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Biomedical subjects

G Ducloux

Publications and source records attributed to G Ducloux.

At least 37 records · Page 2Linked to original sources
PubMed1995

[Current respective role of surgery and permanent endocavitary stimulation in the treatment of hypertrophic cardiomyopathies].

Surgery and cardiac pacing are the two main non-drug treatments for hypertrophic cardiomyopathy. Various surgical techniques have been proposed over the last 35 years: myotomy, myotomy-septal myomectomy, isolated mitral valve replacement, heart transplantation. Patients eligible for surgery are those with severe symptoms (NYHA stage III or IV) and refractory or no longer responding to drug treatment. The choice between the various techniques is based on morphological and haemodynamic criteria (significant subaortic gradient associated with increased septal thickness, severe and/or organic mitral regurgitation, either isolated or associated with obstruction, or less severe or heterogeneous septal thickness [< 18 mm]) or therapeutic criteria (failure of primary myomectomy, depletion of all surgical possibilities). Analysis of the results of surgery is complicated by the variety of techniques performed and the experience of the various teams. The operative mortality was markedly decreased (between 2 and 11% at the present time); the complications of myomectomy (ventricular septal defect, disturbances of conduction requiring continuous pacing) are still frequent. Intraoperative transoesophageal ultrasonography could help to further decrease the operative risk. Surgery improves functional symptoms and exercise tolerance. This beneficial effect appears to be more marked, more frequent and more lasting than that of medical treatment. Surgical treatment does not ensure permanent cure, as the symptoms related to pathophysiological abnormalities other than intraventricular obstruction (abnormalities of diastolic filling, myocardial ischaemia, arrhythmias) may develop subsequently. No controlled trial has demonstrated a favourable effect on survival. Continuous pacing, introduced more recently, can now be considered to be a therapeutic method in its own right.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Pacing, Artificial↗
PubMed1994

Response of atrial natriuretic factor to surgical pericardial drainage in patients with chronic pericardial effusion.

Previous studies have demonstrated the importance of atrial transmural pressure in the secretion of atrial natriuretic peptide. These studies have been performed in patients with pericardial effusion and hemodynamic compromise. The response of atrial natriuretic peptide to the drainage of chronic pericardial effusion without clinical evidence of tamponade is unknown. We studied 13 patients with chronic abundant pericardial effusion but without hemodynamic compromise. Blood samples for hormonal determinations were drawn before and after surgical pericardiocentesis. Right atrial pressure was measured during the procedure. Drainage induced a significant increase of atrial natriuretic peptide (from 12 +/- 3.9 to 105 +/- 22.8 pmol/l, P < 0.001, mean +/- S.E.M.), correlated with the fall in right atrial pressure (from 7.65 +/- 1.18 to 4.31 +/- 1.46 mmHg, P < 0.05, r = 0.68, P = 0.01). This increase was inversely correlated with the rise of mean blood pressure after surgery (from 84 +/- 2.37 to 100 +/- 5.3 mmHg, P < 0.05, r = 0.65, P < 0.02). Plasma renin activity decreased after drainage (from 8.12 +/- 2.57 to 3.27 +/- 0.65 ng/ml/h, P < 0.05). Surgery induced an increase of plasma levels of aldosterone (from 811 +/- 241 to 1199 +/- 249 pmol/l, P < 0.05), which were reduced after pericardiocentesis (371 +/- 102 pmol/l, P < 0.02). In patients with chronic abundant pericardial effusion, surgical pericardiocentesis induced a significant increase of atrial natriuretic peptide, correlated with a fall in right atrial pressure. The increase of atrial natriuretic peptide was similar than in patients with tamponade, despite a moderate fall in right atrial pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Cardiac complications in adult onset Still disease: from pericarditis to tamponade as manifestations].

Pericarditis is a common manifestation of adult still's diseases (ASD), observed in 20% to 3% cases. Pericardial tamponade is more seldom, less than ten cases have been reported in the literature. We reported two observations of patients with ASD and pericardial tamponade above a series of 18 patients with ASD, in one case revealed the disease. The first patient was a 32-year-old women and had fever, arthritis, high white blood cell count and developed pericardial tamponade. The evolution was favourable with bolus of methylprednisolone. In the second case, cardiac tamponade occurred several years after the onset of the disease. Surgical drainage was first required (800 ml) because of inefficacity of oral prednisone. A dramatic improvement was observed after bolus of methylprednisolone. In conclusion pericardial tamponade is a seldom but sometimes the first manifestation of ASD and may required in first intention bolus of methylprednisolone.

Adolescent↗
PubMed1994

[Inappropriate ADH secretion syndrome and hypereosinophilia in Horton disease with stenosis of the subclavian arteries].

