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Biomedical subjects

J Beaune

Publications and source records attributed to J Beaune.

At least 37 records · Page 2Linked to original sources
PubMed1992

Plasma sex hormones and aromatase activity in tissues of patients with systemic lupus erythematosus.

Clinical observations and experimental data suggest that sex hormones influence the development of systemic lupus erythematosus (SLE). An imbalance between androgen and estrogen plasma levels may suggest an abnormality in the aromatase activity involved in estradiol synthesis. Aromatase activity in skin and subcutaneous tissue and plasma sex-hormone levels (testosterone, androstenedione, estrone, estradiol, dehydrosterone sulfate, cortisol) were measured in 15 SLE patients (nine female, six male) who had never received corticosteroid treatment and in eight (four female, four male) healthy control subjects. There was a tendency toward an increase in aromatase activity in SLE patients when compared to control subjects. Among SLE patients the aromatase activity varied inversely with disease activity. Patients with SLE had decreased androgen and increased estrogen levels. Aromatase activity in SLE patients had significant direct correlation with estrogen levels. These data suggest that abnormal regulation of aromatase activity may partially explain the abnormalities of estrogen synthesis in SLE.

Adolescent↗
PubMed1991

Influence of associated valvular lesions on long-term prognosis of mitral stenosis. A 20-year follow-up of 202 patients.

Other valvular lesions associated with pure MS were studied in 202 consecutive patients whose mean age was 43.4 +/- 12.7 years; 76.7% were females. MS was isolated in 63.4%, associated with aortic regurgitation (AR) in 27.7%, aortic stenosis in 1.0%, tricuspid stenosis (+aortic valve lesion) in 1.0%. In isolated MS, 42.4% were NYHA class III or IV, compared with 49.0% in MS + aortic valve lesion. One hundred and sixty-nine (85.4%) patients were operated on; 23.1% had mitral valve replacement, 76.9% had closed (31.4%) or open (45.6%) mitral commissurotomy; 7.1% had associated aortic valve replacement. There were perioperative complications in 20.4%, and the perioperative death rate was 4.1%. Two patients were reoperated in the postoperative course, and 28 patients after this period. The follow-up was 13.3 +/- 4.5 years. The survival rate was 77.7 +/- 4.6% (SE) for isolated MS, and 71.1 +/- 6.3% for MS associated with an aortic valve lesion (NS). The prognosis of MS is very good: the survival rate at 20 years follow-up is 75%. The association of aortic stenosis or tricuspid stenosis does not appear to alter this survival, but numbers are small. Important aortic regurgitation is a significant predictor of higher mortality in patients with MS.

Adolescent↗
PubMed1991

[Abnormal origin of the left coronary artery in the adult. Scintigraphic and surgical correlations].

The authors report two cases of anomalous origin of the left coronary artery from the pulmonary artery in the adult. The two patients were pauci-symptomatic and were successfully operated, the one by reimplantation of the left coronary artery in the aorta and the other by an internal mammary artery left anterior descending artery bypass. Resting and stress myocardial scintigraphy and radionuclide ventriculography were performed before and after surgery in both cases. An analysis of segmental wall motion was possible in one patient. Before surgery, there was hypo-fixation of the tracer during the stress test and an alteration of left ventricular function. Postoperative isotopic investigations confirmed the efficacy of surgery the absence of regional ischemia and the normalisation of the ventricular contraction. These results argue in favour of a surgical reconstruction of a two coronary system, given the spontaneous risk of sudden death in this condition.

Adolescent↗
PubMed1990

Cerebrovascular accidents in infective endocarditis: role of anticoagulation.

