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Biomedical subjects

J Gay

Publications and source records attributed to J Gay.

At least 19 recordsLinked to original sources
PubMed1990

Iowa Agricultural Health and Safety Service Project.

A model community-based comprehensive agricultural occupational health and safety service program has been implemented in Iowa. The functional center of coordination is based in the College of Medicine at the University of Iowa. The community-based hub of the service is the community hospital, where the majority of the direct client services originate. The University provides training of hospital staff, programming, direction, consultation, and referral. The services offered include primary care, health surveillance, industrial hygiene and safety, and education. Through a detailed evaluation of the project's objectives we will be able to evaluate, modify, and disseminate a model agricultural health and safety services delivery program. This model should be effective in changing the farming population's health and safety attitudes and behaviors through a community-based program.

Accidents, Occupational↗
PubMed1990

Relationship of lung function to severity of osteoporosis in women.

To determine if the severity of osteoporosis and its resultant hyperkyphosis cause measurable impairment of lung function, 74 women referred for osteoporosis evaluation underwent pulmonary function testing. Women with thoracic wedge compression fractures secondary to osteoporosis had significantly lower percent predicted FVC than did those without fractures. In hierarchical regression analysis, after controlling for age and arm span, there was a significant effect on FVC of the degree of hyperkyphosis as measured by Cobb's angle (increment in R2 = 0.14, p less than 0.001). The addition of the number of vertebral fractures to the model was also significant (increment in R2 = 0.06, p less than 0.002), but cortical bone volume, bone mineral density, and smoking status did not significantly improve the model. From one half of subjects tested, a regression equation was generated relating %FVC and the number of thoracic fractures: %FVC = 103.4 - 9.4 x number of fractures. When used to predict lung function impairment in the second half of study subjects, the correlation between measured and %FVC was r = 0.59 (p less than 0.002). Kyphosis and thoracic compression fractures caused by osteoporosis produce modest but predictable declines in vital capacity in women.

Adult↗
PubMed1990

[Progression from hypertrophic obstructive cardiomyopathy to dilated cardiomyopathy. Apropos of 4 cases].

Four cases of hypertrophic obstructive cardiomyopathy diagnosed on clinical, phonomechanographic, echocardiographic and haemodynamic criteria progressing to dilated cardiomyopathy are reported. This evolution was observed over a number of years (up to 20 years) and was accompanied by a clinical aggravation in all cases with 2 deaths and atrial fibrillation in 3 of the 4 cases. The signs of intraventricular obstruction [systolic murmur, bulge on the carotid pulse tracing, systolic anterior motion of the mitral valve (SAM) and intraventricular pressure gradient] disappeared as the left heart chambers dilated with a reduction in ventricular wall motion and parietal thinning but no change in myocardial mass.

Adult↗
PubMed1989

Use of a double-lumen pressure monitoring catheter to facilitate pulmonary artery banding.

Pulmonary artery banding is facilitated by simultaneously measuring the pressure above and below the band. This can be accomplished with a commercially available double-lumen central venous pressure monitoring catheter. This catheter is inserted through the outflow tract of the right ventricle and positioned so that the band will be between the two lumens. Gradual tightening of the band can be accomplished while monitoring the pressures proximal and distal to the band.

Catheterization, Central Venous↗
PubMed1988

[Intermediate-term trial treatment of arrhythmia in hypertrophic myocardiopathy with sotalol].

