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P Mathieu

Publications and source records attributed to P Mathieu.

At least 19 recordsLinked to original sources
PubMed1999

Perivalvular abscesses associated with endocarditis; clinical features and prognostic factors of overall survival in a series of 233 cases. Perivalvular Abscesses French Multicentre Study.

AIMS: The purposes of this study were to determine the clinical features and to identify prognostic factors of abscesses associated with infective endocarditis. METHODS AND RESULTS: During a 5-year period from January 1989, 233 patients with perivalvular abscesses associated with infective endocarditis were enrolled in a retrospective multicentre study. Of the patients, 213 received medical surgical therapy and 20 medical therapy alone. No causative microorganism could be identified in 31% of cases. Sensitivity for the detection of abscesses was 36 and 80%, respectively using transthoracic and transoesophageal echocardiography. Surgical treatment consisted of primary suture of the abscess (38%), insertion of a felt aortic or mitral ring using Teflon or pericardium (42%), or debridment of the abscess cavity (20%). The 1 month operative mortality was 16%. Actuarial rates for overall survival at 3 and 27 months in operated patients were 75 +/- 10% and 59 +/- 11%, respectively. Increasing patient age, staphylococcal infection, and fistulization of the abscess were found to be independent risk factors in both 1 month and overall operative mortality. Renal failure was a risk factor predictive of operative mortality at 1 month, whereas uncontrolled infection and circumferential abscess were regarded as risk factors predictive of overall operative mortality. CONCLUSION: The data determined prognostic factors of abscesses associated with infective endocarditis.

Abscess↗
PubMed1999

Evaluation of the 'Lequesne's false profile' of the hip in patients with hip osteoarthritis.

OBJECTIVES: To compare the value of Lequesne's false profile (LFP) radiograph of the hip and antero-posterior (AP) X-ray of the pelvis in the assessment of joint space narrowing (JSN) and osteophyte (Ost) in patients with hip osteoarthritis (OA). METHODS: AP and LFP radiographs of the hip were performed using a standardized method in 50 consecutive patients with hip OA. JSN and Ost were graded at different days by a single observer blinded for patients identity, using a six point scale (JSN:0-5) and a four point scale (Ost:0-3) from AP and LFP respectively. Scores obtained from AP and LFP were compared. RESULTS: Mean JSN grade was significantly higher for LFP (2. 7+/-1.0) than AP (2.4+/-1.2) (P=0.001). It was identical for AP and LFP in 28 patients (56%) while the highest grade was found on LFP in 16 (32%) and on AP in 6 (12%). No significant difference between LFP and AP was found for osteophyte grading. CONCLUSION: These data suggest that the combination AP+LFP provide more information than AP alone for the evaluation of joint space narrowing in about one third of patients. LFP may be helpful for the radiographic assessment of OA changes particularly in structure modifying drugs evaluation.

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PubMed1999

Suppression of cell cycle progression by flavonoids: dependence on the aryl hydrocarbon receptor.

Some flavonoids are ligands of the aryl hydrocarbon receptor (AHR) and cause cell cycle arrest. The dependency of the cytostatic effects of five flavonoids (flavone, alpha-naphthoflavone, apigenin, 3'-methoxy-4'-nitroflavone and 2'-amino-3'-methoxyflavone) on a functional AHR was examined in AHR-containing rat hepatoma 5L cells and an AHR-deficient cell line (BP8) derived from the 5L line. The potent AHR ligand 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) was cytostatic to the 5L line due to the induction of a G(1) arrest and dramatically elevated steady-state levels of CYP1A1 mRNA. TCDD affected neither the proliferation nor CYP1A1 mRNA contents of BP8 cells. With the exception of apigenin, the flavonoids under study induced G(1) arrest in both 5L and BP8 cells when used at concentrations at which they functioned as AHR agonists, but not antagonists. Apigenin-treated 5L and BP8 cultures primarily arrested in G(2)/M. The AHR-containing murine hepatoma cell line 1c1c7 arrested following exposure to AHR agonist concentrations of flavone and alpha-naphthoflavone, but not TCDD. Unlike the G(1) arrest observed in 5L cultures, the latter two flavonoids caused principally G(2)/M arrest in 1c1c7 cells. These studies demonstrate that the cytostatic activities of flavonoids do not require the AHR and the site of checkpoint arrest with a specific flavonoid can vary with cell type.

