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Biomedical subjects

D Didier

Publications and source records attributed to D Didier.

66 records · Page 4Linked to original sources
PubMed1985

[Coronary anomalies associated with the Williams-Beuren syndrome. Apropos of 2 cases].

Two coronary artery anomalies associated with the Williams-Beuren syndrome are reported. The first case was a 14 year old child with severe supra-aortic stenosis associated with severe hypoplasia of the ascending aorta; 2 D echocardiography and angiography showed a voluminous aneurysm of the left main coronary artery. Aortoplasty with a patch gave a good early result. The second case was a two and a half months old baby operated as an emergency after cardiac arrest and who died at the end of surgery. The baby had severe supra-aortic stenosis, occlusion of the left coronary ostium by the left anterior cusp which was abnormally adherent to the aortic wall with subendocardial infarction and reaction fibroelastosis. The frequency of coronary anomalies associated with the Williams-Beuren syndrome is probably underestimated. Because of their severity they must be looked for routinely, by echocardiography and angiography. Their tendency to progress is an indication for early surgical correction of severe supra-aortic stenosis.

Adolescent↗
PubMed1984

[Truncular auriculo-ventricular block disclosing isolated corrected transposition of great vessels].

A case of atrioventricular and ventriculo-arterial discordance with L-transposition of the great arteries (corrected transposition of the great arteries), complicated by complex atrioventricular block is reported. The points of interest in this case were the association of an atrioventricular block and isolated corrected transposition, revealing the underlying malformation, and the intrahisian location of the block which seems only to have been reported on three previous occasions in this context.

Bundle of His↗
PubMed1983

[Ultrasonographic study of retroperitoneal and abdominopelvic hematomas].

A sonographic diagnosis was obtained in 33 hematomas encountered in conditions of emergency. Most hematomas were related to anticoagulant therapy. Most hematomas were located within the psoas muscle sheath, hematomas of the abdominal wall and Retzius'cavum. Follow-up examination of non operated hematomas show a progressive decrease of echogenicity.

Abdomen↗
PubMedDate not supplied

Evaluation of the pancreatic duct: a reappraisal based on a retrospective correlative study by sonography and pancreatography in 117 normal and pathologic subjects.

A retrospective study of 117 normal and pathologic pancreatic ducts by endoscopic retrograde cholangiopancreatography (ERCP), with ultrasonic correlation in 80 cases, confirmed the value of ultrasound in the diagnosis of ductal dilatation. The specificity of ultrasound is good: the ultrasonic discovery of a dilatation constitutes a relevant feature. Sensitivity is however poor, particularly in moderate and localized dilatations: a suggestive clinical picture requires ERCP even if sonography is in favor of a normal pancreatic duct. Correlative measurements show discrepancies, with higher ERCP values in normal subjects. The average ERCP diameter in the corporeal ductal segment is 2.6 mm. Until correlative results arising from a prospective study are available, the ultrasonic diagnosis of ductal dilatation must take into account the high normal values demonstrated by ERCP.

Adult↗
PubMedDate not supplied

Thrombolytic therapy compared with mechanical recanalization in non-acute peripheral arterial occlusions: a randomized trial.

PURPOSE: To evaluate whether thrombolytic therapy followed by angioplasty has any added benefit compared with angioplasty alone for the treatment of chronic peripheral arterial occlusions. PATIENTS AND METHODS: Twenty patients with claudication or limb-threatening ischemia of at least 3 weeks duration due to iliac or femoropopliteal artery occlusions were randomized either to thrombolytic therapy with recombinant tissue-type plasminogen activator for up to 4 hours (n = 11) followed by angioplasty or to angioplasty alone (n = 9). Clinical follow-up was obtained for 1 year. RESULTS: Life-table analysis revealed a significant improvement in the cumulative primary patency rate for patients with claudication treated initially with thrombolysis followed by angioplasty (n = 7; 86% at 6 months; 51% at 1 year) compared with angioplasty alone (n = 9; 11% at 6 months and 1 year) (P < .02). All four patients with limb-threatening ischemia were randomized to thrombolytic therapy, and none exhibited continued patency at 1 year. The most common complication in the thrombolysis group was peripheral embolization; three of these four patients were among those who had limb-threatening ischemia as the indication for entry into this study. There was no increased incidence of bleeding with thrombolytic therapy. CONCLUSIONS: A short course of thrombolytic therapy prior to angioplasty appears to improve the 1-year patency rate for claudication due to iliac or femoropopliteal occlusions. However, patients with limb-threatening ischemia have a high prevalence of peripheral embolization and dismal patency rates with this form of therapy. A larger scale study is necessary to confirm these findings.

Adult↗
PubMedDate not supplied

Quantitative assessment of average velocity in inferior vena cava by phase-display MR imaging: pulsed Doppler correlation.

