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Biomedical subjects

A Kane

Publications and source records attributed to A Kane.

At least 37 records · Page 2Linked to original sources
PubMed2001

[Peripartum idiopathic myocardiopathy: prospective echocardiographic study].

Still frequent in Africa, the idiopathic peripartum cardiomyopathy (PPC) is the subject of only few prospective studies. The aim of this prospective work was to assess the echocardiographic abnormalities of the PPC and to determine on 26 patients the evolution and the prognostic factors of this disease. Six women had mild to moderate pericardial effusion. The abnormalities of the wall motion, constantly found, were diffuse in 20 cases (77.1%) and localized or prevalent on the interventricular septum or the left ventricular posterior wall in the other cases. The cardiac chambers were dilated in 24 cases (92.3%). Left ventricular hypertrophy was noted among 16 patients (61.5%); it was eccentric in 15 cases. The left ventricular systolic dysfunction was constant. The other abnormalities were: the abnormal left ventricular relaxation (one case), low mitral and aortic flow (12 cases), the mitral (21 cases) and tricuspid regurgitation (five cases). One noted a septal hypertrophy and an isolated dilatation of the right ventricle. The mean follow-up was 7.3 +/- 1 month (1-18 months). Two patients died at the 4th and 8th month. Among the 24 survivors, 11 had normalized were: the gestity (p = 0.01), the parity (p = 0.01), the cardiothoracic ratio (p = 0.04), the left ventricular volumes (p = 0.02), and the parameters of left ventricular function. The echocardiography of patients with PPC usually shows a pattern of dilated and hypokinetic cardiomyopathy, but many variations are possible. Most of the patients keep echocardiographic abnormalities after mean term follow-up.

Adolescent↗
PubMed2001

Profiling the adult human liver transcriptome: analysis by cDNA array hybridization.

BACKGROUND/AIMS: A comprehensive profile of genes expressed at the mRNA level (transcriptome) in human liver tissue is important for elucidating the pathogenesis and treatment of hepatic diseases. The recent development of cDNA array hybridization allows the parallel monitoring of thousands of genes expressed in a single organ. METHODS: High-density microarrays containing 4043 known and unique human cDNA gene targets were used to quantitatively analyze the expression of genes in human livers. Expressed gene transcripts were classified by function and listed with information of their chromosomal positions. Computational analysis was used to cluster genes according to similarity in pattern of gene expression. RESULTS: A total of 2418 unique gene transcripts were detected in five liver specimens. Through relational database analysis, we determined 1212 genes that were commonly expressed in 4 of the five liver specimens. Furthermore, analysis of the total 2418 expressed genes by self-organizing maps and hierarchical clustering unexpectedly revealed a genomic acute phase response in two of the liver specimens. CONCLUSIONS: These findings represent a comprehensive preliminary molecular index of genes transcribed in the adult human liver. The information may serve as a resource for speeding up the discovery of genes underlying human hepatic diseases.

Adult↗
PubMed2001

[Echocardiographic aspects in pediatric patients with sickle cell disease].

