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Biomedical subjects

J P Binet

Publications and source records attributed to J P Binet.

At least 37 records · Page 2Linked to original sources
PubMed1990

[Accessory mitral tissue responsible for left ventricular outflow obstruction. Reports of 7 cases].

The authors report the medico-surgical experience of Marie Lannelongue hospital of a rare condition: accessory mitral valve tissue. Seven patients aged 2 to 28 years (average: 8.7 years) had left ventricular outflow obstruction due to accessory mitral valve tissue. The diagnostic was not obvious clinically and was based on the association of echocardiographic and angiographic data. This condition was associated with another intra-cardiac malformation in 6 of the 7 patients. Surgical treatment included resection of the accessory mitral valve tissue by an aortic or combined aorto-left atrial approach, together with correction of the associated intracardiac abnormality. The postoperative results were excellent with the regression of the ventriculo-aortic pressure gradient and the physiological integrity of the mitral valve.

Adolescent↗
PubMed1989

Evidence of enhanced recombinant interleukin-2 sensitivity in thymic lymphocytes from patients with myasthenia gravis: possible role in autoimmune pathogenesis.

We evaluated the activation state of thymic lymphocytes in patients with myasthenia gravis (MG) by cytofluorographic analysis of CD25 expression and by testing their sensitivity to recombinant interleukin-2 (rIL-2) in the absence of any known previous stimulation. We detected no phenotypic signs of activation in fresh MG thymic lymphocyte suspensions, while functional signs of activation were reflected in a significantly higher sensitivity to rIL-2 in MG patients than in controls. The responses to rIL-2 were time- and dose-dependent, were inhibited by a blocking anti-IL-2 receptor antibody, and were associated with an increase in CD25+ T cells in both patients and controls. The T cells with functional signs of previous activation may represent autoreactive cells involved in the autoimmune process and confirm thymus gland hyperactivity in MG. These cells could result from primary autosensitization against the thymic acetylcholine receptor (AChR)-like molecule or from altered migration of peripheral activated cells into an abnormal thymic environment. Our results also provide a clue for understanding the effect of thymectomy in myasthenia gravis.

Antibodies, Monoclonal↗
PubMed1989

[Repair of ventricular septal defects before 6 months of age. Apropos of a series of 194 infants].

Between 1982 and 1988, 194 infants under 6 months of age underwent surgical closure of a ventricular septal defect at the Marie Lannelongue Surgical Centre. The hospital death in this series was 6.7 p. 100. Mortality was influenced by the infant's age, by associated cardiac or extracardiac lesions and by the pre-operative ventilatory status. A residual ventricular septal defect was present in 11 infants (5.6 p. 100). Complete atrioventricular block occurred in 2 cases (1.1 p. 100). These results are in favour of a complete repair of simple ventricular septal defects at a very young age if medical treatment does not result in a satisfactory improvement.

Abnormalities, Multiple↗
PubMed1989

[Middle-term result of surgery in 78 cases of complete atrioventricular canal before one year of age].

Between 1970 and 1985, 78 children with complete atrioventricular canal were operated upon before the age of one year at the Marie-Lannelongue Surgical Centre. Forty-seven survivors were followed up for periods of 3 months to 13 years after the initial operation; 2 were lost of following. Among the 13 children who survived banding, 1 died spontaneously, 1 had Blalock-Taussig anastomosis and 11 underwent full repair with 5 deaths; out of 6 survivors, 4 are doing well without any treatment, 1 was reoperated upon twice and died during the second operation, and 1 was lost sight of; the survival rates at 5 and 10 years are 46 +/- 23 p. 100 and 29 +/- 23 p. 100 respectively. Among the 34 children who survived an initial complete repair, 2 were reoperated upon 3 months after the repair, with 1 death, 7 subsequently died of infection (6 had trisomy 21); out of 26 survivors followed up for 3 years and 3 months on average after the complete repair (2 to 13 years), 18 show an excellent result and 3 a mediocre result; the survival rates at 5 and 10 years are 45 +/- 9 p. 100 and 30 +/- 27 p. 100 respectively. Whether the patients initially had banding followed by complete repair or complete repair from the start, the probability of survival at 5 and 10 years was the same. The presence of trisomy 21 is an unfavourable prognostic factor at medium-term.(ABSTRACT TRUNCATED AT 250 WORDS)

Down Syndrome↗
PubMed1989

[Anatomical repair of transposition of the great vessels in the neonatal period. 5 years' experience. 246 patients].

