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Biomedical subjects

J Bensaid

Publications and source records attributed to J Bensaid.

At least 37 records · Page 2Linked to original sources
PubMed1994

[Syncopal angina caused by sinus arrest; cured by transluminal coronary angioplasty and calcium inhibitor].

The authors report the case of a 42 year old man who smoked and who presented with recurrent spontaneous anginal chest pain followed by syncope due to sinus arrest. The mechanism underlying these symptoms was spasm of the left circumflex artery at the site of severe stenosis of its middle segment just before the origin of the sinus node artery. Treatment with a calcium antagonist with transluminal coronary angioplasty of the narrowed segment of the circumflex artery resulted in complete regression of all symptoms with a follow-up of 15 months. Seven other reports of the same type were found in the literature concerning 6 men and 1 woman, with an average age of 49 years, presenting with the same symptoms and sinus arrest associated with the minimal coronary artery disease. The proof of coronary spasm was documented in 6 of the 7 cases by a positive ergometrine stress test or by the observation of spontaneous spasm during coronary angiography or rapid atrial pacing. The outcome was good with calcium antagonist therapy in 5 cases, and with slow release nitrate derivatives in 1 case. One patient, treated by betablockers, died. It is useful to investigate some sino-atrial blocks to diagnose the underlying ischaemic mechanism as the patients may be treated simply with calcium antagonists rather than undergo implantation of a pacemaker.

Adult↗
PubMed1993

[Left ventricular hypertrophy: a real compensatory mechanism?].

Our understanding of left ventricular hypertrophy has increased considerably in recent years with the introduction of new investigative techniques and the publication of clinical and epidemiological studies. The mechanism of the genesis of LVH is complex and multifactorial: besides the purely mechanical explanation which places LVH in a purely compensatory complex, counteracting the increase in left ventricular load, many other factors have been incriminated including a genetic predisposition and neurohormonal activation. A long phase of compensation is followed by ventricular insufficiency and cardiac failure. In addition, LVH has been identified as an independent cardiovascular risk factor for increased morbidity and mortality. Partial regression of LVH after surgical correction of valvular disease and especially after treatment with certain antihypertensive drugs, should be considered with great interest, even though the long-term prognosis of this regression remains uncertain.

Humans↗
PubMed1993

[Failure and complications of transesophageal echocardiography. Apropos of 1500 consecutive cases].

Transesophageal echocardiography (TEE) requires the introduction of a flexible probe into the oesophagus and therefore cannot be strictly considered to be non-invasive. This manipulation exposes the patient to complications which are benign in the large majority of cases. The authors report their experience in a prospective study analysing the failures and complications of TEE in the first 1,500 cases performed in their laboratory between May 1988 and May 1992, in mainly adult and ambulatory patients. The probe could not be introduced in 24 patients (1.6%), including 5 cases during the initial learning period. No serious complications were observed during of after TEE. Minor incidents were noted in 28 cases (1.9%) intolerance of the probe (12 cases), nausea and/or vomiting (4 cases), dyspnea (4 cases) due to tracheal intubation in 2 patients, laryngeal in 1 patient and to cardiac failure in 1 case. Pharyngeal haemorrhage (2 cases), atrial fibrillation (3 cases), vertigo (1 case), mandibular dislocation (1 case) and salivary hypersecretion affecting the quality of the imaging (1 case), were also observed. The investigation had to be interrupted prematurely in 12 cases (0.8%) usually because of intolerance of the probe. These results show that TEE is not dangerous in trained hands. Failure to introduce the probe is usually encountered during the learning period, which reinforces the need for apprenticeship in a teaching center. The safety of this technique, plus its considerable diagnostic value in many clinical indications, justify its present role in everyday cardiological practice.

Atrial Fibrillation↗
PubMed1993

[Comparison of VVI and DDD cardiac stimulation during exercise test evaluated by respiratory gas exchange measurement. Study of patients with normal systolic function and complete atrioventricular block unchanged during exercise test].

