Biomedical subjects
Publications and source records attributed to E Lefebvre.
A prospective registry of 187 patients who underwent percutaneous coronary angioplasty with attempted long NIR stent delivery was performed. A successful stent delivery was achieved in 93% of cases with a low rate of major cardiovascular events, and 6-month follow-up showed low rates of clinical events, new revascularization procedures, and angiographic restenosis.
BACKGROUND: Impaired oxidative and energy metabolism are important features in Alzheimer's disease. These metabolic abnormalities may induce functional disturbances and are associated with significant cognitive impairment. OBJECTIVE: To determine whether mitochondrial function is altered by Alzheimer's disease, a quantitative analysis of substrates that enter the tricarboxylic acid cycle was carried out in cerebrospinal fluid (CSF) from Alzheimer patients. METHODS: Organic acid levels related to carbohydrate oxidation were measured in CSF from patients affected by dementia of Alzheimer type (n = 17) and from nondemented elderly controls (n = 17) using a gas chromatography/mass spectrometry system. CSF glucose and glutamine concentrations were determined by a quantitative enzymatic method and by ion exchange chromatography, respectively. RESULTS: Compared to age-matched controls, patients had a higher CSF level of lactate (p = 0.002) and a lower mean level of succinate (p = 0.002), fumarate (p = 0.003) and glutamine (p = 0.0005). The CSF glucose level was not modified. CONCLUSION: Our results suggest an impairment of mitochondrial oxidative metabolism in brain cells of patients with Alzheimer's disease.
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The authors report on one case of 3-hydroxy-3-methylglutaryl-coenzyme A lyase (HMG-Co A lyase) deficiency in a 3 year-old girl, presenting as Reye's syndrome. Urinary organic profile suggested this inherited metabolic disease; decreased activity of HMG-Co A lyase was demonstrated in cultured fibroblasts. The metabolic etiologies of Reye's syndrome are summarized; clinical, biological, and therapeutic assessment of HMG Co A lyase deficiency are developed. The pattern of organic aciduria must be studied in all patients presenting with Reye's syndrome.
The authors report the results of a series of 3 cases of double valvuloplasty with a balloon catheter in young patients with combined mitral and tricuspid stenosis. Haemodynamic and Doppler echocardiographic evaluation after the procedure showed comparable results to those of surgical commissurotomy without significant secondary valvular regurgitation. Clinical and echocardiographic follow-up showed that valvular opening remained satisfactory in the 2 cases examined. Percutaneous valvuloplasty would seem to be a valuable alternative to surgical commissurotomy in selected patients with combined mitral and tricuspid valve stenosis.
Seventy-two consecutive patients with severe aortic stenosis and impaired by left ventricular ejection fractions (EF less than 40%) underwent percutaneous aortic valvuloplasty between September 1985 and November 1987. Forty-five patients had been turned down by the surgeons because of their age (29 patients over 80 years of age), their impaired left ventricular function or associated pathologies. Valvular dilatation with 15 to 23 mm diameter balloons resulted in a reduction of the transvalvular pressure gradient from 63 +/- 21 to 26 +/- 11 mmHg (p less than 0.001) and an increase in valve surface area from 0.48 +/- 0.15 to 0.91 +/- 0.32 cm2 (p less than 0.001) but with large individual variations. No cases of aggravation of associated aortic insufficiency were observed after the procedure. One 98-year old woman died during the dilatation and 4 other patients died during the hospital period. Immediate clinical improvement was observed in 80 per cent of patients. During the one-year follow-up period, 33 patients died, 31 of cardiac causes. Of the 34 survivors at one year, 21 had maintained their clinical improvement. A repeat hemodynamic study was performed in 22 patients 7 months after valvuloplasty. Eleven patients had restenosed and their hemodynamic parameters had practically returned to pre-valvuloplasty values. The left ventricular ejection fractions of the 11 patients without restenosis had increased from 28 +/- 7 to 40 +/- 18 per cent (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
