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Biomedical subjects

J L Rey

Publications and source records attributed to J L Rey.

At least 127 records · Page 7Linked to original sources
PubMed1987

[Echo-Doppler evaluation of normal Starr-Edwards prostheses in mitral and aortic position].

Although the Starr valve still is the most commonly used prosthesis, no systematic Doppler evaluation of its normal functioning has yet been performed. For this reason, 49 patients with mitral (25) or aortic (25) Starr valve and without evidence of cardiac failure, other valve disease or coronary disease were prospectively explored. Parameters measured were: maximum velocity, maximum and mean gradients, half-decrease time under pressure and corresponding valve areas. A. Mitral prosthesis. With Starr valves size 3 M and 4 M, corresponding to diameters of 30 and 32 mm respectively, the results obtained were: Vmax 1,7 +/- 0.3 m/s, maximum gradient 12.3 +/- 4.5 mmHg, mean gradient 5.3 +/- 2.2 mmHg, T1/2 120 + 30 ms, valve area 1.96 + 0.45 cm2. These 5 parameters were not significantly different with 3M and 4M valves. B. Aortic prosthesis. Contrary to mitral valve prosthesis, the results here were influenced by the size of the valve. With Starr valve No 10 (diameter 24 mm), values were: Vmax 3.3 +/- 0.4 m/s, maximum gradient 45 +/- 11.6 mmHg, mean gradient 26.7 +/- 8.8 mmHg. Aortic regurgitation was present in 20 p. 100 of the cases. The validity of the continuity equation was tested for non-invasive determination of the aortic valve functional area.

Aortic Valve↗
PubMed1987

[Metastatic pericardial effusions. Apropos of 12 cases. Review of the literature].

The authors report 12 cases of metastatic pericardial effusions with clinical manifestations. Primary bronchial cancer is the most frequent with 7 cases; in 3 of these patients, the original manifestation is a tamponade. The contributions of sonocardiography to the diagnosis are analyzed: evaluation of hemodynamic tolerance and visualization within the effusion, in 4 out of 7 patients undergoing bidimensional sonocardiography, of dense masses, implanted on the visceral layer of the pericardium; the frequent epicardic location of these metastases may be explained by preferential invasion of the visceral layer by retrograde lymphatic route. The advantage of pericardial cytology is discussed. From the therapeutic standpoint, a pleuro-pericardial window or tetracycline instillation tend to prevent a recurrence of the effusion and the risk of tamponade; the neoplastic process is controlled with local and/or general chemotherapy and radiotherapy; therapeutic strategy depends on the sensitivity of the primary tumor. The prognosis remains very dim with a mean survival of 3.7 months in our series.

Adult↗
PubMed1987

[Streptobacillus moniliformis endocarditis. Apropos of 2 cases].

The authors report two cases of endocarditis secondary to Streptobacillus moniliformis. A 41 year-old man, bitten by a rat, is hospitalized 5 weeks later for an endocarditis demonstrated by echocardiography, with massive aortic escape and hemodynamic failure requiring emergency valve replacement: after a favorable course, the patient dies suddenly 4 months later. A 63 year-old woman is admitted for a septicemic syndrome with sterno-clavicular arthritis which occurred 10 days after a rat bite; followed by a transient ischemic cerebral vascular accident; echocardiogram shows a clubshaped bulge of the distal end of the large mitral valve; the course is uneventful under antibiotherapy. In both cases, blood cultures isolate a Streptobacillus moniliformis. Infections secondary to Streptobacillus moniliformis are rare; this Gram negative bacillus, saprophyte of the rat's rhinopharynx, is transmitted to man, most of the time, by bite, and this causes a septicemia, the evolution of which is usually favorable. Complications, especially endocarditis, are exceptionally rare: only 12 cases are found in the world's literature. The evolution is always fatal in the absence of treatment which must include the association penicillin-aminoside. Prophylaxis of this disease is provided by penicillin antibiotherapy which should be systematic after a rodent's bite.

Adult↗
PubMed1987

[The esophagus in patients with coronary disease. A sensitive area not to be neglected].

The authors report the case of a 35 year-old man, suffering from Prinzmetal's angor and stress angor associated to a complicated esophago-gastric reflux. Coronary angiography demonstrates a capillary network well dilated under Trinitrin. The Methergin test is explosive. After failure of calcium inhibitors, the sole treatment of the reflux alleviates the spontaneous pain. From this report, the place of esophageal pathology in coronary patients, the means to recognize it, the role of the reflux in the definition of myocardial ischemia, are discussed.