The authors describe a case of giant cell arteritis with subclavian involvement in association with a syndrome of inappropriate anti-diuretic hormone secretion and hypereosinophilia. Subclavian involvement, which may be the first symptom, occurs in five to twenty percent of giant cell arteritis. Hypereosinophilia, a frequent manifestation of specific granulomatosis vasculitis, is rarely described in association with giant cell arteritis. Dysfunction of the hypothalamo-pituitary axis such as inappropriate anti-diuretic hormone secretion or diabetes insipidus has been recently reported in giant cell arteritis. The syndrome of inappropriate anti-diuretic hormone secretion may either reveal the disease or occur during the evolution, in particular with gradual reduction of steroid treatment. It may be isolated, without clinical feature of arteritis and without an elevated erythrocyte sedimentation rate. This inappropriate anti-diuretic hormone secretion, probably due to ischemic involvement of the pituitary or hypothalamic region, always improves quickly after institution of steroid therapy.

Constriction, Pathologic↗
PubMed1994

Treatment of recurrent pericarditis with colchicine.

Corticosteroid therapy, because of its frequent and severe side effects should be avoided if possible, and colchicine may be an effective substitute in steroid-dependent recurrent pericarditis. The aim of our study was to assess the usefulness of colchicine in recurrent pericarditis before initiating corticosteroid treatment. Nineteen consecutive patients (10 males, nine females, age 46 +/- 7 years) with recurrent pericarditis (two episodes or more) were included in this prospective open-label study. Before the study, the patients suffered a total of 57 episodes of pericarditis (mean = 3.0 +/- 0.5 episodes.patient-1) despite the use of non-steroidal anti-inflammatory drugs. The mean interval time between the episodes was 7.3 +/- 5.3 months. Colchicine was given at a loading dose of 3 mg and a maintenance dose of 1 mg daily (for 1 to 27 months (mean = 7.7). During the clinical follow-up, the efficacy was estimated by the occurrence of new episodes of pericarditis and by the need for corticosteroid treatment. No recurrence occurred in 14 out of the 19 patients (74%) during a follow-up of 37.4 +/- 6.5 months. In four out of the 19 patients (21%), five recurrences occurred, which resolved without corticosteroids. Follow-up at 23.8 +/- 12.7 months was free of further recurrence. Only one patient (5%) had several recurrences and required corticosteroids for chronic rheumatism. Tolerance was good except for two cases of diarrhoea, one case of hypothyroidism due to associated long-term antidiarrhoeal therapy (containing iodine), and one case of mild leucopenia.(ABSTRACT TRUNCATED AT 250 WORDS)

Colchicine↗
PubMed1994

A miniature cesium iodide-photodiode detector for ambulatory monitoring of left ventricular function.

The physical characteristics of a portable nonimaging scintillation probe system for continuous ambulatory monitoring of the left ventricular function are described. The detector of the equilibrium radionuclide labeled blood pool is a single cesium iodide (CsI) crystal coupled to a silicium photodiode and interfaced to a microcomputer. The spatial properties of this small CsI crystal (1 x 1 x 1 cm3) were evaluated with various single-hole collimators. Linearity was studied in nonattenuating medium. Saturation began at 3000 cps, count loss was 10% at 4000 cps, maximal count rate was 24,000 cps. In attenuating medium, isocount curve of 5% of the maximal count rate was 100 mm deep and 160 mm wide. The most appropriate tested lead collimator to record the global ejection fraction of the left ventricle was a disc-shaped (thickness 5 mm, diameter 41 mm) single-hole (proximal aperture 8 mm, distal aperture 18 mm) collimator. Sensitivity was similar to the sensitivity of a sodium iodide nuclear probe. The detection performance appeared comparable to other available detector systems. Our results indicate that such a CsI-photodiode probe is a promising candidate for left ventricular function monitoring. The application to an ambulatory multicrystal detector system is presented and discussed.

Biophysical Phenomena↗
PubMed1994

Long-term follow-up after peripheral and coronary angioplasty in patients undergoing both types of procedure.

Restenosis rates after peripheral and coronary angioplasties have been assessed only in patients who had either peripheral angioplasty or coronary angioplasty but never in patients who had both types. Among the 6364 angioplasties performed in the authors' institution since 1980, they studied 38 patients (36 men, 2 women, mean age fifty-five years, range thirty-four to seventy-seven) who had both peripheral and coronary angioplasty. The peripheral angioplasties were most often performed on iliac artery stenoses. They were performed before coronary angioplasty in 22 patients (58%) and after coronary angioplasty in 16 patients (42%). The follow-up after peripheral angioplasty was based on clinical data; ultrasound investigation was performed when the result of the clinical follow-up was poor (maximal walking distance lower than 500 meters). Follow-up after coronary angioplasty was assessed by a systematic coronary angiography at six months and with long-term clinical follow-up. The mean durations of the follow-up after peripheral or coronary angioplasty were not significantly different (respectively fifty-six +/- eleven and forty-two +/- nine months [mean +/- 2 SEM]). No patient was lost to clinical follow-up; 17 (45%) ultrasound investigations, 12 (32%) peripheral angiographies, and 34 (89%) coronary angiographies were performed. The restenosis rate after peripheral angioplasty was 18% and that after coronary angioplasty was 34%. These rates are similar to the classic rates observed in the literature. In conclusion, as reported for either procedure alone, the restenosis rates after peripheral angioplasty and after coronary angioplasty are different when assessed in patients who undergo both types of angioplasty.

