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Biomedical subjects

J Acar

Publications and source records attributed to J Acar.

At least 235 records · Page 13Linked to original sources
PubMed1979

[Conduction abnormalities after single heart valve replacement (author's transl)].

A total of 300 patients were operated upon for heart valve disease by the same surgeon. The affected valve was the aortic in 200 cases and the mitral in the other 100 patients. The tricuspid valve, coronary arteries, and myocardium were not involved. This report attempts to define the frequency progression, prognosis, and significance of conduction abnormalities which appear during the course of this operation. In 35 cases, of which 16 were post-operative deaths, a histological examination of the conduction pathways was possible. The conclusions to be drawn from these observations are: Conduction abnormalities after single aortic or mitral valve replacement are frequent (1 out of 3 patients).

Aortic Valve↗
PubMed1979

[Severe aortic incompetence from dysplasia of the valve. A report on 19 cases of this real but often unrecognized disorder (author's transl)].

A total of 19 patients were found to have severe aortic incompetence from dysplasia of the valve (thin, spread-out valves having a tendency towards eversion). This type of valve abnormality is often unrecognized but is found in 13,6% of cases of severe aortic incompetence. The relationship between this condition and Marfan's syndrome or its aberrant forms are discussed, as well as its frequency when unrelated to this disease. The dysplasias can be isolated phenomena or associated with pathological conditions of the ascending aorta. The results of this review suggest that some of these dysplasias might be rheumatic in origin.

Adolescent↗
PubMed1978

[Echocardiography in the diagnosis of mitral valve insufficiency due to valve mutilations or chordal ruptures. 41 cases with anatomical findings].

This study analyses the echocardiographic findings in 41 cases of severe mitral regurgitation due to chordal rupture (33 cases), elongation of chordae (4 cases) or valve trauma (4 cases). The operative findings are given. It was possible to make the diagnosis of chordal rupture in 60% of cases by recording one or more of the following signs:--For the anterior cusp: amplitude of motion equal to or greater than 38 mm; co-existence of chaotic diastolic fluttering and multiple systolic echoes; recording of several diastolic wave forms of the anterior cusp, out of phase and crossing each other;--For the posterior cusp: paradoxical movement of the cusp in systole and diastole; presence of an echo in the left atrium in systole. The group studied was compared with a group of 40 normal subjects and 48 cases of other types of mitral regurgitation which were severe and received surgery. The various signs had good specificity. The sensitivity of the different signs varied from 33 to 50% of cases. It was greater when the number of chordal ruptures was greater. Whichever cusp was affected, it was sometimes the site of high frequency and large amplitude systolic vibrations, which were found in a quarter of the patients. The specificity of this sign is discussed. The diagnosis of rupture of chordae is possible in a large proportion of cases and the causes of error are analysed.

Adolescent↗
PubMed1978

[Surgically treated chronic aortic valve insufficiency. Long term results. Surgical indications].

The timing of surgery in chronic aortic regurgitation depends to a large extent on the operative results that may be expected in this type of valve disease. In 88 cases of chronic aortic regurgitation submitted to surgery there were 6 operative deaths (6.8%). Five years after operation the actuarial survival was 58% for the whole of the group and 68% for cases of rheumatic aortic regurgitation. Analysis of the causes of failures, late deaths, persistence or recurrence of severe impairment of activity, and of serious disturbances of ventricular rhythm, showed that the most important cause was myocardial dysfunction, which was responsible for two thirds of the bad results. Analysis of the late prognosis as a function of the various pre-operative parameters revealed the bad influence of cardiomegaly as measured by radiological examination (cardio-thoracic ratio and cineangiography) and of disturbances in left ventricular function. The actuarial survival curves showed very significant differences according to whether the cardiothoracic ratio was greater or smaller than 58%, and according to the amount of heart failure pre-operatively. Similarly, an end-diastolic volume index of 240 ml/m2 and an ejection fraction less than. 40 seemed to be serious findings. These facts, taken in conjunction with the natural history of this valve lesion, suggest that the indications for surgery should not only be symptomatic aortic regurgitation but also well tolerated regurgitation in which cardiomegaly, end-diastolic volume and/or the ejection fraction have reached a certain level.

Aortic Valve Insufficiency↗
PubMed1978

Renal transplantation and viral infections. III. Clinical and virological correlations.

Studies of the serological development after 26 renal transplants confirm the high frequency of antibody rises not only against the herpes virus group, but also against other virus groups such as measles, Coxsackie B viruses. These antibody rises correlate with febrile episodes and hepatic dysfunction in which CMV is the most often involved. However, the frequency of antibody rises against various viral antigens without any clinical event to suggest viral etiology; the lack of concomitant virus isolation (except the herpes group), as well as the ocurrence of simultaneous antibody rises against several viruses, all suggest that some of these various antibody rises observed may be related to immunological dysfunction rather than to virus infection.

