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Biomedical subjects

Y Juillet

Publications and source records attributed to Y Juillet.

At least 55 records · Page 3Linked to original sources
PubMed1978

[Thrombolytic treatment of arteriopathies].

Systemic streptokinase has shown its effectiveness in the treatment of recent arterial obstruction of the limbs. The haemorrhagic and embolic complications of this type of treatment nevertheless limit its indications. Streptokinase should be reserved for acute thromboses present for less than two months, and responsible for severe ischaemia without the possibility of surgical treatment. The intra-arterial administration of urokinase limits the risks of systemic fibrinolysis, though the effectiveness of the therapeutic protocols proposed has yet to be demonstrated.

Arterial Occlusive Diseases↗
PubMed1978

[Cardiac amyloidosis: clinical, x-ray, electric, hemodynamic, developmental and pathological aspects. Apropos of 85 cases collected from French cardiology departments].

85 cases of cardiac amyloidosis have been collected from the university cardiac departments of France. Four distinct clinical pictures have emerged: 1. Primary cardiac amyloidosis (36 cases) which combines: congestive cardiac failure, ECG signs (extreme axis deviation, low voltage, signs of myocardial necrosis), arrhythmias (67%), and a rapidly fatal outcome (23.2 m +/- 8.5); 2. Cardiac amyloidosis associated with a marked neuromuscular amyloidosis (8 cases), in patients of Portuguese extraction (4 out of 8), with a positive family history (6 out of 8), characterised by arrhythmias (5 out of 8), and with a better prognosis (1 death out of 8); 3. Cardiac amyloidosis associated with a dysglobulinaemia (14 cases) with a clinical picture which is almost identical with that of primary cardiac amuloidosis; 4. Senile cardiac amyloidosis, whose frequency increases with age, may sometimes be discovered at routine post mortem examination, and is characterised by atrial fibrillation (13 out of 27) and its association with anaemia, signs of inflammation, and coronary atheroma.

Aged↗
PubMed1977

Hemodynamic evaluation of hypotension during chronic hemodialysis.

Hypotensive episodes occur frequently during hemodialysis; they are often sudden and difficult to prevent despite careful clinical control. Their etiology was studied by investigating the hemodynamic response of five patients submitted to ultrafiltration during their three first dialyses. A Swan Ganz catheter was inserted and left in position for 5 days. Simultaneous determination of cardiac output, mean pulmonary artery (PAP) and capillary and systemic arterial pressures were recorded. 10 hypotensive episodes were observed. In 3 patients in whom the first hypotensive episode occurred 10 minutes after the start of dialysis, there was a significant drop in PAP, cardiac index and stroke index while heart rate and peripheral resistance remained unchanged. Paradoxical bradycardia was observed. In 4 patients hypotension was observed more than one hour after initiation of dialysis. Before the hypotensive episode there was moderate elevation of heart rate and peripheral resistance and an insignificant reduction in PAP. Cardiac index and stroke index were diminished. The decrease in MAP was only 2 mm Hg. Hypovolemia is the most important factor in hemodialysis-induced hypotension but other factors such as vagal stimulation, autonomic neuropathy and osmotic disequilibrium can interfere with blood pressure control and trigger hypotension. Methods of preventing hypotension during dialysis, including the infusion of low molecular weight dextran, are discussed.

Adult↗
PubMed1976

[Course and prognostic factors of unstable angina. Apropos of 100 cases].

The immediate and medium term (3 years) of unstable angors was specified by the study of 100 hospitalized patients. The cases selection was based on the existence of angina pain which had appeared or reappeared less than a month before, during more than fifteen minutes and/or repeated, which were more and more frequent, less and less sensitive to nitroglycerine, and in the absence of recent myocardial infarction signs. The immediate course seemed relatively favorable; during the initial hospitalisation there were only nine myocardial infarctions and three deaths. The alarming factors of initial prognosis are essentially the persistence or recurrence under medical treatment of angina pain hardly relieved by nitroglycerine. The course over three years was bad; 23.6% of deaths, especially of cardiac origin (14/17) were noted; more than 80% or the surviving patients kept enduring more or less severe pains; persistence of electric signs on the ECG during the initial course was the only significant pronostic factor that was regularly noted. As regards the 16 patients treated by surgery, operative death rate remained high (3/16), but remote functional results were good (8/12 asymptomatic). Only randomized studies on homogenous groups, carried out during an enough long course, will enable us to specify therapeutic indications better.

