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Biomedical subjects

R Cartier

Publications and source records attributed to R Cartier.

At least 145 records · Page 8Linked to original sources
PubMed1991

Accelerated coronary atherosclerosis after cardiac transplantation: major threat to long-term survival.

Accelerated coronary atherosclerosis (ACA) has been documented at autopsy and was noted at coronary angiography in seven patients, 11 to 48 months after cardiac transplantation. To delineate the importance of this problem, the risk factors and the therapeutic approaches in 7 patients who had ACA after heart transplantation were compared with those in 28 patients free of ACA at annual coronary angiography. Ischemic cardiomyopathy was the preoperative diagnosis in all but one patient in the ACA group. The age of the transplant recipients, total myocardial ischemic times and arterial blood pressures at follow-up were similar in both groups. Donor age averaged 31 +/- 3 years in the ACA group and 22 +/- 1 years in patients free of ACA. Preoperative cholesterol, triglyceride and high-density lipoprotein levels were lower in ACA-free patients and the low-density lipoprotein level was higher. At the last follow-up visit, serum lipid levels were similar in both groups. The incidence of acute rejection and of infection was slightly, but not significantly, higher in patients with ACA. The actuarial survival of ACA patients 4 years after transplantation was 30% +/- 20% compared with 100% for patients free of ACA (p less than 0.01). Actuarial rates of freedom from ACA and from death due to ACA were 73% +/- 11% and 81% +/- 11% respectively. Stepwise discriminant analysis showed that older donors and higher pretransplant triglyceride levels were independently related to the development of ACA after cardiac transplantation. In conclusion ACA remains an important cause of late death after heart transplantation. Although therapeutic measures are limited, prevention should focus on strict control of serum lipid levels after transplantation.

Adult↗
PubMed1990

Angiogenic factor: a possible mechanism for neovascularization produced by omental pedicles.

To determine possible mechanisms by which omental pedicles protect bronchial anastomoses from ischemia, we studied the angiogenic potential of a lipid extract of omentum. A rabbit cornea model was used to quantify neovascularization produced by methanol-chloroform extract of homogenized autologous omentum or perirenal fat. In 22 anesthetized rabbits, 10 microliters of omental lipid extract was injected into the cornea. In each animal the opposite eye was used as a control and was injected with a similar volume of extract prepared from perirenal fat. The side of injection of autologous omental fat was randomized and was not known to the investigator who assessed neovascularization on days 4, 7, 14, and 21 after injection. Neovascularization was recorded on microphotography and quantified by a point-counting method. Four days after injection, neovascularization in corneas injected with autologous omental fat was significantly (p less than 0.05) greater than in control corneas for all indices of neovascularization including total point count, which was three times greater than control. The angiogenic effect diminished with time, and by 21 days after injection corneal neovascularization was comparable for the two groups. Our results suggest that the lipid fraction of omentum has angiogenic activity that may stimulate neovascularization in ischemic tissues. Lack of sustained activity may be due to washout by neovessels or local tissue metabolism.

Animals↗
PubMed1990

Circulatory support during crossclamping of the descending thoracic aorta. Evidence of improved organ perfusion.

