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Biomedical subjects

C Dupuis

Publications and source records attributed to C Dupuis.

At least 19 recordsLinked to original sources
PubMed1992

The "adult" form of the scimitar syndrome.

One hundred twenty-two cases of the adult form of the scimitar syndrome were collected from different cardiologic centers. The clinical, radiographic and hemodynamic findings are described. The scimitar syndrome is defined as an anomalous right pulmonary venous drainage, partial or complete, to the inferior vena cava. Additional characteristics of this syndrome such as hypoplasia and abnormalities of the vascular supply to the right lung, dextrocardia and abnormalities of the bronchial segmentation are common; bronchiectases are rare. The left to right shunt was less than 50% in 100 of the 122 patients. The pulmonary arterial pressures were normal in 94 patients and slightly elevated in 28. A follow-up study of these patients showed that, without surgical correction, they lead a normal life. An awareness of this syndrome may avoid unnecessary invasive diagnostic procedures and surgical treatment for most patients.

Adult↗
PubMed1992

Lidocaine hydrocarbonate and lidocaine hydrochloride for cesarean section: transplacental passage and neonatal effects.

Twenty-six patients, ASA physical status 1, scheduled for elective cesarean section, were divided at random into two groups and received via an epidural catheter 20 ml of 2.2% lidocaine hydrocarbonate (17.3 mg.ml-1 lidocaine base) with 5 micrograms.ml-1 epinephrine freshly added (Group CO2 = 13 patients) or 20 ml of 2% lidocaine hydrochloride (17.3 mg.ml-1 lidocaine base) also with 5 micrograms.ml-1 epinephrine freshly added. Following clampage of the umbilical cord (at 40.1 +/- 4.9 min after the injection of lidocaine for the CO2 group and at 41.0 +/- 5.4 min for the HCl group), serum concentrations of lidocaine were measured both in the mother and in the umbilical vein. All newborns were examined by the same blinded pediatrician with Apgar scores at 1, 5 and 10 min and with Neurobehavioral Adaptive Capacity Scores (NACS) at 15 min, 2 h and 24 h. The concentrations of lidocaine in the serum were comparable in both groups: in the mothers 8.61 +/- 1.48 mumol.l-1 for the CO2 group vs 8.04 +/- 2.36 mumol.l-1 for the HCl group and in the newborns 3.86 +/- 0.84 mumol.l-1 for the CO2 group vs 3.92 +/- 0.95 mumol.l-1 for the HCl group. The ratio of umbilical vein to maternal vein concentrations of lidocaine was also similar in both groups: 0.45 +/- 0.07 for the CO2 group vs 0.54 +/- 0.24 for the HCl group. The percentage of newborns with a normal NACS (score > or = 35/40) was equal in both groups, i.e. 91% at 15 min and 2 h of life and 100% at 24 h of life.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Physiological↗
PubMed1992

Glial cell localization of acidic fibroblast growth factor-like immunoreactivity in the optic nerve of young adult and aged mammals.

The number of axons in the optic nerve decreases with age and this degeneration is greater in patients suffering from Alzheimer's disease. Alterations in the role of neurotrophic factors could lead to this degeneration. Acidic fibroblast growth factor (aFGF)-like immunoreactivity was examined by indirect immunofluorescence on cryostat sections incubated with a rabbit polyclonal antiserum specific for aFGF. Staining was observed by photonic microscopy on optic nerves of Wistar rats (1- to 25-month-old), bovine animals (0.5- to 7-year-old) and normal human adults (24-, 34-, 54- and 84-year-old). In the three species studied, the results show that (1) glial cells were stained in the nuclear region and (2) aFGF-like immuno-reactivity was present over a large age span in adult subjects. Endogenous aFGF may have trophic effects on retinal ganglion cells and their axons throughout the adult life span.

Adult↗
PubMed1992

Neonatal treatment of giant naevi.

A technique of curettage of giant congenital naevi in newborns was proposed by Moss in 1987. We used this technique in 6 children during the last 2 years. The long-term aesthetic results appear to be better than those observed after other methods of treatment. Light microscopy of the pigmented skin confirmed the presence of the majority of naevus cells in the upper dermis. For 3 patients, cultures of the curetted cells showed a melanocyte behaviour similar to that seen in malignant melanoma. These observations are limited to in vitro cultures and are not representative of the in vivo evolution as biopsies of the remaining naevus cells at 3 months of age did not show any malignant characteristics.