BACKGROUND: Cardiovascular involvement is not well studied in children with sickle cell disease. The aim of this study was to evaluate the echocardiographic parameters of children with sickle cell disease. PATIENTS AND METHODS: We performed a transversal and case-control study including 80 subjects of six months to 16 years of age divided into four groups of 20 children each: heterozygous sickle cell disease, homozygous sickle cell anemia, anemia of other causes than sickle cell, and healthy children. All children had a complete physical examination, biological screening including hemogram and hemoglobin electrophoresis, chest x-ray, electrocardiogram, and Doppler echocardiogram. Data were compared using the chi 2 method and the Student's t-test. RESULTS: The mean age was 8.5 years and the sex-ratio was 1. Echocardiographic abnormalities were observed in seven patients with anemia unrelated to sickle cell, 15 children with heterozygous anemia and all the homozygous patients. The main abnormalities were: left ventricular enlargement (ten homozygous patients, one heterozygous subject, five of the patients with another cause of anemia), increased contractility of the heart (18 homozygous patients, seven heterozygous patients, five in the anemia group) and mild to moderate mitral or tricuspid regurgitation (12 homozygous, five heterozygous and five patients in the anemia group). One homozygous child had a dilated and hypokinetic cardiomyopathy with pulmonary hypertension. The parameters of left ventricular systolic function and left heart chamber dimensions were lower in the control group (P < 0.04). DISCUSSION: This study shows the frequency of heart chamber dilatation with left ventricular hyperkinesis usually described in the literature. The lack of case of chronic cor pulmonale may be due to the young age of our patients. One case of dilated and hypokinetic cardiomyopathy suggests that other causes than anemia should be considered, particularly myocardial ischemia, which could not be demonstrated because of our limited investigative methods. CONCLUSION: These results emphasize the frequency of the heart involvement in sickle cell disease, particularly in the homozygous type, and point out the importance of the cardiologic screening of these patients.

Adolescent↗
PubMed2001

Plasticity of the endocranial base in nonsyndromic craniosynostosis.

Limited in vivo data exist on the dysmorphology of the cranial base in nonsyndromic craniosynostosis. Few studies have documented the effect of calvarial surgery for synostosis on endocranial morphology. Previous work has suggested that the dysmorphology of the endocranial base is diagnostically specific for metopic, sagittal, and unicoronal sutures. The purpose of this study was to further evaluate the endocranial base in infants with nonsyndromic craniosynostosis by testing the hypothesis that the dysmorphology is, to some degree, a secondary deformation rather than a primary malformation. Three questions were addressed: (1) Can individuals reliably identify affected suture-specific endocranial-base morphology using standard templates? (2) Does calvarial surgery in infancy for craniosynostosis affect the perception of endocranial-base morphology? and (3) Does calvarial surgery in infancy for nonsyndromic craniosynostosis normalize the endocranial base?In this study, three-dimensional volumetric reconstructions from archived computed tomography digital data were processed using the ANALYZE imaging software. Dysmorphology was assessed by nine independent, blinded skilled observers who reviewed two separate sets of images of endocranial bases. Both sets contained images from the same patients: one set contained preoperative images, and the other contained images of the endocranial base 1 year after calvarial surgery. Observers were asked to sort each set into four suture-specific diagnostic groups: normal, unicoronal, metopic, and sagittal. Each set contained 10 patients with unicoronal synostosis, 10 with metopic synostosis, 10 with sagittal synostosis, and four normal patients. Seventy-eight percent of the total number of preoperative images were correctly sorted into the suture-specific diagnostic group, whereas only 55 percent of the total number of postoperative images were correctly matched. With regard to the individual sutures, the results were as follows (data are presented as preoperative accuracy versus postoperative accuracy): metopic, 76 percent versus 44 percent; sagittal, 58 percent versus 34 percent; unicoronal, 100 percent versus 79 percent; and normal, 83 percent versus 72 percent. Although 36 of 306 total images per group (12 percent) actually represented normal patients, the observers called 72 of 306 normal (24 percent) in the preoperative set versus 110 of 306 normal (36 percent) in the postoperative set. In conclusion, (1) the endocranial dysmorphology of nonsyndromic craniosynostosis is recognizably specific to the affected suture; (2) calvarial surgery for nonsyndromic craniosynostosis normalizes the endocranial base qualitatively with regard to the diminished ability of raters to identify the primary pathology; and (3) the documented postoperative changes in endocranial base morphology after calvarial surgery for nonsyndromic craniosynostosis in infancy indicates that a major component of that dysmorphology is a secondary deformity rather than a primary malformation.

Craniosynostoses↗
PubMed2001

Human glioma cells transformed by IGF-I triple helix technology show immune and apoptotic characteristics determining cell selection for gene therapy of glioblastoma.

