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Biomedical subjects

J Gay

Publications and source records attributed to J Gay.

At least 91 records · Page 5Linked to original sources
PubMed1983

[Indication for and the future of valvular bioprosthesis].

Two fundamental characteristics distinguish bioprostheses from mechanical prostheses: disadvantage: reoperation inevitable after a variable delay; advantage: the problems of anticoagulation are avoided in the majority of cases and, above all, thromboembolic complications are reduced, thus improving the quality of life even if anticoagulation proves necessary. Before weighing up these considerations and making the difficult choice of the best prosthesis, two factors must be taken into account: the advances in cardiac surgery have enabled surgical therapy to be considered even in asymptomatic patients with the object of ensuring longer and better quality life; the concept of reoperation is still too often synonymous with surgical failure whilst thromboembolic complications are referred to fatality. To delay reoperation is to significantly increase the risks, so falsifying the statistical mortality rate and making it impossible to answer the fundamental question: "does the use of bioprostheses prolong life expectancy compared to mechanical prosthesis?".

Adult↗
PubMed1982

Do all diuretics have equal hypotensive efficacy?

An open parallel study was carried out in general practice on 70 patients with uncomplicated mild to moderate hypertension to compare the hypotensive efficacy of hydrochlorothiazide/amiloride with that of cyclopenthiazide/potassium. After a 2-week baseline period on placebo, patients were allocated at random to receive treatment with one or other of the diuretics starting with 1 tablet per day and increasing up to a maximum of 4 tablets per day or until their supine diastolic blood pressure was 90 mmHg or less. They were then continued at their optimum dose for a further 4 weeks. Analysis of the results from 62 patients showed that the hydrochlorothiazide/amiloride preparation produced both a greater decrease and better control of blood pressure in a greater percentage of patients that did the comparison diuretic. In addition, the beneficial effects were attained with fewer tablets, of importance for patient compliance.

Adult↗
PubMed1982

[Obstructive hypertrophic myocardiopathy and Osler's endocarditis].

Four cases of bacterial endocarditis (BE) complicating hypertrophic obstructive cardiomyopathy (HOCM) were observed between 1978 and 1980. The causal organism was a streptococcus in all cases and the portal of entry, dental. The mitral regurgitation (MR) observed in HOCM as an epiphenomenon of the obstruction became autonomous in 2 patients as shown by phonocardiography with methoxamine. In one case, the MR became severe and justified mitral valve replacement; at surgery, the chordal rupture suspected on echocardiography was confirmed. Antibiotic therapy was effective on the infectious process in all cases. However, 2 of the 4 patients died, one of thrombosis of the mitral prosthesis on the 15th postoperative day, and the other of a cerebrovascular accident. None of the patients had a detectable aortic or septal infectious lesion. Eight of 27 reported cases (30 p 100) of HOCM complicated by BE were operated; 10 (37 p. 100) died as a result of the endocarditis. These cases underline the incidence of BE in HOCM (5 p. 100) its gravity and the necessity for systematic antibiotic prophylaxis, especially before dental treatment.

Adult↗
PubMed1982

[Syncope with a rare etiology, cardiac hydatidosis].

A case of left ventricular hydatid disease causing mitral insufficiency and revealed by accelerated idioventricular rhythm (AIVR) is reported. The traditional and more recent diagnostic procedures including echocardiography and immunology are reviewed. The persistence of AIVR and mitral insufficiency after excision of the cyst are discussed with respect to the surgical treatment.

Adult↗
PubMed1981

Combination therapy of hormone and cytotoxic agents in advanced breast cancer.

The effectiveness of combination therapy with diethylstilbestrol, cyclophosphamide, and 5-fluorouracil (DES + CTx + FU) was compared with DES alone or CTx + FU in 87 postmenopausal women with advanced breast cancer. Therapy was randomized according to the tumor estrogen-receptor (ER) status. In 30 patients with ER-rich tumors and 35 patients with ER-unknown tumors, combination therapy yielded a higher response rate than DES therapy (87% vs. 64% and 59% vs. 23%, respectively). The pooled data from these two groups of patients suggest that the improved response rate from DES + CTx + FU against DES becomes more apparent in patients with visceral involvement (89% vs. 47%) (P less than 0.025) and that patients treated initially with combination therapy (DES + CTx + FU) appeared to have a longer survival than those treated with sequential therapy (DES leads to CTx + FU) (P = 0.06). The survival data in 22 patients with receptor-poor tumors were significantly inferior to those with receptor-rich tumors (P = 0.001). The ER status and presence of visceral metastases are significant factors in the selection of treatment programs.