Anticoagulation is still a matter of debate in infective endocarditis, since it can increase the risk of complications, mostly neurological. In our series of 269 patients with native valve endocarditis studied between 1970 and 1982, 35 were anticoagulated. We observed 14 patients with brain infarcts, of whom five died, and 12 patients with cerebromeningeal or brain haemorrhage of whom six died. In a similar series of 63 patients with prosthetic valve endocarditis, all of whom were on anticoagulation and were studied between 1972 and 1987, we observed five patients with brain infarcts, three of whom died, and two patients with brain haemorrhage, one of whom died. The frequency of cerebrovascular accident (CVA) was similar for both groups (11.1% in prosthetic endocarditis vs 11.5% in native valve endocarditis, P = ns), as was mortality rate (57% vs 48.4%, P = ns). CVA are significantly more frequent among anticoagulated patients (19/94 vs 19/238: P less than 0.01), but the mortality rate in CVA is similar for anticoagulated and non-anticoagulated patients (11/19 vs 8/19: P = ns). The indications for anticoagulation in infective endocarditis remain similar to those in valvular heart disease. In patients with infective endocarditis, anticoagulation with heparin should be maintained whenever a brain infarct is present, unless it is large and/or haemorrhagic.

Adolescent↗
PubMed1989

Comparison of enalapril versus digoxin for congestive heart failure.

A multicenter, randomized, double-blind, parallel-group trial was conducted to compare the effects of enalapril and digoxin on clinical signs and symptoms, as well as exercise capacity, in 142 patients with congestive heart failure classified as mild to severe (New York Heart Association functional classes II to IV). The patients received optimal treatment with digitalis and diuretics for 2 to 4 weeks. Thereafter, they were randomly assigned to receive either enalapril plus diuretics (n = 72) or digoxin plus diuretics (n = 70). After 8 weeks of treatment, a significant improvement in classification was observed in 22 of 63 patients (35%) in the enalapril group and in 17 of 61 (28%) in the digoxin group (difference not significant [NS]). Similarly, duration of exercise increased in both groups (p less than 0.005; p = NS between groups). Blood pressures decreased in the enalapril group (from 129 +/- 19/80 +/- 10 to 121 +/- 20/78 +/- 11 mm Hg; p less than 0.001), but not in the digoxin group (from 134 +/- 19/82 +/- 12 to 138 +/- 19/85 +/- 10 mm Hg; NS). Serum creatinine and electrolytes did not exhibit any significant change from baseline values, except for serum potassium, which increased slightly in the enalapril group (from 4.24 +/- 0.48 to 4.43 +/- 0.49 mmol/liter; p less than 0.05) and decreased slightly in the digoxin group (from 4.28 +/- 0.47 to 4.18 +/- 0.40 mmol/liter; p less than 0.05). Adverse events were reported in 13 patients (5 withdrawals) in the enalapril group and in 7 patients (2 withdrawals) in the digoxin group (p = NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Trials as Topic↗
PubMed1989

[Prognosis of chronic non-dystrophic and surgically treated aortic insufficiency].

Between January 1972 and March 1983, 123 patients with isolated non dystrophic aortic insufficiency underwent aortic valve replacement. During a mean follow-up period of 4.3 years per patient, 25.6 p. 100 of the patients died, including a 4.1 p. 100 hospital death rate. The actuarial survival rate was 74 p. 100 at 5 years and 62 p. 100 at 10 years. The main causes of mortality were heart failure, dysrhythmias and sudden death. A study of prognostic factors based on the preoperative data showed that clinical, radiological, electrocardiographic and haemodynamic signs were informative. In agreement with other authors, we found that preoperative cardiac dilatation and left ventricular dysfunction were predictive of a poor prognosis.

Adult↗
PubMed1987

[Valvular replacement for isolated aortic stenosis. Predictive value of the preoperative cardiac index in survival].

