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Biomedical subjects

F Delahaye

Publications and source records attributed to F Delahaye.

At least 19 recordsLinked to original sources
PubMed1998

Antibiotic prophylaxis for permanent pacemaker implantation: a meta-analysis.

BACKGROUND: Infection remains a serious complication after permanent pacemaker implantation. Antibiotic prophylaxis is frequently prescribed at the time of insertion to reduce its incidence, although results of well-designed, controlled studies are lacking. METHODS AND RESULTS: We performed a meta-analysis of all available randomized trials to evaluate the effectiveness of antibiotic prophylaxis to reduce infection rates after permanent pacemaker implantation. Reports of trials were identified through a Medline, Embase, Current Contents, and an extensive bibliography search. Trials that met the following criteria were included: (1) prospective, randomized, controlled, open or blind trials; (2) patients assigned to a systemic antibiotic group or a control group; (3) end point events related to any infection after pacemaker implantation: wound infection, septicemia, pocket abscess, purulent secretion, right infective endocarditis, inflammatory signs, a positive culture, septic pulmonary embolism, or repeat operation for an infective complication. Seven trials met the inclusion criteria. They included 2023 patients with established permanent pacemaker implantation (new implants or replacements). The incidence of end point events in control groups ranged from 0% to 12%. The meta-analysis suggested a consistent protective effect of antibiotic pretreatment (P=.0046; common odds ratio: 0.256, 95% confidence interval: 0.10 to 0.656). CONCLUSIONS: Results of the present meta-analysis suggest that systemic antibiotic prophylaxis significantly reduces the incidence of potentially serious infective complications after permanent pacemaker implantation. They support the use of prophylactic antibiotics at the time of pacemaker insertion to prevent short-term pocket infection, skin erosion or septicemia.

Adult↗
PubMed1998

Interaction and dissociation by ligands of estrogen receptor and Hsp90: the antiestrogen RU 58668 induces a protein synthesis-dependent clustering of the receptor in the cytoplasm.

The in vivo interaction of estrogen receptor (ER) and Hsp90, demonstrated in the absence of hormone by a nuclear cotranslocation assay of the cytoplasmic Hsp90 with the karyophilic receptor, was disrupted by agonist and antagonist ligands, which, after dissociating the Hsp90, allowed the chaperone protein to be relocalized in the cytoplasm. The pure antiestrogen RU 58668 (RU), which was unable to stimulate an estrogen-dependent reporter gene and completely inhibited its estradiol-induced activity, also profoundly modified the subcellular distribution of ER in a specific time- and dose-dependent manner; ER appeared as speckled fluorescent clusters mainly located in the perinuclear region of the cytoplasm. The kinetics of appearance and reversal of the RU-dependent ER mislocalization in the presence or absence of cycloheximide demonstrated 1) that this effect was reversed by RU withdrawal or estradiol (E2) treatment, and 2) that cycloheximide with RU inhibited and reversed the ER cytoplasmic mislocalization induced by RU alone. These results point to a protein synthesis-dependent step in the mechanism of action of this antiestrogen. After RU treatment, a large portion of ER was found in the particulate fraction of the cytoplasm. However, confocal and electron microscopic analysis showed that ER clusters were not associated with specific cytoplasmic organelles or compartments. Using ER mutants, it was found that the ligand binding domain was sufficient for RU to produce receptor mislocalization, while the constitutive nuclear localization signals were dispensable. We propose that the antiestrogenic properties of RU are primarily due to the induction of an aggregation-prone receptor conformation that cannot undertake the constitutive and the ligand-induced nuclear localization function of the receptor because it is sequestered in the cytoplasm by fast turning over protein(s). We predict that antiestrogens able to block ER nuclear localization will behave as pure antihormones and will inhibit all the nuclear action of ER elicited by agonistic ligands or by ligand-independent mechanisms such as growth factor stimulation.

Animals↗
PubMed1997

[Epidemiology and natural history of cardiac failure].

Congestive heart failure is a major and growing public health problem. Its prevalence is 3-20 per 1,000, and increases steeply with age. Coronary heart disease is the underlying cause in 50% of the cases, idiopathic cardiomyopathy in 20%. Survival at 5 years after the onset of heart failure in the Framingham study was 25% in men and 38% in women; the mortality rate of heart failure patients was 6-7 times that of the general population. Three variables--functional class, natremia, left ventricular ejection fraction--are powerful prognostic factors. Quality of life of heart failure patients is severely impaired.

