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Biomedical subjects

F Delahaye

Publications and source records attributed to F Delahaye.

120 records · Page 7Linked to original sources
PubMed1989

[Relation of alcohol consumption and blood lipids and apolipoproteins--a study of a population of 3,897 wage-earners from the Lyon region].

Between June 1982, and September 1984, a survey was conducted among 3,897 employees in the Region of Lyon to study the relationship between alcohol consumption and serum concentrations of total cholesterol and triglycerides. In 400 randomly selected men, the following data were also obtained: concentrations of the cholesterol of the high density lipoproteins (HDL) and of their subfractions, and concentrations of the apoproteins A-I, A-II and B. All these biochemical concentrations increased, more or less, with alcohol consumption. Relative to non drinkers, the concentrations increased among males who declared drinking more than 80 grams of alcohol per day: for total cholesterol, by 10.0%; for triglycerides, by 24.7%; for HDL-cholesterol, by 26.7%; for HDL2-cholesterol, by 76.0%; for HDL3-cholesterol, by 15.0%; for apoprotein A-I, by 30.0%; for apoprotein A-II, by 52.2%; for apoprotein B, by 5.1%. These results, with the limitations inherent in a cross-sectional study, suggest that regular consumption of alcohol raises the concentrations of blood lipid components, both atherogenic and non-atherogenic.

Adult↗
PubMed1988

Infective endocarditis on stenotic aortic valves.

Charts were reviewed of 42 adult patients (27 men, 15 women, mean age 55 years, with 17 older than 60) hospitalized and/or autopsied between 1970 and 1986 with diagnosis of definite or highly probable infective endocarditis (IE) on pure aortic stenosis (AS). Ring and/or septal abscesses were found in 18/37 patients who were operated upon and/or autopsied. IE was recognized in 32 patients, undiagnosed in 10 (revealed at autopsy in seven, at operation in three). Infecting organisms were identified in 26 patients (Str. viridans, 16; Str. D, three; Staphylo., four; other, three). Twenty-seven patients were treated in our institution, 14 of them more than four weeks after the beginning of the symptoms. Echocardiograms were recorded in 17, with vegetations in only six. Severe cardiac failure was present in 17 cases. One patient was lost to follow-up. Fourteen patients died (mean delay between IE and death 22.4 months): eight of the 13 non-operated patients (cardiac failure, four; myocardial infarction, two; neurological complications, two) and six of the 14 operated patients (peri-operative death, four; late sudden death, two). Twelve patients are alive (mean follow-up 51.6 months), eight of them in NYHA class 1. IE on pure AS is rare, difficult to recognize echocardiographically, and of poor prognosis. It usually requires rapid aortic valve replacement.

Adult↗
PubMed1988

Valvular aortic stenosis and coronary atherosclerosis: pathophysiology and clinical consequences.

New methods of investigation (ECG, echocardiography, angiography, histology) allow a better understanding of the pathophysiology of valvular aortic stenosis (VAS) associated with coronary atherosclerosis. The progressive decrease in valvular aortic area modifies the coronary blood flow and leads to myocardial ventricular hypertrophy. These two mechanisms worsen left ventricular function. A significant atherosclerotic stenosis on a large coronary artery creates a considerable reduction of the available coronary blood flow. This reduction is permanent: present at rest, it is obviously increased during exercise. The study of the relationship between the severity of the VAS and the myocardial hypertrophy (MH) is of great interest. It seems that in VAS with coronary artery disease, different situations exist: (i) when the hypertrophy is severe (left ventricular mass greater than 180 g m-2), the angina pectoris is more attributable to the VAS than to the coronary lesions. Thus the removal of the aortic outflow obstruction is the most essential therapy; (ii) when the hypertrophy is less severe (left ventricular mass less than 180 g m-2), surgical treatment of the valvular lesion and myocardial revascularization are justified.

Aortic Valve Stenosis↗
PubMed1988

Acute heart failure due to Q fever endocarditis.

