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Biomedical subjects

J Ninet

Publications and source records attributed to J Ninet.

At least 181 records · Page 10Linked to original sources

[The limits of the medical treatment of angina pectoris].

The limitations of medical treatment in angina pectoris depend on its efficacity and indications. 1. Efficacity of medical treatment.--Anti-anginal drugs are able to relieve anginal pain in at least 3/4 of cases. However, the ability of medical measures (diet, exercise, stopping smoking, hypolipidemic drugs, antihypertensive drugs, anticoagulants, platelet anti-aggregants, antiarrhythmics, inotropic agents, vasodilators and diuretics) to prevent coronary atherosclerosis delay its progression and prevent its complications--so increasing the life expectancy of coronary patients--remains very uncertain. 2. Frontiers and judications of medical treatment.--Coronary patients with few or no symptoms appear to be best suited for long-term anti-anginal treatment with long acting nitrate derivatives and/or betablockers. The ability of the latter group to increase the life expectancy of all coronary patients remains to be shown. The limits of the indications of medical treatment are more difficult to define either by purely subjective criteria (incapacitating angina after trials of anti-anginal drugs at adapted doses) or by "objective" criteria (ergometry, coronary angiography).

Adrenergic beta-Antagonists↗

[Resection of left ventricular aneurysm for clinical heart failure. Long-term results and prognostic factors (author's transl)].

Between 1970 and 1980, 46 resections of left ventricular aneurysm were carried out in patients with clinical evidence of heart failure but without associated septal perforation or severe mitral regurgitation. Aortocoronary bypass was simultaneously performed in 28% of the cases. The mean post-operative follow-up was 67 months. The early (1 mont) post-operative mortality rate was 15.2%. The actuarial survival rate (taking into account the early post-operative mortality rate) was 52.4% at 5 years and 32.9% at 10 years. Most early and late deaths were of cardiac origin. Among long-term survivors, 48.5% had no post-operative heart failure and 67% had no residual angina pectoris. In a statistical analysis of the factors involved in overall post-operative survival, no significant influence could be found for sex and age (within the limits of the study), risk factors associated with atheroma, duration of the myocardial necrosis responsible for the aneurysm, location of the aneurysm, time taken for the post-infarction heart failure to develop, presence of pre-operative angina on ECG, number of coronary arteries stenosed, extent of the aneurysm as determined by cineventriculography, cardiac index, left ventricular end-systolic pressure and associated aortocoronary bypass. In contrast, a significant prognostic value was demonstrated for the ejection fraction of the contractile area of the left ventricle (p less than 0.02), the maximal cardiac dysfunction observed prior to surgery (P less than 0.02), the presence of pre-operative dysrhythmias (P less than 0.1) and the quality of cardiac performance recovered immediately after the operation (P less than 0.001).

Age Factors↗

[Infectious aneurysm of the abdominal aorta and Salmonella septicemia. Favorable development over 2 years of a case treated by resection and axillobifemoral bypass].

A 57 years old man had a two months history of chills and fever with abdominal pain. Blood cultures were positive for Salmonella ohio. He suddenly became hypotensive with oedema of lower limbs. Angiographic findings were infrarenal aortic rupture with pseudoaneurysm formation and inferior vena cava compression. After ligation of the aorta and both common iliac arteries, an axillo-bi-femoral graft was constructed to bypass the infection area. Subsequent occurrence of lumbar osteomyelitis required debridement and drainage of retroperitoneum. The patient was discharged on oral amoxicilline given for eleven months. Two years postoperatively he is able to walk without evidence of further infection. With a review of 32 other cases in the literature, emphasis is placed on theories of pathogenesis and on modes of surgical management.

Aged↗

[Changes in barbiturate self-poisoning during the last ten years. A comparison between two series of cases (author's transl)].

The study compared two homogenous series of attempted suicide with barbiturates: 1012 patients from November 1967 to July 1969, and 327 patients in 1977. During these ten years there was a 10% decrease in the incidence of barbiturate intoxications to the benefit of intoxications with benzodiazepines. A similar trend was seen in the use of medium - or long - acting barbiturates alone as compared with association with other drugs. There also was a remarkable shortening of the delay in admission to hospital: 66% of the patients were admitted within 6 hours of poisoning in 1977, as against 56% in 1967-69) to 1% (3 deaths out of 327 cases in 1977).

Acute Disease↗

[Galactorrhoea and thoracic surgery (author's transl)].

The authors report 4 cases where galactorrhoea complicated thoracotomy. It was only possible to find 21 cases altogether in the literature where this complication followed thoracic surgery. Galactorrhoea started in the week following surgery. It follows irritation of the 3rd, 4th, 5th and 6th thoracic nerves which induces hyperprolactinaemia. Stress which is linked to the surgery and the drugs used for the anaesthetics can not by themselves be responsible for so persistent a hypersecretion. The galactorrhoea is cured spontaneously in two or three months, and treatment with bromocriptine which might have been prescribed was contraindicated in two out of the four cases that have been reported because there was a Raynaud's syndrome which was the indication for thoracic sympathectomy.

Adult↗

[Primary postural hypotension. Physiopathological study of 8 cases (author's transl)].

Physiological tests showed that both branches of the baroreflex arc-vagal cardiomoderator and, predominantly, sympathetic vasoconstrictor--were affected. There was no rise in serum and urinary noradrenaline levels in standing position, and adrenaline concentrations were rarely increased under induced hypoglycaemia. Dopamine beta-hydroxylase activity and reactivity of the renin-angiotensin-aldosterone system remained normal in most cases. Physiopathologically, the two clinical forms described (i.e. with and without central nervous symptoms) cannot be differentiated.

Aged↗

[Clinical study and diagnostic criteria of periarteritis nodosa. Apropos of 27 cases].

Periarteritis nodosa is a necrotizing vasculitis diagnosed on clinical, angiographic and histological criteria. We conducted a retrospective study of the various clinical and paraclinical manifestations of the disease in a series of 27 patients hospitalized in an Internal Medicine department. Visceral angiography showed microaneurysms in only 12.5% of the cases, and we consider that the indications of this method are limited. Segmental necrotizing vasculitis of the medium- and small-caliber arteries was found in only 33% of muscle biopsies. This criterion has low sensitivity and must be improved by systematic electromyography which showed abnormal results in 87% of the patients. Due to the insufficient sensitivity of paraclinical criteria, the clinical criteria proposed by Godeau and Guillevin are of great practical value. However, we suggest that their definition should be modified on three points: multineuritis should be replaced by peripheral neuropathies; livedo should be included in the cutaneous criterion, and positive serology for hepatitis B or C virus should be added to the positivity criteria.

Adult↗