Curettage↗
PubMed1992

Intramedullary epidermoid cysts of the spinal cord. Case report.

Epidermoid cysts are tumors familiar to neurosurgeons, but intramedullary epidermoid cysts are rare. The authors report the case of a 6-year-old girl presenting with progressive paraparesis. A midthoracic intramedullary mass was revealed on myelography and magnetic resonance (MR) imaging and confirmed as an intramedullary epidermoid cyst at surgery, at which time the cyst was removed. This is the fourth report documenting a purely intramedullary epidermoid cyst occurring in a child. The pathology and etiology, epidemiology, clinical features, radiology (including MR image characteristics), and surgical treatment of such rare intramedullary benign tumors are discussed. Magnetic resonance imaging reduces the delay in diagnosis of spinal cord tumors but should be guided by clinical judgment.

Child↗
PubMed1992

[Doppler echocardiography after anatomical repair of transposition of great vessels].

Forty seven patients who underwent anatomical repair of transposition of the great arteries were assessed by Doppler Echocardiography on average 16 months after surgery. Thirty three had transposition alone and 14 had an associated ventricular septal defect. Abnormal left ventricular function was observed in 4 patients (8%) and was associated with a preoperative left to right ventricular systolic pressure ratio less than that of patients with normal left ventricular function (0.76 +/- 0.22 vs 0.90 +/- 0.14 respectively, p = 0.10). Aortic regurgitation was detected in 19 children (40%). It was minimal in 18 cases and mild in the other case, in which a ventricular septal defect has been approached via the original pulmonary valves. Previous pulmonary banding before detransposition was a predisposing factor for postoperative aortic regurgitation. Thirteen patients had pulmonary pressure gradients of over 20 mmHg. The site of obstruction was usually the main pulmonary artery. The 3 cases in which the coronary orifices were closed with two patches instead of one had significant stenosis of the main pulmonary artery. Pulmonary regurgitation was detected in 38 patients (81%); it was minimal in 29 cases, mild in 5 cases and severe in 4 cases. Five patients (11%) had minimal mitral regurgitation and 16 (34%) tricuspid regurgitation. In the 22 cases who had serial echocardiographic evaluation with an average follow-up of 18 months, the postoperative abnormalities were characterised by their stability, with no significant progression of the regurgitant lesions. A reduction in pulmonary pressure gradient was observed in 5 patients and an increase in 1 patient (from 28 to 40 mmHg).(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Valve Insufficiency↗
PubMed1992

[Permanent junctional reciprocating tachycardia in children and adolescents. Efficacy of medical treatment].

Between 1969 and 1991, 11 patients were followed up for permanent junctional reciprocating tachycardia. The average age at diagnosis was 2 years and 4 months (1 day to 14 years). The tachycardia was diagnosed at routine examination in 5 cases and following an episode of cardiac failure in the other 6. Digitalis was prescribed in all patients with 4 good results, 5 average and 2 poor results. One patient, who remained in mild cardiac failure with digitalis therapy, died suddenly at the age of 9 years. In more recent cases, amiodarone was used from the onset or secondarily with good results in all patients. In 2 patients, in whom amiodarone was withdrawn after 3 months and 3 years' treatment, there was a recurrence of the tachycardia. No side effects of amiodarone therapy were observed in this series. Three patients were prescribed flecainide with 1 good and 2 average results. Propranolol, used in 2 cases, was associated with 1 average and 1 poor result. Disopyramide and Verapamil were ineffective. These results suggest that amiodarone is the drug to choose in permanent junctional reciprocating tachycardia but it must be given long term. The persistence of cardiac failure, poor control of the tachycardia or secondary effects of drug therapy should lead to consideration of non-medical management of the tachycardia.

Adolescent↗
PubMed1992

[Influence of age and body surface on the signal averaged high amplification ECG after complete repair of tetralogy of Fallot].