The aim of this study was to compare respiratory gas exchanges during exercise during VVI and DDD modes of cardiac pacing, the latter offering the possibility of preserving the atrio-ventricular sequence and of increasing the heart rate during exercise. Ten patients with normal systolic function (6 men, 4 women; average age 51 years), complete atrioventricular block and no acceleration of the heart rate during exercise, undergoing implantation of a dual-chamber pacemaker, performed maximal exercise stress testing after programming VVI or DDD modes successively with a one hour interval between the two investigations. The parameters recorded at peak exercise capacity were compared according to the pacing mode. Exercise duration (8 +/- 2 mn), maximal heart rate (133 +/- 10 bpm), systolic blood pressure (175 +/- 24 mmHg), work load (104 +/- 20 watts) were significantly higher in the DDD than in the VVI mode (6 +/- 2 mn, 73 +/- 8 bpm, 147 +/- 22 mmHg, 84 +/- 17 watts respectively, p < 0.001 for each parameter). Above all, peak oxygen uptake in the DDD mode was 23.2 +/- 6 ml/kg/mn compared to 19.2 +/- 5.1 ml/kg/mn in the VVI mode (p < 0.001). The increased heart rate obtained with DDD pacing seems to be the main factor which explains the differences observed. At lower exercise levels, there was no significant difference in ventilatory threshold between VVI and DDD pacing. The absence of underlying cardiac disease and a single, fixed atrioventricular delay may reduce the value of maintaining the atrioventricular sequence at more moderate exercise levels. This study shows that dual-chamber pacing increases maximal exercise capacity. These observations may be useful when considering the choice of a cardiac pacemaker.

Adolescent↗
PubMed1993

[Listeria monocytogenes femoral aneurysm].

Secondary infection of arterial aneurysms being a constantly possible complication, the bacteriological examination of peroperative specimens appears to be appropriate. Among responsible organisms, the presence of Listeria monocytogenes is very rare since only 13 cases have been reported in the literature. It is for this reason that it was felt to be of interest to report a new, entirely similar case of femoral aneurysm.

Aged↗
PubMed1992

[Prevention of postinfarction cardiac insufficiency: role of angiotensin converting enzyme inhibitors].

Cardiac failure remains a serious complication of myocardial infarction. In addition to therapeutic interventions to limit the infarct size, it would seem possible to influence the progressive changes in geometry and size of the left ventricle, known as remodeling. Experimental and clinical studies have shown beneficial effects of angiotensin converting enzyme inhibitors and the SAVE trial evaluated the prognostic consequences of this therapy, reporting a significant reduction in mortality after 10 months' treatment. Many questions remain which require further research in this field, mainly concerning the optimal time of introduction the treatment, the importance of the chemical molecule used, the most appropriate dosage and the influence of associated drug therapy. ACE inhibitors are now part of the therapeutic arsenal of myocardial infarction but their prescription should be strictly reserved for the population concerned by these trials, that is to say patients with a recent, extensive infarct with left ventricular dysfunction but without clinical signs of cardiac failure.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1990

[Echocardiography by the transesophageal route. Technique and the main clinical indications].

Transoesophageal Doppler-echocardiography is a new heart imaging technique avoiding many of the problems which sometimes limit standard transthoracic exploration. The transducer, mounted on a fibroscope sheath, is introduced into the oesophagus and therefore lies in the immediate vicinity of the atrial complex, the mitral valve, the aortic valve and the different segments of the thoracic aorta. The examination can be carried out on ambulatory patients in the echocardiography laboratory. The main clinical indications of this technique are: studies of prosthetic valves (notably the mitral valve); detection of vegetations or annular abscesses in infective endocarditis; determination of an emboligenic focus after arterial embolism; study of the causative mechanism in mitral valve regurgitation; pathology of the thoracic aorta and, in particular, of aortic dissection. The usual lack of difficulty in skilled hands, the quality of the images obtained and the diagnostic value of information collected by this route explain why this relatively new technique has very rapidly progressed from evaluation to routine use in most echocardiography laboratories.

Aortic Diseases↗
PubMed1990

Doppler ultrasound in aortic dissections: a study of cephalic and peripheral arteries.