The efficacy, morbidity, and 1-year follow-up of balloon aortic valvuloplasty in patients with low ejection fraction (less than 40%) were studied on a consecutive series of 55 patients (mean age, 77 years) treated from September 1985 to February 1987. Because of their age (20 patients greater than 80 years old), poor left ventricular function, and associated diseases, 45 patients were definitely not surgical candidates. Balloon dilatation with 15-23-mm diameter balloon catheters decreased the transvalvular gradient from 66 +/- 24 to 28 +/- 14 mm Hg (p less than 0.001) and increased the valve area from 0.47 +/- 0.15 to 0.83 +/- 0.27 cm2 (p less than 0.001). Immediately after dilatation, ejection fraction mildly increased from 29 +/- 7% to 34 +/- 9% (p less than 0.001) in 38 patients who had undergone a second left ventricular angiogram after dilatation. No significant change in the degree of aortic regurgitation was found after the procedure. Three patients died in hospital (femoral arterial complications in two, septicemia in one). Immediate clinical improvement was noted in 80% of the patients. During the follow-up (mean, 11 months), 22 patients died (heart failure in 15 patients, sudden death in five patients, myocardial infarction in one patient, cancer in one patient). Thirty patients survived, 21 with persistent clinical improvement. Repeat cardiac catheterization was performed at 6 months in 20 patients, of whom eight had recurrence of symptoms. Nine patients had restenosis: their hemodynamic indexes had returned to prevalvuloplasty values.(ABSTRACT TRUNCATED AT 250 WORDS)
Very elderly patients with severe aortic stenosis will probably benefit from percutaneous balloon valvuloplasty. Ninety-two patients, aged 80 or older (mean age, 84 +/- 3.7 years) and all severely incapacitated (18 with an associated pathologic condition or in critical condition with terminal heart failure), underwent a valvuloplasty procedure. Femoral access was used in all cases except seven (8%), in whom the femoral route had to be abandoned and the brachial approach was used due to severe arterial tortuosity. Peak-to-peak ventriculoaortic gradient decreased from 71 +/- 27 to 27 +/- 15 mm Hg, and the aortic valve area increased from 0.48 +/- 0.16 to 0.91 +/- 0.35 cm2 (p less than 0.01). Thirty-two percent had a postprocedure aortic valve area more than or equal to 1 cm2. The final valve area was less than or equal to 0.7 cm2 in 30% of the patients. There were three deaths (ages, 82, 92, and 98 years) in the procedure room. One stroke occurred 1 day after the procedure. Hematoma or thrombosis at the femoral puncture site was observed in 14 cases (15%), requiring surgical repair in only five cases. Three patients died in the hospital; the total in-hospital mortality was 6.5%. Among the 62 patients about whom information could be obtained at a mean follow-up interval of 13 +/- 5 months, there were 18 late deaths (mean age, 85 +/- 11 years). The majority of the surviving 44 patients experienced marked symptomatic improvement. The results indicate that balloon valvuloplasty can be offered to very elderly patients with severe aortic stenosis and can produce improvement in hemodynamic and clinical status.
Intrapulmonary haematomas occurred during mechanical ventilation of two patients with advanced chronic obstructive pulmonary disease and bullous dystrophy. In both cases, the haematomas were revealed by blood-stained aspirates, a fall in haemoglobin level, and the appearance of radiological opacities. Haematoma occurrence in the area of a bulla which recently has rapidly increased in size, suggests that the haematoma is due to the rupture of stretched vessels embedded in the wall of the bulla.
The repercussions of food intake on blood pressure may account for certain malaises which occur after meals in elderly people. In this study, blood pressure and heart rate were measured during and after a meal in 39 elderly hospital patients divided into two groups depending on whether or not they were taking drugs likely to act on arterial blood pressure. The patients were compared with two groups of controls: 29 young adults examined after a meal and 16 elderly subjects examined at a distance from meals. A significant fall in blood pressure starting 18 minutes after the meal and without concomitant increase in heart rate, was observed in the 2 groups of elderly patients. No significant changes in blood pressure and heart rate were observed in the 2 control groups. In elderly people, food intake might act on blood pressure through entrapment of blood in splanchnic territories and/or through alteration of baroreceptors.