Animals↗
PubMed1999

Comparison of long term outcome in patients with or without aortic ring abscess treated surgically for aortic valve infective endocarditis.

OBJECTIVE: To assess the long term prognostic significance of aortic valve ring abscess in patients with aortic endocarditis. PATIENTS: A consecutive series of 75 patients who had surgery for aortic infective endocarditis between 1981 and 1989; 35 had aortic ring abscesses (group 1) and 40 did not (group 2). Mean age did not differ between the two groups. Prosthetic valve endocarditis was present in 17% of group 1 and 5% of group 2. Pneumococcal or beta haemolytic streptococcal endocarditis was more common in patients with native valve endocarditis who had aortic ring abscesses (20% v 5%). DESIGN: Cohort analysis. RESULTS: In-hospital mortality (11.4% v 7.5%) and 10 year survival (56% v 66%) were not significantly different between groups 1 and 2. In patients with native valve endocarditis, 10 year survival was 62% and 66%, respectively for patients with or without ring abscess, and 10 year reintervention-free survival was 38% v 58% (p = 0.11). In these patients, the presence of an intercurrent illness, severe congestive heart failure before surgery, and use of valved conduits for surgical treatment were predictors of poorer long term survival. At follow up residual aortic regurgitation was documented in 72% of patients in group 1 and 26% in group 2 (p < 0.01). CONCLUSIONS: Aortic valve ring abscess is not an independent marker of poor long term outcome in patients with infective endocarditis. However, as residual aortic regurgitation appears frequent at follow up, specific surgical techniques should be considered in patients with paravalvar abscesses.

Abscess↗
PubMed1999

Conversion of cyclosporine A to tacrolimus following heart transplantation.

BACKGROUND: Cyclosporine A (CyA) is ususally the immunosuppressive drug of choice in organ transplantation; however, some side effects have limited its use. Tacrolimus is a novel immunosuppressive drug that is more potent than CyA, and has been used as a rescue agent following heart transplantation when the use of CyA is undesirable or inefficient. PATIENTS AND METHODS: Since 1996, 14 heart transplant recipients under CyA were switched to tacrolimus therapy, for refractory rejection or intolerance, to conventional immunosuppression. RESULTS: After a mean of 35+/-7 months of treatment, tacrolimus was substituted for CyA therapy. The reason for substitution was refractory rejection in six patients, gingival hypertrophy in five patients, hypertrichosis in one patient, severe arterial hypertension in one patient and hepatotoxicity in one patient. Five patients underwent a successful rescue therapy and one patient died of refractory rejection despite the use of tacrolimus. All patients with CyA side effects recovered with tacrolimus. After conversion from CyA to tacrolimus, the number of episodes of acute rejection decreased from a mean of 0.42+/-0.17 to 0.14+/-0.09 episodes/patient/month under CyA and tacrolimus therapy (P=0.11), respectively. The mean dose of prednisone was 0.18+/-0.06 mg/kg/day before compared with 0.06+/-0.01 mg/kg/day after conversion from CyA to tacrolimus (P=0.09). Creatinine serum levels averaged 124+/-7 mmol/L under CyA treatment compared with 113+/-7 mmol/L with tacrolimus therapy (P=0.002). CONCLUSION: In patients with refractory rejections or intolerance to CyA after heart transplantation, conversion to tacrolimus-based immunosuppression is safe and effective.

Adult↗
PubMed1999

[Results of surgery after failed mitral percutaneous dilatation].

