Search PubMed⌕ Search

Biomedical subjects

J Acar

Publications and source records attributed to J Acar.

At least 217 records · Page 12Linked to original sources
PubMed1981

[Tendinous hyperlipoproteinaemic xanthomatosis associated with supravalvular aortic xanthomatosis (author's transl)].

A 56-year-old woman with familial heterozygous type II hyperlipoproteinaemia and tendinous xanthomas, presented the unusual findings of acquired supravalvular aortic stenosis associated with a congenital stenosis of the orifice. Analysis of clinical, paraclinical, and particularly pathological data confirmed the existence of several associated lesions: congenital hypoplasia of the aortic ring and proximal aorta, calcified valve stenosis probably increased by the dyslipidaemia, and finally and principally, supravalvular stenosis formed of a veritable circular rim of atheromatous material, making up a second haemodynamic obstacle. It is probable that the pre-existing congenital aortic lesions in this case, apart from the hyperlipoproteinaemia, account for the observation, not previously reported in a heterozygous type II hyperlipoproteinaemia, of massive supravalvular atheromatous deposits. This latter of acquired lesion is described in 9 cases reported in the literature with a homozygous form of familial hypercholesterolaemic xanthomatosis, the atheromatous deposits in the proximal aorta appearing earlier in these patients, and in the absence of pre-existing anatomical anomalies.

Aorta↗
PubMed1980

[Antibiotic audit].

Explore the source record for details and available documents.

Anti-Bacterial Agents↗
PubMed1980

[Metastatic pulmonary emboli: clinical types and incidence (author's transl)].

Pathological examinations during autopsy of 1457 cases of cancer demonstrated the presence of metastatic pulmonary emboli in 10 p. cent (148 cases). The were divided, as a function of their site and histological type of the primary neoplasm, as follows: hepatoma 33 p. cent, chorioepithelioma 25 p. cent, endocrine glands 19 p. cent, biliary tract 17.6 p. cent, hypernephroma 15.6 p. cent, sarcoma 13 p. cent, and various other tumors such as cancer of the pancreas, and breast. Two anatomical types of these emboli can be distinguished: one mixed type associated with a pulmonary cancerous lymphangitis (90 cases), and observed at a later stage in the disease. This may be latent or cause a subacute cor pulmonale. The other type is not associated with lymphangitis (58 cases), results from hematogenic cancers (hepatoma, hypernephroma, etc...), is often seen at an early stage, and causes sudden death. Histological examination enabled the consequences of any infarct developing as a result of the emboli to be demonstrated, and the origin of the emboli from neoplasmatic thromboses in the primary cancer drainage routes or from metastases in the liver to be determined.

Breast Neoplasms↗
PubMed1980

[Bacteriological cultures by laparoscopy in salpingitis (author's transl)].

Out of a series of 50 salpingitis, we have made bacteriological swabs of tubes and peritoneum in 37 cases (25 cases by laparoscopy and 2 cases by laparotomy). 27 women had received no antibiotic treatment before swabbing: bacteriological culture was positive in 14 cases and gram Stain positive in 15 cases: thus we had either a complete study, either a "good idea" of pathological flora in 20 cases out of 27. 10 women received some antibiotic treatment before swabbing: bacteriological culture was positive in 2 cases, gram stain positive in 3 cases. We had idea of pathological flora in 4 cases out of 10. Tubal cultures show either a one-agent infection (gonococcus, E. Coli or anaerobic agent) either a various aero-anaerobic flora. In 18 cases we could compare abdominal flora and low genital tract flora: results were identical in half of cases only (7 cases on 18). Gonococcus was cultured either in women with P.I.D. either in their partner's genital tract, in 11 cases on 37. Both cultures and gram stain were negatives in 13 cases: in these cases, we could perhaps incriminate either a supplement requiring bacterie, either other micro-organisms (chlamydia trachomatis or Mycoplasma) which will be studied in a further series (to be published).

Anaerobiosis↗
PubMed1980

[Osteogenesis imperfecta and aortic incompetence. One case with pathological findings. Review of the literature (author's transl)].

Cardiovascular manifestations of Lobstein's disease are rare, probably unrecognized, and determining factors for the final prognosis, the most frequent lesion being aortic incompetence. The eleventh case to be reported with pathological findings in the literature is described. This complication is usually found in men, blood regurgitation being large in amount, symptomatic, and progressive. Its mechanism is related less to dilatation of the aorta and its ring than to valvular changes, they being frequently bicuspid and dysplasic. Histological findings, not however pathognomonic, are myxoid degeneration in the valves and parietal cystic necrosis in the aortic wall. Apart from the absence of an aneurysm and aortic dissection, macro- and microscopic lesions are similar to those observed in Marfan's syndrome and osteogenesis imperfecta. Operative therapy was employed in all eleven cases, with three postoperative deaths and three later deaths. Certain complications arise from uncontrollable severe hemorrhage, which justifies the use of valve heterografts not requiring antivitamin K administration.

