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Biomedical subjects

F Jault

Publications and source records attributed to F Jault.

At least 55 records · Page 3Linked to original sources
PubMed1990

Inhibition of HSV-1 multiplication in rat embryo fibroblasts constitutively expressing the EJ-ras oncogene.

In order to examine cellular gene involvement in HSV-1 expression, we constructed different rat embryo fibroblast cell lines immortalized by adenovirus E1A or c-myc, with or without the human EJ bladder carcinoma transforming oncogene EJ-ras. HSV-1 multiplication was strongly inhibited in cells expressing EJ-ras genes compared to immortalized control cells. Virus adsorption and penetration were not quantitatively modified, but HSV-1 DNA replication was inhibited. The expression of viral thymidine kinase (TK) activity after infection by recombinant virus with the TK coding sequence under immediate-early (IE) promoter control showed that IE gene expression is inhibited in cells expressing EJ-ras. Analysis of IE gene transcription by Northern-blot hybridization and by nuclear run-off transcription assay indicates that this inhibition takes place at the transcriptional level.

Adenovirus Early Proteins↗
PubMed1990

Surgical treatment of chronic aortic dissections.

Between January 1976 and March 1987, 78 patients underwent surgery for chronic aortic dissection at our institution. The ascending aorta was involved in 66 cases (Stanford type A) and was not involved in 12 cases (Stanford type B), wherever the initial dissection was suspected. Aortography remains the main preoperative investigation. The surgical technique varies according to the type of dissection. It seems essential to exclude the primary intimal tear and all dilated segments of the aorta must be replaced. The overall operative mortality was 11.5% (7.5% in type A, 33.3% in type B dissection). Sixty-three patients have been followed for a period varying between 6 months and 10 years (mean 5 years). The overall survival at 6 years is 60% +/- 5.6%. Because of the ultimate risk of aneurysmal dilatation of the false channel, these patients must be followed by CT scanning, colour flow Doppler echocardiography, magnetic resonance imaging, and in some cases, aortography.

Aortic Dissection↗
PubMed1990

[Results of thrombo-endarterectomy of chronic pulmonary embolism].

Between 1973 and 1987, 33 patients underwent pulmonary thromboendarterectomy for chronic pulmonary embolism. Twenty-six patients were in Class III of the NYHA Classification, 5 in Class IV with overt right ventricular failure and 2 in Class II. The average pO2 was 60 mmHg under basal conditions without oxygen therapy. The amputation of the pulmonary vascular tree was greater than 50 per cent in all patients. The average systolic pulmonary artery pressure was 70 mmHg. Twenty patients were operated by a lateral thoracotomy without CPB and 6 by sternotomy with CPB under normothermia with or without cardiac fibrillation. The later method avoids having to open the pleura and seemed to give better haemodynamic control. Interruption of the inferior vena cava was systematic in all cases. The global operative mortality was 20 per cent but this seemed to be less in the patients operated by sternotomy under normothermic CPB (no deaths in 6 patients). The authors consider that this technique should be studied in a larger series of patients. Eighteen patients are still being followed up; the clinical and scintigraphic and/or angiographic improvement is clearcut in the majority of cases.

Chronic Disease↗
PubMed1990

[Value and results of coronary surgery before the repair of abdominal aortic aneurysm].

Seventeen polyarteriosclerotic patients underwent coronary bypass surgery before repair of an abdominal aortic aneurysm between December 1979 and November 1988 in the Cardiovascular Surgical Department of the Pitié Hospital. Sixteen patients had triple vessel disease and 1 patient had single vessel disease but with mitro-aortic valvular disease. The abdominal aortic aneurysm was asymptomatic in 9 cases. The diameter of the aneurysm was over 5 cm in all patients. The average time between the two operations was 6.3 +/- 5.4 months. One myocardial infarction was observed following the coronary bypass surgery. There were no complications related to the coronary artery disease or operative deaths after repair of the abdominal aortic aneurysm. Two late deaths occurred, one due to an aortoduodenal fistula and the other to extra cardiovascular causes. One patient underwent femoro-popliteal bypass surgery 4 years after repair of the aortic aneurysm. One patient had successful percutaneous transluminal angioplasty of an aorto-coronary venous bypass graft 8 years after its implantation. All the other patients are asymptomatic from the coronary and peripheral arterial points of view. The 7 year survival was 85.7 +/- 9.4 per cent. These results seem to justify immediate and late preventive myocardial revascularisation in patients with coronary artery disease requiring surgery prior to repair of an abdominal aortic aneurysm.