The need to support the distal circulation during aortic crossclamping and the subsequent effects on hemodynamics and organ perfusion prompted our review of 51 patients who underwent repair of aneurysm of the descending thoracic aorta from 1983 through 1987. Forty-three patients had aneurysms originating distal to the left subclavian artery, and eight had aneurysms involving the distal aortic arch and the proximal descending aorta; 10 patients had emergency operation for aneurysm rupture. Three different techniques were used: Seventeen patients had left atrial-distal aorta arterial bypass with a centrifugal pump, 18 patients had a Gott shunt, and 16 patients had no circulatory support during aneurysm repair. Location and type of aneurysm, age, sex, diabetes, preoperative hypertension, and serum lipid levels were similar in the three groups. Duration of crossclamping was 54 +/- 12 minutes for left atrial-aortic assist, 45 +/- 5 for the shunt group, and 34 +/- 4 for patients without circulatory support. With crossclamping, all groups had similar and significant increases in heart rate (p less than 0.03). Proximal systolic blood pressure did not change during left atrial-aortic assist, but a transient increase occurred in patients with shunts (p less than 0.01), and a sustained increase occurred in patients without circulatory support (p less than 0.05). With crossclamp release, arterial pH and capillary pulmonary wedge pressure decreased significantly (p less than 0.05) in patients without shunt or bypass. Postoperative renal function did not vary significantly when circulatory support was used, but serum creatinine rose transiently in patients with unsupported aortic crossclamping. We conclude that support of the distal circulation during thoracic aortic crossclamping stabilizes hemodynamics and prevents systemic acidosis and renal ischemia. Further, our data suggest that the centrifugal pump may provide better protection than a passive shunt.

Adult↗
PubMed1989

Increased alkylation of liver DNA and cell turnover in young versus old rats exposed to vinyl chloride correlates with cancer susceptibility.

To investigate the factors responsible for the high sensitivity of the livers of young rats to the carcinogenic stimulus of vinyl chloride (VC) adult and 11-day-old Wistar rats were exposed to [1,2-14C] VC. Adult rats received either a single 6-h exposure, or 2 single 6-h exposures separated by a treatment-free time interval of 15 h. Eleven-day-old rats received 2 single 6-h exposures, according to the same treatment schedule. The animals were sacrificed 1 h after the end of the corresponding exposure period; liver DNA was isolated, enzymatically hydrolyzed and analyzed by column chromatography. Incorporation of [14C]VC-derived radioactivity into the physiological deoxyribonucleosides (presumably reflecting the activity of DNA replication) was observed for all three sets of experiments. Virtually no difference in 14C-incorporation was observed between adult rats sacrificed immediately after one single 6-h exposure to [14C]VC and those which received a second exposure on the following day. In contrast, an about 8-fold increase in 14C-incorporation into the physiological purines of DNA of young versus adult rats was detected. This difference is indicative of a significantly elevated DNA synthesis/cell replication in the liver of young (11-d) rats. Radioactivity associated with 7-(2-oxoethyl)guanine was taken as an indicator of DNA alkylation by [14C]VC. Analysis of 7-(2-oxoethyl)guanine revealed that in adult animals the amount of this alkylation product formed is increased by a second exposure to VC. About 5-fold of the amount of 7-(2-oxoethyl)guanine present in adults could be determined in liver DNA of young (11-d) animals exposed under the same exposure conditions. Our results suggest that the high sensitivity of young rats to VC-induced hepatocarcinogenesis can reasonably be explained by enhanced DNA-alkylation and by increased cellular proliferation at an early age.

Age Factors↗
PubMed1989

Carcinoma of the lung. Evaluation of satellite nodules as a factor influencing prognosis after resection.

Satellite nodules are considered to be predictive of poor prognosis in breast cancer and in melanoma. In lung cancer, there is no information as to their definition, prevalence, or implication as a prognosis factor of survival after resection. Over the past 18 years (1969 to 1987), 84 patients underwent pulmonary resection for primary lung cancer accompanied by satellite nodules. These nodules were defined as well-circumscribed accessory carcinoma foci clearly separated from the main tumor but with identical histologic characteristics. All were smaller than the primary carcinoma and most were located within the same lobe. Survival rates of patients with satellite nodules were compared to those of 1021 patients without satellite nodules who underwent resection during the same time interval. The 1-, 3-, and 5-year survival rates for all patients classified as having no satellite nodules were 78%, 54%, and 44%, respectively, and the median survival for the entire group was 30 months. In patients with satellite nodules, these survival rates were 60.9%, 32.7%, and 21.6%, respectively, with a median survival of 15 months. The deleterious effect of satellite nodules was more significant in patients with stage I disease (p = 0.0008) than in patients with stage II (p = 0.0354) or stage III (p = 0.0145) disease. Survival data obtained by comparison of satellite nodule status and histologic characteristics shows that 5-year survival figures are better for patients with no satellite nodules in both the squamous and the nonsquamous groups. This study demonstrates that satellite nodules associated with lung cancer are indicative of locally advanced and/or premetastatic disease. These patients should be included in the stage group IIIa of the TNM stage grouping classification.

