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Biomedical subjects

E Tatou

Publications and source records attributed to E Tatou.

30 records · Page 2Linked to original sources
PubMed1997

[Unexplained pulmonary edema: demonstration of obstruction to pulmonary venous return by transesophageal echocardiography. Apropos of 4 cases].

The usual causes of pulmonary edema are left ventricular dysfunction, mitral valve disease or left atrial myxoma. Obstruction to pulmonary venous drainage is a rare and unrecognised diagnosis which should be considered when the usual investigations are unproductive. The authors report four cases in which transesophageal echocardiography showed pulmonary edema to be due to compression of one or more pulmonary veins by a mediastinal mass (2 cases), by the false lumen of dissection of the aorta (1 case) and postoperative stenosis of the pulmonary veins (1 case). These cases underline the diagnostic value of this technique which rapidly provides diagnostic information with privileged visualisation of the pulmonary veins and abnormalities of acceleration of blood velocities in the Doppler mode due to obstruction.

Aged↗
PubMed1996

[Advances in surgery for carotid stenosis. 900 operations (1983-1994)].

OBJECTIVES: To evaluate morbidity and mortality in carotid endarterectomy in a personal series. METHODS: Nine hundred endartectomies were performed from 1983 to 1994. All patients had > 70% carotid narrowing. Five hundred five patients underwent without preoperative angiography. RESULTS: Outcome was analyzed for 3 periods showing decreasing mortality from 4.56% in 1983-86 to 0.67% in 1990-1994. CONCLUSION: The reduction in morbidity and mortality resulted from the combined effects of pre-, per-, and post-operative care including noninvasive preoperative diagnosis of internal carotid artery stenosis using ultrasound duplex and surgery without previous angiography, delayed surgery in case of recent prolonged hemispheric deficit or of ischemic defect detected on computed tomography (CT) or magnetic resonance imaging (MRI), cerebral evaluation with CT-scan or MRI the day before operation, surgery under locoregional anesthesia, monitoring of arm arterial blood pressure during the first 24 hours following surgery.

Aged↗
PubMed1996

Effects of cyclosporin and cremophor on working rat heart and incidence of myocardial lipid peroxidation.

Cyclosporin A (CsA) is widely used as the immunosuppressant of choice for preventing graft rejection. However, its clinical use is hampered by certain side effects, especially its nephrotoxicity and other cardiovascular side effects. CsA for intravenous infusion contains cremophor (Cre) and this vehicle has significant adverse effects on endothelial function and vascular muscle. The present study was aimed at investigating the direct effects of CsA and Cre on isolated and perfused rat hearts in the dosage that closely approximates the peak level achieved for the prevention of graft rejection in the rat. Transplantation is a clinical setting in which the myocardium may be exposed to transient ischemia. In this study, we have shown that the vehicle of CsA, namely Cre, has significant adverse effects on cardiac function. We observed a reduction in coronary flow and aortic output. Addition of CsA appeared to induce a further reduction of aortic flow. We have also shown that a significant increase of thiobarbituric acid reactive substances, considered as an index of lipid peroxidation, occurred in the reperfused heart in the presence of Cre+CsA. Our experimental study shows that Cre turned out to be toxic to myocardium by itself. In the heart, potential Cre-CsA interactions possibly potentiating CsA toxicity could not be excluded. The increase of lipid peroxidation in the heart perfused with CsA suggests that reactive oxygen species may be involved in the detrimental effects of this substance on the heart.

3,4-Methylenedioxyamphetamine↗
PubMed1996

[Emergency angioplasty for total thrombosis of the left main coronary artery. Apropos of a case].

Complete thrombosis of the left main coronary artery is a rare angiographic finding and usually gives rise to cardiogenic shock during unstable angina or myocardial infarction. The prognosis of this condition is very dependent on the collateral coronary circulation and the myocardial protection seems to depend on the rapidity of revascularisation. Two therapeutic approaches may be envisaged; emergency coronary bypass grafting or percutaneous angioplasty, the natural history being particularly disastrous. The authors report the case of a 42-year-old patient with complete occlusion of the left main stem responsible for unstable angina and acute pulmonary oedema. The outcome with angioplasty in the acute phase associated with surgical revascularisation four days later, was good.

Angina, Unstable↗
PubMed1996

[Leg embolisms: treatment via percutaneous thrombo-aspiration].

PURPOSE: Benefits of the local thrombolytic therapy in the treatment of acute peripheral arterial ischemia have been proved (13), but the place of thrombo-aspiration in this percutaneous treatment is not well defined. This study evaluates the results of thromboaspiration with or without local thrombolysis for the treatment of arterial embolism associated with a lower limb arteriopathy. METHODS: From May 1991 to May 1992, ten arterial embolisms (below the common femoral artery) associated with a lower limb arteriopathy have been treated by thromboaspiration with or without local thrombolysis. RESULTS: Nine immediate successes have been obtained. One failure has been operated on with success. On the third day, an occlusion of the popliteal artery occured and a femoroperoneal bypass was performed. But the occlusion of the bypass obligated to an amputation above the knee. This patient died one month later (hospital mortality 10%). During the follow-up (2 months), other procedures were patent. CONCLUSIONS: Thromboaspiration with or without thrombolysis is efficient for the treatment of arterial embolism associated with a lower limb arteriopathy.