The immediate and long-term results of aortic valve replacement for pure or predominant aortic valve stenosis were evaluated in 186 patients operated upon since 1975 and followed for up to 10 years. This population fell into two groups depending on whether the pre-operative cardiac index was superior (group I, n = 111) or inferior (group II, n = 75) to 2.3 l/min/m2. There was no significant difference between the two groups as regards the immediate (i.e. within 30 days) post-operative mortality rate (6.6% vs 8.1% respectively). In contrast, the cardiac index proved to be a significant post-operative prognostic factor in aortic stenosis, since the probability of survival at 5 years was 96.4% in group I and only 71.7% in group II (p less than 0.001). This high rate of mortality in group II was exclusively due to myocardial dysfunction (sudden deaths included) in these patients with low cardiac index. When late mortality was analyzed according to age (over or below 60 years) and to pre-operative cardiothoracic ratio (over or below 50), these two criteria also proved to be significant prognostic factors. However, considering the poor prognosis of unoperated aortic stenosis, these long-term results in group II should encourage surgical treatment in many cases, even those with advanced cardiopathy.

Aged↗
PubMed1986

[Isolated aortic valve replacement in an advanced stage of cardiac failure. Results and prognostic study apropos of 71 cases].

Between January 1970 and December 1982, seventy-one patients in functional Stage IV of the NYHA classification underwent isolated aortic valve replacement for aortic incompetence (27 cases), aortic stenosis (18 cases) or mixed aortic valve disease (26 cases). Three haemodynamic criteria were chosen: left ventricular ejection fraction less than 40% (average 34 +/- 2%); arteriovenous difference greater than 6 volumes per 100 ml (average 6.7 +/- 0.2 vol.); left ventricular end diastolic pressure greater than 20 mmHg (average 26 +/- 1.3 mmHg). Analysis of the preoperative data defined the clinical profile of these patients: average cardiac index 2.2 +/- 0.07 l/min/m2; 75% had a cardiothoracic index greater than 0.50%; 61% had at least one conduction defect. The average Sokolow index was 50 +/- 2 mm. Twenty seven of the 71 patients died (36%); there were 7 early postoperative deaths (1st month) (10%), mainly due to ventricular arrhythmias (6 out of 7). There were 20 late deaths (31%) on average 52 +/- 8 months after surgery: 70% were of cardiac origin with a predominance of sudden deaths. There were no deaths in the group of patients operated after 1977, probably because of improved techniques of peroperative myocardial protection. The actuarial survival was 72% at 5 years and 63% at 10 years: long term survival was lower in aortic incompetence (25% at 10 years) compared with aortic stenosis (68%) and mixed aortic valve disease (78%). There was a significant relationship between long term survival and cardiothoracic ratio, ejection fraction, the duration of symptoms before surgery and the presence of atrioventricular or left bundle branch block.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

Mitral valve prolapse and infective endocarditis.

In a review of 350 consecutive patients with infective endocarditis (IE) 14 patients were found to have mitral valve prolapse (MVP) and mitral IE between 1970 and 1982 in our institution. We first describe the clinical features, laboratory findings and follow up of this group; then we compare it with the data obtained in patients with IE with other types of mitral regurgitation (MR). All patients with MVP had a murmur or a click with a murmur before the acute episode of IE, the most frequent consecutive organism was Streptococcus (nine cases) and the response to antimicrobial therapy was good; only one patient died and three others needed a mitral valve replacement from one month to 12 years later. The comparison with other types of mitral regurgitation with IE was done by sex, age, duration of symptoms before IE diagnosis, frequency of atrial fibrillation, number of congestive heart failures, heart volume on chest X-ray, number of echographic vegetations and echographic left ventricle size, and number of mitral valve replacements and deaths. None of these items differed significantly, but the duration of symptoms before diagnosis was shorter in the group of patients with MVP.

Acute Disease↗
PubMed1983

[Current etiology of organic mitral insufficiency in adults].