Adolescent↗
PubMed1979

Synergistic activity of co-trimazine and co-trimoxazole in the urine.

Co-trimazine (sulphadiazine, 410 mg + trimethoprim, 90 mg) is a new drug combination developed especially for use in the treatment of urinary tract infections. In cross-over experiments in volunteers receiving daily doses of co-trimazine (2 X 500 mg and 1 X 1000 mg), co-trimoxazole (2X960 mg), or nitrofurantoin (3X50 mg), the degree of antibacterial activity of co-trimazine in the urine was at least as high as that of co-trimoxazole and much higher and more consistent than that of nitrofurantoin. In further cross-over experiments in volunteers receiving co-trimazine 2X1000 mg or co-trimoxazole 2X960 mg for four days no or only slight activity was found in the urine against a sulphonamide-resistant Group D streptococcus, but distinct synergistic activity between the components was found against four Escherichia coli strains sensitive to trimethoprim and sensitive or resistant to sulphonamides. Against three of the latter strains the degree of activity in the urine was higher after co-trimazine than after cotrimoxazole. The synergistic action of trimethoprim and sulphonamide in the urine appeared greater with the former than with the latter combination.

Drug Combinations↗
PubMed1979

Fate of circulating immune complexes in infective endocarditis.

To examine the role of circulating immune complexes (CIC) in infective endocarditis, we studied 64 patients with infective endocarditis for the presence of CIC by the polyethylene-glycol (PEG)-precipitation test and the Clq binding test. This study was repeated during the course of the disease in 23 patients. CIC were found in 84 per cent of patients (66 per cent with acute infective endocarditis, 89 per cent with subacute infective endocarditis) during the active phase of the disease. Higer PEG precipitates were associated with typical cutaneous signs, cryoglobulins and nonstreptococcic culture-positive infective endocarditis. Under appropriate antibiotic treatment, the PEG precipitate levels of 17 patients fell within 1 month to the normal range, with a concomitant drop in cryoglobulinemia and rheumatoid factor. Conversely, uncontrolled sepsis always (six of six) yielded a rising level of CIC. These findings support the hypothesis that CIC may be important in the pathogenesis of peripheral lesions in infective endocarditis.

Adolescent↗
PubMed1979

[Conduction disorders after aortic valve replacement. Apropos of 200 cases].

The following points become apparent after the study of 200 cases of aortic valve replacement:--Conduction defects are very common after this type of surgery, affecting one in three patients in this series;--Above all, the frequency of conduction defects of the left bundle branch (2/3 cases) must be underlined. They are much more common than complete atrioventricular block, bifascicular block or isolated right bundle branch block;--Diagnosed immediately after operation in almost all cases, regression is common (50%) especially of left anterior hemiblock;--The long term prognosis is good. There was no long or short term mortality due to this cause in this series;--Apart from traumatic lesions which are difficult to avoid when the aortic orifice is calcified, ischaemia of the conduction pathways due to insufficient myocardial protection probably plays a role in the aetiology of these conduction defects.

Aortic Valve↗
PubMed1979

[Risks and median-term results of aortic valve replacement for calcifying aortic stenosis in 100 patients more than 70 years old].

100 patients with poorly tolerated calcific aortic stenosis underwent aortic valve replacement by the same surgical team (Starr-Edwards prosthesis: 52 cases, Bjäork prosthesis: 43 cases, Lillehei-Kaster prosthesis: 2 cases, and Hancock bioprosthesis: 3 cases) between July 1971 and April 1978. The hospital mortality was 17% and acute pulmonary oedema and cardiomegaly were poor preoperative prognostic factors. The late mortality was 14.5% with an average follow-up period of 25 months (range: 2 to 74 months). The survival rate expressed as an actuarial graph was 63.1 +/- 4% at 4 years. 90% of the patients operated move up at least one class in the New York Heart Association classification and 2/3 return to Stage I. The cardiothoracic ratio improved from 0.58 +/- 0.06 to 0.51 +/- 0.03 (p less than 0.02) and the Soko low-Lyon index from 40 +/- 13 to 25 +/- 6 (p less than 0.001). The main complication encountered at middle term was haemorrhage, observed in 17.5% patients. Comparison of the spontaneous outcome of the disease with the results of surgery favour surgical treatment of patients over 70 years old with poorly tolerated calcific aortic stenosis. The valve of choice should be the bioprosthesis when dependance on anticoagulant therapy and the associated risks of haemorrhage are taken into consideration.

Aged↗
PubMed1979

[Late thrombosis of mitral valve prosthesis in 27 cases].