AIMS: Insulin-like growth factor type I (IGF-I) antisense cellular gene therapy of tumours is based on the following data: rat glioma or hepatoma cells transfected with the vector encoding IGF-I antisense cDNA lose their tumorigenicity and induce a tumour specific immune response involving CD8(+) T cells. Recently, using the IGF-I triple helix approach in studies of tumorigenicity, major histocompatibility complex class I (MHC-I) antigens were demonstrated in rat glioma transfected cells. This study used comparative IGF-I antisense and triple helix technologies in human primary glioma cells to determine the triple helix strategy that would be most appropriate for the treatment of glioblastoma. METHODS: The cells were transfected using the IGF-I triple helix expression vector, pMT-AG, derived from the pMT-EP vector. pMT-AG contains a cassette comprising a 23 bp DNA fragment transcribing a third RNA strand, which forms a triple helix structure within a target region of the human IGF-I gene. Using pMT-EP, vectors encoding MHC-I or B7 antisense cDNA were also constructed. RESULTS: IGF-I triple helix transfected glioma cells are characterised by immune and apoptotic phenomena that appear to be related. The expression of MHC-I and B7 in transfected cells (analysed by flow cytometry) was accompanied by programmed cell death (detected by dUTP fluorescein terminal transferase labelling of nicked DNA and electron microscopic techniques). Cotransfection of these cells with MHC-I and B7 antisense vectors suppressed the expression of MHC-I and B7, and was associated with a pronounced decrease in apoptosis. CONCLUSION: When designing an IGF-I triple helix strategy for the treatment of human glioblastoma, the transfected tumour cells should have the following characteristics: the absence of IGF-I, the presence of both MHC-I and B7 molecules, and signs of apoptosis.

Apoptosis↗
PubMed2001

Oro-dental and craniofacial anomalies in LEOPARD syndrome.

'LEOPARD syndrome' is a syndrome affecting many systems or organs. The main anomalies are summarized in the acronym LEOPARD in which each letter corresponds to the damage of a given organ. In the presented case, there are oro-dental and craniofacial anomalies. The relationship between the LEOPARD syndrome and the given anomalies and the possibilities of the management and the follow-up of the diseased are studied. The clinical case presented is a 4-year-old boy with LEOPARD syndrome showing retardation of dental development, delayed development and possible agenesis of permanent teeth, and craniofacial anomalies (osseous hypodevelopment). The bibliographical study shows that LEOPARD syndrome is due to damage of the neural crest cells. Thus, the dental and craniofacial anomalies arise since neural crest cells participate in the formation of the teeth and some craniofacial bones. Therefore, dental and craniofacial anomalies might be expected in some cases of the disease. The therapeutic management of the lesions, and the follow-up of the patient would be done by a multidisciplinary team.

Abnormalities, Multiple↗
PubMed2001

[Cardiac tamponade. Clinical, paraclinical, outcome, and therapeutic features. Report of 15 cases].

The authors perform a prospective study of 15 cases of cardiac tamponade in the Department of Cardiology of the University Hospital of Dakar (Senegal) from January to July 1999. The prevalence of cardiac tamponade is 4 %. The mean age is 33 years. There is no sex predominance. The clinical findings are: class III or IV NYHA dyspnea (86.6 %), pulsus paradoxus (66.6 %), and decrease intensity of the heart sounds (100 %). The electrocardiogram revealed sinus rhythm in 86.6 %, a low voltage of the QRS in all cases, and abnormalities of repolarization, mainly inverted T waves (73.3%). The echocardiography shows circumferential pericardial effusion (66.6 %), a "swinging heart" (53.3 %) and compression of right heart chambers (66.6 %). The main etiology was tuberculosis. The evolution is good after pericardiocentesis, surgical drainage and medical therapy. Cardiac tamponade is cardio-vascular emergency almost always due to tuberculosis with a good outcome if a prompt pericardiocentesis is performed.

Adolescent↗
PubMed2001

[Infective endocarditis at the University Hospital of Dakar. Clinical, outcome, and therapeutic features].