Adult↗
PubMedDate not supplied

[Communication and transparency concerning risk-benefit analysis in public health: the example of medication].

As far as communication of the evaluation of risk benefit assessment of medications is concerned, validated and interpreted data only have to be taken into account. Free access to information by the public has to be considered seriously and there is now a real and strong demand. This situation has to be viewed in parallel with the huge development of websites communicating information on health issues. This report summarizes the discussion between the authorities and pharmaceutical companies and reports the different concrete proposals that emerged.

Adverse Drug Reaction Reporting Systems↗
PubMedDate not supplied

[Compliance, efficacy and quality of life].

Compliance is the appropriateness of patient behaviour to therapeutic prescriptions. Good compliance increases treatment efficacy although its constraints may harm quality of life. Factors affecting compliance are related to the patient, the disease, health-care workers, family and treatment itself. Psycho-sociologic theories have attempted to explain patient behaviour. In clinical trials, compliance has to be optimized, i.e. in the protocol, during the study and the statistical analysis. In real life, compliance concerns all those involved in health-care, particularly for education, training and motivation of the patients and their immediate environment. Observational surveys relating to compliance are needed to determine prioriites and to develop a "compliance approach" based on improving information and the use of tools for better therapeutic adherence. Evaluation of the quality of life and patient satisfaction aspects is necessary to validate this approach.

Drug Therapy↗
PubMedDate not supplied

[Antithrombin III in 86 patients with venous thrombosis (author's transl)].

Antithrombin III concentration was studied in 86 patients with recurrent or extensive venous thrombosis. Two of them were found to have an hereditary antithrombin III deficiency. 25 patients receiving heparin therapy had low antithrombin III concentration. After stopping heparin treatment antithrombin rose to a normal level. Pathological antithrombin III modifications are recalled (synthesis decrease in liver diseases, intra vascular consumption during active venous thrombosis). Antithrombin III decreased activity induced by heparin treatment is pointed out.

Antithrombin III↗
PubMedDate not supplied

[Lactic acidosis and intensive care. 16 cases (author's transl)].

Sixteen cases of lactic acidosis are reported: 7 phenformin treated diabetes, 5 cardiovascular diseases (2 myocardial infractions, 2 pulmonary embolisms, 1 heart failure). In 2 patients no etiology was found. Concomittant renal failure or liver diseases were found in respectively 9 and 4 cases. Patients presented the usual criteria of lactic acidosis: clinical, polypnea, severe hypotension (9/16), peripheral symptoms of shock (12/16), hypothermia (9/16), abdominal pain (9/16): biologically, acidosis (pH = 6,99 +/- 0,01, HCO3- = 5,9 +/- 1,5 mmol), hyperlactatemia (14,1 +/- 3,6 mmol/l) with hig lactate/pyruvate ratio (105 +/- 73), and anion gap (24,3 +/- 4,2 mmol/l). Sodium bicarbonate infusion was performed in all cases (2,5 to 42 mmol/kg). Few cases required volhemic expansion or furosemid induced diuresis. One patient was treated with extrarenal dialysis. 13 patients were alkalinised with less than 185% of estimated deficit measured from alkalin reserve: 12 died. 3 patients received 185% more than this deficit, associated with furosemid (1,8 to 12,5 mg/kg): only one patient died ten days after by casual disease, with lactatemia of 3,2 mmol/l. In spite of the small number of patients, these findings suggest that an early and massive alkalinisation, with large doses of furosemid, can improve the severe lactic acidosis prognosis.

Acidosis↗