Echocardiography is not a good way of monitoring cardiac grafts after abdominal heterotopic transplantation in the rat.
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Abdomen↗
Biomedical subjects
A Tabib
Publications and source records attributed to A Tabib.
Activation of the proto-oncogene c-myc and c-fos by c-ras: involvement of polyamines.
Rat kidney cells infected with a temperature-sensitive mutant of Kirsten sarcoma virus (Ki-MSV ts 371) expressed Ki-Ras at 37 degrees C but not at 42 degrees C. This expression of the oncogene was accompanied by an increase in the activity of ornithine decarboxylase (ODC) and the accumulation of putrescine. Elevation of cellular polyamine content triggered the transcription of c-myc and c-fos. alpha-Difluoromethylornithine, a specific inhibitor of ODC, prevented the transcription of c-myc in cells grown at 37 degrees C. Putrescine, at physiological concentrations, triggered the transcription of c-myc and c-fos in cells grown at 42 degrees C, when Ki-ras was not expressed. It has been suggested that polyamines participate in a cascade of events leading to the communication between membrane-bound and nuclear oncogene products. These findings may attribute a new function to the naturally occurring polyamines.
Animals↗
[Malignant mesothelioma of the pericardium. An anatomo-clinical study of 10 cases].
Ten pericardial mesotheliomas (8 of which had associated unilateral pleural involvement) were observed over a 22 year period in subjects over 50 years of age. The diagnosis was only confirmed several months after the presenting symptoms (shortness of breath, chest pain), usually by histological studies of pericardial biopsies performed during construction of a pleuro-pericardial window because of tamponade or of pleural biopsy in cases of pleuro-pericardial disease. There is no specific diagnostic feature and even modern imaging methods are unable to distinguish mesothelioma from pericardial tuberculosis. In 7 cases, there were large haemorrhagic pericardial effusions. At present, there is no effective treatment for mesothelioma and the physician's goal is to make the patient's short survival time as comfortable as possible with respect to the severe pain and recurrent pleuro-pericardial effusions. The pericardial mesothelioma is rare (less than 1% compared with 96% pleural and 3% peritoneal localisations) and possibly related to exposure to asbestos, at least in those cases with associated pleural involvement. The authors underline the utility of histological analysis of the utility of histological analysis of the pericardium if only to establish the diagnosis of mesothelioma and to enable administration of curative treatment of other pathologies (tuberculosis, malignant lymphoma) with identical clinical presentations.
Aged↗
[Artefacts and intravascular ultrasonography. Analysis and implications for a better reliability in the interpretation of images and measurements].
Intravascular ultrasound catheters provide cross-sectional images of vessel walls and surrounding tissues with rotating transducers, and the behavior of ultrasound in heterogeneous media both cause degradation of image quality. Qualitative and quantitative analyses of in vivo studies are operator-dependent and limited by artifacts. We investigated these limitations by an in vitro study on plexiglass phantoms and segments of fresh arteries. We observed, analyzed and interpreted the most specific reasons for image artifacts: geometric distortions, the point spread function of the imaging system and the near field effects. Various practical implications have resulted from this study. Knowledge of the most obvious pitfalls will enable the user to obtain maximum benefits from intravascular ultrasound imaging, and to appreciate its limitations.
Arterial Occlusive Diseases↗
[Pericardium and heart transplantation].
The authors emphasise the role of the pericardium in the post-operative complications of cardiac transplantation: its role is as important as it is underestimated in its frequency, severity and the pathogenic discussions that it induces. This study, based on a retrospective analysis of 191 anatomo-clinical cases (156 autopsies and 35 retransplantations) of patients undergoing cardiac transplantation before the 1/03/1993 including macroscopic and histopathologic analysis of the pericardial lesions, histochemical analysis of the lymphocytic populations, and analysis of associated coronary and myocardial lesions. The results were classified as early or late (after the 75th postoperative day) complications. Early complications included 27 suppurating mediastino-pericarditis (13 aspergillosis and 14 bacterial), 16 autonomous non-infective pericardial complications (6 haemopericardiums, 6 organised compressive haematomas, 4 early constrictive pericarditis) and 9 lymphocytic epicarditis associated with acute myocardial rejection. Late complications included one common constrictive symphysis and 14 reactivated epicarditis associated with transplantation coronary disease (chronic rejection) with associated lymphoplasmocytic nodules and a myocardial vasculitis. These observations suggest two important conclusions: 1) the need for active diagnostic measures to detect pericardial complications in cases of cardiac transplant dysfunction in the early postoperative period with no signs of acute rejection on myocardial biopsy: the presence of epicardial lesions on biopsy should be taken into account and not just assumed to be a postoperative epiphenomenon; 2) the presence of epicarditis due to reactivated epicarditis may cause inextensible hardening of the epicardium which adds to the effects of restrictive cardiomyopathy of chronic rejection.