Adolescent↗
PubMed1997

Left ventricular pressure-volume relationships before and after cardiomyoplasty in patients with heart failure.

BACKGROUND: The aim of this study was to elucidate whether beneficial effects of cardiomyoplasty (CMP) in patients with dilated cardiomyopathy are the result of a decrease in existing ventricular dilatation or a prevention of further dilatation. METHODS AND RESULTS: Combined micromanometer-conductance catheters were used to evaluate left ventricular pressure-volume relationships in six patients with dilated cardiomyopathy before and at 6 and 12 months after CMP. Acute changes in preload and afterload were induced by a standardized leg-tilting intervention and a bolus infusion of nitroglycerin. After CMP, end-diastolic volume (EDV) decreased from 138+/-10 to 103+/-18 mL/m2 (P<.01) at 6 months and to 83+/-17 mL/m2 (P<.01) at 12 months. End-diastolic pressure (EDP) decreased from 20.2+/-6.4 to 13.9+/-7.7 mm Hg (P<.01) at 6 months after CMP. Peak ejection rate and ejection fraction increased at 6 months after CMP from 594+/-214 to 799+/-214 mL/s (P<.05) and from 26.6+/-4.7% to 40.1+/-8.3% (P<.05), respectively. Peak dP/dt decreased at 12 months after CMP from -842+/-142 to -712+/-168 mm Hg/s (P<.05). Leg-tilting before CMP increased EDP from 20.2+/-6.4 to 25.6+/-5.2 mm Hg (P<.01), end-systolic pressure (ESP) from 118+/-17 to 122+/-17 mm Hg (P<.05), and tau from 50.8+/-2.8 to 53.8+/-2.3 ms (P<.05). Six months after CMP, leg-tilting also increased EDV from 103+/-18 to 110+/-22 mL/m2 (P<.05) and ESV from 62+/-14 to 66+/-14 mL/m2 (P<.05). Before CMP, nitroglycerin decreased EDP from 20.2+/-6.4 to 10.4+/-3.8 mm Hg (P<.01), ESP from 118+/-17 to 96+/-11 mm Hg (P<.05), ESV from 100+/-11 to 89+/-7 mL/m2 (P<.05), and tau from 50.8+/-2.8 to 44.5+/-3.7 ms (P<.05). Six months after CMP, nitroglycerin decreased EDP, ESP, and tau to similar values. CONCLUSIONS: Our findings show that up to 1 year after CMP, marked decreases in left ventricular volume are present. Our measurements suggest that CMP actively reduced the dilated ventricle but did not prevent a higher EDV on an increased venous return. The latissimus dorsi muscle wrap contraction results in better synchronization of contraction and more rapid emptying of the left ventricle.

Cardiomyopathy, Dilated↗
PubMed1997

Retrospective risk analysis for early heart-related death after cardiomyoplasty. The Worldwide Cardiomyoplasty Group.

BACKGROUND: Dynamic cardiomyoplasty is an evolving treatment for heart failure that uses an electrically stimulated latissimus dorsi muscle wrapped around the heart to improve cardiac function. Preoperative patient characteristics and deaths after cardiomyoplasty have been recorded during the past 5 years in a cumulative database representing worldwide experience of 42 medical centers. METHODS: Statistical models of hazards (monthly death rates) were used to identify risk factors for transiently increased risk of cardiovascular mortality within 2 months after cardiomyoplasty. RESULTS: Actuarial survival (n = 261) was 88%, 80%, and 76% at 1, 3, and 6 months after cardiomyoplasty, respectively. The peak hazard of 6% dying per month occurred during the first month after the surgical procedure. Lower ejection fraction, increased number of major coronary arteries with > or = 70% stenotic lesions, and lower chronotropic responses during exercise were independent risk factors for the transient increase in early cardiovascular mortality. Early risk of cardiovascular mortality was significantly reduced as centers gained experience with more than 3 patients. CONCLUSION: Early survival after cardiomyoplasty has improved with experience and might be reduced further by preoperative assessments that identify patients at highest risk.

Actuarial Analysis↗
PubMed1996

[Prophylaxis of infectious endocarditis].

Prophylaxis of infective endocarditis has been the subject of recommendations from most countries for several years. The basis of the recommendations is the administration of prophylactic antibiotics preceding a procedure at risk for patients with a known at risk cardiac disease. The antimicrobial agent is selected to be active against the main microorganisms causing bacteremia according to the type of at risk procedure. Furthermore, the choice and modalities of antibiotic prophylaxis are adapted to take into account a possible documented allergy to penicillin, the type of predisposing cardiac disease, the number of performed procedures and the requirement for general anesthesia. Future advances should concern the diffusion and application of these recommendations, and the appropriateness of these practices in terms of general cost benefit assessment.