Adult↗
PubMed1987

Methodical intrauterine resection.

A technique using a fine intrauterine resectoscope with mobile electrical loop and continuous flow providing a thoroughly clear vision in all circumstances was used to resect 61 submucous leiomyomas. This technique allows complete resection of intrauterine benign tumours such as submucous leiomyoma sessile type partially embedded in the myometrium, old and wide marginal synechiae, or uterine septa. Under direct visual control it allows one to perform deep biopsies leading to precise histologic diagnoses with determination of possible myometrial penetration. The advantages of this technique, which may be performed eventually on outpatients with paracervical block, are: precise hemostasis; complete and controlled uterine evacuation, avoiding postoperative infections; precise histologic diagnosis; suppression of a good percentage of hysterectomies and open myomectomies; simplicity of follow-up; brevity of hospitalization and convalescence, which are sometimes nil; and conservation, or even restoration, of fertility.

Adult↗
PubMed1987

Factors influencing early and late survival in patients with combined mitral valve replacement and myocardial revascularization and in those with isolated replacement.

During a 5 1/2-year period, 251 patients underwent mitral valve replacement (MVR) at our institution: 76 had combined MVR and coronary artery bypass grafting (CABG), and 175 without major coronary artery disease (CAD) had isolated MVR. In-hospital mortality for MVR + CABG was 13.2% (10/76); it was 8.6% (6/70) when patients with preoperative mechanical support were excluded, 7.9% (5/63) for elective operations, and 8.2% (5/61) for nonischemic mitral disease. Overall, in-hospital mortality for isolated MVR was 6.3% (11/175); it was 4.4% (7/161) excluding patients requiring mechanical support and 3.1% (5/157) for elective operations. Of a host of clinical characteristics in patients with MVR +CABG, few were found to influence in-hospital mortality: age greater than 60 years, degree of incapacitation (New York Heart Association Functional Class IV), previous history of myocardial infarction or congestive heart failure, cardiac enlargement (cardiothoracic index greater than 50%), and ischemic mitral disease (33.3% in-hospital mortality; p less than 0.05). Of the invasive variables, only one influenced in-hospital mortality: wall motion score greater than 10 (31.6% in-hospital mortality; p less than 0.01). Of the operative variables studied, the number of grafts (3 or more: 33.3% in-hospital mortality; p less than 0.05), the need for mechanical support (47.4% in-hospital mortality; p less than 0.0001), and emergency operation (38.5% in-hospital mortality; p less than 0.005) had a significant effect on mortality. The type of mitral lesion, the type of prosthesis, the extent of CAD or the completeness of revascularization, the presence of pulmonary hypertension, and atrial fibrillation appeared to have no influence.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1986

Usefulness of anticoagulant therapy in the prevention of embolic complications of atrial fibrillation.

The medical records of 254 patients with atrial fibrillation were reviewed to determine the incidence of embolic events in relation to type of cardiovascular disease, duration of atrial fibrillation, and use of anticoagulants. During a total follow-up of 833 patient-years in atrial fibrillation, there were 32 instances of systemic embolism: 21 involved the cerebral circulation and 11 were extracerebral. Thirty of these events occurred during 549 patient-years of follow-up without anticoagulation therapy (5.46 of 100 patient-years), while only two embolic events occurred during 284 patient-years on anticoagulants (0.7 of 100 patient-years). Thus, the incidence of embolism was eight times more frequent during the unanticoagulated period of observation in atrial fibrillation (p less than 0.002). The incidence of embolism during follow-up without anticoagulants was the same regardless of the presence or absence of mitral valve disease and regardless of whether atrial fibrillation was chronic or paroxysmal. The rate of serious hemorrhagic complications on anticoagulants was acceptably low (2.11 of 100 patient-years). We conclude that in this study population anticoagulant therapy reduced the risk of embolic complications of atrial fibrillation. The results also indicate that the use of anticoagulants should not be limited to patients with atrial fibrillation due to mitral valve disease.