Mainly because of rheumatic fever,infective endocarditis (IE) is frequent in our countries and is associated with many diagnostic and therapeutic problems. We perform a retrospective study on 86 cases of IE hospitalized from December 1986 to November 1996. The prevalence of IE is 4.3% and there is a female predominance (the sex ratio is 0.56). The mean age is 26.45+/-13.22 years. 74.4% of the patients have of low socioeconomic status. The mean duration of inhospital stay is 54 days and the average diagnosis retardation is 35 days. The source of infection is found in 19 cases (15 sources are dental). The main clinical signs are: fever (63.9%), anaemia (67.4%) and weight loss (38.3%). The underlying heart disease is mainly due to rheumatic valve regurgitation (95.3%). The blood culture find microbialagent in 12.7%. Echocardiography reveals vegetations in 69.7% of patients. The main complications are : heart failure (47.6%) and stroke (33.7%). The mortality rate is high (30.7%). The treatment is only medical, none of the patients has surgical repair. This study shows that IE is frequent and is associated with many complications and a high mortality rate. These observations amphasize the importance of prevention of rheumatic fever.

Adolescent↗
PubMed2000

Comprehensive gene expression profile of the adult human renal cortex: analysis by cDNA array hybridization.

BACKGROUND: Profiling of gene expression in healthy and diseased renal tissue is important for elucidating the pathogenesis of renal diseases. Comprehensive information about the genes expressed in renal tissue is unavailable. The recently developed cDNA array hybridization methodology allows simultaneous monitoring of thousands of genes expressed renal tissue. METHODS: Complex [alpha-33P]-labeled cDNA probes were prepared from histopathologically uninvolved remnants of nine renal tissues obtained by nephrectomy. Each probe was hybridized to a high-density array of 18,326 paired target genes. The radioactive hybridization signals by phosphorimager screens were quantitated by special software. Bioinformatics from public genomic databases were used to assign a chromosomal location of each expressed transcript and gene function. Cluster analysis was used to arrange genes according to the similarity in pattern of gene expression. RESULTS: A total of 7563 different gene transcripts was detected in the nine tissue samples. Approximately 870 of these genes were full-length mRNA human transcripts (HT), and the remaining 6693 were expressed sequence tags (ESTs). The full-length transcripts were classified by function of the gene product and were listed with information of their chromosomal positions. To allow a comparison between gene expression in clinical and experimental studies, the mouse genes with known similar function to the human counterpart were included in the bioinformatics analysis. Cluster analysis of 502 full-length genes that are expressed in four or more renal tissues revealed more than 110 genes that are highly expressed in all the renal specimens. CONCLUSIONS: The presented data constitute a comprehensive preliminary transcriptional map of the adult human renal cortex. The information may serve as a resource for speeding up the discovery of genes underlying human renal disease. The integrated listing of the full-length expressed human and mouse genes is available through e-mail (Abdalla_Rifai@Brown.edu).

Adult↗
PubMed2000

Primary care workshops can reduce and rationalize antibiotic prescribing.

We describe a controlled study comparing the effects on primary care prescribing in west Gloucestershire, UK, where antibiotic workshops were offered, with those in east Gloucestershire, where microbiology tutorials were given. The year-on-year changes in quantity and costs of antibiotics dispensed following general practice prescriptions were measured. There was no significant difference in the number of antibiotic items prescribed across the county, but the number of prescriptions for broad-spectrum agents (quinolones, cephalosporins and co-amoxiclav) declined by 15.4% in west Gloucestershire, compared with a 6.5% increase in east Gloucestershire (P: = 0.002). Use of narrow-spectrum antibiotics (penicillin V, trimethoprim and nitrofurantoin), whose use was encouraged, did not change in west Gloucestershire practices, but decreased by 12% in east Gloucestershire practices (P: = 0.003). There was increased use of clarithromycin and azithromycin in both groups of practices. Antibiotic workshops held in the primary care setting can rationalize antibiotic prescribing. This can reduce prescribing costs and selection pressure by broad-spectrum antimicrobial agents and, perhaps, go some way to reducing the development of resistance.

