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Biomedical subjects

C Pelletier

Publications and source records attributed to C Pelletier.

At least 55 records · Page 3Linked to original sources
PubMed1985

Therapy of symptomatic pyelonephritis in women.

A prospective randomized controlled study was performed on 44 women with community-acquired, uncomplicated pyelonephritis requiring hospitalization. The study was designed to determine if an extended course of therapy (21 days) would be more effective than the conventional 10-day course of therapy. All patients initially received either gentamicin or tobramycin parenterally for 48 to 72 hours, and then were prescribed an oral agent that possessed in vitro inhibitory activity for the urinary pathogen to complete the course of therapy. Duration of medication was assigned according to a table of random digits. Of the 22 women receiving the 10-day treatment 17 were cured, 4 experienced a reinfection and none had a relapse, compared to 12, 5 and 3, respectively, of 22 receiving the 21-day treatment. Analysis of the therapeutic failures did not demonstrate any superior response for either treatment program (p less than 0.75 and greater than 0.50). No statistically increased incidence of adverse drug reactions occurred in patients receiving the extended course of therapy. Our data do not support an extended course of therapy in women with acute symptomatic pyelonephritis uncomplicated by structural abnormalities.

Adolescent↗
PubMed1985

[Actinobacillus actinomycetemcomitans infectious endocarditis. Apropos of 2 cases and review of the literature].

This work reports two cases of endocarditis caused by Actinobacillus actinomycetemcomitans. As noted in the medical literature, the mean clinical features are a subacute infection without know source of bacteremia, in a male patient aged 40 years or older and who is suffering from a heart disease. In our two presentations, the good response to single antibiotic treatment, although the optimal therapeutic approach is not yet defined, and the lack of embolism phenomena are of special interest. Spectrum of bacteria which can be responsible of infective endocarditis is widening rapidly; this study is an example of this trend.

Actinobacillus Infections↗
PubMed1984

Late tears in leaflets of porcine bioprostheses in adults.

Of 836 patients with a mitral or aortic bioprosthesis who were followed over an 8-year period, 32 required reoperation for prosthetic dysfunction. Of the 26 prostheses removed at operation, 18 (12 mitral and 6 aortic prostheses) showed tears in the valve leaflets. In 7 of the 12 patients with rupture of "mitral" leaflets and in 1 of the 6 patients with torn "aortic" leaflets, the onset of symptoms was sudden, requiring urgent reoperation. Two of the 18 patients died early after reoperation; both had progressive disability and underwent elective operation. In 5 of the 7 patients with torn leaflets in a mitral prosthesis who had acute onset of symptoms, a single tear was found and no gross evidence of calcification was detected. Macroscopic calcification was found in only 8 of the 18 (44.4%) prostheses with torn leaflets (mitral and aortic). Microscopic examination revealed calcific deposits in 9 of the 12 mitral and in all of the aortic bioprostheses. Of the 54 leaflets examined, 29 had tears: 10 were type I; 6, type II; 7, type III; and 6, type IV. Tears in porcine valve leaflets are not an uncommon cause of dysfunction. These tears often lead to acute hemodynamic changes, particularly in the mitral position, and usually require emergency reoperation. They may occur in prostheses that appear grossly normal.

Adult↗
PubMed1983

A simple classification of the risk in cardiac surgery.

A new risk classification for patients undergoing cardiac surgery has been used for the last two years by the anaesthesiologists of the Montreal Heart Institute. The following factors known to be associated with a greater operative morbidity and mortality were selected: (1) poor left ventricular function, (2) congestive heart failure, (3) unstable angina or recent (less than 6 weeks) myocardial infarction, (4) age over 65 years, (5) severe obesity (Body Mass Index greater than 30), (6) reoperation, (7) emergency surgery, (8) other significant or uncontrolled systemic disturbances. Patients with none of the above factors were classified as normal risks; those presenting with one of those selected factors were classified as increased risks, and those with more than one factor were said to carry a high risk. In a prospective study of 500 consecutive open-heart surgery patients classified according to this method, we found that the operated population at normal risk (50 per cent of cases) had a mortality of 0.4 per cent, the patient group with increased risk (32 per cent of cases) had a mortality of 3.1 per cent, and the high risk group (18 per cent of cases) had a 12.2 per cent mortality. Furthermore, 50 deaths following open-heart surgery were assessed retrospectively using the classification; 58 per cent of these patients were classified as high risk, 34 per cent had an increased risk, and only eight per cent were found to be in the normal risk group. Thus, this new risk classification has proven to be a reliable and useful tool for preoperative assessment of patients undergoing open-heart surgery and for teaching purposes.