Aged↗
PubMed1989

[Results of simultaneous myocardial and cerebral revascularization surgery].

Out of 3,678 patients who underwent aorto-coronary bypass between May, 1979 and October, 1987 at the La Pitié Hospital, Paris, 48 had simultaneous myocardial and cerebral revascularization. Operative mortality rate was 4.2 p. 100. Peri-operative myocardial infarction occurred in 3 cases (6.2 p. 100). No neurological complication was observed. The survival rate at 5 years (operative mortality included) was 74.8 +/- 8.66 p. 100. These results obtained in patients with multiple arterial disease are in agreement with those found in the literature. The lack of neurological complications is in favour of a systematic combined surgical treatment of severe carotid and coronary lesions.

Aged↗
PubMed1989

[Left thoracotomy: an alternative to median sternotomy in coronary bypass in cases of pericardial adhesions].

Coronary bypass on the circumflex artery network was performed by left thoracotomy in 5 patients. All presented with pericardial adhesions due to coronary artery surgery (n = 4) or to mediastinal irradiation (n = 1). The left thoracotomy route provides excellent exposure of the lateral aspect of the heart and may be an advantageous alternative to sternotomy when pericardial adhesions are present.

Coronary Disease↗
PubMed1989

[Delayed autotransfusion associated with the cell-saver method in cardiovascular surgery. Values, methods, initial results].

The aim of deferred autotransfusion associated with the Cell-Saver system, i.e. the recovery of intraoperative blood loss, is to avoid using external homologous blood products. Transfusion-transmitted diseases and immunisation problems can be avoided: normovolumic haemodilution is an advantage in patients with coronary artery disease and economies can be made in the use of homologous blood. This technique has been in use in Professor Cabrol's department since 1987 with the help of the Blood Transfusion Centre of the Pitié Hospital. The contraindications are unstable angina, severe cardiac failure and anaemia of less than 11 g Hb at the first consultation. A review of the first 65 patients included in the protocol showed that deferred autotransfusion was well tolerated in all cases and that only 10 per cent of patients required transfusion with homologous blood. Autotransfusion associated with the Cell-Saver system is therefore a good method which should be extended to the largest possible number of patients referred for elective cardiac surgery.

Adult↗
PubMed1989

[Systematic peroperative use of an autotransfusion system in heart surgery. A prospective and comparative study in 283 patients].

A series of 283 patients undergoing cardiac bypass surgery was studied to determine whether intraoperative autotransfusion, haemodilution, and a change in transfusion techniques of the same surgical team could reduce homologous blood requirements. The Cell-Save Haemonetics* system was used systematically in 167 consecutive patients (Group I). This group of autotransfused patients was analysed prospectively and compared with a control group (Group II) of 116 patients operated one year before and analysed retrospectively. During the whole hospitalisation, homologous blood products were required in 40.7% of patients in Group I compared with 73.3% of patients in Group II (p less than 0.0001). The average requirements of packed cells per patient were 2.7 +/- 1.3 in Group I compared with 4.1 +/- 2.5 in Group II (p less than 0.0001). The haematocrit on discharge from the department was 29.9 +/- 4% in Group I compared with 32 +/- 4.5% in Group II (p less than 0.0001). The average volume of blood recovered by the system and then autotransfused was 620.8 +/- 242.6 ml. There was no significant difference in postoperative bleeding in the first 24 hours between the two groups. This study confirms that peroperative autotransfusion during cardiac surgery and the acceptance of a clinically well tolerated normovolumic anaemia are associated with a significant reduction in homologous blood consumption.

Adult↗
PubMed1989

Surgical treatment for chronic pulmonary thromboembolism.