Adult↗
PubMed1986

Long-term reproducibility and significance of provokable ventricular arrhythmias after myocardial infarction.

The long-term reproducibility and significance of inducible ventricular arrhythmias were assessed in 21 survivors of a myocardial infarction. Programmed ventricular stimulation performed a mean of 12 +/- 2 days (range 8 to 18) after infarction provoked ventricular fibrillation in 2 patients, sustained monomorphic ventricular tachycardia in 8 and nonsustained ventricular tachycardia in 11. Patients were restudied using the same protocol a mean of 8 +/- 2 months (range 4 to 11) after infarction. All patients underwent programmed ventricular stimulation studies in the absence of antiarrhythmic drug treatment. Ventricular tachyarrhythmias could be reinitiated in 16 patients (76%): ventricular fibrillation in 2, sustained ventricular tachycardia in 5 (monomorphic in 4) and nonsustained ventricular tachycardia in 9. A preponderance of inferior infarction was observed among patients with reinducible tachycardias (9 of 16 patients versus 0 of 5 with noninducible tachycardias) (p less than 0.05). No significant difference existed between patients with and without reinducible arrhythmias with respect to severity of coronary artery disease, degree of left ventricular dysfunction, occurrence of ventricular fibrillation in the acute phase of infarction and ventricular arrhythmias detected by 24 hour ambulatory electrocardiographic (Holter) monitoring. There was no significant difference between patients with and without a positive late study in stimulation thresholds, ventricular refractory periods, time interval between initial and repeat testing and use of beta-adrenergic blocking agents. During a mean follow-up period of 17 months (range 10 to 23) one patient with inducible sustained monomorphic ventricular tachycardia at both studies died suddenly. The remaining patients have survived follow-up without experiencing an arrhythmic event.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Common functional origin for simple and complex responses of atrioventricular node in dogs.

The possibility that variations in atrioventricular nodal conduction time observed during transient and steady-state nodal responses share common characteristics was examined in six anesthetized dogs. Atrioventricular conduction times (AV intervals) obtained during transient (incremental atrial pacing rates, short frequency steps, and Wenckebach cycles) and steady state (periodic premature stimulation performed at 5 basic rates) responses were plotted together against the corresponding preceding ventriculoatrial (VA) intervals on a graph for each dog. Despite their diversity, nodal responses consistently resulted in AV intervals that fell within a well-defined, relatively narrow, crescent-shaped zone on the graphs. AV interval variations were small in the long VA interval range and increased slightly but predictably as the VA intervals decreased. AV intervals of transient and steady state nodal responses overlapped markedly. These results show that AV intervals of transient and steady-state nodal responses vary within a given common functional domain despite the diversity of their sequential patterns and suggest that the AV node may be obeying the same set of conduction rules during these very distinct responses.

Animals↗
PubMed1986

[The surgical alternative in the treatment of terminal cardiomyopathies: cardiac transplantation].

Between April 1983 and November 1985, 14 patients have undergone a heart transplant, or 10 men and 4 women, aged from 17 to 55 years. The surgical indication was a cardiomyopathy in terminal evolutive phase, of which the etiology was ischemia in 8 cases, congestion in 5 cases and rheumatism in one case. There was one operative death (7.1%) from acute rejection and a late death secondary to chronic rejection. The actuarial rate of survival at one and 2 years was 81.9%. Post-operative complications, most frequent at an early stage, were arterial hypertension (9 cases), rejection (8 cases) and renal insufficiency (6 cases). During an average post-operative evolution of 13 months, 17 rejection episodes occurred in 10 patients (71.4%) and 5 patients (35.7%) presented with 7 infectious episodes, one of them severe. Cyclosporin's toxicity appeared in the immediate post-operative period by an always reversible increase of the bilirubin and creatinin levels. On a long term, all patients present with arterial hypertension, accompanied by a moderate renal insufficiency (creatinin between 2.2 and 2.4 mg%). Among the survivors, 9 patients (75%) remain completely asymptomatic and have resumed normal physical activities. Cardiac transplantation has therefore become a valid therapeutic alternative, able to greatly improve survival and the functional condition of patients with terminal cardiomyopathy.