Antibodies, Viral↗
PubMed1978

[Acquired interventricular communications in bacterial endocarditis. Apropos of a case with review of the literature].

The case reported here concerns a female of 33 who presented, during the course of an acute bacterial aortitis which had been treated, with an inflammatory perforation of the membranous septum. The clinical picture consisted of an association of very severe heart failure with severe aortic incompetence, an apical pansystolic murmur, and atrioventricular conduction defects. Although it was carried out in the presence of active endocarditis (valve cultures positive for streptococci), operative intervention (Patch + Starr) allowed rapid healing and excellent cardiovascular function after a 30 month follow-up period. Careful study of this case and of the eleven others in the literature has enabled us to underline the following points:--the sudden appearance, in a case with infective aortic incompetence, of a gross pansystolic murmur associated with atrial or intraventricular conduction defects, should be taken as suggesting a septal perforation;--examination of the haemodynamic system in such a case runs certain risks, and should never be allowed to delay the operation, which must always be carried out urgently;--despite the unfavourable operative conditions, the results strongly support the need for surgical intervention in these patients in good time.

Adolescent↗
PubMed1978

[Contribution of echocardiography to the study of stenotic mitral valve diseases in adults].

The "time motion" echocardiographic findings in 133 patients, with stenotic mitral valve defects were compared with the anatomical and haemodynamic findings. The information was derived either by monosound, or after a multiscan survey, selecting the lines in two perpendicular planes. A morphological analysis of VMA has allowed us to define a statistical profile according to the type of valve defect: a single diastolic slope in the pure uncalcified stenoses, 2 slopes with the first being more rapid than the second, in other mitral conditions. The cinetics of VMP were related to the presence of associated regurgitation and to the type of fusion. In cases with multiple diastolic slopes, the degree of stenosis was correlated only with the first slope, whilst the second was fairly closely related to the left ventricular end-diastolic pressure. The degree of valvular involvement can be predicted on the coexistence of a thick contour with multiple images, or in their absence on the diminution of amplitude of opening (less than 12 mm) and on the maximum speed of opening (less than 250 mm/s). By contrast, the sub-valvular lesions are underestimated whichever technique is used.

Calcinosis↗
PubMed1978

Surgical correction of chronic postembolic obstructions of the pulmonary arteries.

Following episodes of pulmonary embolism, the presence of thrombi in the pulmonary arteries leads to severe respiratory insufficiency and chronic right heart failure. We have operated upon 16 such patients, nine men and seven women from 23 to 68 years of age. All had severe dyspnea, 14 had chronic cor pulmonale, six had mental disturbances with syncope, and four had severe cardiac failure. The presence of clots was demonstrated by pulmonary angiography, and the permeability of the distal arterial bed was ascertained by selective injection of the bronchial arteries. In all cases but two a lateral thoracotomy was used so that the obstructed arterial branches could be approached distally. The inferior vena cava was always ligated to prevent recurrences. There were six operative deaths, three from cardiac failure, one from acute pulmonary edema, one from hemothorax, and one following a pyothorax. Ten patients are surviving after 6 months to 10 years. One is still limited because of significant pleuropulmonary sequelae. Six are enjoying good results with marked improvement in their functional limitations, a significant drop in the pulmonary artery pressure, and radiological permeability of previously obstructed arteries. Three are excellent condition--completely asymptomatic.

Adult↗
PubMed1977

[Antivitamin K].

Explore the source record for details and available documents.

Anticoagulants↗
PubMed1977

Two distinct types of trimethoprim-resistant dihydrofolate reductase specified by R-plasmids of different compatibility groups.

R-Plasmids from a number of trimethoprim-resistant Escherichia coli and Citrobacter sp. were studied after transfer to E. coli K12 hosts. Each was found to specify a dihydrofolate reductase which was resistant to trimethoprim and Methotrexate, and which could be completely separated from the host chromosomal enzyme by gel filtration. Two distinct types of R-plasmid dihydrofolate reductases were identified. Type I enzymes, typified by the R483 enzyme previously described (Sköld, O., and Widh, A. (1974) J. Biol. Chem. 249, 4324-4325), are synthesized in amounts severalfold higher than the chromosomal enzyme. The 50% inhibitory concentrations (I50) of trimethoprim, Methotrexate, and aminopterin are increased several thousandfold over the corresponding values for the chromosomal enzyme. Type II R-plasmid dihydrofolate reductases are synthesized in about the same amount, or less, as the chromosomal enzyme, but are practically several hundredfold higher than those for the type I enzymes. Both types of R-plasmid dihydrofolate reductase showed little difference from the chromosomal enzyme in the binding of dihydrofolate, NADPH, folic acid, and 2,4-diaminopyrimidine.

Chromosomes, Bacterial↗