In the period between april 1984 and march 1989, 246 newborn children with transposition of the great vessels benefited from anatomical repair of their heart disease. 221 children had simple transposition with normal interventricular septa. These were aged 2 to 23 days (mean age 7.8 +/- 3.5 standard deviation). 25 had transposition of the great vessels associated with a large interventricular septum defect. These were aged 7 to 30 days (mean age 18 +/- 8.3 S.D.). Associated lesions included a small interventricular septum defect in 20 cases which was not treated at the time of the operation; tricuspid insufficiency in 3 cases; and isthmic coarctation of the aorta in 10 cases. According to Yacoub's classification relative to the anatomical distribution of the coronary arteries, all the children fell into the following groups: type A, 172 cases; type B, 8 cases; type C, 12 cases; type D, 40 cases; type E, 14 cases. Preoperative catheterization was carried out in all the children. 96% benefited from Rashkin's atrioseptostomy, 90% had a prostaglandin infusion continuing through surgery. The surgical technique included the use of continuous extracorporal circulation at 20 degrees C, without circulatory arrest. Protection of the myocardium was ensured during aortic clamping by injecting of a crystalloid cardioplegia-inducing solution. The main steps of surgical repair were repositioning of the coronary arteries onto the ancient aortic stump and reconstruction of a pulmonary shunt. Repositioning of the coronary arteries was carried out in accordance with Yacoub's technique in all cases except for the 10 first patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1988

[Congenital tracheal stenosis due to complete circular rings. Tracheoplasty using autologous pericardium].

The case of a 9-month old infant with congenital tracheal stenosis due to complete tracheal rings, associated with an aberrant left pulmonary artery is reported. Surgery was carried out under extracorporeal circulation to ensure adequate oxygen supply. Extubation, thus made possible, enabled the lesion to located accurately by bronchoscopy. Tracheoplasty by means of an autologus pericardial patch was performed. The quality of the repair was checked by a second bronchoscopy. The long-term result is satisfactory.

Cartilage↗
PubMed1988

Correction of tetralogy of Fallot with combined transatrial and pulmonary approach: experience with 184 consecutive cases.

The authors present their technique and results for complete correction of Fallot's tetralogy by closure of the ventricular septal defect by the transatrial approach, and resection of the infundibular hypertrophy by a combined approach through the tricuspid and pulmonary valve orifices. Right ventricular pressures were often high at the end of operation due to a residual muscular gradient but the outcome of these postoperative gradients was similar to that of valvular pulmonary stenosis with an intact ventricular septum.

Arcuate Nucleus of Hypothalamus↗
PubMed1988

[Surgery for incomplete atrioventricular canal. Mid-term follow-up apropos of 128 patients].

Among 128 consecutive patients operated upon between 1972 and 1984 at the Marie-Lannelongue Surgical Centre for incomplete persistent atrioventricular canal, 102 could be followed up for periods ranging from 18 months to 11 years. Of the 23 patients lost sight of, 19 were foreigners. One patient died during the first postoperative month and two died during the following five months; there was no death thereafter. One patient developed complete atrioventricular block immediately after surgery. At the end of the follow-up period, three patients had been reoperated upon for disinsertion of the patch on the ostium primum associated in one case with massive mitral regurgitation; two complete atrioventricular blocks requiring permanent pacing had occurred some time after surgery; five patients had presented with late atrial dysrhythmia, and only six patients had signs of heart failure primarily due to residual mitral regurgitation. At radiography, the cardiothoracic ratio was reduced in 74 p. 100 of the cases from 0.60 +/- 0.08 to 0.53 +/- 0.05 (p less than 0.001), and the earlier the operation had been performed, the greater the reduction in cardiothoracic ratio (p less than 0.05). A mitral regurgitation murmur was observed in 72 p. 100 of patients immediately after surgery and in 82 p. 100 of patients at the end of the follow-up period. The murmur was usually weak (79 p. 100) with a tendency to remain stable (44 p. 100) or to increase in intensity (43 p. 100, but reoperation was necessary in only one case.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