Unlike amiodarone, beta-blockers have proved ineffective in the treatment of severe ventricular rhythm disorders encountered in hypertrophic myocardiopathy. We tried to evaluate the efficacy of sotalol, a betablocker with anti-arhythmic properties, like amiodarone, on the supraventricular and ventricular rhythm disorders of this disease. 13 patients (6 men and 7 women, mean age 53.5 +/- 26.5 years) were evaluated with a 48 hours electrocardiographic recording, before and 8 and 120 days after a sotalol treatment at a mean dose of 290 mg/day (160 to 640 mg). The diagnosis of hypertrophic myocardiopathy was established on standard clinical, phonomecanographic (13 cases), sonocardiographic (13 cases) and haemodynamic (9 cases) criteria. Five patients presented bursts of supraventricular tachycardia on DO. Their number decreased to 4 on D8 and to 3 to D120. Six patients presented Lown's class III or IV ventricular rhythm disorders on DO. Their number went from 2 on D8 to 4 on D120. Therefore, in this short series, sotalol has shown a non-negligible efficacy on the rhythm disorders encountered in hypertrophic myocardiopathy.

Adolescent↗
PubMed1988

[Hemodynamic effects on intravenous propafenone in hypertrophic myocardiopathy].

None of the medical treatments of hypertrophic cardiomyopathy is perfect. In the present study conducted on 11 patients with hypertrophic cardiomyopathy in whom the usual treatments were either ineffective or badly tolerated, the haemodynamic effects of propafenone administered intravenously were investigated. The drug was injected centrally in doses of 2 mg/kg over 10 minutes, then by continuous intravenous infusion of 1.5 mg/min during 30 minutes. Various parameters were recorded before and after propafenone treatment by right and left cardiac catheterization. This anti-arrhythmic drug, which has beta-blocking and amiodarone-like properties, reduced left intraventricular obstruction but had no beneficial effect on diastolic function. The baseline and induced left intraventricular gradients were reduced from 30.4 to 17.7 mmHg and from 74 to 43 mmHg respectively. Diastolic function values showed a fall in dp/dt min from 1470 to 1307 mm/sec and an increase in T value from 0.066 to 0.084. The use of propafenone in hypertrophic cardiomyopathy must be accurately determined by long-term oral studies.

Adolescent↗
PubMed1987

[Porcine valvular bioprosthesis. Results 6 years later].

Between January, 1977 and December, 1980, 128 porcine bioprostheses were implanted in 109 European patients hospitalized at the Boucicaut hospital, Paris: 47 were aortic valve replacements (AVR), 43 mitral valve replacements (MVR) and 19 dual valve replacements (DVR). The operative mortality rate was 11% (12 patients): MVR 21%, AVR 6.4%, DVR 0%. 3 patients were lost sight of. The mean follow-up period was 59.3 months (3-96 months). The overall survival rate at 6 years, including early deaths, was 74.4 +/- 8%: MVR 66.1 +/- 15%, AVR 84.9 +/- 10%, DVR 68.6 +/- 20%. Eighteen late deaths were reported (3.7% patient-years [PY]), 3 of which were due to the valve (0.6% PY). The probability at 6 years of escaping death due to the valve was 96.3 +/- 4%: MVR 96.9 +/- 4%, AVR 100%, DVR 87 +/- 17%. Complications associated with the valve were observed in 17 patients (3.5% PY); they were: degeneration in 2 (0.8% PY), thromboembolic accident in 2 (0.4% PY), haemorrhagic accident in 4 (0.8% PY), endocarditis in 5 (1% PY) and simple disinsertion in 2 (0.4% PY). The probability at 6 years of escaping a complication due to the valve was 80.7 +/- 10%: MVR 90.4 +/- 13%, AVR 81.8 +/- 13%, DVR 55.3 +/- 35%. The probability at 6 years of escaping death and re-operation due to the valve was 88.5 +/- 8%: MVR 96.0 +/- 6%, AVR 87.9 +/- 11%, DVR 60.2 +/- 37%. This study and those already published show that compared with mechanical prostheses, bioprostheses clearly reduce the incidence of thromboembolic and haemorrhagic accidents.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1987

[Dilated cardiomyopathy: electrocardiographic forms].