Aged↗
PubMed1995

Aortic valve regurgitation caused by blunt chest injury.

Aortic valve regurgitation is an uncommon consequence of closed chest injury. It is caused by damage to the valve apparatus (ruptured cusp) or when subadventitial rupture of the ascending aorta causes prolapse of a subjacent valve cusp. Aortic valve regurgitation was detected in 4 patients (2 men and 2 women, 30 to 65 years old) who had sustained multiple injuries in road accidents 1 week to 30 years before. Three had subadventitial rupture of the ascending aorta and one had isolated rupture of the noncoronary cusp of the aortic valve. The mechanism responsible for the damage was believed to be a consequence of multiple chest lesions (right costal flap, sternal fracture, pulmonary contusion). It is difficult to diagnose and treat aortic regurgitation in patients with multiple injuries. Three patients had repair operations and the remaining patient needed valve replacement. If aortic regurgitation is haemodynamically well tolerated, the operation should be postponed until the patients have recovered from their other injuries. The results in these 4 patients and in other reported cases indicate that operations can be performed soon after the acute phase.

Adult↗
PubMed1994

Effects of atrial pacing on right ventricular contractility after coronary artery surgery.

Increasing heart rate enhances the strength of contraction of cardiac fibers. This has been demonstrated in vitro and recently for the left ventricle. To study this phenomenon on the right ventricle, the effects of increasing heart rate by atrial pacing on right ventricular (RV) contractility were observed after coronary artery surgery in 20 patients. Right ventricular ejection fraction (EF) and stroke volume (SV) were measured by use of a rapid-response thermistor pulmonary artery catheter. Right ventricular volumes were calculated from EF and SV. Right ventricular contractility was assessed by the slope of the end-systolic pressure-volume relationship (ESPVR) before and after increasing RV preload by means of military antishock trousers (MAST) inflation. The dP/dtmax/end-diastolic volume index (EDVI) ratio, which is independent of ventricular preload, was also used as an inotropic index. Results are expressed as mean +/- SEM. Right ventricular preload, as reflected by RVEDVI, was increased by MAST inflation (99 +/- 6 mL/m2 v 106 +/- 7 mL/m2, P < 0.01), but returned to control values when inflation of MAST was combined with pacing (100 +/- 6 mL/m2). The slope of the RV ESPVR significantly increased when heart rate was increased (0.22 +/- 0.03 mmHg/mL/m2 before pacing v 0.77 +/- 0.07 mmHg/mL/m2 during pacing, P < 0.05). The dP/dtmax/EDVI ratio was also increased by pacing (2.32 +/- 0.4 mmHg/min/mL/m2 before pacing v 3.15 +/- 0.5 mmHg/min/mL/m2 during pacing, P < 0.01). Moreover, cardiac index was increased by pacing alone (2.45 +/- 0.2 L/min/m2 v 2.78 +/- 0.2 L/min/m2, P < 0.01), and significantly more when MAST were inflated (2.94 +/- 0.2 mL/m2, P < 0.05 v pacing alone). It is concluded that increasing heart rate by atrial pacing increases RV inotropic status after coronary artery surgery.

Adult↗
PubMed1994

[Carotid surgery without systematic preliminary angiography. 402 patients treated by surgery between 1986 and 1992].

Ultrasonography of the carotid bifurcation is a high performance technique for the detection of carotids stenosis. Associated with Doppler and echography, ultrasonography offers a means of precisely evaluating atheromatous stenoses of the bifurcation. The degree of narrowing can be calculated from the pulsed Doppler recordings and colour echo-Doppler measurements, reducing the subjective interpretation factor (the operator-dependent nature of the exploration is no longer related to data collection). Most severe stenoses can be diagnosed with these techniques. The question now is whether carotid angiography is still necessary to establish the indication for surgical endarterectomy. We attempted to give an answer based on our prospective series of 402 endarterectomies of the carotid bifurcation performed between 1986 and 1992 without prior routine angiography. Arteriography was performed occasionally in the pre-operative work-up but was limited to cases in which the ultrasonography was judged insufficient. We observed a mortality of 0.25% and a morbidity of 0.5%. This diagnostic approach is justified by its lower cost and reduced risk due to arteriography. In addition, unidentified arterial lesions downstream have little or no effect on indications and outcome.

Aged↗
PubMed1992

[Post-traumatic aortic valve insufficiencies].

Aortic regurgitation due to closed chest trauma is rare. It is related either to a valve lesion itself (ruptured cusp) or to trauma of the ascending aorta (subadventitial rupture with prolapse of the underlying aortic valve cusp). Four cases are described, 2 men and 2 women aged 30 to 66 years, after severe injuries in road traffic accidents: three patients had rupture of the aorta and the other had isolated rupture of the non-coronary aortic valve cusp. This pathology is unique due to the pathogenic mechanism associated with multiple thoracic injuries (right costal flap, sternal fracture, pulmonary contusion ...). The polytraumatic context explains the diagnostic difficulties and the secondary importance of the valve problem. Late surgery of these lesions was conservative in 3 cases: valve replacement was necessary in 1 case. If the haemodynamic tolerance of the aortic regurgitation is good, surgery should be deferred until the polytraumatic emergency has been dealt with. Good surgical results, often with conservative procedures, encourage earl operation after the acute polytraumatic period.

Adult↗