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Biomedical subjects

J Julien

Publications and source records attributed to J Julien.

At least 127 records · Page 7Linked to original sources
PubMed1988

Left ventricular outflow obstruction after mitral valve repair (Carpentier's technique). Proposed mechanisms of disease.

Left ventricular outflow tract obstruction (LVOTO) after mitral valve repair by Carpentier's technique has been recently reported in the literature. To assess the mechanisms of this phenomenon, we investigated 307 mitral valve repairs performed between July 1985 and December 1986. Incidence of LVOTO related to the mechanism of the mitral insufficiency and to the etiology demonstrates a direct relation to preoperative mitral valve prolapse (posterior leaflet +/- anterior leaflet) of degenerative origin. No LVOTO occurred after rheumatic mitral insufficiency repair regardless of size of the left heart cavities or of the prosthetic ring. Intraoperative and surficial two-dimensional echocardiography, color Doppler methods, and cardiac catheterization were used to investigate the mechanisms leading to LVOTO. Nonspecific modifications induced by reduction in size of the mitral annulus by the prosthetic ring (anterior displacement of the posterior ventricular wall and of the posterior mitral leaflet and narrowing of the mitroaortic angle) are not sufficient to explain the LVOTO. The association of mitral leaflets (composed of excess tissue and opposed to flow by a perpendicular position attributable to a narrow mitroaortic angle) and geometric left ventricular modifications (responsible for the superposition of mitral inflow to ventricular outflow) also qualifies as a mechanism for the induction of LVOTO after mitral surgical repair.

Cardiac Catheterization↗
PubMed1987

[24-hour efficacy of a system of transcutaneous administration of nitroglycerin. Evaluation by the exercise test and gamma angiography].

The effects of a nitroglycerin transdermal therapeutic system (TTS NG 10 mg/24 h) 24 hours after application were evaluated by exercise left ventricular radionuclide cineangiography. 20 patients with ischemic heart disease were included in a double-blind, within patient, acute study comparing TTS NG to placebo. Were measured: exercise-test parameters and global (EF) and regional (rEF) ejection fractions at rest and during exercise. At maximum load, the double product rose from 18,680 +/- 4,118 with placebo to 21,538 +/- 3,988 with TTs NG (p less than 0.01) and ST-segment depression at same load decreased from 2.6 +/- 0.7 mm with placebo to 1.0 +/- 0.7 mm with TTS NG (p less than 0.001). Exercise EF increased from 0.57 +/- 0.15 with placebo to 0.63 +/- 0.12 with TTS NG (p less than 0.001) and was higher at exercise than at rest. Two hypokinetic territories improved during exercise with TTS NG: basal rEF increased to 0.45 +/- 0.07 with TTS NG versus 0.31 +/- 0.13 with placebo (p less than 0.01); anteroseptal rEF increased to 0.49 +/- 0.14 versus 0.43 +/- 0.14 with placebo (p 0.05); no significant improvement was observed in anterolateral and inferior territories were previous myocardial infarction occurred predominantly. These data demonstrate the 24 hours efficacy of this new galenic form of TTS NG in ischemic heart disease on exercise test parameters. TTS NG improving predominantly regional kinetics of ischemic but non infarcted territories and thus improving EF at exercise.

Administration, Cutaneous↗
PubMed1987

[Divry-Van Bogaert cortico-meningeal angiomatosis and Sneddon's syndrome. Nosological study. Apropos of 4 cases].

Four patients with idiopathic livedo reticularis and multiple cerebral ischemic events leading to a severe dementia are reported. Imaging (CT, MRI, angiograms) and pathological features (in one case) are presented. Similar clinical features have been described previously in Divry-van Bogaert's disease and Sneddon's syndrome. Data from our cases and a review of the literature did not find distinctive characteristic between these entities. Thus, for practical purposes, considering them as one group appears at present warranted.

Adult↗
PubMed1987

[Neurogenic muscular hypertrophy. Association with abnormal electrophysiological activities].

