operative course. Patients' mean follow-up was 3.4 +/- 2.4 years. Fourteen patients died during follow-up. One hundred and four completed Nottingham Health Profile questionnaires were returned. Five per cent of the patients lived in an old people's home. Six per cent of the patients were unable to walk at all. One patient out of five felt isolated. Fifteen per cent of the patients were in constant pain. Half of the patients took sleeping pills. Conversely, 87% of the patients felt an improvement after surgery. Sixty-two per cent continued to drive. Ninety-seven patients (92%) did at least one of the following three activities: watched television, listened to the radio, read books or magazines. Fifty-eight patients (56%) walked on a regular basis. The different types of pathology, of surgical procedures and whether or not a pacemaker was implanted during the post-operative course were not reflected in the quality of life (QOL) scores. After cardiac surgery, most of the patients were physically autonomous and related to their exterior world.

Aged↗

PubMed1996

Crystalloid cardioplegia route of delivery and cardiac troponin I release.

BACKGROUND: Cardiac troponin I (CTn I) has been shown to be a marker of myocardial injury. Incomplete distribution of cardioplegic solution may be responsible for injury in jeopardized myocardial areas. The aim of this study was to compare CTn I release with respect to the route of delivery of crystalloid cardioplegia, either antegrade only or initially antegrade followed by retrograde cardioplegia for the remainder of the operation, in patients undergoing elective coronary artery bypass grafting. METHODS: Sixty patients were randomly assigned to one of two cardioplegia groups. Cardiac troponin I concentrations were measured in serial venous blood samples drawn just before cardiopulmonary bypass and after aortic unclamping at 6, 9, 12, and 24 hours and daily thereafter for 5 days. Analysis of variance with repeated measures was performed to test the effect of route of delivery, coronary disease, collateral circulation, risk of cardioplegia maldistribution, and number of grafts on release of CTn I. RESULTS: Compared with the antegrade route, the combined route offered no advantage in an unselected group of patients undergoing an elective first cardiac operation and having preserved left ventricular function. The CTn I concentration did not differ between groups for any of the samples considered. In patients with major left main coronary artery stenosis, CTn I release was significantly higher at hour 9 in the antegrade group than in the group with combined delivery. CONCLUSIONS: A combined route of delivery of crystalloid cardioplegia is beneficial in patients with major stenosis of the left main coronary artery. Cardiac troponin I sensitivity is relevant in this study. Release of CTn I should be useful in determining the best form of myocardial protection for each patient.

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PubMed1996

Is surgery for aortic stenosis justified in patients over 75 years of age?

UNLABELLED: The upper age limit for cardiac surgery has constantly been extended since the 1980's, with the most pronounced extension observed in surgery of the calcified aortic stenosis (CAS). The aim of this study was to examine whether surgery is beneficial to the elderly population in terms of hospital mortality, long-term survival and quality of life. Between January 1989 and October 1992, 95 patients over 75 years of age underwent aortic valvular replacement (AVR) for CAS. There were 54 male and 41 female patients with a mean age of 79.7 +/- 2.8 years. All of them suffered from isolated or predominant CAS, associated with a coronary lesion requiring additional bypass procedures in 14 cases. Before surgery 67% of the patients were in NYHA class III and IV and 30% of them had suffered from acute pulmonary edema. Surgical priority was urgent in 10 patients. Mean aortic clamp time was of 55 minutes for the isolated CAS and 78 minutes for the bypass-associated CAS. A Carpentier-Edwards supra-annular bioprosthesis was implanted in 95.7% of the cases, associated with coronary bypass in 14 cases, with a mean of 1.6 bypasses per patient. Global hospital mortality was 11.5%. Emergency surgery was a predictive factor of in hospital mortality in multivariate analysis. Among the 84 survivors, 12 died secondarily, 4 of them due to cardiac causes during the follow-up period (26 +/- 4 months); similar to the mortality rate of the global population for the same age. The factors responsible for this late mortality in multivariate analysis were poor left ventricular status and diabetes mellitus. Survivor's quality of life is excellent with 78.6% of patients termed class I, autonomous and free of sequelae. IN CONCLUSION: despite an operative mortality rate much higher than in patients under 70, AVR for CAS is justified even in patients over 75 years as it offers a good quality of survival and a life expectancy identical to that of the general population of the same age.

Age Factors↗

PubMed1995

Use of cardiac troponin I as a marker of perioperative myocardial ischemia.

Troponin I is a contractile protein comprising three isoforms, two related to the skeletal muscle and one to the cardiac fibers. Cardiac troponin I (CTn I) is specific, without any cross-reactivity with the other two. Several studies have demonstrated its release after acute myocardial infarction. In contrast, CTn I never has been found in a healthy population, marathon runners, people with skeletal disease, or patients undergoing non-cardiac operations. Thus, CTn I is a more specific marker of cardiac damage than common serum enzymes. It is also more sensitive, allowing diagnosis of perioperative microinfarction and detection of acute myocardial infarction much earlier after the onset of ischemia (4 hours). Using a rapid one-step assay, we measured the release of CTn I in two groups of patients after operation: 20 with calcified aortic stenosis and normal coronary arteries (aortic valve replacement group and control group) and 20 undergoing coronary artery bypass grafting. In the overall population CTn I peaked at hour 6 and practically disappeared after day 5. Mean values were higher in the coronary artery bypass grafting group. In the aortic valve replacement group, a positive correlation was found between aortic cross-clamping time and CTn I, which is a reliable marker of cardiac ischemia during heart operations and can be used to evaluate cardioprotective procedures.

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PubMed1995

X-linked familial exudative vitreoretinopathy. Report of one family.

BACKGROUND: Familial exudative vitreoretinopathy is an uncommon heredodegenerative disease with different types of inheritance and degrees of severity. METHODS: Findings in five affected members of a family in which the X-linked mode of inheritance of familial exudative vitreoretinopathy is present are discussed. RESULTS: Patients presented with characteristic retinal exudative tractional detachment, temporal retinal vessel traction, capillary dilatation, neovascularization, and vitreous veils. CONCLUSION: A review of the 21 cases of X-linked familial exudative vitreoretinopathy reported to date indicates a worse outcome in this mode of inheritance than in cases of autosomal dominant inheritance.

Adolescent↗