Although the Starr valve still is the most commonly used prosthesis, no systematic Doppler evaluation of its normal functioning has yet been performed. For this reason, 49 patients with mitral (25) or aortic (25) Starr valve and without evidence of cardiac failure, other valve disease or coronary disease were prospectively explored. Parameters measured were: maximum velocity, maximum and mean gradients, half-decrease time under pressure and corresponding valve areas. A. Mitral prosthesis. With Starr valves size 3 M and 4 M, corresponding to diameters of 30 and 32 mm respectively, the results obtained were: Vmax 1,7 +/- 0.3 m/s, maximum gradient 12.3 +/- 4.5 mmHg, mean gradient 5.3 +/- 2.2 mmHg, T1/2 120 + 30 ms, valve area 1.96 + 0.45 cm2. These 5 parameters were not significantly different with 3M and 4M valves. B. Aortic prosthesis. Contrary to mitral valve prosthesis, the results here were influenced by the size of the valve. With Starr valve No 10 (diameter 24 mm), values were: Vmax 3.3 +/- 0.4 m/s, maximum gradient 45 +/- 11.6 mmHg, mean gradient 26.7 +/- 8.8 mmHg. Aortic regurgitation was present in 20 p. 100 of the cases. The validity of the continuity equation was tested for non-invasive determination of the aortic valve functional area.
Doppler sonography permits to diagnose the gravity of valvular aortic stenosis if absolute conditions of reliability of the method are respected. The Doppler examination must be performed by a physician particularly familiar with this technique because it is a difficult examination. Systematic trial of the 5 possible approaches of the aortic orifice must be required: apical, left and right parasternal, substernal and sub-xyphoid approaches. Only velocity curves with a well defined contour must be retained and the concordance of the maximal velocities obtained by apical and parasternal approaches is in favor of a good alignment of the ultrasound beam on the aortic flow. It must be remembered that any sub-aortic obstacle or severe aortic insufficiency simulates an aortic stenosis on a continuous Doppler and that it is necessary to resort to the pulsated Doppler to rectify the diagnosis: acceleration of the flow occurs therefore in the flush chamber of the left ventricle and not at the level of the sigmoid orifice. We will remember that the Doppler does not provide the peak to peak gradient seen in hemodynamics but the maximal instant gradient which is always higher than the first one, and more especially as the aortic stenosis is more moderate. The best criteria of gravity of an aortic stenosis remain the mean gradient and the valvular area: the mean gradient is easily deduced from the quadratic transformation of the Doppler velocity curve and from a simple planimetry. The valvular area is obtained by applying the continuity equation which permits to get rid nicely of the cardiac output but still requires more validation before becoming part of the routine.
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Skin surface lipids and lipids from open and closed comedones in acne patients were analysed by thin layer chromatography. The results showed that these lipids were enriched in polar lipids, as compared with the skin surface lipids obtained from controls without acne. In both open and closed comedones, these polar lipids appeared to be derived mainly from the oxidation of squalene, which is in agreement with our previous in vitro results. We suggest that squalene oxidation is the link between comedogenesis and bacterial colonization, and based on this, we propose a hypothesis of the pathogenesis of acne.
A method is described for the extraction of urinary organic acids in children, their conversion to TMS and oxime TMS derivatives and their separation by gas liquid chromatography on a packed column of 10% OV 101. The compounds are identified by mass spectrometry. Profiles of urinary organic acids in normal neonates and in several metabolic disorders are presented.
The authors report on two cases in which parotid localization enabled diagnosis of an unsuspected sarcoidosis io be made. They feel that, apart from Sjogren-Goygerot's syndrome, all patients with parotiditis, even non-specific, should be examined systematically to exclude the possibility of a latent sarcoidosis.
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The authors used the technique of Z-palsty in the surgical treatment of hypertrophy of the superior labial fraenum. They consider that this operation is indicated when there is hypertrophy of the fraenum with a low insertion, associated with an inter-incisor diastema, and that the lateral incisors have appeared without causing the diastema to disappear. This technique eliminates the possibility of a hypertrophic scar, a possible source of failure.