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J Fourcade

Publications and source records attributed to J Fourcade.

At least 37 records · Page 2Linked to original sources
PubMed2001

[Value of an antibiotic lock for the prevention of bacteremia recurrence from central catheters in chronic hemodialysis].

Prospectively since 11/1997, all central venous catheter related bacteremias in our dialysis center (n = 60) was recorded. We systematically tested antibiotic lock technique using pure heparin (1 ml = 5000 Ul) mixed with antibiotic matched to isolated micro-organism after 15 days of systemic antibiotherapy. During 39 months of study, 27 bacteremias were documented from 23 patients. Seventeen locks in 15 patients were performed after each dialysis sessions during one month. Associated tunnel infection did not allow to stop the lock in 3 cases. In the 12 remaining patients, we observed 4 recurrences for 3 patients after the stop of the lock with the same micro-organism in 3 times/4 without modifications of antibiotics sensibility. No septic metastases were notified and the patency of all catheters were respected. The incidence of bacteremias was 4.6 per 1000 catheters days before the lock and 0.88 after, during a mean observation period of 15 months per patients. Sterilisation of infected catheters seems possible and the incidence of bacteremias is reduce by the lock technique without coming out of septic complications or selected micro-organisms.

Anti-Bacterial Agents↗
PubMed2000

Ten-year clinical and angiographic follow-up of coronary wallstent.

Although stents have been implanted in human coronary arteries since 1986, the long-term angiographic outcome of coronary stenting is unknown. We performed 10-year angiographic follow-up in 8 patients who had undergone stent implantation without acute complications or 6-months' restenosis. Analysis of the changes in minimal luminal diameter within the stent and the reference vessel diameter of the stented segment at 10 years do not suggest that atherosclerosis is accelerated or prolonged beyond 6 months within coronary stents.

Aged↗
PubMed2000

[Clinical trials in the elderly: ethical and methodologic considerations].

INTRODUCTION: Based on a literature review, main ethical and methodological issues raised by the implementation of randomized clinical trials involving elderly patients are discussed. CURRENT KNOWLEDGE AND KEY POINTS: Despite their rapidly growing number and the subsequent significant increase in consumption of health care services and its cost, elderly patients have seldom been involved in clinical trials. FUTURE PROSPECTS AND PROJECTS: However, the need for accurate scientific information on which relevant therapeutic decisions regarding this vulnerable population may be based has introduced marked changes in attitudes towards either clinical trials conducted in the elderly or requirements of various licensing authorities in regard to assessment of new drugs in elderly patients. Although difficulties pertaining to controlled clinical trials involving elderly patients may hamper both planning and carrying out of studies, completion of such trials may be achieved.

Aged↗
PubMed2000

[Shock? Stop!].

Explore the source record for details and available documents.

Adrenal Gland Neoplasms↗
PubMed2000

Hemoperitoneum in patients receiving hemodialysis.

Acute abdominal pain in chronic hemodialysis patients has well-known causes, including acute pancreatitis, mesenteric arterial insufficiency, or complicated duodenal ulcer. Others, such as hemoperitoneum, are far less common. Although hemoperitoneum occurs in patients receiving peritoneal dialysis, dialysis is seldom if ever the direct cause of the bleeding. Hemoperitoneum is often related to menses or ovulation, particularly to ovarian cyst rupture; therefore, it is more common in young women. In most cases, no specific treatment is required. Hemoperitoneum is rarely considered as the cause of acute abdominal pain in chronic hemodialysis patients. In this report of hemoperitoneum confirmed by emergency laparotomy in 3 women, bleeding was not related to gynecologic origin. All of the women were younger than age 50 and undergoing long-term hemodialysis. All patients had a history of acute abdominal pain associated with shock. The cause of bleeding was always an organ lesion: hepatic amyloidosis with suspected portal hypertension or sclerosing peritonitis and acute hemorrhagic pancreatitis. Coagulation abnormalities and the use of anticoagulants during hemodialysis sessions may have been aggravating factors in all three patients. Hemoperitoneum is difficult to diagnose, particularly in the minor forms, and consequently its incidence may be underestimated. Therefore, it should be considered whenever a chronic hemodialysis patient presents with persistent acute abdominal pain.

Abdominal Pain↗
PubMed2000

Depressed low frequency power of heart rate variability as an independent predictor of sudden death in chronic heart failure.