Muscle hypertrophy in neurogenic disorders is an uncommon phenomenon which has been reported in various conditions: hereditary or acquired anterior horn cell diseases, essentially S1 radicular compressions, and polyneuritis generally of a demyelinating type. We report two cases of denervating disease with muscle hypertrophy. The first was an S1 radiculopathy, and the second a compression with ischemia of the spinal cord by herniation of the D11-D12 disc, and showing partial improvement after surgery. In both cases, electrophysiological examination of the hypertrophic muscles revealed abnormal activities identified as complex repetitive discharges. In the second case they were associated with a syndrome of continuous motor unit activity. Such activities are rare in peripheral nerve involvement. However they have quite often been recorded in cases of neurogenic muscle hypertrophy and may therefore be partly responsible for the development of the hypertrophy.

Adult↗
PubMed1986

[Epilepsy with continuous discharges during slow-wave sleep. Treatment with clobazam].

The authors describe the case of a 12 years old boy suffering from an epilepsy with complex partial seizures evolving to a syndrome of epilepsy with continuous spikes-waves during sleep. A dramatic improvement follows clobazam introduction in the treatment. The originality of this case report and the possible mechanism of action of clobazam are discussed.

Anti-Anxiety Agents↗
PubMed1986

[Intraoperative evaluation of mitral valve reconstruction using two-dimensional contrast echocardiography].

20 patients who underwent reconstructive surgery for mitral regurgitation were peroperatively investigated by contrasted bidimensional echocardiography using intraventricular injection of 20 ml of physiologic saline. Before the valvuloplasty, the peroperative quantitation of mitral leakage was in all cases closely correlated with the data obtained preoperatively. After the mitral reparation, three groups of patients could be observed: group I (12 cases): absent or minimal regurgitation (0-+); group II (5 cases): moderate mitral regurgitation (++); group III (3 cases): marked regurgitation ( - +) necessitating an immediate ECC. In two cases it was possible to improve successfully the valvular function, in the third case valvular replacement was necessary. The correlation between the data of peroperative contrasted echography at one hand and the clinical examination and the postoperative paraclinical investigations on the other hand was excellent in all cases. Thus the contrasted bidimensional peroperative echocardiography represents a reliable method for predicting the immediate results of mitral reconstructive surgery.

Adolescent↗
PubMed1985

[Tomaculous neuropathy. Electrophysiologic study].

In two cases with recurrent palsies, the results of electrophysiological studies led to nerve biopsy showing typical tomacula. The first case was an inherited neuropathy with liability to pressure palsies. The second case was an apparently sporadic painless recurrent brachial neuropathy. Electrophysiological alterations were diffuse and sensory fibres of the median nerve between index and wrist were the most involved. Conduction blocks were observed without palsy in narrow anatomical passageways where nerve compressions are frequent (ulnar nerve at the elbow, peroneal nerve at the fibula). A compression by a neighbouring anatomical structure could make the prognosis worse and justify nerve decompression. The nerves with slowest conduction have the most important risk of palsy and the patients should be given advice to avoid their compression.

Adolescent↗
PubMed1985

[Post-radiotherapy anterior horn cell syndrome].

Three patients developed a progressive flaccid paraparesis without sensory or sphincter disturbances, following radiotherapy for lymphoma in two cases and carcinoma of testis in one case. The course was progressive with stabilization between two and four years. Electrophysiological study suggested anterior horn cell damage the mechanism of which remains unclear.

Adolescent↗
PubMed1985

[Congenital hepatic fibrosis disclosed late by hepatic encephalopathy].

A case of hepatic encephalopathy revealing congenital hepatic fibrosis in a 47-year-old woman is reported. The characteristic features of this observation were: a) the long clinical latency of a congenital disease usually discovered in childhood or in adolescence; b) the existence of hepatocellular insufficiency which appeared without any other reason than an ordinary infection; c) the absence of digestive bleeding or portacaval shunt, factors always found in the rare, previously described cases of encephalopathy in congenital hepatic fibrosis.

Ammonia↗