The aim of this study was to assess the influence of age and body surface area on the signal averaged ECG after complete repair of Tetralogy of Fallot. Fifty eight patients operated for Tetralogy of Fallot in whom the postoperative ECG showed right bundle branch block without any significant arrhythmia on Holter monitoring or exercise stress testing underwent signal averaged electrocardiography. A very significant relationship was observed between age and body surface area and the duration of the filtered QRS (r = 0.45, p = 0.0004 and r = 0.49, p = 0.00009 respectively) or the average voltage of the last 40 milliseconds (r = -0.49, p less than 0.03 and r = -0.31, p less than 0.02 respectively). Therefore, signal averaged ECG in patients operated for Tetralogy of Fallot varies with age and morphology. An adjustment of the parameters of the signal averaged ECG with respect to clinical characteristics is necessary before assessing the value of this technique for identifying patients at risk of developing ventricular arrhythmias.

Adolescent↗
PubMed1991

Acidic fibroblast growth factor (aFGF)-like immunoreactivity in the optic nerve.

Acidic fibroblast growth factor (aFGF)-like immunoreactivity was examined in the optic nerves of 1- to 25-month-old Wistar rats, 0.5- to 7-year-old bovine animals and normal human adults (24 and 35 years old), using cryostat sections incubated with a rabbit polyclonal antibody specific for aFGF. The immunoreactivity was associated with glial cells, and was localized predominantly in the nucleus. The presence of endogenous aFGF in the optic nerve of adult subjects and 'old' rats suggests that aFGF could play a role in the survival of retinal ganglion cells and their axons during aging.

Adult↗
PubMed1991

[Aortic valve insufficiency: an unrecognized complication of the surgical repair of ostium primum atrial septal defect].

Between 1974 and 1989, eight children undergoing surgical repair of a partial atrioventricular canal comprising an ostium primum atrial septal defect, mitral regurgitation due to a cleft mitral valve (6 cases) and a small ventricular septal defect (1 case) developed aortic regurgitation. This complication was diagnosed on the finding of a diastolic murmur 1 day to 9 years after the repair of the atrial septal defect. The degree of regurgitation was Grade I in 4 cases but in the other patients it was severe from the outset requiring emergency surgery the next day (1 case), or moderate at the beginning but rapidly progressive (1 case) or slowly progressive (2 cases) leading to aortic valvuloplasty in these 3 patients. The cause of the regurgitation was iatrogenic: perforation of the non coronary cusp secondary to repair of the ostium primum atrial septal defect. None of the patients required aortic valve replacement. After surgical valvuloplasty, all children had Grade 1 aortic regurgitation. Color coded Doppler echocardiography confirmed the diagnosis and helped assess the clinical course of this lesion during follow-up.

Adolescent↗
PubMed1991

[Holter monitoring, exercise test and atropine test in isolated congenital atrioventricular block in children].

Twenty-four patients with isolated congenital heart block were investigated by 24-hour Holter monitoring at an average age of 9.3 +/- 5.5 years. Six patients were symptomatic and 18 were asymptomatic. Eight asymptomatic patients underwent exercise stress tests and an atropine test was performed in 10 asymptomatic patients to evaluate the capacity to accelerate the heart rate. The symptomatic patients were older than the asymptomatic patients. None of the parameters which analyse ventricular rate were significantly different in the two groups of patients. Significant ventricular arrhythmias (Lown Grade 2 or over) were recorded in 1 symptomatic and 3 asymptomatic patients. The incidence of these ventricular arrhythmias increased with age and degree of bradycardia. The percentage increase in ventricular rate after atropine correlated with what was observed on effort (r = 0.95, p = 0.01) but there was no relationship between the ventricular rates during these two tests and those recorded on Holter monitoring. The results of this series of children with isolated congenital heart block show the Holter parameters cannot distinguish symptomatic from asymptomatic patients. The exercise stress and atropine tests gave very similar results but their prognostic value has not yet been established.

Adolescent↗
PubMed1990

[Transcutaneous transport of trinitrin in children after application of nitroglycerin patches].

Plasma levels of nitroglycerin were measured 13 to 24 hours after the application of nitroglycerin stamps in 7 children aged from 1 month to 7 years and suffering from heart failure. The plasma levels varied considerably from one patient to another, confirming that the bioavailability of transdermal nitroglycerin is extremely variable in children. Only 3 patients had a nitraemia higher than 1 ng/ml, a figure compatible with a haemodynamic effect of the drug. No side-effect associated with the nitroglycerin stamps was observed. The dosage we use (a quarter of a stamp for 5 kg bodyweight) seems to be adequate at the beginning of treatment, to be progressively increased according to the way the drug is tolerated.

