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Biomedical subjects

S Witchitz

Publications and source records attributed to S Witchitz.

At least 19 recordsLinked to original sources
PubMed1992

[Outcome of prognostic factors of infectious endocarditis over a 16 year period. Apropos of 471 cases].

Four hundred and seventy one cases of infective endocarditis (IE) were reviewed: 338 native valve IE and 133 prosthetic valve IE (42 early and 91 late IE). Two periods were compared: 1973-1980 (250 cases) and 1981-1988 (221 cases). There was a decrease in native valve IE (78% to 64%) and an increase in late prosthetic valve IE (13% to 27%), little change with respect to age, causal cardiac disease, delay in diagnosis (except in native valve IE, 39 to 29 days), or frequency of complications, especially cardiac (50% and 51%). However, global mortality decreased from 41% to 27% (p < 0.001). The evolution of the frequency of cardiac complications, cardiac surgery and mortality for the two periods was: for native valve IE respectively 53% to 42%, 41% to 37%, 37% to 20% (p < 0.005); for early prosthetic valve IE respectively, 45% to 55%, 41% to 55%, and 82% to 50% (p < 0.05); for late prosthetic IE, respectively 34% to 69%, 34% to 69% and 37% to 36%. The frequency of surgery had therefore little influence on prognosis except in early prosthetic valve IE. The percentage of infections which could not be controlled medically decreased from 17% to 11%. The mortality of unoperated patients decreased from 46% to 28% (p < 0.01), suggesting more effective antibiotherapy, and the mortality of operated patients fell from 34% to 26%. Global surgical mortality was 35% in the acute phase (positive valve culture), 14% after sterilisation (p < 0.001) and the corresponding frequencies of paravalvular leaks was 17% and 4% (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1979

[Echocardiographic diagnosis of 4 cases of tricuspid valve endocarditis].

Four tricuspid endocarditis cases are reported. Echocardiography found, four times, large vegetations on the tricuspid leaflets leading to the diagnosis. The degree of tricuspid insuffisancy was appreciated by the RV/LV ratio. Successive echos have permitted to survey the evolution and specially to establish a clear decrease of abnormal tricuspid echoes succeeding to pulmonary embolisms. In the four cases, surgery confirmed the diagnosis.

Adolescent↗
PubMed1979

[Risks and long-term results or tricuspid monovalvular replacement, using a ball or disk prosthesis. Apropos of 21 cases].

21 patients (15 with stage IV and 6 with stage III symptoms by the NYHA classification) underwent monovalvular tricuspid replacement with a ball or disc prosthesis for varying tricuspid pathology, bacterial endocarditis in half the cases, between June 1964 and July 1973. Hospital mortality was 29 p. 100 (6 patients), medium-term mortality, nil. There were 23 survivors (62 p. 100) with an average follow up of 7 years (range 5 years to 10 years 4 months), 12 of whom recovered to stage I disability by the NYHA classification after the first postoperative year. 12 patients are on long-term anticoagulant therapy and 3 on diuretic or digitalo-diuretic therapy. The main complications observed were 2 prosthetic thromboses and 3 haemorrhages for 1095 patient-months. The results are to be compared with those bioprostheses, which, not requiring anti-coagulant therapy, may tend to supplant ball and disc prostheses.

Adolescent↗
PubMed1979

[Biological determination of the beta blocking activity of human serum].

A method of biological assessment of the Beta blocking activity of human serum is reported. It is based on the catecholamine response of rat myocardial cells in culture, incubated in the serum to be tested. Its advantage is that it takes into account all block-blocking substances present in the serum, not only the drug itself but also its possible active metabolites. The results obtained by this method in 10 healthy subjects after 60 mg penbutolol were compared with those given by chemical dosage and ergometry. The ergometric and biological changes were parallel from the 2nd and the 8th hour while the serum levels of the drug rapidly. This discordance could be due to the presence of an active metabolite, 4-hydroxy-penbutolol.

Adrenergic beta-Antagonists↗
PubMed1978

Acute mitral valve obstruction during infective endocarditis.

Five patients were found during surgery or at necropsy to have the mitral valve orifice obstructed by vegetations. They had had unexplained severe and recurrent episodes of acute febrile pulmonary oedema, and four had few cardiac ausculatory findings. Three patients died suddenly and unexpectedly; the other two were operated on and survived. In view of its ominous prognosis, acute mitral valve obstruction should be considered in patients whose pulmonary symptoms are compatible with endocarditis and are not adequately explained by the findings on examination of the heart. The condition, which should be confirmed by echocardiography, requires emergency surgery.

