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Biomedical subjects

N Danchin

Publications and source records attributed to N Danchin.

At least 289 records · Page 16Linked to original sources
PubMed1984

Transplantation of human hyperthyroid tissue to the nude mouse. An experimental model.

This study analyzes the outcome of human normal and hyperfunctioning thyroid tissue transplanted to the nude mouse. Thyroid fragments from 7 patients with Graves' disease were transplanted to nude mice (nu/nu). Before surgery, the patients had been treated with propranolol and iodine; none had received antithyroid therapy. The transplants were removed on the 12th day following transplantation and were studied by light microscopy and autohistoradiography. At this time, all immunologic disorders found on the operative samples had disappeared, and the tissue had lost its hyperfunctioning characteristics. In contrast, transplants from toxic adenoma remained hyperfunctioning, with elevated serum T3 and T4 levels. Similarly, transplants from normal thyroid tissue remained unchanged, and serum T3 and T4 levels remained within the normal range, as if under the influence of the hypothalamic and pituitary regulation of the mice. These findings emphasize the role of the extrathyroid immunologic environment in the regulation of Graves' disease, whereas toxic adenoma remains autonomous.

Adenoma↗
PubMed1983

[Return to work after myocardial infarction].

The working status of 41 men under the age of 60, who developed myocardial infarction while in vocational activity was investigated by means of a questionnaire, 3 years on average after the infarction: 63% had resumed work some time after the disease and 59% were working when the enquiry was made. The ability to resume work cannot be predicted from the patient's medical condition at the time of infarction (location of the infarct, complications during the acute stage, left ventricular ejection fraction). The only unfavourable factors are age and the presence of residual angina or marked post-infarction dyspnoea, although most patients who had not resumed work were fit for employment. Clinicians should be fully aware of the occupational future of patients with coronary artery disease--a future that is particularly at stake in this period of economic crisis in industrial countries.

Disability Evaluation↗
PubMed1983

Can the mode of death be predicted in patients with angiographically documented coronary artery disease?

To determine whether sudden versus non-sudden cardiac death could be predicted in high risk patients, 1157 medical patients were followed for an average of 46 months after a diagnostic coronary angiogram and 18 clinical, hemodynamic, and angiographic variables known to be associated with a high risk of mortality were analyzed. The total group of 141 deaths was classified into 3 subgroups: (1) 82 sudden deaths (less than 1 hour after onset of symptoms); (2) 46 deaths due to acute myocardial infarction with or without heart failure, and (3) 13 deaths unrelated to cardiac symptoms. In a subset of 64 patients, the duration of electrical systole (QTc) was calculated before angiography and before death. A comparison was made of QTc measurements at entry with QTc values of subjects with normal coronary arteries and normal left ventricular function. Deaths from cardiac causes could often be predicted from older age, male sex, history of myocardial infarction, unstable angina, congestive heart failure, abnormal cardiothoracic ratio, multivessel disease, abnormal left ventricular contraction, and abnormal ejection fraction. However, these variables did not discriminate between sudden and nonsudden cardiac deaths and both modes of death were characterized by depressed left ventricular function and multivessel coronary disease. During follow-up the incidence of acute myocardial infarction was not different in patients with cardiac and noncardiac deaths and in long-term survivors. However, patients dying from cardiac causes had a higher incidence of heart failure. Patients dying suddenly did not present new infarctions during follow-up whereas patients dying from acute myocardial infarction had a 13% incidence of prior infarction and a higher incidence of heart failure. In addition, QTc at entry was longer in nonsurvivors than in normal subjects (p less than 0.0001) and patients experiencing sudden death exhibited the highest incidence of QTc prolongation (greater than or equal to 440 ms) during follow-up (p less than 0.05). We conclude that: (1) although the severity of coronary disease and left ventricular dysfunction are closely related to cardiac mortality, they do not discriminate between sudden and nonsudden cardiac deaths; (2) patients experiencing sudden death are characterized by a low incidence of new myocardial infarction or congestive heart failure and prolongation of the QTc interval during follow-up.

Adult↗
PubMed1983

Coronary artery surgery as a measure of vocational rehabilitation: an analysis of the working status of patients with mild angina randomly assigned to medical or surgical treatment.

Work status was studied in 76 male patients under the age of 60, who had been randomly assigned to surgical or medical treatment for coronary artery disease with relatively stable angina (Class I or II NYHA) One year after catheterization or surgery, there were as many patients employed in the medical (84%) as in the surgical (81%) groups, despite a marked improvement of functional symptoms in the latter group; 8% in surgical patients and 11% in medical patients were on social welfare. Surgery did not improve work resumption in patients who had been unemployed for seven months or more before inclusion into the study (71%, versus 67% in medical patients). It is concluded that aorto-coronary bypass surgery cannot be considered as a measure of vocational rehabilitation sufficient to improve employment in patients with mild stable angina, when compared to medical treatment.

