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Biomedical subjects

Y Etienne

Publications and source records attributed to Y Etienne.

At least 37 records · Page 2Linked to original sources
PubMed1995

Establishing water and sanitation programmes in conflict situations: the case of Iraq during the Gulf War.

In armed conflicts, health and technical assessments made before initiating emergency water and sanitation programmes are hardly ever complete and accurate. Obstacles and constraints inherent in the initial assessment phase have an inevitable impact on the selection and ranking of priorities. The emergency phase of a programme calls for short-term objectives: the first activities are already under way as problem identification proceeds. Frequently updated assessments are an integral component of ongoing programmes, so as to ensure continuous readjustment of short-, medium- and long-term objectives and an appropriate response to needs. In this article, as an example, we describe the various stages in assessing water and sanitation problems, first in Baghdad and then in southern and northern Iraq, between February and May 1991. Our aim is to explain the background that led to the implementation of the programme in the Iraqi capital and the provinces.

Emergencies↗
PubMed1994

[Elastic recoil after transluminal coronary angioplasty; implications of clinical and angiographic data].

Secondary elastic recoil after transluminal coronary angioplasty is a constant and immediate phenomenon after successful coronary angioplasty. It was studied by quantitative coronary angiography in 75 consecutive patients undergoing transluminal coronary angioplasty. This procedure was performed on lesions presumed to be responsible for the clinical presentation. The population was divided into 3 groups: stable angina (25 patients), unstable angina (25 patients) and recent post-infarction ischaemic syndromes (25 patients). There were 57 men and 18 women (mean age 59 +/- 11 years) with 31 left anterior descending (LA), 29 right coronary (RC) and 15 left circumflex (Cx) dilatations. The lesions dilated were eccentric in 29 cases and calcified in 37 cases whereas only one thrombus was detected at coronary angiography. The elastic recoil appreciated 10 mn after the last balloon inflation was 0.97 +/- 0.28 mm for the whole population. There was no significant difference between the 3 groups studies (respectively 0.94 +/- 0.24 mm; 0.96 +/- 0.26 mm; 0.99 +/- 0.33 mm). This appeared to be greater than the RC (1.06 +/- 0.30 mm) with respect to the Cx (0.86 +/- 0.23: p < 0.02) or LAD (0.92 +/- 0.25 mm: p < 0.04). Overall, a balloon to vessel diameter ratio > 1 and a lesion length > 10 mm were parameters predicting greater secondary elastic recoil (p < 0.07 and p < 0.001 respectively), whereas the degree of eccentricity only played a role in the post-infarction ischaemic syndromes and calcification only in unstable angina (p < 0.01 and p < 0.001 respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Prevalence survey of precancerous lesions of the oesophagus in a high-risk population for oesophageal cancer in France.

The prevalence of precancerous lesions of the oesophagus and their association with alcohol drinking, tobacco smoking and some dietary factors were examined in an endoscopic survey carried out in Lower Normandy, France, a high-risk area for oesophageal cancer. The study included 134 male volunteers of 35-64 years of age. In 124 of the volunteers oesophageal biopsies were evaluable. At histology, the prevalence of chronic oesophagitis, epithelial atrophy and dysplasia was 63%, 1.6% and 4.8%, respectively. The prevalence of these precancerous lesions was significantly associated with cigarette smoking and frequent consumption of butter.

Adult↗
PubMed1993

[Spontaneous and isolated dissection of the coronary arteries, apropos of 8 cases with favourable outcome].

Spontaneous coronary artery dissection is rare compared with the high incidence of atheromatous coronary artery disease. Eight new clinical and angiographic cases diagnosed between 1984 and 1990 are reported. The patients were 6 men and 2 women with an average age of 44.1 +/- 10.7 years. The initial presentation is angina in half the cases, and myocardial infarction in the other half. Clinical signs and the results of non-invasive investigations are non-specific. Diagnosis is made by coronary angiography. The dissection is usually observed on a proximal segment of one of the main coronary arteries. In 5 cases, the disease was confined to a single vessel left anterior descending (3) and right coronary arteries (2). One patient had double vessel disease (left anterior descending and left retroventricular arteries); one patient had triple vessel disease (left anterior descending left circumflex and right coronary arteries), and finally, one patient had left main stem disease extending to the left anterior descending and first diagonal arteries. There was no aetiological factor in 5 cases whereas 3 had coronary atherosclerosis. After a period of 25 months all patients are alive. Five have drug therapy and 3 have undergone coronary bypass surgery. Six patients are asymptomatic and 2 have mild angina. One patient's coronary circulation has returned to normal. The extension of the indication of coronary angiography explains the diagnosis of an increasing number of spontaneous coronary artery dissection. The condition is serious but there are more and more long-term survivors as in our series.