AIMS: Identification of patients with chronic heart failure at risk for sudden death remains difficult. We sought to assess the prognostic value for all-cause and sudden death of time and frequency domain measures of heart rate variability in chronic heart failure. METHODS AND RESULTS: We prospectively enrolled 190 patients with chronic heart failure in sinus rhythm, mean age 61+/-12 years, 109 (57.4%) in NYHA class II and 81 (42.6%) in classes III or IV, mean cardiothoracic ratio 57.6+/-6.4% and mean left ventricular ejection fraction 28.2+/-8.8%, 85 (45%) with ischaemic and 105 (55%) with idiopathic dilated cardiomyopathy. Time and frequency domain measures of heart rate variability were obtained from 24 h Holter ECG recordings, spectral measures were averaged for calculation of daytime (1000h-1900h) and night-time (2300h-0600h) values. During follow-up (22+/-18 months), 55 patients died, 21 of them suddenly and two presented with a syncopal spontaneous sustained ventricular tachycardia. In multivariate analysis, independent predictors for all-cause mortality were: ischaemic heart disease, cardiothoracic ratio > or =60% and standard deviation of all normal RR intervals <67 ms (RR = 2.5, 95% CI 1.5-4.2). Independent predictors of sudden death were: ischaemic heart disease and daytime low frequency power <3.3 ln (ms(2)) (RR = 2.8, 95% CI 1.2-8.6). CONCLUSION: Depressed heart rate variability has independent prognostic value in patients with chronic heart failure; spectral analysis identifies an increased risk for sudden death in these patients.

Arrhythmias, Cardiac↗
PubMed2000

[Implantation of long coronary stents. Immediate and long-term results].

There have been few clinical reports of the long term results of implantation of long coronary stents. The authors performed a retrospective study of the long term results of 213 implantations of long stents (20 mm long) in 202 patients. These results were compared with those obtained in patients implanted with short stents (< 20 mm long) during the same period (630 implantations in 530 patients). The angiographic and clinical success rates were respectively 96.5 and 95.4% in the "long stent" group compared with 97.2 and 94.9% in the "short stent" group. In the "long stent" group, at 6, 12 and 24 months (follow-up, the cumulative incidence of nex revascularisation procedures of the target lesion were 9.8, 14.3 and 20.6% respectively, whereas the cumulative incidences of major cardiac events (mortality, infarction, angina, coronary bypass surgery and angioplasty) for the same periods were 12.7, 21.1 and 40% respectively. There was no significant differences compared with the "short stent" group concerning all these events. However, after 6 months, there was a tendency for more major cardiac events and for more new revascularisation procedures of the target lesion in the "long stent" group. In multivariate analysis, the independent predictive factors for major cardiac events were: a Jeopardy score > 6 (p = 0.002), and the complex nature of the lesion (B2 or C) (p = 0.045), whereas the indépendant risk factors for a new revascularisation procedure of the target lesion were: minimal luminal diameter after the procedure, a Jeopardy score > 6, complex lesions, diabetes and the reference diameter of the stented arterial segment. The authors conclude that although the length of the stent as such is not a long term predictive factor, the complexity of the lesion and the severity of the coronary disease which are more common in the "long stent" group explain the non-significant tendency for a higher incidence of major cardiac events in this group.

Aged↗
PubMed2000

[Utilization of heart rate at the ventilatory threshold for the prescription of intensity of exercise training in cardiac failure].

Physical exercise is a treatment for cardiac failure but a large range of intensities of exercise is proposed. The aims of this study were to determine the range of intensities of effort used and to individualize the intensities used. Thirty patients with stable cardiac failure (NYHA Classes II-III, age: 53 +/- 2.1 years, ejection fraction: 31 +/- 1.4%) underwent a cardiorespiratory exercise stress test before and after individualized training at the ventilatory threshold. However, before and after the training period, standard methods of calculation of the intensities at the ventilatory threshold showed individual differences greater than +/- 2 standard deviations, indicating different metabolic stimulations. After the individualized training programme, peak oxygen consumption on exercise (1679 +/- 100 vs 1487 +/- 89 ml.min-1, p = 0.0001) and at ventilatory threshold increased (1365 +/- 85 vs 1133 +/- 65 ml.min-1, p = 0.0001), the ventilatory threshold/peak exercise ratio increased (81.2 +/- 1.3 vs 76.7 +/- 1.4%, p = 0.0008), and there was a decrease in heart and ventilatory rates at submaximal metabolic levels (p = 0.0001). The authors conclude that protocols using intensity of effort at the ventilatory threshold give similar results with respect to improvement of aerobic capacity as other methods of indirect calculation, based on maximal heart rate of oxygen consumption. The value of this particular method lies in the adequation between aerobic capacity of the patient and the intensity of training. The results obtained attain the physiopathological aims of rehabilitation.