Anti-Bacterial Agents↗
PubMed2000

[Tumoral mycetoma of the buttock].

BACKGROUND: Mycetomas are actinomycosic or fungal infections where the infectious agent produces grains. We report an atypical case of fungal mycetoma presenting as a tumoral formation on the buttock. CASE REPORT: A 56-year-old unemployed man from the Diourbel region of central Senegal consulted in February 1997 for a fistulalized tumor of the right buttock which had developed spontaneously and progressed for 5 years. The patient's general health remained satisfactory. Physical examination showed a voluminous 25 cm tumefaction extending from the right buttock to the perineum. The tumor showed a few areas of fistualization which discharged black grains under pressure. There was a 1.5 cm right inguinal node which did not appear to be inflammatory. The remainder of the physical examination was normal. Pathology reported inflammatory connective tissue surrounding a brownish polycyclic grain composed of spores and mycele filaments. The diagnosis of fungal mycetoma was retained and surgical excision under general anesthesia was performed. DISCUSSION: This is an atypical case of fungal mycetoma because of its tumoral form and gluteal localization. The differential diagnosis was cutaneous neurofibroma, myoma, or Darier-Ferrand dermatofibrosarcoma. The frequency of extrapodal red grain mycetomas has been pointed out by several authors from Senegal, but extrapodal black grain forms as seen in our case are more exceptional.

Buttocks↗
PubMed2000

Combined carotid artery injury and laryngeal fracture secondary to dog bite: case report.

Approximately 914 new dog bite injuries requiring emergency department visits occur daily in the United States. Attacks by dogs with training and strength to attack should be triaged cautiously because of the possibility of serious internal injury. A high index of suspicion is needed when treating patients with neck injuries secondary to dog bites. We report a case of successfully treated combined carotid artery and laryngeal injury produced by a dog bite.

Adult↗
PubMed2000

[Short-term course under beta blockers of clinical and echocardiographic parameters in mitral stenosis in sinus rhythm].

The purpose of this study is to evaluate the short-term benefit of a beta-blocker (atenolol) on clinical and echocardiographic parameters of patients presenting isolated or predominant mitral stenosis in sinus rhythm. It is a prospective study performed on 26 patients who have had a clinical and echocardiographic assessment before and 15 days after treatment by atenolol. After 15 days of beta-blocker treatment, there is a significant improvement of dyspnea (57.6% in class III or IV before beta-blockade versus 15.3% with atenolol; P = 0.001) and a significant decrease of the heart rate (83.3 +/- 15.2 versus 68.9 +/- 13.9; P = 0.001) and the diastolic blood pressure (8 mmHg +/- 1.3 versus 7.2 mmHg +/- 0.9; P = 0.01). The Doppler echocardiography shows a significant increase of the stroke volume calculated by the Doppler method (28.7 +/- 6.2 versus 38.6 +/- 9.7 mL; P = 0.04). There is an insignificant trend to an improvement of the left ventricular systolic function, an increase of cardiac output and the decrease of the mean transmitral gradient. The factors associated with the failure of beta-blocker treatment are: the right heart failure (P = 0.04) and the low diastolic blood pressure (P = 0.01). The beta-blockers could be a logical and effective treatment of patients with mitral stenosis waiting for balloon commissurotomy or surgery.

Adolescent↗
PubMed2000

[Intraventricular thrombosis complicating peri-partum idiopathic myocardiopathy].