Adult↗
PubMed1993

[Current etiologies of chronic or subacute surgical, pure aortic insufficiencies in adults. Apropos of 91 medico-surgical cases].

Ninety one patients (78 men, mean age 53; 13 women, mean age 50) from a geographically stable and ethnically homogeneous population (Eastern Brittany) underwent surgery for chronic or subacute aortic insufficiency (AI), present alone, between 1986 and 1992 (72 aortic valve replacements, 17 Bentall type (Cabrol modification) operations, 2 ascending aorta reduction plasties combined with aortic valve replacement). Preoperative clinical and paraclinical findings were reviewed in the context of peroperative and pathological findings. Etiologies were as follows in decreasing order of frequency: 1) degenerative: 40 cases (44%): 34 men and 6 women, with aneurysm of the ascending aorta (19 cases); 2) sequelae of infectious endocarditis: 20 cases (22%): 14 men, 6 women; 3) post-inflammatory (rheumatic): 16 cases (18%): 16 men; 4) congenital bicuspid valves: 15 cases (16%): 14 men, 1 woman. Chronic (or subacute) surgical AI is currently an essentially male disorder, presenting mainly during the 6th decade of life, the foremost cause of which, identifiable in the majority of cases on the basis of simple preoperative findings, is degenerative disease of the aorta of or the aortic valve itself.

Adult↗
PubMed1992

[Patency of the artery responsible for myocardial infarction: role on ventricular function and long-term outcome].

Out of 3,171 consecutive patients referred for coronary angiography, 240 were selected on the following criteria: recent primary myocardial infarction, single vessel coronary disease, no angioplasty or coronary surgery after the angiography which was performed 20 to 90 days after the onset of myocardial infarction. The patients were divided into 2 groups according to whether the artery responsible for infarction was patent (Group I: 115 patients) or not (Group II: 125 patients). The left ventricular ejection fraction was significantly higher in Group I (58 +/- 10.8%) than in Group II (53.7 +/- 11.3%) and end systolic and end diastolic left ventricular volumes were greater in Group II (51.8 +/- 22 ml/m2 and 88 +/- 22 ml/m2 respectively). Long-term follow-up (56 +/- 25 months in Group I and 61 +/- 26 months in Group II) was possible in 112 patients in Group I and 123 patients in Group II. Of the 7 patients who died in group II, 4 deaths were of cardiac origin; in addition, 2 cases of sustained ventricular tachycardia were observed in this group. None of the 6 deaths observed in Group I was of cardiac origin and there were no cases of ventricular tachycardia (p = 0.05). The functional status was identical in the two groups at the end of the study. These results suggest that the patency of the coronary artery responsible for myocardial infarction at a distance from the acute event is associated with better left ventricular function and a better long term prognosis.

Adult↗
PubMed1991

[One year results of sequential mammary artery anastomoses. 120 clinical cases. Angiographies: 71 patients].

From 1985 to november 1989, 270 patients underwent sequential anastomosis with left internal mammary artery (LIMA) on left descending artery (LDA) and diagnonal artery (DA). The first 120 cases have 100% one year follow-up. The perioperative status was: angina stage III or IV: 59%; myocardial infarction (MI): 45%, stenosis of 3 vessels: 52.5%; stenosis of main coronary artery: 10.8%. 2.25 anastomoses were performed per patient. Side-to-side anastomosis (kissing) were not diamond anastomoses but axial and longitudinal. The use of fibrin gllude provides regular curves of the graft between anastomosis. Mortality was 0.8%, morbidity was: MI: 4.2% (2 small infarcts in anterior vessels, 3 others in non-grafted vessels); mediastinitis: 1%; severe bleeding (reoperation): 1%. At one year 93% of patients are free from angina and 71 patients underwent angiographic assessment (145 LIMA anastomosis). Results are as follow: side-to-side anastomosis patency: 98.5%; distal anastomosis obliteration: 3%; LDA anastomosis patency: 95.7% overall sequential anastomosis patency: 97.6%. These results have led our cardiologist in Brest to naturally prefer a surgical approach than percutaneous angioplasty when LDA and DA are involved.