Calibration↗
PubMed1999

Angiotensin I-converting enzyme gene polymorphism in a low-risk European population for coronary artery disease.

An insertion/deletion (I/D) polymorphism of the angiotensin I-converting enzyme (ACE) has been associated with an increased risk of coronary artery disease (CAD) and myocardial infarction (MI). However, this finding has not been fully investigated in European populations with very low CAD risk. In a case-control study on a population from Southern Europe (Toulouse, France), we evaluated the ACE I/D polymorphism in 405 men, aged 35-65 years, who underwent coronary angiography and in 357 representative control men within the same age range. We also explored associations in the patients between this polymorphism and CAD severity. The ACE genotype was not associated with the presence of either CAD or MI. The ACE genotype was not a marker for angiographically assessed CAD severity. In a sample in one of the European populations with the lowest CAD risk, ACE I/D polymorphism was not associated with an increased risk for CAD or MI and did not influence the extent of CAD.

Adult↗
PubMed1999

[Intestinal complications of thrombotic microangiopathy in the adult. 4 cases and review of the literature].

We report four cases of adult thrombotic microangiopathy associating diarrhea with severe ischemic colitis. In one case, the intestinal complications was severe and diffuse ischemic colitis, in two cases an inaugural colonic perforation requiring colectomy and in the last case a massive mesenteric infarct. In three cases, histologic examination showed vessel occlusion with microthrombi. Despite treatment with plasma exchange and plasma infusion, death ensued in two cases. Principally described in childhood thrombotic microangiopathy, intestinal complications occur exceptionally in adult thrombotic microangiopathy and are associated with a poor prognosis. Inaugural ischemic colitis revealing an adult thrombotic microangiopathy is also uncommon and thrombotic microangiopathy could be evoked in all patients presenting acute ischemic colitis.

Acute Kidney Injury↗
PubMed1999

Combined idiopathic retroperitoneal and mediastinal fibrosis with pericardial involvement.

We report the case of a 54-year-old woman with renal failure related to bilateral hydronephrosis. Clinical and radiologic findings were consistent with retroperitoneal fibrosis associated with pleuro-pericardial involvement. These features matched criteria for combined idiopathic retroperitoneal fibrosis and idiopathic mediastinal fibrosis. There are few reported cases of pericardial involvement in this combined disorder. In our observation, nuclear-magnetic resonance was the radiologic procedure of choice for aortic exploration. The responsibility of therapeutic agents (beta-adrenoreceptor-blocking drugs and ergotamine) and therapeutic options for the sclerosing disease are also discussed. Bilateral ureteral stents and corticosteroids produced favorable outcome without recurrence one year after treatment was stopped.

Adrenal Cortex Hormones↗
PubMed1999

[Cardiac factors predictive of 10-year survival after coronary surgery].

Although the predictive factors of postoperative mortality after coronary artery surgery are well known, those predictive of long-term survival have received less attention. This study reviews the outcome of a group of 480 patients between 50 and 65 years of age, operated between 1984 and 1986. The patients were classified in two groups according to the presence or absence of internal mammary artery bypass grafts: Group I (304 patients with saphenous vein bypass grafts alone) and group II (176 patients with an internal mammary artery +/- saphenous vein bypass grafts). The long-term results were assessed according to 3 criteria: isolated cardiac mortality: cardiac mortality associated with a repeat revascularisation procedure and cardiac mortality associated with reoperation or recurrence of angina. Cardiac survival at 10 years was significantly better after internal mammary-LAD bypass: 91.4% (CI 87.1-95.1) than after saphenous vein bypass grafting alone: 79.6% (CI 74.8-84.4) (p = 0.012). Univariate analysis identified the following poor predictive factors: three vessel disease (p = 0.03), preoperative left ventricular dysfunction with an ejection fraction inferior to 45% (p = 0.0001), incomplete revascularisation (p = 0.0003), use of venous bypass graft alone (p < 0.014) and perioperative infarction (p = 0.0254). For each criterion of survival (cardiac isolated or associated with a new revascularisation and/or recurrence of angina), multivariate analysis identified three independent predictive factors of long-term extramortality: not using internal mammary artery-LAD bypass graft, incomplete revascularisation and preoperative hypertension. This study confirms the beneficial effects of internal mammary-LAD artery grafting on long-term survival after coronary artery surgery, and also demonstrates the prejudicial effects of hypertension.

