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Biomedical subjects

J L Rey

Publications and source records attributed to J L Rey.

At least 73 records · Page 4Linked to original sources
PubMed1993

[Contribution of transesophageal ultrasonography in the etiologic evaluation of a systemic embolic accident. Apropos of 451 patients].

In order to compare the respective values of transoesophageal and transthoracic echocardiography in the investigation of systemic embolic events, 451 consecutive patients (average age 60 +/- 15 years) presenting either with a cerebral ischaemic event (n = 401) or a peripheral arterial embolism (n = 50), were examined. One hundred and ninety eight patients had documented cardiac disease and/or atrial fibrillation; 253 patients had no previous cardiovascular history. Transoesophageal echocardiography revealed a possible cardiac embolic lesion in 37% of patients compared with 11% by transthoracic echocardiography (p < 0.001). In those patients with previous cardiac disease, transoesophageal echocardiography was contributory in 50% of cases compared with 27% of cases in patients with no previous cardiac disease (p < 0.001), whereas transthoracic echocardiography was only contributory in 12% and 9.8% of cases, respectively. Transoesophageal echocardiography was more sensitive for the diagnosis of intracavitary thrombus (7.5% vs 2.2%, p < 0.001), prosthetic valve thrombosis (2.4% vs 0.6%, p < 0.01), spontaneous contrast in the left atrium (10.8% vs 0%, p < 0.001), interatrial septal aneurysm (6.4% vs 1.9%, p < 0.001), mitral valve prolapse (5.3% vs 2.8%, p < 0.01). Moreover, irregular atheromatous plaques in the thoracic aorta could only be visualised by transoesophageal echocardiography (9% of cases). This study underlines the superiority of transoesophageal echocardiography over transthoracic echocardiography in the investigation of systemic embolic events. Transoesophageal echocardiography is even more contributory in patients with a history of cardiac disease.

Aged↗
PubMed1993

[Contribution of transesophageal and transthoracic echography in the evaluation of the mechanism and quantification of regurgitation in mitral and aortic bioprosthetic valves].

The respective values of transoesophageal (TOE) and transthoracic echocardiography (TTE) in the evaluation of the mechanism and the quantification of pathological regurgitation of bioprosthetic heart valves were analysed in 23 patients (14 mitral, 9 aortic; duration of implantation 108 +/- 43.2 months). Surgical or pathological correlations were available in all cases and catheter data in 18 of the 23 patients. With regards to mitral bioprostheses, the TOE evaluations of the mechanism and site of regurgitation corresponded in all cases with the operative or pathological findings and quantification of mitral regurgitation concorded with angiography. There was an underestimation of the severity of mitral regurgitation in 30% of cases by TTE compared with angiography; prolapse was diagnosed in 7 of the 10 cases with cusp tears. It was not possible to accurately determine the intra or perivalvular site of regurgitation by TEE. With regards to aortic bioprostheses, TOE and TTE were equally useful in determining the mechanism of regurgitation, showing cusp prolapse in 6 of the 9 cases with cusp tears. However, TTE quantified regurgitation accurately in all cases with respect to angiography, whereas TOE was only contributive in 50% of cases. These results show that single plane TOE is superior to TTE in the quantification and determination of the mechanism of regurgitation in mitral bioprostheses, but that TTE remains better for the quantification of regurgitation of aortic bioprostheses.

Adult↗
PubMed1993

[Epidemiological features of retroviral infection by HTLV-1 in central Africa].

Subsaharian Africa is the most important reservoir of HTLV1 virus but its epidemiology is not well-known. The authors have studied from 1987 to 1990 the situation in 6 countries in Central Africa. The already described routes of transmission are present: through blood transfusions (but it's not such a common practice), heterosexual transmission (but it doesn't seem to be as important as in other continents), and mother to child transmission through breast feeding. Nevertheless, environmental factors--which have to investigated--could play a role for transmission, among them one could think to vectors and parasites.

