Biomedical subjects

D Himbert

Publications and source records attributed to D Himbert.

78 records · Page 5Linked to original sources

PubMed1987

[Hydatid cyst of the right heart and post-embolic pulmonary hypertension].

A 22-year old man with hydatid cyst of the right ventricle presented, for about 10 years, with clinical signs of post-embolic pulmonary hypertension. Despite tumoral resection, the patient died post-operatively of his pulmonary hypertension. Post-mortem examination showed a hydatid cyst on the main pulmonary artery and fixed post-embolic pulmonary hypertension, but we were unable to determine whether we were dealing with old migrated cysts or blood clot emboli developed in contact with the cardiac tumour.

Adult↗

PubMed1986

[Left ventricular hypertrophy. Advantages and drawbacks].

The increase of the muscular mass of the left ventricle represents, for the ventricular pump, a mechanism of adaptation to a normal process (growth, sport, etc.) or a pathological process (mechanical overload or cardiomyopathy). The geometrical variations which are associated, tend to normalize the performances and/or the systolic constraints, determining elements of the metabolic needs of the myocardium. If left ventricular hypertrophy is not quantitatively, geometrically and functionally adequate and if the contractility and precharge reserves become exhausted, the systolic performance of the ventricular pump is altered and becomes extremely dependent upon the systolic constraints which are then increased. It may be difficult to take into consideration an insufficiency of the contractility of the ventricular muscle in front of clinical signs of cardiac insufficiency which is conditioned by abnormalities in the filling of the ventricular pump. In addition, some "pathological" hyperthophies may secondarily induce an alteration of the intrinsic properties of the muscle (during its contraction, relaxation an/or extension), susceptible to induce or aggravate a ventricular insufficiency. The causes remain uncertain, since a metabolic imbalance of the myocardium by increase of the needs as well as a decrease of the coronary reserve and the exchange capabilities are commonly accepted. What are the mediators of these mechanisms of quantitative, geometric adaptation and also--at least in some animals--structural adaptation (isoenzymes of myosin)? Why do they seem, at times, strangely absent or quickly out-of-date, or sometimes excessive, with all the drawbacks specific to hypertrophy? The answer to these questions would perhaps represent a new therapeutic approach to left ventricular insufficiency.

Adaptation, Physiological↗

PubMed1986

[Mitral stenosis with notable or important subvalvular changes. Complete open commissurotomies supported by chorda transfer].

Since 1983, 40 consecutive patients with mitral stenosis (MS) and significant disease of the subvalvular apparatus underwent open heart mitral commissurotomy (OHMC). The aim of the study was to evaluate the effects of an unrestricted dilatation of the two commissures followed by repair of the subsequent mitral regurgitation. The mitral regurgitation created by this procedure in 24 cases was corrected by transferring 2 to 6 chordae tendinae to the free border of the anterior and/or posterior leaflet in the commissural region. A central regurgitant lesion due to lack of coaptation of the valvular surfaces was treated by annuloplasty with a Carpentier prosthesis in 12 cases. The subvalvular abnormalities were treated by the conventional techniques of fenestration, resection and division of the papillary muscles. Thirty of the 38 survivors had no residual murmur, and 6 had a short low intensity systolic murmur. The 2D echocardiographic study showed no residual stenosis. The residual systolic murmurs were evaluated by pulsed Doppler and corresponded to very localised regurgitation. This extensive operative technique gives very good immediate valvular results which, associated with an adequate subvalvular procedure, are considered to be an important prognostic factor.

Adolescent↗

PubMedDate not supplied

[Unstable angina in the elderly].

Unstable angina and acute coronary syndromes without persistent ST-segment elevation are frequent and their prognosis is poor in the elderly. Indeed, age is the most powerful predictor of in-hospital mortality in this setting. The clinical benefit of interventional strategies, as demonstrated by FRISC II and TACTICS TIMI 18 studies, seems to be most important in this age subset. PURSUIT trial demonstrates that the efficacy of eptifibatide, a IIb/IIIa platelet receptor inhibitor, increases in elderly patients who simultaneously undergo revascularization interventions. Individual application of such treatment strategies may be difficult. Potential triggering factors of unstable angina and comorbidities have to be taken into account, and the overall management should be highly individualized in elderly patients. The aim remains to achieve appropriate myocardial revascularization, as often as possible by focusing coronary angioplasty on the culprit vessel. Coronary surgery generally should be reserved for coronary lesions which are not suitable for percutaneous revascularization. Clinical improvement is maximal in patients with severe initial presentation.

Age Factors↗

PubMedDate not supplied

[Sudden death in heart failure. Analysis and prevention].

Sudden death is a frequent complication of heart failure occurring in 35 to 45 per cent of the cases. This multifactorial event may be of haemodynamic origin (acute heart failure, electro-mechanical dissociation) or, more often, of rhythmic origin (torsade de pointe, sustained ventricular tachycardia, ventricular fibrillation, bradycardia, asystole). Numerous structural, haemodynamic, metabolic, ionic, neurohormonal and iatrogenic factors facilitate ventricular hyperexcitability. The main predictive factors of sudden death in heart failure are the presence of coronary heart disease and of reduced left ventricular ejection fraction; the prognostic value of ventricular rhythm disorders is controverted. Prevention of sudden death begins with correcting those factors which facilitate disturbances in rhythm and conduction. Beta-blockers are effective in the post-infarction period, but there is no evidence that other drugs are useful. Identifying patients at high risk and determining the therapeutic approach that reduces this risk are still incompletely resolved problems.

Adrenergic beta-Antagonists↗

PubMedDate not supplied

[Acute myocardial infarction. Experiences of the referral network of the Beaujon and Bichat hospitals (with the collaboration of the Emergency Medical and Resuscitation Service of Beaujon)].

OBJECTIVES: Hospital management of acute myocardial infarction raises many problems in terms of medical care and organization, especially concerning the use or not of emergency corongraphy and angiography. We assessed the pertinence and consequences of a referral network operating between two cardiology units at the Beaujon and Bichat hospitals in Paris. All interventional procedures were performed at the Bichat unit. Prehospital emergency care units were integrated into the exprience and informed of indications for first line coronarography. METHODS: All cases of myocardial infarction admitted within 6 hours to the two units between 1993 to 1996 were analyzed and compared. RESULTS: Indications for referral from Beaujon to Bichat for emergency coronarography and possible angioplasy declined from 21% in 1993 to 10% in 1996. This decline was particularly noteworthy for first intention indications suggesting improved prehospital selection since the number of cases of acute myocardial infarction admitted to Beaujon remained unchanged. Certain patient characteristics differed between the two units: age (68.4 +/- 12.9 years at Beaujon versus 60.5 +/- 13.6 years at Bichat in 1996, p < 0.01) and reperfusion attempts (73% versus 90% in 1996 respectively, p < 0.01). The rate of fatal and non-fatal events were not different: 40 and 40% at Beaujon and 38 and 28% at Bichat in 1993 and 1996 respectively. CONCLUSION: These findings demonstrate that a management network can operate effectively between two hospital cardiology units and emergency care structures, allowing better patient selection for emergency coronography and possible angioplasty.

Age Factors↗