Adult↗
PubMed1983

[Echographic rediscovery of an anatomical structure: the Chiari network. Apropos of 16 cases].

In 1897, the anatomist Chiari described a structure in the right atrium connected to the Eustachian valve identified as the embryological vestige of the right valve of the sinus venosus. This structure was then forgotten. Recently, Werner described the echocardiographic appearances. During 1981, 1 600 consecutive patients underwent 2D echocardiography and the right atrium (RA) was visualised in several incidences. Abnormal RA echos fulfilling the echocardiographic criteria of the Chiari network were detected in 16 cases. The 2D echo appearances were as follows: a fine, mobile echo crossing the RA at right angles to its long antero posterior axis; arising from the anterior border of the orifice of the inferior vena cava, variably attached to the RA walls (lateral, superior, interatrial septum). The recordings were made from the transverse parasternal and apical or subcostal 4 chamber views. An M mode recording of this structure usually guided by the sector scan was made in 13 patients. This showed a fine curvilinear echo animated by antero-posterior vibrations during the cardiac cycle situated behind the anterior tricuspid leaflet. The pathological associations of the 16 patients in whom the Chiari network was demonstrated were as follows: 5 congenital cardiopathies including 3 ASDs, 1 isolated abnormal pulmonary venous drainage, 1 complex case comprising 1 ASD and 5 acquired lesions: aortic endocarditis; chronic cor pulmonale, idiopathic atrial fibrillation, pericarditis and coronary artery disease. Six patients did not appear to have cardiac disease. This structure was confirmed at surgery in 2 cases: the operative findings were a fine network of filaments stretching from the orifice of the inferior vena cava (Eustachian valve) to the RA walls.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1983

[Rehabilitation and return to work of patients after aortocoronary bypass].

A pilot project with medical, physical and psychosocial evaluation and a physical and psychosocial rehabilitation program included 59 men, under age 60, inactive for less than one year and who underwent aortocoronary bypass surgery between november 1978 and march 1980. A control group of 60 comparable patients was studied by questionnaire one year after the operation. The percentage of return-to-work was not significatively different: respectively 92 p. 100 and 89 p. 100. A previous study on a similar population determined 9 predictive sociodemographic and medical factors: age, angina class, duration of symptoms, associated vascular disease, non cardiovascular illness, education, physical workload, length of preoperative unemployment, annual income. The evaluations of this study showed the importance of the psychosocial factors and alcoholism. In comparison with our previous studies, the increased percentage of return-to-work (from 69 p. 100 to 89 p. 100) is mostly due to a shorter preoperative period of inactivity; the percentage of patients operated on within three months of inactivity increased from 44 p. 100 to 74 p. 100 in the last ten years. In the group of patients with a good or excellent preoperative prognosis, 94 p. 100 were working after one year. We conclude that a strategy for improving return-to-work after surgery is to decrease the period of preoperative inactivity. By using nine objective predictive factors and a psychosocial evaluation, it is possible to screen patients with a poor return-to-work prognosis and to submit them to an individualized rehabilitation program.

Adult↗
PubMed1983

[Natural development of old heart valve disease].

The authors report the natural history of 36 patients with end-stage valvular disease defined by the presence of a functional stage IV and/or a 0.60 and/or dilatation of the LA 90 mm and/or dilatation of the LV 70 mm and/or increase in the systolic PAP 80 mmHg and/or a decrease in the EF of 0.45. 11 patients are alive with a mean survival of 36.8 months (30.5%) and 25 have died after a mean interval of 7.8 months. The prognosis is very poor for aortic valvular disease (14 deaths out of 16 cases), but there were only 3 deaths out of 10 patients with isolated mitral valve disease.

Adult↗
PubMed1982

Factors predicting working status after aortocoronary bypass surgery.