The shape of the QRS complex was analyzed in 90 cases of dilated cardiomyopathy and was divided into 6 electrocardiographic types which may be interpreted as follows: A predominant S wave in V2, V3 and V4 leads, surrounded by a reduced QRS voltage in the other leads was the most frequent characteristic pattern, being found in 31 cases (34.4%). This pattern coexisted with a lack of R wave progression from V1 to V4, with primary disorders of ST-T and with alterations in P wave. The deep S wave is probably due to a growth of vectors in the base of the left ventricle and in the septum in response to lesions in the rest of the myocardium. Second in frequency (22.2%) came left bundle branch block, with 20 cases. If to these are added the 19 cases of left anterior half-block observed, dilated cardiomyopathy appears as the major cause of the cardiac pathology that partially or completely interrupts the left branch. These cases also show that the lesions predominate in the left ventricle. The 14 cases (15.5%) of QS with elevated and convex ST-T betray extensive areas of fibrosis or necrosis. This pattern is characteristically located at the apex of the heart and associated with ventricular tachycardia. In 11 cases (12.2%) the QRS complex was normal in shape but associated with depressed ST-T and atrial disorders. This shows that the ventricular myocardium which produces QRS is neither badly damaged nor hypertrophic, but that repolarization is highly sensitive to the constant alterations of the subendocardial layers observed in dilated cardiomyopathy. Left ventricular hypertrophy was seen in 9 cases (10%).(ABSTRACT TRUNCATED AT 250 WORDS)

Arrhythmias, Cardiac↗
PubMed1987

[Lesions of coronary atherosclerosis in drug users. Preliminary studies].

A study of hearts removed during medicolegal autopsy of drug addicts after their sudden death demonstrated the constant presence of coronary lesions very similar to common atherosclerosis but remarkable by their magnitude, especially in patients dying at an age when atheromatous disease is relatively rare. Coronary circulation was studied in 10 cases by histoenzymatic, immunologic, histologic and ultrastructural examination of fresh and fixed tissues. The parietal thickening, noted in all cases to variable degrees, had provoked stenosis in several cases, preferentially in the proximal portion of the anterior interventricular vessel. On light and ultrastructural microscopy, the lesions observed were similar to atherosclerotic lesions, but differed in several respects and notably the absence of antiglobulin and the lack of increase of glycosaminoglycans. Although the relations between the drug and atheroma are undeniable, their mechanism is at present unknown.

Adolescent↗
PubMed1986

Cigarette smoking during coronary angiography: diffuse or focal narrowing (spasm) of the coronary arteries in 13 patients with angina at rest and normal coronary angiograms.

To evaluate the acute effects of cigarette smoking on coronary arteries (CA), repeated coronary angiograms were performed in 13 patients with angina at rest and with normal coronary angiograms at basal state, during smoking, and then after methylergometrine (MEM) and after intracoronary nitroglycerin. Smoking induced anginal pain in three patients, triggered spasm (focal narrowing) in six, and/or an abnormal segmental diffuse narrowing (greater than 30%) in eight. The narrowing of the left CA was on average -21 +/- 13% (P less than 0.001), with more important narrowing of the mid-left anterior descending (-29 +/- 19%, P less than 0.001). The mean of the maximal segmental narrowing by patient was -34 +/- 13% (P less than 0.001). MEM produced similar effects and induced focal CA spasms in nearly the same patients at the same sites. Cigarette smoking may induce vasoconstrictive effects on CA in patients with rest angina and normal coronary angiograms. This action is not dose-dependent and may be initiated by less than one cigarette. These observations offer a new perspective for the understanding of the role of smoking in the precipitation of coronary events.

Adult↗
PubMed1986

[Hemodynamic evaluation of the Carpentier-Edwards porcine bioprosthesis and the Hancock pericardial bioprosthesis in aortic position].