Twenty seven cases of late thrombosis of ball and floating or tilting disc prostheses were studied. All patients were on anticoagulant therapy which appeared to be well adapted in 33% patients. Signs suggestive of thrombosis were inconsistant and the diagnosis was made on the association of severl of the following features: -- systemic embolism (44%); -- radiographic signs of left ventricular failure (51%); -- absence of opening click, variable A2 -- opening click intervals, apparition or aggravation of a systolic regurgitant murmur or a distolic murmur suggestive of obstruction on the phonocardiogramme; -- delayed opening of the mobile component or the presence of abnormal echos between the ball and anterior cage echo on the echocardiogramme; -- a gradient of over 12 mmHg across the prosthesis. An isolated episode of systemic embolism when the rest of the work-up is negative may be managed by the addition of a platelet antiaggregant and reinforcement of the anticoagulant therapy; further investigaton is advisable in the face of progressive symptoms. Fibrinolytic treatment and/or surgery is justified when systemic emboli recur or if the work-up is positive.

Adult↗
PubMed1979

[Coronary lesions due to aortic valve disease. II -- Results and indications of aortocoronary bypass surgery].

454 cases of aortic valve replacement were studied: 217 had no significant coronary artery disease, 197 had associated aorto-coronary bypass surgery and 40 coronary artery disease without revascularization surgery:-- The early mortality in the three groups was 5.5%, 21% and 12.5% respectively, the only statistically significant difference being between the first two groups. -- The coronary artery disease was signigicantly more severe in the group which underwent associated aorto-coronary bypass surgery. The early mortality was significantly raised in the group without bypass surgery in cases with severe coronary artery disease (28%) and in the group with bypass surgery with unsuitable coronary artery lesions (35.5%). On the other hand, the long term survival and functional capacity of patients who underwent associated bypass surgery approached that of the non-coronary patients. Combined aortic valve replacement and coronary bypass surgery should therefore be continued in selected cases.

Aortic Valve Insufficiency↗
PubMed1979

[Triple-valve replacements].

34 patients aged between 17 and 62 years underwent triple valve replacement, 14 of whom exclusively with Starr-Edwards prosthesis; 25 patients were operated at Stage III and 4 at Stage IV of the NYHA classification; the operative mortality was 14%, the late mortality 21%. The actuarial survival curve shows 66% survival at 5 years; in all, 21 good results were obtained with a follow-up ranging from 3 months to 11 years (average 41 months). A notable late complication specific to these patients was dysfunction of the tricuspid prosthesis; a gradient across the tricuspid prosthesis was observed in 14 postoperative catheter studies; one of these patients had to be reoperated for thrombosis of a Starr-Edwards tricuspid prosthesis. Analysis of the results of this series suggests that surgery is beneficial, especially when the very precarious preoperative state of these patients is taken into consideration.

Adolescent↗
PubMed1979

[Risks and long-term results or tricuspid monovalvular replacement, using a ball or disk prosthesis. Apropos of 21 cases].

21 patients (15 with stage IV and 6 with stage III symptoms by the NYHA classification) underwent monovalvular tricuspid replacement with a ball or disc prosthesis for varying tricuspid pathology, bacterial endocarditis in half the cases, between June 1964 and July 1973. Hospital mortality was 29 p. 100 (6 patients), medium-term mortality, nil. There were 23 survivors (62 p. 100) with an average follow up of 7 years (range 5 years to 10 years 4 months), 12 of whom recovered to stage I disability by the NYHA classification after the first postoperative year. 12 patients are on long-term anticoagulant therapy and 3 on diuretic or digitalo-diuretic therapy. The main complications observed were 2 prosthetic thromboses and 3 haemorrhages for 1095 patient-months. The results are to be compared with those bioprostheses, which, not requiring anti-coagulant therapy, may tend to supplant ball and disc prostheses.

Adolescent↗
PubMed1979

[Operated aortic stenosis. Evaluation of the long-term prognosis using clinical and hemodynamic parameters in a series of 249 cases].

The long-term results and the prognostic factors in aortic valve replacement for aortic stenosis were assessed from a series of 249 operated cases (comprising 199 pure or dominant stenosis and 50 mixed aortic lesions) followed up for a maximal period of 9 years. The postoperative survival rate, 71% at 5 years, 62,6% at 8 years, including the operative mortality, is better than in a comparable series of pure chronic aortic incompetence (58% at 5 years) despite a higher average age. In the same age group the difference is significant at the 6th year. However, no difference was observed between mixed aortic disease and aortic stenosis. Irreversible myocardial dysfunction is relatively rare (6,6% of survivors at 1 month, 24% of poor results or late deaths) and much less common than in aortic incompetence of which it represents the main cause of failure. Even in these cases, prolonged symptomatic improvement may be observed. 3 prognostic factors affect the operative and late mortality. They act to variable degrees and independantly of each other. They are : age, cardiomegaly and heart failure. The actuarial 5 year survival is: 81,77% and 53% for under 50, 50 to 65 and over 65 years age group respectively; 88%, 78% and 48% for cardiothoracic ratios of less than 0,50, between 0,50 and 0,58 and greater than 0,58 respectively; 83%, 65% and 47% for patients without signs of heart failure, with a history of pulmonary oedema, and with a history of congestive cardiac failure respectively. These results encourage a liberal attitude towards surgery, even in old patients with severe valvular lesions.

Adult↗