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Biomedical subjects

J Ninet

Publications and source records attributed to J Ninet.

At least 163 records · Page 9Linked to original sources
PubMed1987

[Re-permeation of deep venous thrombosis of the lower extremities: comparison between plethysmographic indices and phlebography scores. Preliminary results].

A prospective study, now pursued, has the aim of determining anatomical features (permeability of deep venous trunks and/or development of a collateral venous circulation) related to improvement in plethysmographic indices and comparing these with phlebographic data. Twelve patients have been investigated by occlusive plethysmography and bilateral phlebography of lower limbs on the day of diagnosis, after 10 days of heparin therapy and after 6 months of antivitamin K anticoagulant treatment started on the 11th day. Whereas a progressive improvement in plethysmographic indices and phlebographic scores exists during the course of treatment, no correlation has been observed between plethysmographic indices and degree of phlebographic obstruction. This suggests that the emptying rate indices cannot be considered as an absolute criterion for the decision to discontinue anticoagulant therapy.

Collateral Circulation↗
PubMed1987

[Involvement of arterial trunks of the upper limbs in giant cell arteritis. Apropos of 7 cases].

On 91 patients with temporal arteritis (TA) and/or polymyalgia rheumatica (PMR), we observed 7 females aged 62 to 73 years with upper extremities ischemia. Arm claudication and/or Raynaud's phenomenon were the initial manifestations of the disease in 2 cases, or appeared simultaneously with other symptoms in 2 cases, or complicated decreasing corticosteroid therapy in 3 cases. A temporal artery biopsy was performed on 6 patients with, in all of them, typical giant cell granulomatous arteritis pathology findings. Angiograms showed, in all cases, multiple bilateral smooth stenosis and/or obliterations of post vertebral subclavian arteries and/or axillary arteries. Symptoms always improved on corticosteroid treatment and no patient needed reconstructive surgery. In conclusion, large arteries involvement, which can occur in TA and/or PMR, affect in our experience most commonly the subclavian and axillary arteries, with female predominance as found in Takayasu's arteries. These disorders should be considered in cases of occlusive disease of the arms in elderly women and the response to steroids is usually adequate to eliminate the need for early surgical intervention. Early recognition of asymptomatic large artery involvement by Doppler evaluation, in all TA and/or PMR patients, and transient anticoagulant therapy might prevent vessels occlusions.

Aged↗
PubMed1986

[X-ray computed tomography in central pontine myelinolysis. 2 cases].

Two cases of central pontine myelinolysis were studied by computerized tomography (CT). One patient had chronic alcoholism, the other porphyria variegata; both initially presented with water-and-electrolyte disorders, notably hyponatraemia. The neurological disorders consisted of acute pseudobulbar syndrome which totally regressed within 15 days to 1 month. CT demonstrated a low density area in the pons, extending to the mesencephalon in one case. Despite clinical cure, this low density persisted for 16 and 20 months respectively, counting from the onset of neurological symptoms. In central pontine myelinolysis, CT images only are of diagnostic value in cases with suggestive neurological symptoms and aetiology. CT can recognize minor forms of the disease and confirms that in some cases severe forms may follow a regressive course.

Adult↗
PubMed1986

[Primary tumors of the heart. Diagnostic, anatomic and therapeutic aspects].

Primary cardiac tumours are rare. They are usually benign, the most common ones being left atrial myxomas. The authors report their experience of 16 cardiac tumours operated between 1978 and 1985. The patients were 12 adults and 4 children. The tumours were benign in 14 cases and malignant in 2 cases. Complete (14 cases) or incomplete ablation of the tumour was carried out under cardiopulmonary bypass with an early mortality of 6.25 per cent (1 case) and late mortality of 12.5 per cent (the two malignant tumours). The tumours were identified as myxomas in 11 cases, rhabdomyomas in 2 cases, fibroma in 1 case and malignant sarcomas in 2 cases. The average follow-up period of the 13 survivors is 30 months (range 4 months to 5 years) with excellent clinical and anatomical results. Clinical and paraclinical diagnosis of these tumours does not pose any major problems nowadays because of the reliability of the methods of investigation. However, the nature of the tumour is not always predictable and the operative findings are fundamental, not so much for the treatment which is relatively stereotyped but for the prognosis. Age is not a significant prognostic factor as excellent results may be obtained in the very young and the very old despite a sometimes precarious preoperative clinical condition. The benign or malignant nature of the tumour is the only real factor which affects the prognosis.

Adult↗
PubMed1985

Cutaneous postocclusive reactive hyperemia monitored by laser doppler flux metering and skin temperature.

The initial Laser Doppler Flux (LDF) values and skin temperature in the first, third, and fifth finger were evaluated as well as the postocclusion reactive hyperemia (PORH) response to a 4-min suprasystolic compression. The mean values varied from 276.5 to 335.3 mV while the skin temperature ranged from 32.5 to 34.2 degrees. The LDF-monitored PORH response was very reproducible with an average increase of 144.7 +/- 63.6 mV (from an initial LDF value of 327.1 +/- 134 mV). Four different time-related indices were analyzed: t/2recovery = 6.0 +/- 5.5 sec; trecovery (time to reach the initial value) = 16.7 +/- 11.5 sec; tmax (peak of overshoot) = 48.2 +/- 20.6 sec and t/2 overshoot (time to reach 50% of the tmax on the downslope) = 97.4 +/- 31.8 sec. The simultaneously monitored skin temperature changes lagged significantly behind the LDF changes probably due to the large heat capacitance of the tissue. It is expected that the described results obtained from 20 normal subjects will serve as a basis for future clinical studies involving skin perfusion disorders.