Antibiotic Prophylaxis↗
PubMed1996

Comparison of infective endocarditis in patients with and without previously recognized heart disease.

In a consecutive series of patients with infective endocarditis, we compared the charts of 123 nonaddicted patients without previously known heart disease with those of 174 patients with native valve disease. The 2 groups were similar in age, sex, clinical findings, and mortality rates, but infective endocarditis was more often located on the aortic valve, more often due to Streptococcus bovis and enterococci in patients without previously known heart disease.

Aged↗
PubMed1996

[Diagnostic value of echocardiography under dobutamine in everyday practice].

In order to evaluate the place of dobutamine echocardiography in everyday practice, this test and a stress ECG were performed in 34 patients referred for diagnostic or assessment coronary angiography. Dobutamine, administered in 3-minute stages from 5 to 30 micrograms/kg/min, was well tolerated. The anti-ischaemic treatment was continued in 26 patients before dobutamine echocardiography and in 15 patients before the stress ECG. The electrocardiographic, echocardiographic and angiographic documents were each analysed by 2 independent observers. Dobutamine echocardiography was considered to be positive in the presence of the development of a new abnormality of segmental kinetics or when abnormality of segmental kinetics was identified outside of the territory of infarction. With reference to coronary angiography, the sensitivity of stress ECG and dobutamine echocardiography was 46% and 42%, respectively, and the specificity was 75% and 88%, respectively; the sensitivity of each test was low, probably because of fake tests. The combination of the two tests improved the sensitivity (69%) without altering the specificity (75%). Dobutamine echocardiography could usefully complete a negative stress ICG whenever a false-negative result is suspected to avoir wrongly reassuring some patients and to allow appropriate management.

Adult↗
PubMed1996

[Fibrous aortic valve tumor (Lambl's excrescence) trapped in the right coronary artery. Apropos of a case].

Lambl's excrescences are filliform aortic or mitral valve tumours. They do not usually cause any clinical problems and are autopsy findings. The authors report a case of a 64 year old female with an invalidating angina in whom echo and angiographic investigations suggested obstruction of the right coronary ostium by a valvular tumour. This was confirmed at surgery and tumorectomy was followed by regression of the anginal syndrome.

Angina Pectoris↗
PubMed1995

Beat-to-beat analysis of left ventricular pressure-volume relation and stroke volume by conductance catheter and aortic Modelflow in cardiomyoplasty patients.

BACKGROUND: Since the clinical introduction of dynamic cardiomyoplasty, a discrepancy has been observed between unchanged measurements of cardiac function and improved clinical outcome. METHODS AND RESULTS: We performed a beat-to-beat analysis of cardiac performance at rest in nine cardiomyoplasty patients 6 to 24 months after operation. Conductance and micromanometer catheters were placed in left ventricle and aorta and used for measurements over a 15-second period, during which the wrapped latissimus dorsi (LD) muscle was stimulated for 10 seconds in a 1:2 synchronization mode followed by a 5-second period without LD stimulation. The synchronization delay between start of the QRS complex and the LD contraction was changed from 4 up to 125 ms at the patient's clinical stimulation strength and at an increased supramaximal amplitude. Comparing the LD assisted period to the unassisted period, at the clinical settings no significant changes in stroke volume (SV) as measured by the conductance technique and the aortic Modelflow technique were observed. A significant (P < .05) rise in left ventricular end-diastolic pressure (LVEDP) was observed directly after the assisted 10-second period. The peak ejection rate (PER) of left ventricular volume increased (P < .05), with a mean of 28 +/- 23% during the LD stimulated beats. At the patient's individual best setting, SV of the stimulated beats increased (P < .01) by a mean of 20 +/- 15%. Systolic aortic pressure increased (P < .01) by a mean of 7 mm Hg, peak negative dP/dt increased (P < .01), and PER increased, with a mean of 68 +/- 24% (P < .01). LVEDP was similar in stimulated and unstimulated beats and increased (P < .05) in the nonpaced 5-second period. The delay for the best setting ranged from 25 to 125 ms; the stimulus strength was 1.5 to 3 V higher than the clinical setting. At the patient's individual worst setting, SV remained unchanged and PER was higher, with a mean of 30 +/- 25% (P < .05). The worst setting was observed at the 1.5- to 3-V-higher stimulus strength; in six patients, it was at a short delay (4 to 25 ms) and in three patients, at the longest delay (100 to 125 ms). CONCLUSIONS: By the left ventricular conductance catheter and aortic Modelflow methods, improvement in cardiac function by dynamic cardiomyoplasty was demonstrated in this patient group. The synchronization interval, stimulus strength, and stimulus duration appeared to be critical for obtaining optimal improvement.