Administration, Cutaneous↗
PubMed1990

[Incidence and factors favouring ventricular arrhythmia after surgical repair of tetralogy of Fallot].

The prevalence and factors favorising postoperative ventricular arrhythmias in 62 patients undergoing surgical repair of tetralogy of Fallot between 1971 and 1982 were analysed. Nineteen patients (31 %) had significant ventricular arrhythmias (Lown greater than or equal to 2) on Holter monitoring or exercise stress testing. The arrhythmia could only be recorded after stress testing in 5 patients. The patient's age at operation, the duration of follow-up and age at evaluation were significantly greater in the group with ventricular arrhythmias. However, age at operation was closely related to the other two parameters and a discriminating analysis showed that the age at operation was not a favorising factor for the occurrence of ventricular arrhythmias (p = 0.23), in contrast to the duration of follow-up (p = 0.0015) and age at evaluation (p = 0.0007). No relationship was found between ventricular arrhythmias and the following factors: previous anastomosis, outflow patch, necessity of a ventriculotomy or reoperation, presence of residual ventricular septal defect, postoperative systolic right ventricular pressure, severity of intraventricular conduction defects, and effort tolerance. These results suggest that after surgical repair of tetralogy of Fallot, the incidence of ventricular arrhythmias increases with time. The main problem is to identify patients with a high risk of sudden death, i.e. those with high degree ventricular arrhythmias and poor haemodynamic results of repair.

Arrhythmias, Cardiac↗
PubMed1990

[Anatomic correction of simple transposition of the great vessels during the neonatal period. 5 years' experience in 235 children].

From March 1984 to August 1989, anatomic surgical correction was performed on 235 newborn infants (2 to 32 days old, mean 8.5 +/- 4) with simple transposition of the great arteries. Ninety-four percent of the patients underwent balloon atrial septostomy before the operation. The anatomy of the coronary arteries according to the Yacoub classification was as follows: type A, 160 patients (68%); type B, 5 patients (2%); type C, 11 patients (5%); type D, 41 patients (17%); and type E, 18 patients (8%). Coronary artery relocation was performed according to the Yacoub technique with some modifications, and the pulmonary artery reconstruction was done using the Lecompte manouver in association with a pericardial patch. The perioperative mortality rate was 8.9 percent for the entire series, significantly higher for the type C (46%, p less than 0.01) and significantly lower for the type D (0%, p less than 0.05). Seven patients were lost of follow-up. The follow-up ranged from 1 to 63 months (mean 21 +/- 14). Four late deaths occurred: 2 from myocardial infarction, 1 from pulmonary hypertension and one from a thrombotic occlusion of the superior Vena cava. One patient had an acute posterior myocardial infarction five months after the operation and his left ventricular contractility is normal at echocardiography three years later. Supravalvular pulmonary stenosis occurred in 17 patients but only two were operated on with no death. Mild aortic regurgitation occurred in nine patients. Ninety eight percent of the survivors have a normal life, with no cardiovascular symptoms and receive no medication.

Actuarial Analysis↗
PubMed1989

Evaluation of vein of Galen arteriovenous malformation in newborns by two dimensional ultrasound, pulsed and colour Doppler method.

Two babies with severe cardiac failure caused by a large arteriovenous malformation of the vein of Galen were evaluated with 2-dimensional ultrasound, pulsed and colour Doppler techniques. In both cases similar findings were recorded: dilated right cardiac chambers with high cardiac output in superior vena cava and ascending aorta; retrograde diastolic flow in descending aorta and continuous forward flow in arch arteries reflecting low resistance to flow in cerebral arteries; recirculation of microbubbles through the superior vena cava after passage unchanged through the cerebral malformation following contrast injection of saline into a peripheral vein or an arterial umbilical line. In addition, colour Doppler study of the brain clearly showed the malformation and the dilated straight sinus. Arteriovenous malformation of the vein of Galen can be noninvasively and easily detected by ultrasound studies of the heart and the brain.

Cerebral Veins↗