Adult↗
PubMed1987

[Significance of an upward shift of the ST segment during an exercise test].

The objective of this study is to investigate the significance of the occurrence of an upward shift of the ST segment curing a stress test in patients with no previous history of myocardial infarction. Over 10 years, totalling 9,500 stress tests, we have collected 10 cases. They always concern men including one with angina on exertion, one with spontaneous angina, one with spontaneous angina occurring at the end of an intense stress, and 7 with mixed angina. None of them had a previous history of myocardial infarction or documented spastic angina. The upward shift of the ST segment occurred 9 times during stress and once during recovery. 9 patients had a coronary arteriogram with in 8 cases severe fixed coronary lesions. The patient with the upward shift of ST during the recovery period had a normal coronary arteriogram with a positive methylergometrin test. There is a good correlation between the appearance of an upward shift of ST during stress in the anterior derivations and a significant involvement of the anterior interventricular artery. In our series, there were no complications, especially myocardial infarction, in the immediate period following the stress test. 7 patients underwent an aorto-coronary by-pass. The 10 patients are presently asymptomatic after a 47 months follow-up. The occurrence of an upward shift of ST during stress, in the absence of a previous history of myocardial infarction, represents in more than 80 p. cent of the cases the existence of severe coronary lesions leading to hospitalization and the immediate performance of a coronary arteriogram.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

[Left intraventricular and right auricular double thrombus. Apropos of a case with favorable development under medical treatment].

The authors report a case of right auricular and left intraventricular double thrombus involving the tricuspid valve, diagnosed by two-dimensional echocardiography. This double thrombus developed in a male of 54 years presenting dilated cardiomyopathy with heart failure who was admitted as an emergency case due to cerebral embolism. Surgery and fibrinolytic agents were contraindicated and heparin treatment was initiated. The right auricular mass subsided in 24 hours without symptomatology. Only venous pulmonary digitalized angiography showed a moderate defect. Bearing in mind literature reports, the present observation is particularly interesting on three counts: simultaneous double localization, the fortuitous detection of a right auricular clot before development of pulmonary embolism and the rapid subsidence of the thrombus under heparin treatment as wall as the satisfactory progress without symptomatology of pulmonary embolism.

Heart Atria↗
PubMed1985

[Urinary bilharziasis and sideropenic anemia. Study of their relation in 2 villages in Niger].

In order to assess Schistosoma haematobium as an aetiologic factor in sideropenic anaemias, we compared a village with high prevalence of urinary schistosomiasis and a village without urinary schistosomiasis as a control. In the infested village, anaemias (haemoglobin value lower than 12 g/dl) especially affects children between 5 to 14 years old (71%:45/68). Boys being the most infestated group with S. haematobium (prevalence:100%; mean egg output: 496 eggs/10 ml of urine) are also the most anaemic group (82%:23/28). Comparing the two villages shows that urinary schistosomiasis increases the risk of acquiring anaemia by 30% among children aged 5 to 14. Furthermore, the parasitic disease reduces of 1 g/dl the mean haemoglobin level of adult males. On the other hand, S. haematobium is of minor importance as a cause of anaemia among women. The others aetiologies remain preponderant.

Adolescent↗
PubMed1985

[Schistosoma haematobium bilharziosis and urinary infections. Study of their relationship in 2 villages of Niger].

In order to assess the relation between urinary schistosomiasis and urinary tract infections (U.T.T.), a study of two villages in the surroundings of Niamey (Rep. of Niger) was undertaken. In the first village located near a rice plantation irrigation scheme, the global prevalence of S. haematobium infection was 77%. Boys between 5 to 14 years of age were all infected and their mean egg output was 500 eggs/10 ml of urine. In the second village, where water is supplied from wells, schistosomiasis was almost absent. Urinary tract infections were diagnosed upon the cytologic count of the urinary sediment and the urine culture. Comparison between S. haematobium infected and non-infected villages showed that the prevalence of U.T.I. was 3.8 times higher among the females of the infected village. This was also noticed for old men and especially for boys aged 5 to 14 (5.2% U.T.I.) for whom urinary infection is usually uncommon. However the mean blood pressure and the creatininemia showed no difference between the two populations. If schistosomiasis increases the risk of chronic pyelonephritis, that increase could not be accounted for with the measures of these two variables.

Adolescent↗
PubMed1985

[Torsades de pointe. Apropos of 60 cases].