Aged↗
PubMed1981

[The clinical diagnosis of aorto-coronary bypass occlusion (author's transl)].

The clinical profile of aorto-coronary bypass occlusion was drawn from a study of 49 patients with 56 occluded bypasses and 69 patients with 123 patent bypasses. All patients had undergone postoperative coronary arteriography or post-mortem examination. An anatomical cause of occlusion was retrospectively detected on the basis of pre-operative arteriographic findings or operation records in 82% of the cases, and on account of post-operative myocardial infraction (particularly significant when of late occurrence), residual angina and positive exercise tolerance test in 35%, 55% and 40% respectively of the cases. The last three criteria are of absolute diagnostic value when the arterial defects have been fully corrected by surgery.

Angina Pectoris↗
PubMed1980

Estrogen receptor status and response to chemotherapy in advanced breast cancer.

Tumor estrogen receptor status in women with advanced breast cancer was correlated with clinical response to cytotoxic chemotherapy in a retrospective study. Following an extramural review of the clinical data of 40 patients, 26 responded to chemotherapy (65%). The response rate in 19 receptor-rich tumors was 89% and in 21 receptor-poor tumors, 43% (P < 0.01). The lowest response rate (14%) was observed in seven postmenopausal patients with receptor-poor tumors. Clinical characteristics of patients and variants in chemotherapy programs failed to explain the favorable response of receptor-rich tumors to cytotoxic chemotherapy.

Antineoplastic Agents↗
PubMed1979

[Changes in the exercise electrocardiogram after aortocoronary bypass. Long-term results in 50 patients].

A comparative study of exercise electrocardiogrammes before and after aorto-coronary bypass surgery was carried out in 50 patients over a 2 year period. Coronary arteriography was used to assess the chirurgical results qualitatively ((electrocardiographic appearances) and quantitatively (work capacity and effort tolerance) with respect to the coronary lesions and permeability of the aorto-coronary vein grafts. Exercise electrocardiography has a place in the follow up of patients with aorto-coronary bypass grafts but it only gives information on the permeability of the grafts if all the significant stenosis are bypassed at surgery.

Adult↗
PubMed1979

[Myocardiopathy from a new anthracyclic derivative (author's transl)].

A 58-year-old man with subcutaneous metastases from a naevocarcinoma was prescribed 1 138 mg/m2 of a new anthracylic derivative, dietoxy-acetoxy-daunorubicine, at doses of 180 mg every three weeks. Irreversible cardiac failure occurred nine months after starting treatment, and was considered to be due to the toxic effects of the compound. He improved for a short period after very high doses of vasodilatators but death occured very shortly afterwards. Histological examination revealed severe subendocardial fibrosis, disseminated interstitial fibrosis, and degenerative and necrotic lesions of the myocytes. The authors discuss the factors involved in the cardiotoxicity of the anthracyclines: total dose, intervals between doses, associated risk, factors (age, radiotherapy). Even at usual doses signs of myocardial dysfunction are found in one third of patients treated, with the presence of histological lesions in all these cases, but clinical cardiac failure is rarely observed.

Cardiomyopathies↗
PubMed1978

[Myocardiopathy of pregnancy in white women].

Over the course of 17 years, 7 women have had heart disease either during the last three months of pregnancy or during the first three months post-partum, which appear to be associated with their pregnancy. Enquiries made throughout the country and relating to the last decade have yielded 11 additional cases so far unpublished. The clinical features of these cases do not differ from those of other non-obstructive cardiomyopathies occurring other than in pregnancy. The prognosis depends essentially on the factor of cardiac volume during the first few months of the disorder: if significant cardiomegaly persists, death will follow in one case out of two. There exists the problem of the criteria for making a diagnosis of myocardial disease of pregnancy. It should be emphasised that only 4 of the 18 cases were different from the usual cases of myocardial disease, in that they progressed to recovery which is unusual in this condition. One case was particularly illustrative of this, as clinical cure was followed by a relapse at subsequent pregnancy. Because the pregnancy itself seems to be the cause in such a tiny number of cases, a new hypothesis seems right; this is that pregnancy does no more than aggravate an associated or already existent myocardial disorder.

Adult↗