We report a case of Q fever endocarditis in a patient who presented with a slight pyrexia and acute cardiac failure due to aortic incompetence. The diagnosis was made by detecting high titres of serum IgG and IgA antibody against Coxiella burnetii phase I antigens and confirmed by demonstrating C. burnetii on the excised aortic valve using immunofluorescence and electron microscopy. Aortic valve replacement was followed by initially successful antibiotic treatment for 15 months. Reappearance of IgA anti-phase I antibodies 5 months later suggested continued presence of bacteria, although the patient's condition remained satisfactory. In endemic areas, such as rural southern France, Q fever endocarditis should be considered when there is evidence of acute heart valve damage but are few other features of infection.

Acute Disease↗
PubMed1988

[Results of myomectomy in obstructive cardiomyopathy. Apropos of 28 cases].

Hypertrophic obstructive cardiomyopathy, the pathogenesis of which is controverted, exposes the patient to the risk of sudden death and often evolves towards heart failure. When medical treatment is inadequate, surgery may be considered. The authors report their experience of myectomy performed in 28 subjects with pure obstructive cardiomyopathy. Despite a medical treatment based, in most cases, on beta-blockers, all patients showed severe symptoms, with syncopes in 39 p. 100 of the cases, stage 2 or over angina (Canadian Cardiovascular Society grading) in 57 p. 100 of the cases, and stage 3 or over dyspnoea (New York Heart Association grading) in 61 p. 100 of the cases. The intraventricular pressure gradient, measured in 25 patients, was 81.7 +/- 44.9 mmHg. The operation always consisted of myectomy according to the Morrow procedure, i.e. double myotomy of the subaortic septum extended on a length of at least 4 cm, with excision of the muscle between the two incisions. In addition, mitral valve replacement was performed in 13 patients who had severe mitral regurgitation. Three patients (7 p. 100) died with low cardiac output in the peri-operative period; pre-operatively, these patients were in a particularly poor condition. One patient died suddenly during the 4th post-operative month. The annual mortality rate therefore was 2.3 p. 100, and the actuarial survival rate at 8 years was 89.3 p. 100.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

[Current perspectives in the treatment of infectious endocarditis of a natural heart valve].

In view of the severity of infective endocarditis, which is due to local and general infectious processes and the hemodynamic consequences of valvular destruction, a policy of earlier valve replacement has been adopted. Clinical, bacteriologic and pathologic data collected over two years suggest that early surgery can be recommended in the following cases: congestive heart failure, inadequate results of antimicrobial therapy, and multiple emboli. Further studies should validate this policy, but the necessity of general prophylaxis for infective endocarditis must always be borne in mind.

Aortic Valve Insufficiency↗
PubMed1987

Angiographic morphology and intraluminal coronary artery thrombus in patients with angina pectoris: clinical correlations.

A prospective study was conducted in 104 consecutive patients who underwent coronary angiography for the evaluation of angina pectoris. 50 patients experienced unstable symptoms, while the rest of them were stable. Coronary lesions reducing the luminal diameter by at least 50% were compared between both groups according to localization, grade, length, type and collateralization. Eccentric irregular lesions (EIL) appeared more frequently in the unstable group of patients (27% vs 3%, P less than 0.01), while the incidence of concentric lesions was higher in stable group (45% vs 26%, P less than 0.02). There was no significant difference in localization, grade, length, or collateralization. EIL were most frequently identified as spontaneous AP producing lesions (55%, P less than 0.001) in 29 patients in the unstable group. Spontaneous angina was associated in 86% with EIL, occlusions, or filling defects--all of these lesions might contain occlusive or nonocclusive thrombi. EIL with a narrow neck appeared on angiograms earlier than EIL with a wall irregularity. We conclude that EIL is a sensitive and very specific angiographic marker of unstable AP. The morphologic details of EIL may help one to choose appropriate therapy.

Angina Pectoris↗
PubMed1987

[Prognosis of surgically treated infectious endocarditis].