[Complete repair of the interrupted aortic arch by an anterior approach. Apropos of 9 cases].

Interrupted aortic arch is a duct-dependent heart disease, and this is why the use of prostaglandins E, which keep the ductus arteriosus open to feed the descending aorta, has transformed its formerly sombre prognosis. The authors report the cases of 9 neonates and infants presenting with interrupted aortic arch associated with ventricular septal defect who underwent total repair of the malformations under extracorporeal circulation. Five children were less than 10 years' old. The aortic lesions were of type A in 2 cases (interruption distal to the left subclavian artery) and of type B in 7 cases (interruption between the left carotid and subclavian arteries). In the second group the lesions were of type B1 in 5 cases (without retro-oesophageal right subclavian artery) and of type B2 in 2 cases (right retro-oesophageal artery distal to the interruption). There was one death (11 p. 100). So far, no child has been reoperated upon for residual aortic obstruction or reopened ventricular septal defect. This technique of total repair in one stage, with closure of the ventricular septal defect, seems to be preferable to the two-stage technique in which stage one includes, in addition to aortic arch repair, cerclage of the pulmonary artery, a procedure with numerous disadvantages and a higher overall mortality rate.

Aortic Arch Syndromes↗
PubMed1988

Switch operation for transposition of the great arteries in neonates. A study of 120 patients.

From March 1984 to January 1987, anatomic surgical correction was performed on 110 newborn infants (2 to 23 days old, mean 7.8 +/- 3.5, standard deviation) with simple transposition of the great arteries and 10 additional neonates (7 to 30 days old, mean 17.9 +/- 8.3, standard deviation) with transposition and a large ventricular septal defect. All had preoperative catheterization. Ninety-six percent of the patients underwent balloon atrial septostomy and 90% received prostaglandin E1 infusion until the time of the operation. The anatomy of the coronary arteries according to the Yacoub classification was as follows: type A, 82 patients; type B, 5 patients; type C, 4 patients; type D, 23 patients; and type E, 6 patients. Continuous hypothermic bypass with no circulatory arrest was used for all patients except two. Myocardial protection was ensured by crystalloid cardioplegia. Coronary artery relocation was performed according to the Yacoub technique with some modifications, and pulmonary artery reconstruction was done according to the Lecompte maneuver in all patients, even when the great vessels had a side-by-side relationship. The proximal pulmonary artery was reconstructed with two circular patches for the first 10 patients and with a single large posterior patch for the last 110 patients. Tanned heterologous pericardium was used for the first 25 patients and autologous native pericardium for the last 95 patients. The perioperative mortality rates were 8.3% for the entire series and 5.4% for the last 110 patients, with no deaths in the group having transposition plus ventricular septal defect. Late death from acute myocardial infarction occurred in two patients in the second month after operation. No patient was lost to follow-up, which ranged from 2 to 46 months (mean 16 +/- 11.2, standard deviation). The follow-up included sequential noninvasive evaluations and 32 catheterizations performed 10 to 18 months postoperatively. Two patients were reoperated on for pulmonary stenosis caused by retraction of the two heterologous pericardial patches, but neither died. Six others have mild to moderate pulmonary stenosis. Two patients have trivial aortic regurgitation. None have aortic dilatation or supravalvular aortic stenosis. The 108 survivors have no cardiovascular symptoms. They all are in sinus rhythm, have normal left ventricular function, have no ischemic problems, and receive no medication.

Coronary Vessels↗