Between 1976 and 1981, 173 patients with severe symptomatic mitral incompetence were referred for preoperative assessment. The etiological diagnosis was based on echocardiography, catheterisation, angiography, and, in the 71 patients operated on, the surgical findings. Rheumatic valvular disease was demonstrated in 40 cases (23,1 p. 100), bacterial endocarditis in II cases (6,3 p. 100), myocardial disease in 30 cases (17,3 p. 100) including 19 cases of mitral incompetence during cardiomyopathy with dilatation, and II cases of mitral incompetence during hypertrophic obstructive cardiomyopathy: ischemic heart disease was the underlying cause in 27 patients (15,6 p. 100), congenital heart disease in 9 patients (5,3 p. 100); dystrophic valvular disease (mitral valve prolapse with or without chordal rupture) was detected in 56 cases (32,3 p. 100). These results show a continuing reduction in the incidence of rheumatic fever and an increase in the number of cases of dystrophic mitral valve disease in patients of 50 to 70 years of age, a condition often rapidly progressive with hemodynamic characteristics very similar to those of mitral incompetence observed in ischemic heart diseases.

Adult↗
PubMed1983

[Chronic aortic insufficiency with major left ventricle failure.ion. Results of aortic valve replacement and study of prognosis].

Twenty four patients with chronic aortic incompetence and major left ventricular dysfunction underwent aortic valve replacement. Left ventricular failure was responsible for severe symptoms: NYHA Classes III and IV. It was defined by the following haemodynamic criteria: LV ejection fraction (EF) 40 p. 100 (mean 37 +/- 13 p. 100), LV end diastolic volume 250 ml/m2 (mean 254 +/- 82 ml/m2), LV end diastolic pressure 20 mmHg (mean 26 +/- 10 mmHg), AV difference 6 vol p. 100 (mean 7,07 +/- 1,77). The mean cardiac index was 2,03 +/- 0,59 l/m2. Of the 24 patients, 9 died (Group A). There were 3 perioperative deaths and 6 deaths 5 to 60 months after surgery. One patient died suddenly after improving 3 years after surgery; 3 patients died with moderate persistent cardiac failure and 2 patients died without regression of cardiac failure after surgery. Of the 15 survivors, (mean follow-up 16 months), Group B, 6 were operated within the last three months and rapidly improved. Nine patients were followed up for 8 to 55 months after surgery and had significant symptomatic improvement (NYHA: Class II). No preoperative clinical, electrocardiographic or echocardiographic prognostic criteria were found to distinguish between these two groups of patients. There were no significant differences in cardiac surface area (1,89 +/- 34 compared to 1,95 +/- 23), LVEDP (26 +/- 11 compared to 26 +/- 10 mmHg), LVEDV (257 +/- 21 compared to 252 +/- 60 ml/m2), EF (31 +/- 11 compared to 40 +/- 13) or cardiac index (2,0 +/- 0,58 compared to 2,0 +/- 0,61 l/m2).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1982

[Prognosis of asymptomatic or slightly symptomatic chronic aortic insufficiency. Apropos of 54 patients followed for an average of 36 months].

A series of 54 patients with chronic aortic insufficiency with little (38) or no symptoms (16) were studied. All had severe regurgitation leading to discussion of aortic valve replacement. All patients (44 male and 10 female) underwent clinical, radiological, electrocardiographic, hemodynamic and angiographic investigation with assessment of left ventricular volume by monoplane 30 degrees cineangiography on entry to the study. They were then followed-up for an average of 36 months and the data assessed in a prospective study. At the end of the 36 months period, 4 patients had been lost to follow-up but were still alive, 31 patients were unchanged (Group A) and 19 patients had deteriorated (Group B). The parameters characterising Group B (P less than 0.001) were: corrected cardiac surface area of 1,72 +/- 0,13, a Sokolow index of 60,1 +/- 18,8 mm an ejection fraction of 56.2 +/- 14 % and a left ventricular end diastolic value of 225,3 ml/m2. Therefore, in chronic asymptomatic aortic incompetence, the parameters of cardiac dilatation, cardiac surface area greater than 1,70 and left ventricular end diastolic volume greater than 170 ml/m2, would appear to be good indications for aortic valve replacement. However, the values are nor formal criteria because a discrepancy between symptoms and the volumetric measurements may be observed in some cases, and also large variations in these measurements may be observed in patients in the same functional class.

Adult↗