Adolescent↗
PubMed1985

[The fate of patients with carotid stenosis. Comparative study, based on the literature, of their natural history and evolution under medical treatment or following endarterectomy].

The aim of therapy of carotid artery stenosis is to reduce the number of cerebral ischemic accident complications, but marked uncertainty exists at the present time as to the spontaneous course of these stenotic lesions and the efficacy of the different treatments proposed. After a transient ischemic accident (TIA) there is a 37% risk of a vascular accident (CVA) of a more definite type occurring within 5 years but only 1/4 of these patients die of cerebral complications, death in half of the cases being of coronary origin. Very rapid treatment with anticoagulants after TIA slightly diminishes the number of established cerebral ischemic accidents, but increases the risk of cerebral hemorrhage. Among the anti-aggregant agents, only Aspirin at high dosage (1 to 1.3 g/24 h) appears to be effective in preventing relapses of TIA and/or of CVA and/or on mortality which results from it. Carotid endarterectomy after TIA does not alter long-term survival, dependent on the increased cardiac mortality, but appears to reduce markedly the long-term recurrence rate of TIA and/or CVA. Globally, however, benefits of surgical treatment can be obtained only if post-operative cerebral mortality and morbidity are extremely low, conditions obtained in highly specialized centers only. Spontaneous course of angiographically detected asymptomatic stenosis shows, for a mean 4-year survival, a relatively low level of TIA (3,3 to 19%) and of CVA (0 to 12%) whatever the anatomic type of the stenosis. Prophylactic endarterectomy in practised hands has a low operative mortality (0 to 2%), a limited perioperative cerebral morbidity (1.3 to 4.5%) and a satisfactory later relapse rate of CVA (less than 5% at 4 years). These findings indicate comparable courses for spontaneous and treated cases globally, as well as with respect to cardiac mortality. In the absence of randomized trials it is a controversial point as to whether carotid surgery is superior to a spontaneous course in cases of asymptomatic stenosis.

Anticoagulants↗
PubMed1985

[Congenital aortic valve stenosis. Long-term results after valvulotomy].

The cases of 73 patients undergoing valvulotomy for congenital valvular aortic stenosis between 1957 and 1982 were reviewed. Data was updated after recalling patients to the outpatient clinic and/or analysis of the results of a questionnaire sent to the patient's family doctor or cardiologist. Babies less than 12 months old at the time of surgery were excluded from the study. Operation consisted of valvulotomy under direct control with few associated procedures as the valvular lesion was isolated in 89 p. 100 of cases. 5 patients died in the first 30 postoperative days, an operative mortality of 5,4 p. 100. The follow-up period ranged from 1 to 25 years, with 15 patients having been followed up for over 10 years. 6 patients were reoperated with no operative mortality. 2 of whom have since undergone a second reoperation. Of the 59 patients not re-operated, 54 were class I and 5 class II of the NYHA. Of the latter group, 4 are candidates for aortic valve replacement for significant aortic regurgitation. The actuarial survival graph shows a 92.82 p. 100 probability of survival at 5 years, and 86.83 p. 100 at 10 years. Aortic valvulotomy remains a palliative operation which does not protect the patient from subsequent sudden death.

Adolescent↗
PubMed1984

Bacterial endocarditis presenting as acute vertebral osteomyelitis: 14 cases.

Association between bacterial endocarditis (BE) and vertebral osteomyelitis (VO) has infrequently been noted. In a retrospective analysis of BE (280 cases) and VO (150 cases) 14 cases were found to have this association. There were 12 males and 2 females, ages ranging from 39 to 72 years, mean age 56.6. Blood cultures were positive for Streptococcus viridans (6 cases). Str. faecalis (4 cases), staphylococcus (2 cases), Gram negative bacteria (1 case). Organism was not isolated in one case. Fever and severe back pain antedate the diagnosis of VO 3.5 and 2.5 months. X rays films of the spine and bone scans (4 cases) revealed lumbar (6 cases) or cervical (4 cases), or dorsal (3 cases) or combined cervical and dorsal (1 case) locations. History of murmur (4 cases) and development of mitral (8 cases) or aortic (4 cases) or combined mitral and aortic (2 cases) insufficiencies were consistent with concomitant BE. Echocardiogram revealed vegetations in 6 out of 9 cases. Patients received antibiotic therapy for 3.5 months. Ten patients were cured with antibiotics only, 4 required valve replacement. One died. Thus age, sex, history of heart disease, valvular involvement, duration of symptoms prior to admission and bacteriological pictures are the same in BE with VO as in BE without VO. Survival rates are also the same if early recognition of BE and VO with prompt and prolonged antibiotic therapy may prevent severe haemodynamic or vertebral problems.

Acute Disease↗