Coronary Artery Bypass↗
PubMed1999

[Hyperinsulinism, heart rate variability and circadian variation of arterial pressure in obese hypertensive patients].

AIMS: During insulin resistance, sympathetic nerve activity is increased. However insulin resistance is a common feature of obesity and essential hypertension, it is unclear if chronic hyperinsulinemia per se contributes to sympathetic overactivation. The purpose of our study was to explore++ the relationships between chronic hyperinsulinemia and heart rate variability (HRV), a non-intensive tool to assess autonomic function, in obese and hypertensive subjects. METHODS: 24 hours Holter ECG for HRV time and frequency domain analysis was performed in 77 patients, mean age 53 +/- 10 years, 52 men and 25 women, free of diabetes, without beta-blockers, divided in four groups according to three parameters, body mass index (BMI > 27 kg/m2 in man and > 25 kg/m2 in woman defined obesity), arterial pressure and insulinemia (fasting insulinemia > 25 mUI/L defined hyperinsulinemia): 27 patients obese, hypertensive, with hyperinsulinemia; 28 patients obese, hypertensive, without hyperinsulinemia; 12 patients non obese, hypertensive, without hyperinsulinemia; 10 patients obese, normotensive, without hyperinsulinemia. RESULTS: In comparison with the three other groups, patients with hyperinsulinemia showed a significant decrease (p < 0.05) of SDNN and the power of total spectrum (0.01-1 Hz) band, which are indexes of global HRV, and a significant decrease (p < 0.005) of SD and the normalized power of the low frequency (0.04-0.15 Hz) band, both indexes reflecting sympathetic modulation of HRV. In contrast, no significant difference was observed between the four groups for indexes of HRV reflecting parasympathetic tone. These relations were independent of mean RR. Fasting insulinemia was significantly (p < 0.0001) related with HRV in time domain (SDNN; r = -0.43; SD: r = -0.49) and spectral domain (total spectrum: r = -0.49; low frequency: r = -0.52). CONCLUSION: Chronic hyperinsulinemia appears to be an important determinant of HRV, particularly for the indexes reflecting sympathetic influence, independent of obesity and hypertension.

Adult↗
PubMed1998

Coronary stenting of bifurcation lesions using "T" or "reverse Y" configuration with Wiktor stent.

The purpose of this study was to determine the immediate and long-term angiographic and clinical results of coronary stenting of bifurcation lesions using the "T" or "reverse Y" configuration with a Wiktor GX stent. This series demonstrates that stents can be placed with a high rate of success in coronary bifurcation lesions and the techniques described will overcome the potential limitations of coronary angioplasty in such lesions.

Adult↗
PubMed1998

QT interval dispersion as a predictor of arrhythmic events in congestive heart failure. Importance of aetiology.

AIMS: Identification of patients with congestive heart failure at risk of sudden death remains problematic and few data are available on the prognostic implications of QT dispersion. We sought to assess the predictive value of QT dispersion for arrhythmic events in heart failure secondary to dilated cardiomyopathy or ischaemic heart disease. METHODS AND RESULTS: Twelve-lead ECGs calculated for QT dispersion, 24 h Holter ECGs and signal-averaged ECGs were prospectively recorded in 205 heart failure patients in sinus rhythm. The 86 patients with ischaemic heart disease and the 119 with dilated cardiomyopathy were not significantly different as regards NYHA grades (51 vs 49% in grades III-i.v.), cardiothoracic ratio (57 +/- 7 vs 57 +/- 6%) and ejection fraction (28 +/- 8 vs 29 +/- 9%). The mean QT dispersion (66 +/- 29 vs 65 +/- 27 ms), the frequency of non-sustained ventricular tachycardia (37 vs 38%) and ventricular late potentials (41 vs 40%) were not significantly different in patients with ischaemic or dilated cardiomyopathy. QT dispersion was significantly related to other arrhythmogenic markers. During follow-up (24 +/- 16 months), 66 patients died, 22 of them died suddenly and seven presented a spontaneous sustained ventricular tachycardia. In patients with dilated cardiomyopathy, in multivariate analysis, only a QT dispersion > 80 ms was an independent predictor of sudden death (RR: 4.9, 95% CI 1.4-16.8, P < 0.02) and arrhythmic events (RR: 4.5, 95% CI 1.5-13.5, P < 0.01). In patients with ischaemic heart disease, no studied parameter was found significantly related to sudden death or arrhythmic events. CONCLUSIONS: In congestive heart failure, abnormal QT dispersion can identify patients with dilated cardiomyopathy who are at high risk of arrhythmic events.