Adolescent↗
PubMed1993

[Value and limits of single-plane transesophageal echocardiography in dysfunctions of aortic valve prosthesis].

The authors reviewed retrospectively the results of transoesophageal and transthoracic echocardiography in 26 patients with prosthetic aortic valve dysfunction in order to study the value and limitations of monoplane transoesophageal echocardiography in this condition. Surgical data was available in 14 of these cases. The diagnosis of abscess of the aortic ring was made on 7 occasions by transoesophageal echocardiography and on 3 occasions by transthoracic echocardiography Bacterial vegetations were visualised in 5 cases by transoesophageal echocardiography and in 1 case by transthoracic echocardiography. The diagnosis of thrombosis was made in 1 case by transoesophageal echocardiography and missed by transthoracic echocardiography; fibrous pannus (n = 1) was not recognised on transoesophageal and transthoracic echocardiography. In the latter two conditions, transthoracic Doppler showed signs of obstruction. The diagnosis of a stenotic bioprosthesis due to fibrocalcific degeneration was made in 1 case by transoesophageal and in 1 case by transthoracic echocardiography. Prolapse of cusp was diagnosed in 6 cases by transthoracic echocardiography. An intraprosthetic valve leak was visualised in 7 cases by transoesophageal echocardiography and in 9 cases by transthoracic echocardiography; periprosthetic leaks were diagnosed in 9 cases by transoesophageal and in 12 cases by transthoracic echocardiography. These results indicate that transoesophageal echocardiography is a major advance in the diagnosis of abscess of the aortic ring, bacterial vegetations and prosthetic valve thrombosis. On the other hand, transthoracic echocardiography remains superior for the quantification or regurgitation and enables evaluation of transprosthetic gradients of obstructive prostheses with continuous mode Doppler. Therefore, the two methods are complementary.

Adult↗
PubMed1993

[Infectious endocarditis on permanent endocavitary pacemakers: value of echocardiography and review of the literature].

Infectious endocarditis around indwelling pacemakers is rare (0.15% of all implantations). They have a gloomy prognosis with a global mortality rate of nearly 34% as emerges from this review of the literature concerning 58 cases of infectious endocarditis published within the past 16 years. On the basis of the 6 cases which the authors report, they stress the importance and sometimes difficulty of using ultrasound in a positive diagnosis. Cardiographic ultrasound, which can determine the size and emboligenic nature of vegetations is capital in choosing how to remove the pacemakers. Percutaneous ablation by simply pulling or by catheterization currently gives the best results, but it may be necessary to resort to surgery involving right atriotomy if emboligenic vegetations are present. By combining antibiotic treatment and ablation of the intracavitary material, a cure is obtained in 92% of cases. These figures should be compared with the lack of success of using antibiotic treatment alone which results in a high level of mortality (84%).

Adult↗
PubMed1993

[Delayed angioplasty for residual stenosis following thrombolyzed infarction: arterial permeability and left ventricular function after 6 months].

At medium term, the results of delayed angioplasty (DA) following intravenous thrombolysis (IVT) in terms of arterial permeability but particularly of left ventricular function (LVF) is still poorly understood and is the subject of this prospective study. Over 18 months, 76 patients underwent DA for the residual stenosis on day 8 +/- 5 with complete and partial success rates of 88.2% and 11.8% respectively. Rapid reocclusion (< 48 hours) was documented in 9.2% of cases. After 6 months, there had been no deaths and no recurrence of infarction but a recurrence of angina in 23.7% of cases. Angiographic monitoring, carried out in 56 cases (73.7%) after 6 +/- 2.4 months identified 21 restenosis (37.5%) and 6 re-occlusions (10.7%). 12 of the restenosis were successfully re-dilated. The effect on LV function was investigated in 50 patients. In the absence of reocclusion, the ejection fraction and the kinetics of the infarcted territory were improved; significant restenosis (> 60% by digital densitometry) did not appear to offset these improvements. In addition to the maintenance of arterial permeability, the possibility of functional recovery appears to be conditioned by the degree of contractile abnormality observed during the initial ventriculography. Despite the absence of restenosis after 6 months, the occurrence on day 6 of akinesia or above all of dyskinesia reduces the chances of contractile improvement with as a corollary more marked LV changes.