Age Factors↗
PubMed1983

Postinfarction ventricular septal defect: delayed closure with prolonged mechanical circulatory support.

Three patients who had ventricular septal rupture and cardiogenic shock complicating an acute myocardial infarction were treated by prolonged circulatory assistance using intraaortic balloon pumping. Hemodynamic stabilization was obtained, and surgical repair was delayed for 19 to 27 days after initiation of circulatory support. All three patients survived the operation and were discharged from the hospital 13 to 19 days after operation. Prolonged intraaortic balloon pumping in such patients is safe and often induces hemodynamic stabilization. The patients may then be operated on under more favorable conditions, without risk of multisystem failure, and after fibrosis has developed around the septal rupture.

Aged↗
PubMed1983

[Valve replacement in aged patients. Risk and remote results].

A total of 102 patients aged 65 to 78 years underwent valvular replacement between 1975 and 1980. Calcific aortic stenosis was, by far, the commonest lesion (54 cases), followed by mitral stenosis (16 cases), mitral incompetence (14 cases), aortic incompetence (10 cases) and double valve lesions (8 cases). Sixty four patients underwent aortic valve replacement with 7 early deaths (10,9 p. 100). There were 30 mitral valve replacements with 7 deaths (23,3 p. 100) and 8 patients had double valve surgery with 4 deaths (50 p. 100). Aorto-coronary bypass grafting was associated in 25 cases with a 20 p. 100 mortality. Changes in the technique of peroperative myocardial protection have considerably reduced early mortality which has fallen from over 20 p. 100 to 2,9 p. 100 since the use of cardioplegia with local and systemic hypothermia. There was a higher surgical mortality in patients with poor left ventricular function, cardiomegaly and severe symptomatic incapacity. Non-fatal postoperative complications were common (50 p. 100 of survivors). There were 12 late deaths, 75 p. 100 of which were related to cardiovascular causes. The actuarial survival rate was 65,5 +/- 6 p. 100, 5 years after surgery. When operative mortality was excluded, the 5 year survival rate of the operated patients did not differ from that of the general populations of the same age (79,8 p. 100). Only 5 of our patients were lost to follow-up. Of the survivors, 95,5 p. 100 were asymptomatic or improved by at least one functional grade after an average postoperative period of 30 months. The incidence of late haemorrhagic complications in patients on anticoagulants was 11 p. 100.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1982

Clinical and hemodynamic results with the Carpentier-Edwards porcine bioprosthesis.

Carpentier-Edwards bioprostheses were implanted in 605 patients, 509 of whom had a single valve replacement, and 96 of whom had a multiple valve replacement. There were 54 early deaths (8.9%) and 26 late deaths (4.3%). The five-year actuarial survival was 87% for aortic valve replacement, 83% for mitral valve replacement, and 81% for multiple valve replacement. Of the 525 survivors, all but 3 were followed for a total of 964 patient-years; 354 patients (68%) remained asymptomatic, and 95 patients (18%) were improved. The incidence of thromboembolism, endocarditis, and reoperation due to primary tissue failure of the bioprosthesis were 2.0, 1.3, and 0.1% per patient-year, respectively. The actuarial probability of being free of all valve-related complications was 93% after five years. Satisfactory hemodynamic performance of the bioprosthesis was demonstrated by postoperative studies done in 70 patients. Thus, the Carpentier-Edwards porcine valve provides good clinical improvement, with a low incidence of valve-related complications and tissue failure at five years postoperatively.

Adolescent↗
PubMed1981

Metabolism of sodium [1-14C] and [3-14C] propionate in the non-deficient and biotin deficient rat.