The authors report a personal series of 60 cases of "torsade de pointe" (the largest series published to date) seen in the Cardiology department of Amiens Hospital over a period of 11 years. They review the essential features of this arrhythmia, which was well described by F. Dessertenne in 1966, but which is still sometimes confused with certain forms of ventricular tachycardia. "Torsade de pointe" is still a topical issue, as 25% of the cases in this series were seen over the last two years. These cases were classified into three groups according to their aetiology: severe bradycardia (21 cases), potassium depletion (16 cases), drug causes (23 cases). This arrhythmia was essentially associated with iatrogenic factors, in particular potassium depletion (41.6% of cases). The classical notion of predisposed patients was confirmed: elderly patients (mean age of 68 years), with cardiovascular disease in 70% of cases (i.e. heart failure or coronary insufficiency, hypertension) and with a marked female predominance (70% women). The ECG between episodes of "torsade de pointe" always revealed a prolonged QT interval which, in relation to the heart rate, was more marked in the patients with potassium depletion. During an attack, the average ventricular rate was 210/min (range: 170 to 290/min). 20% of cases subsequently developed ventricular fibrillation. The overall mortality was 16.6% (10 out of 60 cases), but there have been no deaths since 1977 due to the better understanding of this arrhythmia.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1984

[Diagnostic and prognostic value of ST segment depression greater than or equal to 3 mm during exercise testing].

This study was undertaken to assess the diagnostic and prognostic value of ST depression equal to or more than 3 mm during exercise stress testing (EST). Out of 4050 EST performed over an 8 year period, 128 patients (3,2%) had this degree of ST depression. These changes were observed in leads V4 V6 in 92% of cases. Coronary angiography was performed in 56 patients: all had significant coronary artery disease (greater than 50% stenoses) with 50% three vessel, 30% two vessel and only 20% single vessel disease; all patients had at least one severe stenosis (greater than 75%) of a main coronary artery. The predictive value of EST was therefore 100% in the 56 patients undergoing coronary angiography. Angina or ventricular extrasystoles during EST or greater than 5 mm ST depression were predictive of multiple vessel disease. The following correlations were observed between EST and the extent of coronary artery disease: maximal heart rate and systolic pressure were lower, ischemic changes appeared sooner (less than 2 min) and lasted longer during the recovery phase (greater than 7 min) in patients with multiple vessel disease. The 5 year prognosis was studied in 58 patients; it was poor (death or infarction) in 31 cases (53%). The following factors were associated with a poor prognosis: low maximal heart rate and systolic blood pressure, early ischemic changes and frequent ventricular extrasystoles on EST; on the other hand, the development of anginal pain during EST was not of significant prognostic value in this series. ST depression greater than 3 mm on EST is rare.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

[Urinary schistosomiasis. 1st trial of mass treatment in the field (Niger)].

In a village of 841 inhabitants, we were able to examine 553 subjects, 357 of whom had urinary egg excretion. The patients were treated with a single dose of 35 mg/kg oltipraz which was given under surveillance together with either whole milk or herrings in oil. The tolerance of the product was very good as only 3% of the patients reported vomiting and 3% paresthesias of the fingers. 66% of the patients examined on day 30 and/or on day 90 were egg-negative and egg excretion was reduced by at least 90% in 22 other subjects, bringing the percentage of good results to 74%. On day 90, the mean egg excretion was reduced by 82.5% in the overall population and by 80.9% in the 5 to 14 year-olds.

Adolescent↗
PubMed1983

[Propranolol-nifedipine combination in the treatment of exercise-induced asthma].

The therapeutic effects of the association of propranolol (P) and nifedipine (N) were compared with those of propranolol alone in the treatment of effort angina. Ten patients under 65 years of age with stable effort angina confirmed by stress testing and coronary arteriography were studied. The criterion of selection was inadequate improvement of symptoms with the betablocker alone, prescribed in first intention. The patients were divided into two groups (A and B) at random: --Phase I (2 weeks) : group A : P 80 mg/day + N 30 mg/day, group B : P 80 mg/day + Placebo 3 tablets/day; --Phase II (2 weeks) : group A : P 80 mg/day + Placebo 3 tablets/day, group B : P 80/day. The results of this cross-over trial were assessed blind. The association N + P compared to P alone led to a clinical improvement in 7 out of 10 patients, a clear cut increase in maximal exercise capacity (44%), a reduction in ST depression of 0.8 mm and to the disappearance of effort angina in half the patients. The haemodynamic tolerance of this drug association was good. These statistically significant differences between the P + N and P + placebo treatment periods demonstrate that this drug association is beneficial in patients with effort angina who are inadequately relieved by betablocker therapy alone.

Asthma↗