Angiography↗
PubMed1992

Prognostic significance of Doppler-derived left ventricular diastolic filling variables in dilated cardiomyopathy.

To determine the prognostic significance of pulsed wave Doppler-derived left ventricular diastolic filling velocity profiles and the relationship between Doppler variables and clinical functional status, the follow-up outcomes of 62 consecutive patients with dilated cardiomyopathy and symptoms of left ventricular dysfunction were analyzed. All patients had echocardiographic left ventricular end-diastolic dimension > or = 6.0 cm, fractional shortening < 25%, increased E pointseptal separation, and diffuse hypokinesia or akinesia. During a mean follow-up period of 30.5 +/- 13.9 months, 27 patients experienced cardiac events: 23 died of either progressive pump failure or an episode of sudden death and four required cardiac transplantation because of refractory heart failure. Peak early filling velocity (78 +/- 23 cm/sec vs 65 +/- 25 cm/sec; p < 0.03) was higher and late atrial filing velocity (34 +/- 13 cm/sec vs 55 +/- 19 cm/sec; p < 0.001) was lower in patients with cardiac events than in cardiac event-free survivors. The ratio of early to late transmitral filling velocities was higher (2.6 +/- 1.2 vs 1.5 +/- 1.3; p < 0.001), and the deceleration time of early diastole was shorter (133 +/- 48 msec vs 175 +/- 71 msec; p < 0.001) in patients with cardiac events. The cardiac event rate was significantly higher in patients with an early to late filling velocity ratio greater than 2 (77% vs 19%; p < 0.001) or a deceleration time less than 150 msec (58% vs 23%; p < 0.05) than in those without. Stepwise multivariate regression analysis revealed that the pattern of transmitral early to late filling velocity ratio was the only significant independent Doppler echocardiographic predictor of outcome for these patients. Repeat Doppler echocardiographic examinations, which were performed in 31 survivors after intensive treatment (mean, 38.6 +/- 6.5 months), showed that early filling velocity was decreased (55 +/- 20 cm/sec vs 75 +/- 25 cm/sec; p < 0.02), late atrial filling velocity was increased (74 +/- 27 cm/sec vs 57 +/- 21 cm/sec; p < 0.01), early to late filling velocity ratio was reduced (0.8 +/- 0.3 vs 1.7 +/- 1.3; p < 0.001), and deceleration time was prolonged (227 +/- 60 msec vs 167 +/- 82 msec; p < 0.01) in 18 patients with clinical functional improvement, whereas these measurements were unaltered in the remaining 13 patients whose functional status was unchanged or had deteriorated.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1992

Assessment of severity of mitral regurgitation by measuring regurgitant jet width at its origin with transesophageal Doppler color flow imaging.

BACKGROUND: The ability of transesophageal color Doppler echocardiography to provide high-resolution images of both cardiac structure and blood flow in real time is advantageous for many clinical purposes. This study was performed to determine the utility of the regurgitant jet width at its origin measured by transesophageal Doppler color flow imaging in the assessment of severity of mitral regurgitation. METHODS AND RESULTS: Sixty-three consecutive patients with mitral regurgitation underwent transesophageal color Doppler examination, and the diameter of regurgitant jet at its origin was measured. Both right and left cardiac catheterizations were performed within 24 hours of Doppler studies, and angiographic grading of mitral regurgitation and regurgitant stroke volume were evaluated. There was a close relation between the jet diameter at its origin measured by transesophageal Doppler color flow imaging and the angiographic grade of mitral regurgitation (r = 0.86, p less than 0.001). A jet diameter of 5.5 mm or more identified severe mitral regurgitation (grade III or IV) with a sensitivity of 92%, specificity of 92%, and positive and negative predictive values of 88% and 95%, respectively. In 31 patients with isolated mitral regurgitation, the jet diameter correlated well with the regurgitant stroke volume determined by a combined hemodynamic-angiographic method (r = 0.85, p less than 0.001). A jet diameter of 5.5 mm or more identified a regurgitant stroke volume of 60 ml or more with a sensitivity of 88%, specificity of 93%, and positive and negative predictive values of 94% and 87%, respectively. CONCLUSIONS: The regurgitant jet width at its origin measured by transesophageal Doppler color flow imaging provides a simple and useful method of measuring the severity of mitral regurgitation, and it may allow differentiation between mild and severe mitral regurgitation.