Adult↗
Artifacts in intravascular ultrasound imaging: analyses and implications.
The ability of an intravascular ultrasound catheter to give cross-sectional images of vessel walls and surrounding tissues, and the behavior of ultrasound in heterogeneous media, are at the origin of degradation of image quality. Qualitative and quantitative analyses of in vivo studies are then operator-dependent and are limited by artifacts. We investigated these limitations by an in vitro study on plexiglass phantoms and segments of fresh arteries. We used a 20 MHz transducer mounted on the tip of a 4.8 F catheter and an interventional ultrasound system. The ultrasound beam is reflected onto the rotating transducer at 600 rotations per minute (RPM), creating 360 degrees real-time images (10 images/second). We then observed, analyzed and interpreted the most specific reasons for image artifacts: geometric distortions, multiple echoes, the point spread function (PSF) of the imaging system, near-field effects, "petal-shaped" effect, and ultrasound speckle. Various practical implications have resulted from this study. Only a thorough knowledge of how to avoid some of the most obvious pitfalls will enable the user to obtain maximum benefits from intravascular ultrasound imaging, and to appreciate its limitations.
Arteries↗
[Late anatomical lesions after cardiac transplantation. Study of 44 autopsies beyond 6-months survival].
The aim of this study was to attempt to determine which anatomical lesions were found late after cardiac transplant and could be fatal. A series of 44 autopsies, beyond a 6 month survival time, revealed the types of cardiac and extra-cardiac lesions encountered. They were viewed in the context of clinical findings. Three lesion patterns accounted for more than 9 cases out of 10: coronary disease affecting the transplant (accelerated atherosclerosis or chronic cardiac rejection: 48% of cases), infectious lesions (29%), more than half of which were due to aspergillosis, and neoplasia (14%), favourised by immune-depression. Three results show that graft coronary disease is currently the essential long term problem in the many patients who survive the early postoperative period of cardiac transplant.
Adult↗
[Intravascular echographic imaging: experimental validations and limits. An in vitro study].
Intravascular ultrasound is a new method of visualizing details of vascular pathology, providing (real time) high resolution images of vascular walls. Most of the research on the technique has explored its qualitative and quantitative capabilities to improve the assessment of atherosclerotic vascular disease in vivo. Intravascular ultrasound differs from angiography and angioscopy in its ability to penetrate below the surface of the vessel lumen, demonstrating specific appearances of the distribution and composition of plaque. Image analysis is operator dependent. Although this technology is very promising limitations such as artefacts and loss of image quality in heavily calcified vessels hinder its use. There is hope that this imaging technique may ultimately improve the results of endovascular interventions.
Arteries↗
[Anatomoclinical diversity of bronchiolitis obliterans after lung transplantation. Anatomical study of 16 cases among 64 transplantations].
The aim of this study was to define the presence, histological types and extent of bronchiolitis obliterans (BO) after lung transplantation and to discuss the place of bronchiolitis obliterans in the progressive obstructive ventilatory disorder observed in some patients and considered to correspond to "chronic lung rejection". The histological lesions were studied in 16 subjects surviving for more than one month after lung transplantation or heart-lung transplantation: 12 autopsies, 3 surgical biopsies and one lung explanted for retransplantation. Thirteen subjects presented lesions of bronchiolitis obliterans: 5 cases of granulomatous BO, 6 cases of proliferative BO, one acute necrotising BO and one tuberculous granulomatous BO. Three of these patients presented an obstructive ventilatory disorder: one death on the 213rd day (acute necrotising BO), one retransplantation on the 672nd day (granulomatous BO), one death 53 days after surgical biopsy on the 247th day (proliferative BO). Two patients undergoing surgical biopsies with lesions of proliferative BO are still alive (cases 15 and 16) and do not present any signs of obstructive ventilatory disorder. This study suggests the existence of various histological types of BO in transplanted lungs, which is not exclusively of immunopathological origin, that infections and various inhalations also play a role and that alterations of pulmonary structures other than bronchioles are also involved in the pathogenesis of the obstructive ventilatory disorder (functional destruction of the transplant), corresponding to "chronic lung rejection".
Adolescent↗
[Unexpected sudden death and coronary lesions. Apropos of 407 cases out of 1000 deaths in patients under 65 years of age].