Ventricular thrombosis can complicate the development and worsen the prognosis in any case of hypokinetic dilated cardiomyopathy. In the present article, a study has been made of 6 reports of ventricular thrombosis selected out of 58 medical files on women with peri-partum idiopathic cardiomyopathy. Patient age ranged from 22 to 55 years. The clinical picture showed hypokinetic dilated cardiomyopathy, complicated by cardiac failure; with its onset during the last trimester of gestation or in the 6 months post-partum. In all patients, overall cardiac failure was observed, and in all cases the diagnosis of intracardiac thrombosis was made by echocardiography. In all 6 patients, a left ventricular apical thrombosis was detected. In 2 subjects, 2 and 3 left ventricular thrombi were respectively found. In 1 case, a left ventricular thrombosis was present. In another case, a right thrombosis associated with a left ventricular thrombosis was detected. Treatment was initiated with a combination of anticoagulants (heparin and K antivitamins), diuretic and vasodilatory treatment. The clinical outcome was favorable, with the disappearance of thrombi and signs of cardiac failure (between the 15th and 54th day). No embolic complication was observed. These findings clearly show the importance of prescribing an anticoagulant treatment as a preventive measure during PPICM. Even if severe embolic complications are a potential risk, anitcoagulant treatment can ensure a favorable outcome.

Adult↗
PubMed2000

[Cri-du-chat syndrome. A case report].

We report a documented case in Senegal with cri-du-chat syndrome diagnosed in a 3 months old girl. Our patient benefited from clinical examination, ECG (15 derivations), chest X ray and standard laboratory tests. The cry has been recorded on a magnetic band. We performed also a pulsed-Doppler, two dimensional and TM echocardiography. Chromosomal analysis has been realized. These data are discussed and compared to the literature. At admission this patient presents characteristic cat like cry. At examination, there is a facial dysmorphy, important growth retardation and feeding dyspnea. Auscultation shows a 3/6 left sub-clavicular systolic murmur. Laboratory tests show anemia (hemoglobin = 7.8 g/dl). Chest x-ray showed a cardio-thoracic ratio at 0.61 with increased pulmonary vascular markings. ECG showed right ventricular hypertrophy. Echocardiography-Doppler revealed persistent ductus arteriosus (PDA). Chromosomal analysis shows deletion of the short arm of chromosome 5. After treatment with digitalis and diuretics there was an improvement of cardiac failure. Diagnosis of cri-du-chat syndrome is easy when characteristic cat-like-cry is present. Cardiovascular abnormalities are unfrequent in this syndrome (20% of the cases). They are dominated by ventricular septal defect and PDA. Hemodynamic failure and related growth retardation can lead to cardiac surgery.

Abnormalities, Multiple↗
PubMed2000

[Permanent cardiac stimulation in Senegal: preliminary experience at the Cardiology Clinic of Dakar].

We report a prospective and descriptive study in 12 patients who had pacemaker implantation from may. 1996 and dec. 1997. Our patients benefited from complete clinical examination, ECG (12 derivations), standard laboratory tests, chest X ray. Pulsed-Doppler, two dimensional and TM echocardiography have been performed. Stimulation was achieved using endocardial lead introduced percutaneously. During the study, 12 patients over 22, representing 55% of the subjects with symptomatic conduction defects, had definitive pacemaker implantation. Mean age was 53.8 years +/- 18. Most of the patients lived in Dakar. Sex-ratio was 0.58 (7 males/5 females). Most of the patients (83%) had low socio-economical status. Before implantation mean heart rate was 47 bpm +/- 20.8. Mean blood pressure was 155 mmHg +/- 26.7 (systolic) and 71.6 +/- 20.8 mmHg (diastolic). Heart failure was present in 5 patients/12. Others symptoms were mainly syncope (83%). Mean cardiothoracic ratio was 0.56 +/- 0.09. Over a 14 months period we have implanted 7 double chamber stimulators (DDD) and 5 monochamber (VVI). Over a 210 days follow-up, main problems are infection of the pocket in 2 patients. In one of them culture was positive. In Senegal, it is necessary to develop cardiac stimulation. Pacemakers should be available for all patients with symptomatic conduction defects. A national center for electrophysiologic studies and pacemaker implantation is a priority.

Age Distribution↗