OBJECTIVES: Percutaneous balloon mitral valve commissurotomy (BMC) is an alternative to surgical commissurotomy. Complications following BMC includes mitral regurgitation, iatrogenic atrial septal defect, residual mitral stenosis, and pericardial hemorrhage. This study analyzes the outcomes of surgery following failed BMC for mitral stenosis. METHODS: In a series of 298 patients treated with BMC, 53 patients (17.7%) had a complication that necessitated a surgical treatment. Twenty-eight patients needed an immediate surgery before the discharge (group I) and 25 patients were operated on an elective basis (group II). RESULTS: In group I, 27 patients have been operated and one died before the operation. In 21 patients an acute mitral regurgitation occurred, 3 patients had a residual mitral stenosis, and 3 had a left atrial perforation. The operation consisted of 26 mitral valve replacements, 20 concomitant reparations of iatrogenic atrial septal defect, and one open mitral valve commissurotomy. Operative mortality was 3.7% (1 out of 27). In group II, 25 patients have been operated at a mean 18 +/- 14 months after BMC. In the 25 patients the operation was indicated for significant mitral regurgitation (2 + and more). The operation consisted of 25 mitral valve replacements, 9 concomitant reparations of iatrogenic atrial septal defect, 3 patients had also coronary artery bypasses. The operative mortality was 8% (2 out of 25). The echocardiographic score was similar for both groups, it was 8.4 +/- 2.0 in group I and 8.0 +/- 1.5 in group II (P = NS). Despite these complications following failed BMC, surgery appears a safe procedure with an acceptable mortality.

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PubMed1998

Quantitative evaluation of joint space width in femorotibial osteoarthritis: comparison of three radiographic views.

OBJECTIVE: Quantitative evaluation of radiographic methods proposed to improve the detection of joint space narrowing (JSN) in femorotibial osteoarthritis (OA). METHODS: Thirty-two consecutive patients with knee OA and five normal controls had three different weight-bearing radiographs of the knee: (1) anteroposterior film of both knees in full extension (extended knees), (2) anteroposterior film of one knee in extension while the patient was standing on the homolateral foot (standing on homolateral foot), (3) posteroanterior film of both knees flexed at 30 degrees (schuss view). Joint space was analyzed blind using both an evaluation of JSN with a six-grade scale (JSN score) and an image analyser computer measurement of the mean joint space width (mean JSW). The medial compartment of medial femorotibial OA knees, the lateral compartment of lateral femorotibial OA knees, as well as both compartments of control knees, were measured. Extended knee and schuss views were made 1 year later in 10 patients for the evaluation of sensitivity to change. RESULTS: The JSN scores +/- S.D. in schuss, standing on the homolateral foot and extended knee views were 2.75 +/- 1.31, 1.95 +/- 1.3 and 1.66 +/- 1.27, respectively. The mean JSW +/- S.D. in schuss, standing on the homolateral foot, and extended knee views were 2.9 +/- 1.9 mm, 3.5 +/- 1.6 mm and 3.8 +/- 1.5 mm, respectively. Changes in JSN scores and mean JSW with schuss view increased with OA severity. In controls, JSW of the medial compartment did not vary in the three views. JSW of the lateral compartment of controls was significantly larger in the schuss view. The change in JSW after 1 year was -0.41 mm (P = 0.02) in the schuss view and -0.17 mm (P > 0.05) in the extended knee view. CONCLUSION: The schuss view is suggested as the most accurate method for the evaluation of JSW in femorotibial OA.

Adult↗
PubMed1998

Quantitative measurement of joint space narrowing progression in hip osteoarthritis: a longitudinal retrospective study of patients treated by total hip arthroplasty.

OBJECTIVES: To evaluate the rate of progression of radiological joint space narrowing (JSN) in patients operated on for hip osteoarthritis (OA) and to determine its predictive factors. METHODS STUDY DESIGN: retrospective longitudinal trial of 61 patients who underwent total hip arthroplasty (THA) for hip OA (69 operated hips). Mean follow-up 81.2 +/- 9.9 months. Collected data: (1) standing frontal radiographs of the pelvis from diagnosis to surgery (246 films) for morphological evaluation and quantitative measurement of joint space width (JSW) (computerized reading of digitized X-rays); (2) demographic data (sex, age, body mass index, smoking status, professional and sporting activities, family history of OA); (3) clinical data (age at onset-diagnosis and THA, drug consumption, time from diagnosis to permanent disability, OA at other joints, previous THA of the contralateral hip). STATISTICS: multivariate analysis. RESULTS: The yearly mean narrowing (YMN) of MeanJSW was 0.43 +/- 0.43 mm/yr (median 0.29, range 0.03-2.55). YMN correlated inversely with joint space width at operation and follow-up duration, and was increased in atrophic OA (r = 0.71). The time between diagnosis and THA correlated with JSW at diagnosis, and was inversely correlated with age at onset and YMN. It was longer in patients with hypertrophic OA (r = 0.69). CONCLUSION: Rapid progression of JSN, older age and absence of osteophytes appear to be the main factors leading to THA.