Angiocardiography↗
PubMed1992

[Value and limits of the determination of aortic output by Doppler echocardiography in the quantification of aortic valve insufficiencies].

The aim of this study was to assess the value and limitations of Doppler echocardiographic measurement of aortic flow in the quantification of aortic regurgitation. Sixty-one patients were examined by Doppler echocardiography within 48 hours of cardiac catheterisation. There were 9 Grade I, 18 Grade II, 18 Grade III and 16 Grade IV angiographic aortic regurgitations. The mean aortic blood flow in angiographic Grades I and II (p less than 0.01). A correlation was observed between Doppler aortic flow and the angiographic grade of regurgitation (r = 0.66, p less than 0.001) and between aortic flow and regurgitant fraction (r = 0.68, p less than 0.001). Aortic flow greater than 10 l/mn identified angiographic Grades III or IV regurgitation with a sensitivity and specificity of 73.5% and 92.5% respectively and a positive and negative predictive values of 92.5% and 73.5% respectively. Aortic regurgitation with a regurgitant fraction greater than 40% was identified by a pulsed Doppler aortic blood flow greater than 10 l/mn with a sensitivity and specificity of 70% and 93% respectively, and positive and negative predictive values of 95% and 61% respectively. The sensitivity of this criterion is relatively poor as some severe aortic regurgitations have aortic flows of less than 10 l/mn: these patients have low outputs because of left ventricular dysfunction which is apparent from measurement of left ventricular fractional shortening.

Adolescent↗
PubMed1991

Specificity of new peptide immunoassays versus other immunoassays and agglutination tests for detection of HIV antibody in African sera.

The specificity of three HIV EIAs using synthetic peptides was evaluated and compared with that of four commercial EIAs using recombinant proteins or whole virus lysates of HIV-1 or of HIV-1 and HIV-2, and of two tests based on agglutination of sensitized particles. A total of 734 West African sera were screened. The best results were obtained with tests using recombinant proteins. HIV tests using synthetic peptides able to distinguish between HIV-1 and HIV-2 antibodies showed comparable specificity, but some false negative results represent a major handicap of these peptide EIAs in screening for HIV antibodies.

Agglutination Tests↗
PubMed1991

Assessment of severity of aortic regurgitation by M-mode colour Doppler flow imaging.

To assess the value of measuring the aortic regurgitant jet diameter at its origin by M-mode colour Doppler imaging, 82 patients with aortic regurgitation underwent, within 72 h of each other, colour Doppler examination and angiography. After excluding one patient without colour Doppler aortic regurgitation and five with a highly eccentric regurgitant jet, we found a close relationship between the jet diameter at its origin measured by M-mode colour Doppler and the angiographic grade of aortic regurgitation (r = 0.88). A jet diameter greater than or equal to 12 mm identified severe aortic regurgitation (grade III or IV) with a sensitivity of 86.4% and a specificity of 94.4%. In 38 patients, the jet diameter correlated well with the regurgitant fraction measured by a combined haemodynamic-angiographic method (r = 0.88). A jet diameter greater than or equal to 12 mm identified a regurgitant fraction greater than or equal to 40% with a sensitivity of 88.2% and a specificity of 95.2%. This study indicates that the size of the regurgitant jet diameter at its origin measured by M-mode colour Doppler provides a simple and useful measure of the severity of aortic regurgitation. It may allow differentiation between mild or moderate and severe aortic regurgitation and evaluation of regurgitant fraction.