The working status of 1165 patients aged 59 years or less (mean 49.8 years) was evaluated 7 to 77 months (mean 36 months) after aortocoronary bypass surgery. Although 76% of the patients eventually returned to work, only 56% were working 6 months after their operation. The proportion of patients working peaked at 2 years after the operation (at 66%) and decreased progressively to 56% at 4 years and 53% at 5 years without ever reaching the proportions that applied 12 and 6 months before the operation (84% and 69% respectively). Multivariate analysis identified three socioeconomic and three clinical variables as predicting the working status at 6 months and at yearly points during the first 4 years after the operation. Of the socioeconomic variables analysed, preoperative unemployment of long duration, a preoperative occupation that required strenuous physical effort and a low level of education were, in that order, the strongest predictors of postoperative unemployment. Among the clinical variables, associated noncardiovascular illness and the severity and duration of angina pectoris independently influenced the patients' post-operative working status. The authors conclude that modification of some of these variables should by attempted both before and after aortocoronary bypass surgery to see whether the rate of return to employment after the operation can be improved in selected patients.

Adult↗
PubMed1982

Employment following aortocoronary bypass surgery in young patients.

The work status following aortocoronary bypass surgery was evaluated by questionnaire in 268 male patients aged 44 years or less, after a mean follow-up of 38 months. During follow-up, 87% resumed work; when analyzed on a yearly basis, the rate of patients at work peaked at 2 years (80%) and then declined to 70% at 4 years. Multivariate analyses showed that the two most important preoperative variables predictive of work status after surgery were (1) the length of the period of not working, and (2) the educational level. Other influential factors were the presence of an associated vascular disease and the type of work, annual income and functional class. The postoperative health status, as described by the patient, was also closely correlated with return to work. Recurrence of angina after surgery impaired work resumption. A majority of patients who were never gainfully employed after surgery attributed the reason to their physician, while 93% of them stated that they received financial aid from the government.

Adult↗
PubMed1980

[Recurrent angina after coronary surgery. Results of reoperations for myocardial revascularization].

40 patients presented with invalidating angina after initial revascularisation surgery (44 operations). The relapse of angina was attributed to thrombosis or stenosis of the graft (33 p. 100), graft failure plus the presence of non-bypassed coronary lesions (progression of coronary artery disease or incomplete initial revascularisation) (52 p. 100) or to the presence alone of coronary lesions which had not been bypassed (15 p. 100). At reoperation 37 stenosed or thrombosed grafts were replaced or repaired and 36 new aortocoronary bypasses were implanted. The perioperative risk was comparable to that of the initial operation (4,5 p. 100 mortality, 13,6 p. 100 myocardial infarction). The long term clinical improvement (34 months) was however less satisfactory (30 p. 100 unimproved). Several factors may account for the relatively high failure rate: the incidence of incomplete revascularisation; perioperative myocardial infarction and, above all, rapid progression of the coronary artery disease. Reoperation for myocardial revascularisation should therefore be restricted to patients with severe angina despite medical therapy, in whom the angiographic appearances suggest that optimal revascularisation might be possible.

Adult↗
PubMed1980

[Changes in work status in a French-Canadian population after aorto-coronary bypass surgery].

Work status after aortocoronary bypass surgery was evaluated in 1 320 male patients who were less than 60 years old at the time of their operation. The percentage of working patients is maximal two years after surgery (66.5 p. 100) and decreases gradually (53 p. 100) at five years. This percentage remains lower than the 84 p. 100 and 69 p. 100 which were observed twelve and six months before the operation. Multivariate analyses showed that the length of the period of pre-operative inactivity had a preponderant role in predicting work status after surgery. The second best predictor was the type of work in patients aged 45 or more and the educational level in younger patients. All other variables-duration of illness, functional class, other illness, postoperative complications, marital status, annual income, age-had a lesser role. Variables predictive of continued employment (greater than or equal to 2 ans) after surgery were similar. Univariate analyses on postoperative factors showed a negative correlation between recurrence of angina and return to work. A majority of patients who never returned to work after surgery kept a stable income (65.5 p. 100) and 83 p. 100 of them received financial aid from the government.

Coronary Artery Bypass↗
PubMedDate not supplied

[Glycoprotein IIb/IIIa inhibitors in unstable angina].

During the last ten years we have considerably update our knowledge about the pathogenesis of unstable angina or acute coronary syndromes. The platelet activity have in this settings the central role in development of the thrombotic process. Platelet glycoprotein IIb/IIIa inhibitors block fibrinogen binding to platelets, and the effect of this on the final common pathway of platelet aggregation makes these compounds extremely potent antiplatelet drugs. Three intravenous IIb/IIIa receptor antagonists are approved for clinical use, and this class of therapy has update our pharmacologic armatarium to avoid ischemic complication in the settings of percutaneous coronary revascularization at first and now in medical treatment of acute coronary syndromes. Results of large trials using this drugs suggest that this agents are effective in patient with unstable angina particularly in those presenting a high score of risk for acute ischemic events and those requiring coronary intervention.

Abciximab↗