The fixation and elimination kinetics of [1-14C] propionate were studied using autoradiographic technique in the non-deficient and biotin deficient mouse. To quantitate these results, radioactivity was evaluated in the principal organs and excreta over 24 hours from non-deficient and biotin deficient rats, after intravenous injection of sodium [1-14C] and [3-14C] propionate. Radioactivity was eliminated principally via the lungs in the non-deficient rat. Fecal and urinary elimination was weak. Tissular fixation of the radioactivity 24 hours after [14C] propionate injection was carried out principally on the glandular tissues. Almost identical results were obtained in the biotin deficient animal, in which the hepatic propionyl CoA carboxylase activity is decreased by 80 per cent.

Animals↗
PubMed1981

Metabolic abnormalities observed in the rat after administration of sodium dipropylacetate.

Sodium dipropylacetate (DPA) was administered to 10 normally fed rats and 5 biotin-deficient rats. The effects of DPA were measured on propionic acid and glycine levels in urine and blood; and on hepatic propionyl-CoA carboxylase (PCC) activity. No abnormal amounts of propionic acid were found in the blood and urine of the treated rats. Hyperglycinemia and significant constant hyperglycinuria were observed in all animals given DPA, but without significant differences between normal and biotin-deprived rats. DPA treatment did not affect PCC activity in vivo or vitro. These results indicate that the abnormalities of the glycine metabolism are not linked to an accumulation of propionic acid due to PCC inhibition by DPA.

Animals↗
PubMed1980

[The pre-operative visit in cardiovascular surgery].

This text is intended for new residents in the development of anaesthesia of the Montreal Heart Institute. It presents a classification of the risk of cardiovascular surgery used in that institution and discusses current problems encountered with this type of patient (pulmonary and coagulation problems, diabetes renal failure). The attitudes of anaesthetists of this institution towards patients' medication and premedication are also discussed. The risk is classified as usual, increased or high, depending on the presence (or absence) of several factors known to increase the risk: ventricular dysfunction, heart failure, unstable angina or recent infarction, significant involvement of other systems (unstable diabetes, renal insufficiency, significant pulmonary dysfunction), age, emergency surgery and non-cardiac surgery in the presence of important cardiac pathology. With surgical procedures carrying a high mortality, for example dissecting thoracic aneurysm, the usual risk is high and is classified as such. A table of the usual risk of current surgical procedures is proposed.

Adult↗
PubMed1980

Determinants of mortality following coronary bypass surgery.

Factors related to early and late mortality were studied in 663 consecutive patients who had coronary bypass operations. There were 18 operative deaths (2.7%) and 15 late deaths (2.3%). Patients who died were slightly older than surviving patients. Operative mortality was higher (5.3%) in those with congestive heart failure; this correlated directly with the degree of abnormal wall motion shown on left ventriculograms. Preoperative end-diastolic pressure of the left ventricle was not a good predictor of death. While operative mortality was 1.5% in those with stable angina, it increased to 4.2% in patients with unstable angina and to 25% in patients with evolving myocardial infarction. In those with stenosis of the left main coronary artery, early mortality was 12.3%. Although early mortality was unaffected by the extent of coronary disease or by the degree of correction, it increased significantly (P less than 0.05) with the number of grafts inserted and when other cardiac procedures were also performed. Perioperative myocardial infarction was associated with a 28% mortality, but was unrelated to graft failure in 60% of the cases. Late mortality was related only to the number of diseased coronary arteries. Thus, left ventricular function, severity of angina and extent of coronary obstruction appear to be the main determinants of survival following coronary artery operation.

Adult↗
PubMed1980

[Effects of propionic acid metabolic precursors in biotin-deprived rats].

Biotin deficiency induced in the rat, with a biotin-deficient diet but with added avidin involves clinical symptoms of deficiency as well as an important drop (80%) in propionyl-CoA carboxylase activity in the liver, heart and kidneys. But major biochemical anomalies (ketoacidosis and increased urinary elimination of propionic acid), characteristic of propionic acidaemia due to propionyl-CoA carboxylase deficiency in man, are not observed in the rat. Nevertheless, abnormal urinary elimination of methylcitrate and tiglylglycine reflects an appreciable decrease in the metabolism of propionyl-CoA in these animals. The propionyl-CoA load caused by the administration of metabolic precursors of this substance, mainly L-isoleucine, does not induce important biochemical variations except for excretion of propionylglycine.

Animals↗