Angiography↗
PubMed1991

End diastolic flow velocity just beneath the aortic isthmus assessed by pulsed Doppler echocardiography: a new predictor of the aortic regurgitant fraction.

End diastolic flow velocity just beneath the aortic isthmus was measured within 72 hours of cardiac catheterisation by pulsed Doppler echocardiography in 30 controls and 61 patients with aortic regurgitation. The end diastolic flow velocity was determined at the peak R wave on a simultaneously recorded electrocardiogram. In all controls there was no reverse flow at the end diastole beneath the aortic isthmus. In patients with aortic regurgitation the end diastolic flow velocity correlated well with the angiographic grade of regurgitation (r = 0.81) and regurgitant fraction (r = 0.82). The mean (SD) values were 6.3 (5.2), 12.2 (4.3), 22.1 (5.7), and 34.3 (9.3) cm/s for patients with regurgitant fraction of less than 20%, between 20% and 40%, between 41% and 60%, and greater than 60%, respectively. An end diastolic flow velocity of greater than 18 cm/s predicted a regurgitant fraction of greater than or equal to 40% with a sensitivity of 88.5% and a specificity of 96%. The study suggests that the pulsed Doppler derived end diastolic flow velocity is a useful index in the routine non-invasive assessment of the severity of aortic regurgitation.

Adult↗
PubMed1991

[Difficulties in the epidemiological surveillance of measles in Africa: exemplified by the Ivory Coast].

In tropical areas measles cases often are under-reported but the authors comment here two epidemics which had at first been considered as outbreaks of measles but were not. The first epidemic resembled a Chikungunya virus outbreak with important rashes, hyperthermia and pain attacks and was due to Igbo-Ora arbovirus. In the second epidemic children were having rashes with hyperthermia and adenopathy evoking rubella. The authors consider the possibility of over-reporting in view of the surveillance of measles, the target-disease in EPI (Expanded Programme on Immunization). This hypothesis is confirmed by the distribution of reported cases at national level with a high rate of out-season cases and among adults.

Arbovirus Infections↗
PubMed1991

[Malaria infection during childbirth and in newborns in Bécédi (Ivory Coast)].

Authors studied the parasitological and serological status of 108 new-born children from 102 deliveries during the 2nd term of 1987 at the Bécédi Maternity Hospital in Ivory Coast. The parasitism frequency of different studied bloods (mother, cord, delivery) is varying from 8 to 14%, antibodies have been found in 81 to 83% cases. The parity has an effect on the placental lesions frequency but not on the parasitism frequency. Children born with a pathogenic placenta have a lower birth weight. The retrospective study of 11,070 deliveries from last years shows that birth weight are lower while the two first pregnancies.

Animals↗
PubMed1991

[Determination of cardiac output by Doppler ultrasonics. Principle, techniques and limitations].

The development of quantitative applications of Doppler ultrasound for the measurement of cardiac output was a lengthy and difficult process. These applications call for rigor of the part of the ultrasound cardiographer and a sufficiently echoic patient. Numerous studies have demonstrated the reliability of Doppler ultrasound in determining aortic flow. A high degree of consensus has emerged for measuring aortic areas and velocities at the ring. Doppler ultrasound quantification of the pulmonary flow has been validated in children. In adults, measurement of the pulmonary ring is often difficult and may lead to major errors in the estimation of the flow rates. The determination of mitral flow is also possible, either at the ring or at the tip of the mitral funnel. A few publications highlight the value of Doppler ultrasound in evaluation of tricuspid flow, however, these results require confirmation.

Aorta↗