In order to determine the responsibility of coronary artery disease in unexpected sudden death (without known or treated cardiac disease), the authors studied 1,000 cases of "natural" unexpected sudden death in subjects under 65 years old in whom the autopsies were performed in Medico-Legal Institutes and in whom all non-cardiac causes had been excluded. Macro- and microscopic examination of the heart detected 848 potentially lethal lesions (152 autopsies failed to show the cause of death) of which 407 cases corresponded to coronary disease (atherosclerosis in 340 and other disease in 67 cases). The atherosclerotic lesions could be classified in 3 anatomical groups: 75 isolated recent coronary thromboses; 75 recent coronary thromboses associated with multivessel stenoses; 190 coronary stenoses (> 75%) without thrombosis (139 triple vessel, 31 double vessel and 20 single vessel diseases). The presence of a recent myocardial infarct, the cardiac mass and the circumstances of sudden death were determined in all cases with respect to the three pre-defined anatomical groups. This study, though confirming the high prevalence of coronary artery disease, evaluates it at a lower level than previous reports in the literature which takes into consideration "unexpected sudden death" of known and treated coronary patients, and also has allowed identification of other potentially lethal lesions (such as structural abnormalities of the His-Purkinje system) which are undetectable even with sophisticated paraclinical investigations.
Adult↗
[Early fatal lesions after cardiac transplantation. Results of 100 autopsies].
The results of 100 consecutive autopsy studies performed since the introduction and use of cyclosporine (1984 to 1991) in patients who died less than 2.5 months after cardiac transplantation were analysed to try to prevent this type of lethal damage. The lesions were complex but the causes of death may be classified as follows: 44 infections (20 aspergillosis, with 13 septicaemias and 7 predominantly pulmonary complications, 15 severe lung infections, 9 other infections including 7 pyogenic mediastino-pericarditis), 12 acute myocardial rejects, 14 pulmonary arteriolitis reflecting the fact that pulmonary resistances affect the results of cardiac transplantation, 13 non-infectious pericarditis, 17 immediate postoperative deaths (incompetent graft, DIVC). In the discussion, the authors underline the importance of pericardial damage, the direct cause of death in 13 cases but also present in most cases of infection when sometimes clinically confused with the diagnosis of "acute reject". Acute pancreatitis (over 10% of cases) were often labelled "septicaemic shock". Pulmonary involvement is one of the commonest complications related to infection and changes due to passive pulmonary hypertension related to the causal preoperative disease, by silent pulmonary embolism during the 3 months of cardiac failure before surgery and DIVC. Infection was the cause of death in nearly half of the early fatalities, and aspergillosis was particularly common whereas systematic prevention with sulfadoxine-pyrimethamine has eliminated pneumocystosis for example. The management of immuno-depression varies from centre to centre and this is also a factor in the incidence of anatomical complications.(ABSTRACT TRUNCATED AT 250 WORDS)
Aspergillosis↗
[Cytomegalovirus arteriolitis: gangrene of the feet and early coronary disease after heart transplantation].
Peripheral arteriolitis of the legs from the 4th postoperative day after cardiac transplantation caused ischemia of the feet and required bilateral transmetatarsal amputations on the 28th postoperative day. The causal condition was cytomegalovirus infection, confirmed by rising IgM antibody titres, the detection of a viraemia on the 33rd postoperative day, and, above all, the presence of cytomegalic inclusion bodies in many endothelial arteriolar cells of the amputated limbs. The patient died four months after transplantation and autopsy revealed major lesions in all the distal coronary vessels of the graft which occluded over 4/5ths of the coronary lumens. An aspergillus septicemia was the direct cause of death.
Coronary Disease↗
[Fatal aspergillosis after cardiac transplantation. About 26 cases].
Complications due to infection by aspergillus and favorized by therapeutic immunodepression are a significant cause of mortality after cardiac transplantation, but are only rarely diagnosed before autopsy. A detailed description of the anatomical lesions and their localisation might help the interpretation of symptoms observed in vivo. In a series of 147 autopsies subsequent to cardiac transplantation, aspergillosis appeared as the cause of death in 26 cases. Three anatomoclinical presentations could be identified: early post-operative septic pyohaemia (14 cases), delayed septic pyohemia (7 cases) and forms with predominantly pulmonary involvement (5 cases). In the first category, cardiac lesions are the most evident with myocardial micro-abscesses and intracardiac masses of aspergillus presenting a variable risk of embolism. Pulmonary << target lésions >> (infarctus associated with a variable degree of aspergillus arterial thrombosis) were present in all cases. Visceral involvement completes the picture; the more frequent lesions being acute pancreatitis (9 cases), infarctogenic aspergillus emboli of the kidneys (11 cases), the spleen (9 cases) or the brain (6 cases). In 8 subjects, microscopical examination revealed other germs associated with aspergillus. The serious consequences of aspergillus infection after cardiac transplantation imply that every preventive precaution should be taken, especially in avoiding possible contamination of the air of the operating room by the installation of filters and the regular control of airways and air conditioning systems.