A technique for measuring average velocity in the inferior vena cava (IVC) by using phase-display magnetic resonance (MR) imaging is described. Fifteen healthy subjects were imaged, and the velocities and spectra obtained by MR were compared with pulsed Doppler results. Distortions of the "zebra-striped" images obtained along the axis of the vessel were measured at the same level of the IVC as in pulsed Doppler. Measurements of average velocities in the IVC made by the two methods were very similar, and velocity curves obtained during the cardiac cycle were superimposable. Phase-display MR imaging has the potential to noninvasively assess blood flow in large vessels as accurately as pulsed Doppler.

Adult↗
PubMedDate not supplied

Detection and quantification of valvular heart disease with dynamic cardiac MR imaging.

Magnetic resonance (MR) imaging is rapidly gaining acceptance as an accurate, reproducible, noninvasive method for optimal assessment of structural and functional parameters in patients with valvular heart disease. The severity of valvular regurgitation can be evaluated with cine gradient-echo MR imaging, which allows measurement of the area of the signal void corresponding to the abnormal flow jet. Alternatively, this modality can be used to obtain ventricular volumetric measurements and calculate the regurgitant fraction, or velocity-encoded cine (VEC) MR imaging can be used to quantify regurgitant blood flow. The severity of valvular stenosis can be determined by evaluating the flow jet and associated findings with either modality or by using VEC MR imaging to calculate the transvalvular pressure gradient and valve area. Dynamic MR imaging allows accurate assessment of ventricular function and comprehensive evaluation of pathophysiologic changes. In addition, good interstudy reproducibility suggests a role for VEC MR imaging in assessing the effects of therapeutic intervention and monitoring regurgitant fraction, thereby helping in surgical planning and the prevention of ventricular dysfunction. With greater cost-effectiveness and the increasing availability of new hardware and more advanced techniques, MR imaging will become a routine procedure in valvular heart disease.

Blood Flow Velocity↗
PubMedDate not supplied

Effects of percutaneous transluminal angioplasty on skin microcirculation in patients with disabling peripheral arterial occlusive disease.

Percutaneous transluminal angioplasty (PTA) provokes a huge trauma to the arterial wall and potentially liberates fragments of atherosclerotic material that may impair the microcirculation downstream. Incidence and clinical relevance of such embolisms are not known. This study was aimed at investigating the changes of the skin microcirculation in patients with peripheral arterial occlusive disease undergoing PTA of the lower limbs. Pedal transcutaneous oxygen tension (tcpO2) and nailfold skin microcirculation were measured in 21 patients with disabling peripheral arterial occlusive disease before and after PTA. Sixteen matched patients undergoing arteriography alone were used as controls. The skin microcirculation was investigated at the nailfold of the great toe by the combination of laser Doppler fluxmetry and dynamic capillaroscopy. PTA was successful in all patients. The tcpO2 decreased immediately after PTA (delta tcpO2 = -5 mm Hg; p < 0.004), whereas it tended to increase (delta tcpO2 = 1 mm Hg; NS) following arteriography as compared with baseline values. By contrast, blood flow increased in both groups, predominantly for the total circulation in the PTA group and for nutritional circulation (p < 0.0017) in the arteriography group, respectively. Consequently, the 'nutritional index', i.e., the index of nutritional versus total microcirculation, was decreased following PTA, particularly following mechanical recanalization (p < 0.02), but did not change in the controls. The changes of this 'nutritional index' and those of the tcpO2 were positively correlated (r = 0.4, p = 0.023).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMedDate not supplied

[Pragmatic diagnostic value of hepatobiliary echography in 193 consecutive jaundiced patients referred to an endoscopic retrograde cholangiography center].

The aim of this retrospective work was to study the reliability of hepatobiliary sonography (SG) in a population of 193 icteric patients referred to our endoscopic retrograde cholangiography pancreatography (ERCP) unit between January 1980 and January 1983. One hundred and eight patients were female (ages varying from 9 to 90 years, average: 61 years) and 85 were male (ages varying from 9 to 91 years, average: 55 years). This study's objective was purely pragmatic. The initial SG report served as a basis for assessment of the diagnostic value of ultrasound examination. According to the sonographic patterns observed (biliary dilatation or not), jaundice was classified as intra- or extrahepatic. The sonographic results were then compared to the definitive diagnosis as determined from clinical, biological and pathological data. In the case of an obstacle, the final diagnosis was confirmed by either ERCP or laparotomy. When ERCP showed no obstruction, the final diagnosis was based on either percutaneous hepatic biopsy or clinical and biological evolution and in two cases, an autopsy findings. In this population and considering the pragmatic context of the study, the effectiveness of SG in classifying jaundice as extra- or intrahepatic was 76 p. 100 (70-82), the sensitivity was 75 p. 100 (67-83), specificity, 81 p. 100 (72-89), positive predictive value, 87 p. 100 (81-93) and the negative predictive value, 66 p. 100 (56-76). Sixty-seven p. 100 of the 30 false negative diagnoses in 120 cases of obstructive jaundice corresponded to misdiagnosis of cholelithiasis. SG was able to suggest the etiology of jaundice in 94 cases; this was correct in 58 cases (61 p. 100).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