Adolescent↗
PubMed1977

[Anatomic and bacteriological study of surgically extracted valves in patients with bacterial endocarditis].

We studied 64 cases of bacterial endocarditis which required heart surgery for hemodynamic defects and/or failure of the antibiotic therapy. We performed a bacteriologic and histologic investigation of the removed valves. The organisms were evidenced through culture and specific stainings. According to the different organisms we evaluated the best duration of antibiotic therapy to achieved sterilization, and suggest a helpful medical and surgical treatment for the bacterial endocarditis.

Anti-Bacterial Agents↗
PubMed1976

Opening snap and isovolumic relaxation period in relation to mitral valve flow in patients with mitral stenosis. Significance of A2--OS interval.

In 15 patients with pure or predominant mitral stenosis and in a control group of 11 patients without mitral stenosis the blood flow velocity through the mitral valve orifice was recorded by means of a directional Doppler ultrasound velocity catheter introduced transeptally and positioned in the orifice of the mitral valve. A simultaneous surface phonocardiogram was obtained. The timing of the mitral opening snap in relation to the blood velocity record of the flow through the valve supported the hypothesis that the opening snap is due to a sudden tensing of the valve leaflets by the chordae tendineae. Determination of the exact time of mitral valve opening, made possible by the blood velocity record, led to the division of the classical A2-0S interval (aortic valve closure to opening snap) into two components representing respectively the diastolic isovolumic relaxation period and the time of excursion of the mitral valve cusps. The durations of the isovolumic relaxation period were compared with those in the control patients and were found to correlate with the severity of the mitral stenosis, whereas those of the excursion time of the mitral cusps were influenced by the presence or absence of mitral valve calcification.

Adult↗
PubMed1976

Pseudomonas aeruginosa endocarditis. A report of nine cases.

9 cases of Pseudomonas aeruginosa endocarditis are reported and the results of this study are compared with the data of the literature. The source of infection was known in 8 patients: 7 were nosocomial infections (cardiac catheterization in 5 cases, cardiac surgery in 2 cases). The diagnosis was made in 8 patients with left-sided endocarditis. In 1 patient tricuspid endocarditis was diagnosed on postmortem examination. Carbenicillin associated with an aminoglycoside antibiotic appeared to be the most effective treatment when prescribed for several weeks. 6 of 9 patients died of uncontrolled septicemia, 3 of whom underwent surgery which was twice performed because of poor hemodynamic status. In the other 3 patients drug administration was effective at first. However, a relapse occurred in these three cases compelling another effective antibiotic therapy. Surgery was peformed in these three patients. Valve cultures were negative in two cases and positive in 1. These 3 patients survived. They are still alive after a follow-up period of 2 or 3 years.

Adult↗
PubMed1976

[Treatment of obstructive cardiomyopathy using myotomy in a 67-year-old patient. Pharmacological and angiographical studies].

The case is reported of a 67 year old man with obstructive cardiomyopathy treated by an extended myotomy. Serial phonomechanographic tracings and the pre- and post-operative angiograms show the steady progress of the disease towards a major disturbance of left ventricular compliance which became resistant to propranolol, and was partially reversed by myotomy.

Age Factors↗
PubMed1975

Normal pattern and physiological significance of mitral valve flow velocity recorded using transseptal directional Doppler ultrasound catheterization.

In 10 cardiac patients in whom an organic lesion of the mitral valve was exluded by standard investigation procedures during which a diagnostic transseptal catheterization for pressure measurements in the left heart was performed, the authors placed a directional Doppler ultrasonic catheter tip velocimeter at the site of the mitral ring and recorded the mitral flow velocity traces. The pattern of these normal curves is presented and a physiological interpretation proposed. The relation between the mitral flow velocity and low volume curves is discussed in the light of present experimental data on mitral valve flow velocity profiles and variations in size of the mitral orifice. The authors concluded that the flow velocity curves obtained by the Doppler technique constitute a valid physiological reference system for the study of the mitral valve flow velocity tracings that can be recorded in the various forms of mitral valve disease.

Adult↗