Adult↗
PubMed1991

[Current anatomical and etiological aspects of chronic or subacute, surgical, pure mitral valve insufficiency in adults. Apropos of 75 medicosurgical cases].

Seventy five medico-surgical cases (52 men, with a mean age at surgery of 59, and 23 women, with a mean age at surgery of 59) collected between 1983 and 1989, in an ethnically homogeneous and geographically stable population (West Brittany) confirmed that the current anatomical and etiological aspects of chronic (or subacute) pure mitral incompetence (MI) have changed radically. While rates for bacterial and ischemic etiologies remain stable, the share of rheumatic MI (14 cases) has fallen considerably, to the advantage of degenerative MI (51 cases) with a heavy male predominance (39 men) with in 33 cases rupture of the main chordae, and tending to affect the lesser mitral cusp more often. A precise diagnosis in terms of lesions and etiology is possible in almost all cases on the basis of clinical history and echocardiographic findings. In a perfectly homogeneous population, chronic surgical pure MI is currently essentially a male disease, of dystrophic origin, in patients in the 6th and 7th decades of life.

Adult↗
PubMed1990

[Painless myocardial ischemia. Comparison of 2 groups of patients with a positive exercise test after myocardial infarction].

Myocardial ischemia usually presents with chest pain, the characteristics of which are well known. However, anginal pain may be absent during true ischemia, an entity known as painless or silent myocardial ischemia. Does this type of ischemia have special clinical, angiographic or ergometric characteristics after posterior myocardial infarction (MI)? In order to answer this question 183 consecutive patients with recent posterior MI who had undergone coronary angiography and who had positive exercise stress tests on bicycle ergometers were separated into two groups depending on whether they had experienced at least one episode of pain after the acute phase of myocardial infarction or during the exercise stress test (Group S: 83 patients, average age 54 +/- 10 years) or not (Group A: 100 patients, average 54 +/- 8 years). The following parameters were commoner in Group A: cigarette smoking, heart rate and load developed during exercise stress testing provoking electrical signs of ischemia, single vessel disease on coronary angiography, long-term medical treatment. On the other hand, the following parameters were statistically more frequent in Group S: hypercholesterolemia, preinfarction angina, degree of ST depression during exercise testing, reperfusion of the distal vessels of the occluded artery responsible for the infarct by a collateral circulation, triple vessel disease and surgical treatment. However long-term follow-up (average 3 years) shows that mortality and recurrence of MI are similar in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiocardiography↗
PubMed1990

[Evaluation of the normal bioprosthetic Intact aortic valve by Doppler echocardiography].

The Medtronic Intact is a recently commercialized porcine bioprosthesis. Its function and ultrasonic characteristics have not been widely studied. The authors performed a prospective Doppler echocardiographic study of 38 patients with Intact bioprosthesis (n. 19:1, n. 21:10, n. 23:9, n. 25:14, n. 27:3, n. 29:1) implanted in the aortic position and without clinical signs of dysfunction over a period of 8 +/- 5 months after surgery. The following parameters were measured: maximum and mean velocities, maximum and mean transprosthetic pressure gradients, permeability index (PI) or the ratio of subaortic to transprosthetic velocities, and the effective prosthetic surface area (S) calculated using the continuity equation. The PI and S were calculated by two methods, the first using the ratio of maximum velocities (PI1 and S1) and the second using the ratio of the velocity-time integrals (PI2 and S2). The global results were: Vmax 2.65 +/- 0.4 m/s range 1.9 to 3.7 m/s), maximum pressure gradient 29 +/- 9 mmHg (range 15-55 mmHg), mean pressure gradient 16.8 +/- 5.6 mmHg (range 9-32 mmHg), PI1 37.8 +/- 4.5 p. 100 (range 26-48%), PI2 39.1 +/- 5.5 p. 100, S1 1.25 +/- 0.19 cm2 (range 0.96-1.7 cm2) and S2 1.29 cm2 +/- 0.17 cm2. Minimal central prosthetic valve regurgitation was observed in 2 cases (5%). No correlations were found between the size of the prosthesis and blood flow velocities, pressure gradients or permeability indices. On the other hand, a correlation was observed between S and the size of the prosthesis (r = 0.88, p less than 1.10(-6) (S1); r = 0.80, p less than 1.10(-6) (S2)).(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗
PubMed1990

[Left auricular hypertrophy in aortic stenosis in adults].