Adult↗
PubMed1998

Serum concentrations of cartilage oligomeric matrix protein and bone sialoprotein in hip osteoarthritis: a one year prospective study.

OBJECTIVE: To evaluate serum concentrations of cartilage oligomeic matrix protein (COMP) and bone sialoprotein (BSP) as predictors of disease progression in hip osteoarthrtitis (OA). METHODS: Forty eight consecutive patients, referred to hospital for symptomatic hip OA, (ACR criteria) were monitored in a one year prospective trial with radiographs and serum samples. The radiographs were graded for joint space narrowing, osteophytes, and sclerosis and the joint space width was measured by a digitised image analyser. Serum COMP and BSP were quantified by immunoassays. RESULTS: The COMP concentrations at baseline correlated with the joint space width at entry and with its yearly mean narrowing (r = 0.38, p = 0.002) but not with joint space narrowing grade progression. The concentrations were higher in patients with bilateral hip OA (p = 0.03). The serum BSP concentrations at baseline were unrelated to OA progression but correlated inversely to the osteophyte grade (r = -0.36, p = 0.004) and sclerosis grade (r = -0.42, p = 0.0004). CONCLUSION: Serum COMP seems to be a surrogate marker of OA and may be of interest for the detection of patients at risk of rapidly progressing disease in hip OA. Serum BSP changes seem to reflect alterations in the subchondral bone turnover in hip OA. Measurement of joint space width using a digitised image analyser is a sensitive way of assessing OA progression that facilitates evaluation of tissue markers in relation to anatomical changes in the joint.

Adult↗
PubMed1998

[Cardiac abscess in infectious endocarditis. A multicenter study apropos of 233 cases. The Working Group on Valvulopathy of the French Society of Cardiology].

The aim of this retrospective multicenter study was to determine present characteristics of infectious endocarditis complicated by abscess and to identifying predictive factors of mortality. The files of 233 patients with infectious endocarditis complicated by perivalvular abscesses between January 1989 and December 1993 were analysed. Two hundred and thirteen patients underwent medico-surgical treatment (175 aortic and 38 mitral abscesses) and 20 patients underwent medical treatment alone (17 aortic and 3 mitral abscesses). The abscess was observed on native valves in 156 cases and valve prostheses in 77 cases. The causative organism was identified in 69% of cases : the commonest organism was the staphylococcus. The diagnostic sensitivity of transthoracic and transoesophageal echocardiography was 36 and 80% respectively. The operative mortality at one month was 16%. Patients over 65 years of age, staphylococcal infection, renal failure and fistulisation of the abscess, were identified as independent predictive factors of mortality at one month. The survival rate three months after surgery was 75 +/- 10% and 59 +/- 11% at 27 months. An age over 65, staphylococcal infection, uncontrolled infection, circumferential abscess and fistulisation were independent predictive factors of global mortality (the first month and after). The mortality rate in unoperated patients was 40%: cardiac failure and fistulisation of the abscess detected by echocardiography were predictive factors of mortality on univariate analysis.

Abscess↗
PubMed1998

[Alteration of sinus variability after cardiac surgery].