Forty-four asymptomatic patients were catheterised at Boucicaut Hospital 9.5 months after aortic valve replacement to assess the haemodynamic performances of 21 Hancock pericardial (HP) and 23 porcine Carpentier-Edwards (CE) (standard model) bioprostheses, implanted in the aortic position. Left heart catheterisation was performed from a femoral approach; the simultaneous gradient was measured by planimetry and the functional valve surface area calculated at rest and after exercise. The resting calculated surface area of the HP was greater than that of the CE bioprostheses (equation: see text). The transvalvular pressure gradient was lower in the HP than in the CE group (7.8 +/- 4 vs 15.3 cf243 6 mmHg; p less than 0.005). After exercise (15 patients) the calculated surface area increased with the increased transvalvular blood flow in both groups but at each flow rate the calculated valve surface area was greater in the HP group. The haemodynamic performance of the CE bioprosthesis is inferior to that of the HP bioprosthesis, especially in the smaller models. However, the CE bioprosthesis would seem to be mechanically more reliable in the long term than the HP bioprosthesis has since been withdrawn from the market.

Adult↗
PubMed1986

[Phono-mechanographic evaluation of aortic stenoses. Contribution of the B1-maximum murmur/B1-B2 index].

The diagnostic value of phonomechanography in valvular aortic stenosis was reassessed with a rarely used index, the ratio S1-maximum intensity of the systolic murmur/S1-S2, or Thiron's index, the author of which only studied the correlations with the aortic transvalvular pressure gradient. The results obtained by the author being considered inconclusive, we decided to examine its correlations with aortic valve surface area calculated with the Gorlin's formula. The study was carried out in 38 patients with pure aortic stenosis, in whom 4 phonomechanographic parameters, the corrected left ventricular ejection time (Meiners), the carotid pulse half peak time, the S1-maximum intensity of the murmur interval and Thiron's index, were compared with the transvalvular pressure gradient and the aortic valve surface area at catheterisation. The first two parameters mentioned above were of limited value (correlations with aortic valve surface area r = 0.315, p less than 0.05 and r = 0.477, p less than 0.01 respectively). On the other hand, a good correlation was obtained with Thiron's index (r = 0.624, p less than 0.001) which was better than that found with the interval between S1 and maximum intensity of the systolic murmur (r = 0.483, p less than 0.001) in a population not excluding subjects with cardiac failure. These results indicate that: when Thiron's index less than or equal to 0.45, the aortic stenosis is probably mild (aortic surface area greater than 0.8 cm2), when Thiron's index is 0.46 greater than 0.56, the aortic stenosis is likely to be moderately severe (aortic surface area 0.8 less than 0.5 cm2), when Thiron's index is greater than 0.57, the aortic stenosis is probably severe (aortic surface area less than 0.5 cm2). In our series, Thiron's index was the best phonomechanographic parameter for the assessment of pure aortic stenosis. It could not be calculated in 10 out of 48 patients; this drawback was not encountered with the corrected left ventricular ejection time or the carotid pulse half peak time.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

[Presence of immunoglobulins and complement in the walls of the coronary arteries in atherosclerosis].

A histopathological and histoimmunological comparison was performed on 143 fragments on coronary arteries taken from 43 patients who died of ischemic heart disease and from 20 patients who died of other diseases. The immunological study research of Ig (A, G, M) and C3 fraction of complement in the 3 coronary layers was done by the immuno-peroxidase technique. The fixation was essentially observed in fibromyocytes. A good correlation existed between atherosclerosis lesions and fixation of Ig and C3 fraction of complement in both the media and the intima. On the other hand, this correlation was not observed in the adventitia. Accumulation of immunoglobulins and of the C3 fraction of complement in atherosclerosis seemed specific and proportional to the degree of arterial well lesion. The significance and the role of this accumulation remains to be studied. It may be hypothesized that Ig and complement fixation on fibromyocyte cell receptors or on the fibrous tissue fundamental substance is followed by the formation of antigen-antibody complexes, which act as foreign bodies which are either responsible for (or a reflection) of the onset of lesions or, at least, of their increasing severity or their persistence.

Complement C3↗