Abscess↗
Coronary lesions in young HIV-positive subjects at necropsy.
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Adult↗
[Chronic cardiac rejection. 20 anatomico-clinical cases].
Twenty anatomico-clinical cases of chronic cardiac rejection (accelerated coronary disease in heart transplant) consecutive to heart transplantation were studied with the view of obtaining detailed information on the anatomical features of coronary lesions, such as histopathological alterations, modalities of their diffusion to the 3 epicardial trunks and to distal intramyocardial branches, thrombotic complications and their consequences: massive (infarct) or disseminated myocardial ischaemia. The lesions observed were correlated with the corresponding coronary angiographic images, and an interpretation of the aetiopathological factors was attempted. Within a few months or years, the coronary lesions are found to progress towards very diffuse circumferential atherosclerous alterations where the plaques are clearly less individualized than in common atherosclerosis but thrombosis is frequent and multifocal in 50 percent of the cases. This produces a restrictive type of ischaemic cardiopathy which is painless since the heart is denervated, resulting in cardiac failure (11 cardiectomies for retransplantation, 9 autopsies) with coronary angiography tending to underestimate the importance of coronary damage. The most original aetiopathological factors seem to be arterial inflammation of immune origin, viral infections facilitated by immunosuppression and platelet hyperactivity, but their respective importance could not be accurately determined in this study.
Adult↗
Cardiomyoplasty does not preclude heart transplantation.
Stimulated skeletal muscle grafts have been proposed to improve left ventricle function in patients with severe myocardial failure. In 1 particular case reported here, however, the postoperative functional improvement was only transient and disabling heart failure recurred after 9 months in spite of a vigorous latissimus muscle contraction. Heart transplantation was proposed to this patient and performed successfully. Technically, the key to heart removal depends on the retrograde dissection of the ventricular cavities, starting from the right atrioventricular groove. The intraoperative observations confirmed the viability of the latissimus dorsi muscle, inefficient on a highly dilated cardiomyopathy. Histopathological examination of the latissimus dorsi muscles showed that the transformation process of the stimulated muscle was good. Thus, severe cardiac dilatation seems to be one of the limitations of cardiomyoplasty. Cardiomyoplasty, when it fails, does not preclude heart transplantation. The histochemical studies confirm the electrophysiologic principle of cardiomyoplasty in humans.
Assisted Circulation↗
[Anatomoclinical study of 100 cases of hypoplasia of the right ventricular muscle (including 89 unexpected sudden deaths). Relation with Uhl's anomaly].
The authors present the pathologist's view of Uhl's anomaly based on 100 cases recorded over 31 years, 89 of which came from medico-legal autopsies following sudden unexpected death in young subjects. The anatomic diagnosis is made by macroscopic examination of the whole heart in diffuse forms (parchment heart) and from transverse sections of the mid third of the ventricle in incomplete forms, showing absence of myocardium in the juxta-septal anterior wall of the right ventricle. The wall entirely made up of adipose tissue, may retain its normal thickness. On microscopy, normal adipose tissue is observed between the epicardium and endocardium, sometimes with islets of myocardium dispersed in the subendocardial layer and with, in about half the cases, subendocardial bundles of non-hyalinized collagen without any inflammatory cellular infiltration. Other structural histopathological lesions may complicate the malformation, involving the intraseptal arterioles or the conductive system. In addition to the 89 cases of sudden and unexpected death before the age of 50 (preceded by some modification of the patient's life style in 29 cases), 11 cases were symptomatic and 5 were transplanted with a good result. The clinical diagnosis of Uhl's disease is important because of its consequences: ventricular tachycardia and possible sudden death, more rarely cardiac failure with age. Histological analysis should take into account the constant presence of adipose tissue in the right ventricle, and should only interpret excessive quantities with associated myocytic aplasia as pathological.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
[An unusual cause of sudden death: spontaneous dissection of coronary arteries. Apropos of 2 cases].
The authors report two new cases of spontaneous dissection of the coronary arteries in women under 50 years of age without any predisposing factors and responsible for sudden death. One patient had dissection of the left anterior descending artery and the other had dissection of the left anterior descending and right coronary arteries. Special histological stains allow demonstration of abnormalities of the elastic tissue of the media in both cases. In the first case, a plaque of atheroma was present opposite the site of dissection but did not seem to be causal. In the second case, severe periadventitial cellular, infiltration of unknown origin was observed. This pathology of the young woman, often occurring in the postpartum period, is as rare as it is unpredictable.
Adult↗