Adult↗
PubMed1994

[Coronary-left ventricular fistula in post-infarction of the myocardium. Apropos of a new case. Review of the literature].

The authors report a new case of acquired corono-left ventricular fistula found in a 46-year-old man four months after a first myocardial infarction treated by fibrinolysis then conventional angioplasty. This is one of the rare cases of post-infarction corono-ventricular fistula, only five of which have been reported in the literature. While their described features seem relatively constant, enabling their distinction from post-angioplasty corono-ventricular fistulas (also rarely described: four cases), certain doubts persist as to their treatment, and above all their mechanism. Monitoring for four years by coronary angiography, which is the special feature of the case reported here, leads us to include this entity within the wider context of post-infarction ventricular remodelling, of which it would then be a very rare complication.

Coronary Disease↗
PubMed1993

Subclavian angioplasty: immediate and late results in 50 patients.

In order to assess the therapeutic outcome of percutaneous transluminal angioplasty for subclavian stenosis, 50 patients were followed up clinically as well as with a velocimetric Doppler after attempted angioplasty. A minimal clinical follow-up of 9 months was expected. Subclavian stenoses were due to atheroma in 49 patients and to Takayasu's disease in 1 case. Indication of angioplasty was curative in 34 (68%) symptomatic patients (posterior fossa ischemia and/or upper limb ischemia) and preventive in 16 (32%) asymptomatic patients (severe difference of blood pressure between the 2 arms and/or association with carotid stenosis or axillo-femoral bypass). Angioplasty was successful in 45 patients (primary success rate = 90%). Three (6%) thrombosis occurred due to the percutaneous approach, one of the axillary and one of the brachial artery without any significant sequelae, and one of the aorta requiring an aorto-bifemoral bypass. A complication occurred in 2 unsuccessful angioplasties (4%): an ischemic stroke occurred in 1 case and a thrombosis of the dilated site requiring a surgical bypass. Clinical follow-up over a period of 9-101 months (mean = 41) was performed in 43 out of the 45 patients who had undergone angioplasty successfully. Two patients had a follow-up shorter than 9 months: one died after 5 months, the other was lost to follow-up. By the end of the clinical follow-up, 37 (84%) out of the 44 followed-up patients had benefitted from the procedure. Doppler study performed in 35 out of the 44 followed-up patients (80%) over a period of 2-90 months (mean = 39) showed 5 restenosis (14%). This study demonstrates the good long-term results of angioplasty in case of subclavian artery stenosis. Though there are complications, angioplasty could be proposed as a first choice treatment for subclavian stenosis as compared to surgery. Indications in asymptomatic patients should be carefully weighed as complications may occur.

Angioplasty, Balloon↗
PubMed1993

[Pericarditis disclosing at adult age recurrent Still's disease in childhood].

A 29 year old patient with a history of juvenile rheumatoid arthritis had a recurrence 12 years later, presenting as pericardial effusion with cardiac tamponade. Cardiac tamponade is a rare complication of Still's disease. To the author's knowledge, it has never been described as the mode of presentation of adult Still's disease. The diagnostic difficulties and inefficacy of non-steroid anti-inflammatory agents are illustrated by this case.

Adolescent↗
PubMed1993

Multifocal peripheral and coronary angioplasties.

Multifocal atherosclerotic lesions are frequent. It could thus be expected that multifocal angioplasties (performed in one particular patient on several [iliofemoral, renal, subclavian, mesenteric, coronary] sites) are frequent. To study multifocal angioplasty, we considered the 5344 angioplasties (PTA) (4151 coronary and 1193 peripheral PTA) which had been performed over 10 years in our institution. Eighty PTA (1.5%) were considered as multifocal angioplasty. They were performed in 30 patients who were followed up during 7 to 132 months (mean = 55). In case of primary PTA (72 PTA), the most frequent involved site was the iliofemoral site (47%) followed by renal (35%), coronary (8%), subclavian (7%) and mesenteric sites (3%). Eight PTA were performed after primary failure (3 cases) or after restenosis (5 cases). The 30 patients were divided into 2 groups according to the chronology of multifocal PTA. In group I, 20 patients had multifocal lesions on the first workup and multifocal angiopathy over a short operative period (< 3 months). The 10 patients of group II initially had a single procedure. They subsequently had multifocal angioplasty over a longer period (> 2 years) on different sites of the first PTA. Compared to group I, mean age was lower in group II (46 vs 52 year; ns), primary success rate higher (100 vs 90%; p < 0.05), complications less frequent (3 vs 20%, p < 0.05) and restenosis rate lower (7 vs 21%; p < 0.01). In conclusion, multifocal angioplasty is infrequent. A specific group of patients who had multifocal angioplasty spread over several months or years could be individualized.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon↗