[Hazards in therapeutics. V. Inherent risks in the use of anticoagulants].
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Biomedical subjects
Publications and source records attributed to R Loire.
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Postmortem bronchoalveolar lavage of feline immunodeficiency virus-infected cats indicated an alveolitis process, and histological examination of their lungs confirmed the occurrence of alveolitis, parenchymatous lymphoplasmocytic infiltration and myomatosis. Similar lymphoid interstitial pneumonitis has been described in human and animal lentiviral diseases: lymphocytic interstitial pneumonitis in HIV-1-infected human beings, and maedi in sheep infected by the maedi-visna virus. Such lymphoid interstitial pneumonitis may thus be a common feature of lentiviral infections.
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We report a patient with a papillary fibroelastoma arising from the left ventricular posterior wall. The tumor was detected incidentally during echocardiography undertaken to evaluate aortic stenosis. Possible complication from tumor embolization was avoided by surgical resection during aortic valve replacement.
The postmortem anatomopathological examination of eight heart-and-lung specimens obtained from eight HIV-seropositive patients was performed. Three patients were CDC stage II and five patients were CDC stage IV. The mean age was 27 (range: 23-32). Distal and proximal vascular lesions of the coronary arteries were observed. These impairments were marked by major excentric atherosclerosis (with 80-90% obstruction of the arterial lumen) or by fibrosis two-fold or six-fold the thickness of the tunica media. Sclero-hyalinosis of the smaller arteries and myocardial interstitial fibrosis lesions was also revealed. In view of the severity of the described lesions, the absence of any associated cardiovascular risk factors and the context of immunodepression, the role of a virus in the genesis of these lesions is suggested, in particular a virus of the herpes group.
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We shall emphasize the notion of wide variability in the tolerance and resistance to anoxia of the myocardium, although the most important parameters are temperature and time. They can be modified widely by accompanying physical or biochemical conditions: --Cardiac distension and drugs inducing cardiac arrest; --Resuscitative perfusion; --The effect of some biochemical components is more likely explained by their possible action on the mitochondriae (glyoxilic acid-Isoproterenol). The study of the mitochondriae alone can explain the different behaviours of hearts subjected to anoxia in various situations.
We carried out a retrospective analysis of 1500 forensic autopsies following sudden unexpected cardiac death. This analysis showed a group of 43 cases that could have been related to surgery and/or anaesthesia. Pathological examination revealed the existence of cardiac lesions in 40 cases: arrhythmogenic right ventricular cardiomyopathy (14 cases), coronary artery disease (9 cases), cardiomyopathy (8 cases), structural abnormalities of the His bundle (7 cases), mitral valve prolapse (1 case) and acute myocarditis (1 case). These disorders are compatible with a paroxysmal (rhythmic) phenomenon at the origin of the cardiac arrest. Identification of the cause of death in a patient who was presumed to be at low risk may provide major relief to the patient's family and the medical staff.
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