Aged↗
PubMed1995

The long term prognosis of infective endocarditis.

Three problems hamper the prognosis of patients who survive the initial phase of infective endocarditis (IE): the rate of IE recurrence is 0.3-2.5/100 patient years, about 60% of patients will have to be operated on at some time, 20-30% during the initial stay, 30-40% during the following 5-8 years; five-year survival after the hospital phase is about 75% in previous reports and 85% in more recent papers. Death is mainly due to heart failure. We looked at the long-term survival of 330 patients with IE who were hospitalized in our institution in 1970-1982, and at the potential influence of 10 factors: age, gender, previous heart disease, microorganism, location of IE, onset of IE, congestive heart failure (CHF) at onset, CHF during the first year, persistent fever, surgery at the acute phase. Global survival was 75% at 6 months, and 57% at 5 years. The only non-significant factor was IE location. The annual instantaneous risk of death was 0.55 at 6 months, 0.18 at 1 year, then 0.03. After one year, the only prognostic factor was age. The relative risk of dying among patients with IE who survived the first year, as compared to the risk of dying among the general population, was 3.27. The IE prognosis is not uniform. Mortality is high during the initial phase, but after one year the risk of dying is low, although still above that of the general population. Part of the risk is probably the direct consequence of IE, but part is due to the course of the underlying heart disease.

Age Factors↗
PubMed1995

Procedures associated with infective endocarditis in adults. A case control study.

OBJECT: To assess the relative risk of infective endocarditis associated with various procedures and the protective efficacy of antibiotic prophylaxis by a case-control study. BACKGROUND: Recommendations for the prevention of infective endocarditis are based on the hypothesis of a relationship between procedures and infective endocarditis which is supported by anecdotal reports and data from experimental models. METHODS: Cases met the Von Reyn's diagnostic criteria modified with echocardiographic and macroscopic findings Controls were recruited from cardiology or medicinal wards. Cases (n = 171) and controls were matched as regards sex, age and underlying cardiac condition. They were requested to indicate all the medical, surgical or dental procedures within the previous 3 months. Among potential confounding factors, infectious episodes and skin wounds in the previous 3 months were reported. Antibiotic prophylaxis administration was documented for type, dosage, duration and administration schedule. RESULTS: Cases significantly more frequently than controls had undergone at least one procedure (matched odds ratio, 1.6; 95% confidence interval, 1.01 to 2.53). Dental procedures considered as a whole were not associated with an increased risk, although scaling and root canal treatment showed a trend towards a higher risk of infective endocarditis (P = 0.065). Among non-dental procedures, only surgery appeared to be at risk (matched odds ratio, 4.7; 95% confidence interval, 1.02 to 22). Considering all procedures, the risk of infective endocarditis increased significantly with the number of procedures. While general co-morbid conditions did not differ between the two groups, cases significantly more frequently than controls had experienced an infectious episode or a skin wound. In multivariate analysis, only infectious episodes and skin wounds significantly increased the risk of infective endocarditis. Scaling was the only independent risk factor for viridans streptococcal infective endocarditis. The 46% protective efficacy of antibiotic prophylaxis was not significant. CONCLUSIONS: Procedures do increase the risk of infective endocarditis. The interpretation of the apparent low risk associated with dental procedures may be as a result of the current practice of antibiotic prophylaxis. Our data suggest that surgery should be more clearly mentioned in future guidelines, and reemphasize that a rigorous treatment of any focal infection in cardiac patients is mandatory. From the efficacy rate of antibiotic prophylaxis,it can be estimated that the overall incidence of infective endocarditis might be reduced by 5 to 10% in France by appropriate use of antibiotic prophylaxis in cardiac patients.

Adult↗
PubMed1995

Infective endocarditis due to Streptococcus bovis. A report of 53 cases.