The prognostic factors in infective endocarditis patients who underwent surgery in the acute stage were evaluated from the records of 189 cases of native valve endocarditis operated upon between 1970 and 1986. Surgery had been performed before June 30, 1982 in 105 patients (group 1) and since July 1, 1982 in 84 patients (group 2). Group 2 only differed from group 1 in that the proportion of negative blood cultures was lower (13.7% vs 35%; p less than 0.01) and that of subjects older than 70 was higher (11.6% vs 5.7%; p less than 0.01). 105 patients (66 in group 1, 39 in group 2) had been operated upon during the first 6 weeks of antibiotic therapy ("early surgery"), while 84 patients (57 in group 1, 27 in group 2) had been operated upon between 7 and 24 weeks from the beginning of antibiotic therapy ("semi-early surgery"). Hospital mortality was 23.6% in group 1 (29/123) as against 10.6% in group 2 (7/66; p less than 0.05). The difference in mortality between the two groups was significant only in early surgery patients (33.3% vs 7.7%; p less than 0.01) and in patients operated upon while the infection was active with presence of pathogens in valve cultures (47.4% vs 7.7%; p less than 0.05). A study of mortality factors showed that the operative prognosis did not depend on the type of valve replacement performed or on the pathogen involved, but solely on the degree of cardiac failure before surgery. The post-hospital course was evaluated in group 1 patients followed up during 61.8 months on average.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

[Methods of evaluating myocardial revascularization surgery].

The quality of revascularization is evaluated by measurements of blood flow and various imaging methods. The quality of the anastomosis and the graft flow are evaluated per-operatively by ultrasounds and by measurements of intramyocardial pH. After surgery, Doppler velocimetry and radioisotope scanning assess the basal coronary flow and the coronary reserve. Graft patency can be studied by noninvasive methods (Doppler and kinetic CT with contrast injection), but conventional or digital angiography is irreplaceable for visualization. Residual myocardial ischaemia and left ventricular function are evaluated by the usual methods. Angina is not sensitive enough to serve as an indicator of residual or recurrent myocardial ischaemia. ECG at rest detects most peri-operative infarctions; Holter recordings may reveal a silent myocardial ischaemia; exercise stress ECG evaluates (albeit with insufficient sensitivity) post-bypass changes in myocardial ischaemia. Myocardial scintigraphy with thallium-201 is more sensitive, and it locates low perfusion areas. Cardiac wall kinetics and left ventricular function at rest and during exercise are studied by echocardiography and contrast or isotopic ventriculography, pending advances in nuclear magnetic resonance imaging. Surgical results have never been compared with other methods of direct myocardial revascularization, but only with medical treatments. Outstanding among the controlled studies carried out are a European study (E.C.S.S.) and two North American studies (V.A.S. and C.A.S.S.); they have shown what can be expected from coronary bypass, globally and in some subgroups of patients.

Angiography↗
PubMed1986

[Sports and blood pressure: association in a population of wage-earners].

In a cross-sectional epidemiological survey, we examined the association between the practice of sports and blood pressure (BP). The study included 3,388 male employees (representing 90.1% of the target population) who were questioned about their habitual sports activity, in terms of average duration per week and intensity. The proportion of subjects who stated to engage in sports activity decreased with age, from 50.9% in the age class 20-29 years to 16.4% in the age class 50-59 years. We found a negative relationship between both systolic and diastolic BP and the weekly duration of sports activity. However this association increased with age and reached the statistical significance only in the age classes 40-49 years and 50-59 years (p less than 0.01 and p less than 0.001, respectively). Similar results were obtained when intensity of sports was used instead of duration. In order to test the independence of the observed association, the duration of sports activity (hours/week) was included as an independent variable in a multiple linear regression analysis, along with the following potential confounders: age, Quetelet index, alcohol consumption, cigarette smoking, heart rate, and level of education. In this analysis the sports-BP relationship was considerably attenuated or entirely disappeared. It remained statistically significant only in the age class 50-59 (p less than 0.01 for systolic BP an p less than 0.05 for diastolic BP). Our results support those of others showing a modest beneficial effect of leisure time physical exercise on BP.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