Adult↗
PubMed1998

[Functional decoupling of left ventricular beta-adrenoceptor in a canine model of obesity-hypertension].

OBJECTIVE: To assess cardiac beta-adrenoceptors (beta-AR) in an obesity-hypertension model. METHODS: Six male beagle dogs (aged 35 +/- 5 months) receiving during 30 weeks a high-fat diet with 60% uncooked beef fat were compared to 6 normal beagle dogs. With right auricular and left ventricular samples we analysed cardiac beta-AR density through binding study using [125I]-cyanopindolol. beta 1 and beta 2 densities were obtained by competition with CGP 20712A. Affinity state of beta-AR was assessed by competition with isoproterenol. Noradrenaline plasma level was assayed by HPLC. Left ventricular mass (LV mass) was measured by echocardiography. Results are expressed as mean +/- SE. All comparisons were performed using a variance analysis (*: p < 0.05). RESULTS: Systolic blood pressure was significantly higher in obesses (245 +/- 8 vs 197 +/- 10 mmHg in controls). Diastolic blood pressure did not differed between both groups (93 +/- 3 vs 84 +/- 3 mmHg in controls). Noradrenaline plasma levels were similar in both groups (276 +/- 30 vs 235 +/- 50 pg/mL in controls). Obesses were characterized by higher LV mass (80 +/- 24 vs 67 +/- 15 g in controls*). Right auricular and left ventricular beta-AR densities were not different in obesses (57 +/- 6 and 67 +/- 4 fmoles/mg protein) and in controls (68 +/- 7 and 63 +/- 9 fmoles/mg protein). The beta 1-AR proportion was the same in obesses and controls in right auricule (63 +/- 4 vs 64 +/- 3% in controls) and left ventricule (59 +/- 3 vs 60 +/- 4% in controls). The proportion of beta-AR receptors in a high affinity state was similar in right auricular samples (69 +/- 4 vs 67 +/- 3%) in controls) but was significantly different in left ventricule (28 +/- 6 vs 74 +/- 6%) in controls). CONCLUSION: Left ventricular beta-adrenoceptors came under a specific desensibilisation independent of plasma noradrenaline levels. This functional decoupling of beta-adrenoceptors may account for the progressive systolic dysfunction of hypertensive cardiomyopathy.

Animals↗
PubMed1997

Five-year outcome after coronary angioplasty versus bypass surgery in multivessel coronary artery disease: results from the French Monocentric Study.

BACKGROUND: The clinical benefit of percutaneous transluminal coronary angioplasty (PTCA) as compared with coronary artery bypass grafting (CABG) for patients with multivessel coronary artery disease (CAD) has not been established. To determine the outcomes of these treatments in patients referred for the first time for coronary revascularization, we conducted a 5-year prospective trial comparing the two procedures. METHODS: From June 1989 to June 1993, a total of 1939 patients with multivessel coronary disease were screened at a single clinical site, and 152 patients (29%) were randomly assigned to undergo CABG (76 patients) or PTCA (76 patients). Enrollment required that complete revascularization of at least two major vessels supplying different myocardial regions be deemed clinically necessary and technically feasible. RESULTS: After PTCA or CABG, the clinical success rates were, respectively, 82.9 and 84.2%, whereas in-hospital mortality did not differ significantly between the two groups (1.3% in each group). At 5 years, the proportions of patients in the CABG group who required repeated bypass surgery (0%) or angioplasty (9%) were significantly lower than the proportions in the PTCA group (14.5 and 14.5%, P<.01). Event-free survival was higher in the surgery group (82.9%) than in the PTCA group (68.4%) (P<.05). CONCLUSIONS: In a carefully selected population of patients with multivessel CAD, angioplasty may offer an effective alternative to bypass surgery. However, to achieve similar clinical outcomes, the patients treated with PTCA are more likely to require further interventions.

Aged↗