Fifty-three patients (42 men; 11 women) with Streptococcus bovis infective endocarditis attended a tertiary cardiology hospital between 1980 and 1991, and constituted 11% of the total number of infective endocarditis cases hospitalized there during that period. The mean age was 59 +/- 15 years; 15 had previously suffered valvular disease (12) or had a valvular prosthesis (3); one patient had had a previous infective endocarditis. The infective episode involved the aortic valve in 26 patients, both the aortic and mitral valves in 18 patients, the mitral valve only in six and other valves in three. Echocardiographic examination showed one or more vegetations in 44 patients. Cardiac failure was diagnosed in 35 patients and embolic episodes in 22, of whom 11 were cerebrovascular accidents. The patients became afebrile 19 +/- 39 days after starting antibiotic treatment. Valve replacement was performed in 37 patients during their initial hospitalization, and in four during follow-up. After a mean follow-up of 4.6 +/- 3.1 years with a 100% follow-up, 15 patients died: 1 preoperatively, one in the first 30 days after operation, 13 later (8141 operated patients and 5/12 non-operated patients). Actuarial survival was 73% at 5 years. Gastrointestinal signs were present in 12 patients; 43 patients (81%) had a full colonic examination which showed polyps in 20 patients and adenocarcinomas in seven. Of 11 late deaths four were related to a malignant colonic tumour. This study confirms that Streptococcus bövis infective endocarditis is 'relatively benign', but it stresses the frequency and potential severity of the associated colonic lesions, requiring colonoscopy and making the treatment of high risk lesions mandatory.

Adenocarcinoma↗
PubMed1995

Characteristics of infective endocarditis in France in 1991. A 1-year survey.

OBJECTIVE: To update data on incidence and characteristics of infective endocarditis in France. BACKGROUND: Numerous studies have shown that the incidence and course of infective endocarditis remain stable in spite of advances in treatment and of prophylactic recommendations. METHODS: A survey of all consecutive cases of infective endocarditis was conducted over 12 months in all the institutions of three French regions. RESULTS: Data were collected from 415 cases of definite (32%), probable (53%), and possible (15%) infective endocarditis. The adjusted annual incidence was 24.3 cases per million inhabitants. Thirty-four percent of the patients had no previously known heart disease, 33% had native valve disease, 22% had a prosthetic valve, and 11% had miscellaneous underlying conditions. Infective endocarditis was located solely on the mitral valve in 39%, solely on the aortic valve in 36%, and on the tricuspid valve in 6%. Echocardiography showed a vegetation on the mitral valve in 39%, on the aortic valve in 29%, and on the tricuspid valve in 8%. The causal microorganism was identified in 92%; it was a Streptococcus in 58%, and a Staphylococcus in 23%. Twenty patients were intravenous drug users, and 45 had had a medical or a surgical procedure, which might be associated with the occurrence of infective endocarditis. During the first 2 months after admission, 24% of the patients underwent surgery, and 17% of all patients died. CONCLUSIONS: Despite medical and surgical advances, infective endocarditis remains frequent and severe in France.

Adolescent↗
PubMed1995

[Management of myocardial infarction in the Rhone-Alps area. Are there many variations in practice?].

The aim of this study was to determine the diagnostic and therapeutic strategies after myocardial infarction and to examine variations in medical and surgical practice with respect to the severity of disease, status of the hospital and patients' characteristics. The method used was a prospective study with follow-up at 30 days and 18 months. The subjects came from an exhaustive cohort of all patients admitted to hospital for myocardial infarction during the month of April 1991 in 57 public and private hospitals in the Rhone-Alps region (n = 311). The patients were identified after admission by consulting physicians of the Department of Social Security. The study included all patients with acute myocardial infarction with at least two of the three usual diagnostic criteria (prolonged, constrictive chest pain, enzyme increases and electrocardiographic changes). The study excluded patients who were dead before arrival at hospital. The parameters analysed included the clinical management, use of echocardiography, exercise stress testing, myocardial scintigraphy, coronary angiography, thrombolysis, angioplasty and coronary bypass surgery in the first 30 days after admission. The severity of infarction was assessed by seven clinical, enzymatic and electrocardiographic criteria by physicians from the Department of Social Security (pain, syncope, shock, left ventricular dysfunction, elevation of CPK > 1000 IU, anterior or extensive necrosis, arrhythmias). The mortality rate of this cohort was calculated from hospital statistics and then by enquiring in the town halls of the region. The demographic features of the cohort were marked by a predominance of men (69.5%) and a relatively high mean age (69 years; 23% over 80 years). Complementary investigations were used with the following frequencies: echocardiography, 61.1%; coronary angiography, 26.4%; exercise stress testing 22.8%; myocardial scintigraphy, 5.5%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