Adolescent↗
PubMed1984

Effects of diltiazem on atrioventricular conduction and arterial blood pressure: correlation with plasma drug concentrations.

Atrial and atrioventricular conduction variables were studied at control and at the end of each of six consecutive 45-min diltiazem administration periods in eight closed chest-anesthetized dogs. Diltiazem was given as a bolus (50 micrograms/kg, i.v.) followed by an infusion (0.5 micrograms X kg-1 X min-1); doses were doubled in subsequent periods. The plasma concentrations, measured by gas-liquid chromatography, ranged from 8 to 1400 ng/mL and correlated strongly with the doses (r = 0.92; p less than 0.01). The Wenckebach cycle length, basic conduction time, and functional refractory period of the atrioventricular (AV) node increased proportionally with plasma concentration (respective r = 0.90, 0.89, 0.80; p less than 0.01). The minimum mean plasma concentrations affecting these variables significantly were 37, 83, and 175 ng/mL, respectively. Second or third degree AV blocks developed in all dogs for plasma concentrations between 379 and 1400 ng/mL. In four dogs which were given isoproterenol (0.2 micrograms X kg-1 X min-1), these blocks disappeared within 1 min. Atrial conduction time and functional refractory period were slightly but significantly shortened by diltiazem with mean plasma concentrations of 175 ng/mL and over. His-Purkinje intervals were not significantly changed by diltiazem. Systolic and diastolic arterial pressures were decreased by diltiazem (r = -0.64, r = -0.79; p less than 0.01) starting with a mean plasma concentration of 83 ng/mL. We conclude that AV nodal conduction variables are progressively prolonged with increasing plasma concentrations of diltiazem; plasma concentrations affecting blood pressure and AV nodal variables overlap; and the AV blocks produced by toxic concentrations of diltiazem can be corrected by isoproterenol.

Animals↗
PubMed1983

[Predictive value of preoperative acidity tests in ulcer recurrence after supraselective vagotomy].

The authors have analysed the predictive value of the basal and peak gastric acidity levels, measured preoperatively, in a series of 27 supraselective vagotomies. They recommend care in the choice of this operation for hypersecretors and they propose criteria for the preoperative selection of the candidates. They suggest determination of the preoperative basal gastric acidity level and a cimetidine suppression test to identify patients at high risk for recurrence of the ulcer.

Adult↗
PubMed1979

[The role of colposcopy in the diagnosis and treatment of dysplasias and intra-epithelial carcinomas of the uterine cervix (author's transl)].

Colposcopy plays an essential role in the diagnosis and treatment of dysplasias of the uterine cervix. It may be used to assess the lesions recognising dysplasia, observing the degree of severity and indicating regions from which biopsies should be taken. It accurately defines the limits of the lesions by indicating the site of the squamo-columnar junction, on the ectocervix or in the cervical canal. In association with Schiller's test, it defines the peripheral limits of the lesions on the cervix or vagina and leads to the discovery of purely vaginal lesions. On the basis of such an assessment, it is possible to discuss appropriate method for reaching a histological diagnosis, perform selective biopsies or obtain surgical specimen, and the best form of treatment. Only colposcopy offers the possibility of determining the indications for local treatment and observing patients after treatment. Colposcopy must be accompanied by precise technique in the histological examination of biopsies and operative specimens. Colposcopy is not a routine method of examination. In order to be effective and reliable, it must be selective and performed by a specialised colposcopist.

Biopsy↗