UNLABELLED: Sinus tachycardia is frequent after cardiac surgery and this tachycardia is probably due to changes of the autonomic nervous system. The objective of this study was to evaluate the changes possibly induced by cardiac surgery, by studying sinus variability (SV) during a 24-hour Holter monitoring. The examination was performed in 28 patients who had undergone cardiac surgery 1 to 6 weeks previously. These patients had no alteration of left ventricular function, or any causes likely to modify SV and they had a normal postoperative course. Their results were compared to those of 4 subjects developing a postoperative complication (1 case of ventricular tachycardia and 3 cases of resuscitated cardiac arrest). The results were also compared to those of 24 age-matched adult controls without heart disease (control group). The study of SV included temporal and spectral analysis of SV with measurement of the standard deviation of normal RR intervals (SD), mean heart rate (HR), percentage of RR intervals differing by more than 50 m/sec from the adjacent interval (pNN50), coefficient of variability (CV) (SD/RR), square root of the differences between successive RR (rMSSD), spectral properties of low frequencies (LF) and high frequencies (HF) and the fractionated spectral property (LF/HF). RESULTS: (see tables, page 151 and 152). An alteration of SV was therefore observed in the surgical group, and lasted 4 to 6 months after surgery. No difference was observed between subjects without cardiac events and those presenting a cardiac event. IN CONCLUSION: cardiac surgery decreases all parameters of SV during the first few postoperative months. Certain unexpected cardiac accidents during this period could be explained by these changes.

Adult↗
PubMed1998

[The vasoconstrictor effect of cyclosporine on the pulmonary vein is mediated by its vehicle: the cremophor].

OBJECT: Cyclosporin A (CyA) induced vasoconstriction and impaired relaxation to agonists has been related in some models to its vehicle: the cremophor (CRE). There is no data concerning the effect of CyA and its vehicle CRE on the pulmonary veins. Therefore, the present study was designed to characterize the effect of CyA and CRE on isolated pulmonary veins. MATERIAL AND METHODS: Third-order canine pulmonary veins (n = 6) were suspended in organ chambers for measurement of isometric force. Segments were exposed to cumulative doses (10(-9) to 10(-4) M) of CyA in its vehicle CRE, and to CRE alone. RESULTS: CyA induced an ehdothelium-independent vaasoconstriction similar to CRE, maximal constriction (Emax) were: 1.8 +/- 0.3 g versus 2.1 +/- 0.4 g respectively (p = NS). This vasoconstriction observed with CRE was not affected by indomethacine (a cyclooxygenase inhibitor), and by pinane thromboxane (a thromboxane antagonist). However, the vasoconstriction was decreased by diltiazem (10(-5) M), a calcium channel blocker, Emax were: 2.1 +/- 0.4 g and 0.8 +/- 0.04 g respectively for CRE and CRE with diltiazem (p < 0.05). CONCLUSION: CyA vehicle CRE induces an endothelium-independent vasoconstriction in isolated third order pulmonary veins in the dog. This vasoconstriction is not related to a cyclooxygenase product, but is partially mediated by a calcium channel activation in vascular smooth muscle.

Animals↗
PubMed1998

Increased serum C-reactive protein levels by immunonephelometry in patients with rapidly destructive hip osteoarthritis.

OBJECTIVE: To compare serum C-reactive protein levels measured using a highly sensitive immunonephelometry method in patients with rapidly destructive versus slowly progressive hip osteoarthritis. METHODS: Ten patients meeting criteria for rapidly destructive hip osteoarthritis were compared to 25 patients with slowly progressive hip osteoarthritis defined as less than 0.20 mm joint space loss over the last year. Serum C-reactive protein was assayed using an immunonephelometry method with a detection threshold of 0.17 mg/L and a coefficient of variation of less than 5%. RESULTS: One patient in each group was excluded because of a C-reactive protein level greater than 15 mg/L. The mean C-reactive protein level in the remaining 33 patients was 3.05 +/- 3.46 mg/L (range, 0.10-14.9 mg/L). Mean C-reactive protein was significantly higher in the rapidly destructive group than in the slowly progressive group (5.61 +/- 4.75 versus 1.94 +/- 1.98 mg/L, P = 0.01), even after adjustment for potential confounding factors. CONCLUSION: Our data suggest that rapidly destructive hip osteoarthritis may be associated with some degree of inflammation reflected by a small but significant increase in serum C-reactive protein levels.

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