We investigated the role of continuous-wave Doppler ultrasound in predicting the presence of an aortic dissection prospectively in 28 patients whose diagnosis was confirmed either by arteriography or surgery (26 cases) or at autopsy (two cases). We hypothesized that dissections, by creating two channels for flow, would produce velocity disturbances detectable in accessible arteries such as the carotid, brachial, and femoral arteries. Of the 28 patients, 20 had Type I, two Type II, and six Type III dissections. Two abnormalities of the Doppler signals were found: in 18 of Type I dissections, notching was found in the systolic upslope of the velocity tracing from those arteries that were either involved in or distal to the dissection sites. Notching was much less frequent for Type II and III dissections: only one patient with Type II and two patients with Type III dissections showed notching. In addition diastolic backflow with marked aortic valvular insufficiency was present. Notching in brachiocephalic artery continuous-wave Doppler signals appears to have a high positive predictive value for Type I dissections.

Adult↗
PubMed1990

[Giant leiomyoma of the esophagus detected by echocardiography and corroborated by x-ray computed tomography and surgery].

The authors report the case of a 44 year old man with a giant leiomyoma of the lower third of the esophagus. The patient presented with chest pain and the tumour was detected by echocardiography. The diagnosis was confirmed by computerised tomography and histological examination of the surgical specimen weighing 501.5 g. The surgeon performed a large esophago-gastric resection and reestablished the continuity of the digestive track by interposing a section of colon. A good result was obtained with a follow-up of 4 years. The authors underline the potential value of a simple barium swallow during cardiological assessment.

Adult↗
PubMed1990

[Are invasive studies advisable in evaluating heart valve diseases?].

The scope of acquired valvular heart diseases has evolved in France during the past 15 years towards a regression of the rheumatoid etiology with emphasis on degenerative and dystrophic diseases. At the same time, the evaluation of valvular diseases has benefited from the considerable advances in isotopic and mostly ultrasonic non-invasive techniques, not to mention more sophisticated techniques such as nuclear magnetic resonance imaging still infrequently used. The different technical variation of sonocardiography, from the TM and bidimensional sonography to transesophageal sonography and continuous and color coded pulsed echo-Doppler, provide reliable answers to the various questions raised before considering a surgical procedure. The remaining role of invasive techniques, such as cardiac catheterization and angiocardiography, considered as the "gold standard" until recently, and reviewed for each valvular disease whether isolated or combined, is becoming more and more restricted. Only coronary angiography remaining the undisputed and absolutely necessary test in case of angina, complications of myocardial infarction, risk or age factors.

Angiocardiography↗
PubMed1989

[Aortic valve replacement with extracorporeal circulation in a pregnant woman. Apropos of a case].

The authors report a case of surgical treatment of aortic stenosis in a pregnant woman (first pregnancy after four years treatment of sterility). The aortic valve replacement was performed at 16 weeks of amenorrhea. The valve was replaced by an Ionescu-Shiley bioprosthesis. Delivery was performed by caesarean section after 39 weeks of amenorrhea. There was no complication either for the mother or the child. Review of the literature allows analysis of the influence of aortic stenosis on pregnancy, and of the pregnancy on the tolerance of aortic stenosis. Some aspects of cardiopulmonary bypass for valve replacement in pregnant women are also analysed.

Adult↗
PubMed1988

[Barlow's disease and risk for life].

Idiopathic mitral valve prolapse, also called Barlow's disease, has been estimated to affect 5 p. 100 of the general population. Normally a benign disease, it becomes life-threatening in only a very small number of cases. High risk subjects could be detected by simple TM-mode echocardiography, provided this examination is of good quality and reproducible, for it shows a 5 mm or more thickening of mitral leaflets. Should this be the case, according to the Mayo Clinic authors, serious complications, such as sudden death, infective endocarditis or ischaemic cerebral vascular accidents, would be expected to occur in 10 p. 100 of the patients. Sudden death, of which only 60 cases have been published, is exceptional; it mainly concerns young subjects (mean age 40 years), predominantly women, with a family history of sudden death, who have experienced one or several syncopes and present with severe per- or intercritical dysrhythmias. Such subjects must be regularly supervised clinically as well as by basal or ambulatory electrocardiography and, if necessary, by electrophysiological or even haemodynamic exploration. Treatment with appropriate beta-blockers or antiarrhythmic agents is often required as is, in refractory cases, implantation of an automatic defibrillator. Infective endocarditis is a cause of death in 10 to 20 p. 100 of the patients. It mainly threatens subjects whose mitral valve regurgitation is suspected on the presence of a holo- or end-systolic murmur and confirmed by Doppler echocardiography.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