Left atrial hypertrophy (LAH) was noted from the electrocardiograms of 72 of 98 adult patients (81%) who underwent hemodynamic evaluation of calcified aortostenosis (CAS). The relations between LAH and clinical, echographic and hemodynamic findings are specified. The frequency of LAH was not higher in cases of a history of hypertension, angina pectoris, lipothymia or exercise-induced syncope. In contrast, dyspnea was more frequently associated with LAH (84%) than not (17%). An approximately linear relation was seen between LAH and the mean pulmonary capillary pressure, the mean rate of circumferential decrease (RCF), the coefficient of muscle rigidity (ks of Mirsky), the left ventricular mass (LVM) and the left ventricle-aorta gradient. LAH is, therefore, a frequent sign in patients presenting CAS. Its origin is multifactorial, with a predominance of increased mean capillary pressure in cases of clinical signs of poor safety.

Aortic Valve Stenosis↗
PubMed1990

[Anterior interventricular revascularization using the internal mammary artery. Short and medium-term follow-up of 140 patients].

Between February 1983 and June 1987, 140 patients underwent surgery for anterior interventricular revascularization using the left internal mammary artery (the right had been used once). Operative mortality was 3.5%, but this value decreased to 2.2% when the familiarization period for the technique was taken into account. 112 patients were monitored for at least 11 months, and 85 of these accepted an angiographic examination at the end of the follow-up period. No graft was occluded. Only two were thin due to an inadequate stenosis of the anterior interventricular septum. One graft was 90% stenosed at its anastomosis. Moderate competitive flux was noted in five cases. These results are in agreement with published findings, and comparison with literature reports confirms that the internal mammary artery is superior to the saphenous vein as graft material.

Adult↗
PubMed1989

[Short loss of consciousness: etiology and diagnostic approach. Results of a prospective study].

Transient loss of consciousness is a frequent reason for hospitalization, but very few prospective studies have been devoted to this topic. Our study involved 150 patients who were admitted for sudden and total loss of consciousness (syncope) with spontaneous return to normality. All patients underwent thorough physical examination, standard laboratory tests, electrocardiography (ECG) and radiography of the chest. Depending on the results of this first evaluation, the patients were investigated for postural hypotension and had carotid sinus massage, electroencephalography (EEG), computerized tomography of the brain, cardiac Holter recording, electrophysiological exploration and, if necessary, other special examinations. The cause of the syncope was found in 93 cases (62 per cent); it was cardiac in 39 cases (bradycardia 25, tachycardia 14), vascular in 20 cases (vagal 14, postural hypotension 6), epileptic "grand mal" type in 32 cases and "miscellaneous" in 2 cases. The syncope occurred in a state of acute drunkenness in 14 cases and was unquestionably due to the absorption of medicines in 6 cases. Clinical findings and ECG or EEG provided the aetiological diagnosis in 82.7 per cent of the patients and the other, sophisticated examinations in 17.3 per cent. These results are similar to those of other prospective studies found in the literature. It may be concluded that the causes of the syncope are only found in about 2 out of 3 cases, that clinical data are all-important in the diagnostic approach and that complementary examinations are either unnecessary or yield little that is not already suggested by clinical examination.

Adolescent↗
PubMed1989

[Hemodynamic effects of intravenous magnesium sulfate in man].

The haemodynamic effects of a single 3 g dose of magnesium sulfate administered by slow (1 min) intravenous injection were evaluated in 16 patients with coronary disease about to be explored by coronary arteriography. The haemodynamic effects were transient, with maximal values at the end of the injection and return to baseline values within less than 3 min. They consisted of peripheral vasodilatation with a decrease in systolic aortic pressure (128 +/- 18 mmHg versus 113 +/- 17 mmHg, p less than 0.05), an increase of cardiac index (3.0 +/- 0.4 versus 3.8 +/- 0.06 1/min/m2, p less than 0.001) and a fall in peripheral arterial resistance (1168 +/- 203 versus 919 +/- 29 dyn/s/cm-5, p less than 0.01). This action was accompanied by a moderate increase in contractility (Vmax) (1.63 +/- 0.34 versus 1.87 +/- 0.47 CIR/s, p less than 0.01) without changes in the relaxation index T (37 +/- 8 versus 67 +/- 9 s-1, NS), but with concomitant increase in heart rate (80 +/- 12 versus 67 +/- 10 beats/min, p less than 1.10(-4]. It is concluded that the haemodynamic effects of magnesium sulfate are moderate and transient and that this substance can be used safely as antiarrhythmic agent, even in case of marked deterioration of the left ventricular function.

Adult↗