Thrombo-endarterectomy for chronic thromboembolism of the pulmonary artery can be recommended in patients with NYHA classification III or IV symptoms, mean pulmonary artery pressure greater than 30 mmHg and proximal, greater than 50% obstruction of the pulmonary arterial bed. Pulmonary angiography for localization of thrombi is prerequisite. Surgical techniques encompass lateral thoracotomy with or without extracorporeal circulation and median sternotomy with extracorporeal circulation. As an adjunctive measure, an interruptive procedure for the vena cava is performed. Currently we prefer to operate with the beating heart and normothermia. The most frequent complications are congestive heart failure and hemorrhagic pulmonary edema. In 33 patients total mortality was 20%. On use of a median sternotomy, with normothermia and beating heart there were no deaths. In the presence of distally-localized obstruction, thrombectomy cannot be performed.

Chronic Disease↗
PubMed1988

Mid-term results of the Liotta-Bioimplant low profile bioprostheses.

Low profile bioprostheses are particularly useful for certain anatomical conditions. In some patients with rheumatic aortic insufficiency, an important dilatation of the aortic annulus is present, even when the subcoronary aorta is not enlarged. In these cases, the bioimplant heart valve with its low height avoids any threat to the aortic wall or to the coronary ostia. Frequently, the left ventricular cavity is not enlarged in patients with mitral stenosis. The characteristic low profile of this valve avoids left outflow obstruction as well as traumatism of the left ventricular wall. In the tricuspid position, this design is particularly useful because it leaves the right ventricular cavity totally free. From February 1981 to December 1983, 198 bioimplant (LIOTTA) low profile bioprostheses were implanted in 184 patients. There were 63 aortic (AVR), 101 mitral (MVR), 14 mitral and aortic (MAVR), and 6 tricuspid (TVR) valve replacements. Early mortality (30 days) was 6% (AVR = 1.6%; MVR = 8.9%; MAVR = 7.1%; TVR = 0). The 181 survivors were followed over a period of 3-84 months (643 patient-years). The thromboembolic complication rate was low (0.7%/patient-year) and 96.9% +/- 1.4% of patients were free of thromboembolism (AVR = 98.2% +/- 1.7%; MVR = 97.6% +/- 1.7%). Five years after implant, 91.7% +/- 3.2% of patients were free of valve failure (AVR = 93.7% +/- 4.4%; MVR = 88.8% +/- 5.2%). Actuarial analysis shows an expected survival at 5 years (average) of 87.2% +/- 3.4% (AVR = 87.4% +/- 6%; MVR = 87.3% +/- 4%) with an actuarial rate of freedom from reoperation of 87.5% +/- 3.5%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

[Morbidity and mortality seen in patients with a Hancock bioprosthesis, followed for more than 5 years. Experience at the La Pitié Hospital].

Between 1975 and 1983, 305 Hancock bioprostheses were implanted at the La Pitié Hospital, Paris, including 133 on the aortic valve and 172 on the mitral valve. The operative mortality rate was 6 p. 100 in patients with isolated aortic valve replacement and 12.8 p. 100 in patients with isolated mitral valve replacement (including 4 reoperations for mechanical valve thrombosis). 245 patients were followed up for a mean period of 5 1/2 years. The actuarial survival rate, operative mortality excluded, was 77.5 +/- 4.4 p. 100 in the aortic valve group and 76 +/- 4.4 p. 100 in the mitral valve group (non significant difference). Later after surgery, 8 embolic accidents (5 in the mitral valve group, 3 in the aortic valve group) occurred, and 20 patients developed endocarditis. Forty-nine patients required reoperation, 33 of them for deterioration of the bioprosthesis. The probability of being free from such deterioration varied significantly according to the patient's age at the time of the operation. In the aortic valve group this probability at 8 years was 97 p. 100 +/- 2.7 p. 100 for patients over 35 and 63.3 p. 100 +/- 1.7 p. 100 for patients under 35; the corresponding figures at 8 years in the mitral valve group were 80 p. 100 +/- 3.8 p. 100 for patients over 35 and 55.2 p. 100 +/- 2.2 p. 100 for patients under 35. There was no significant difference between the mitral and the aortic valve groups with regard to the percentage of prosthetic valve deterioration. The operative mortality rate in reoperations was 14.2 p. 100 irrespective of the cause of death.

Adult↗
PubMed1986

[Acute native endocarditis. The results of surgical treatment].

Between January 1978 and December 1984, 141 cases of acute native valve endocarditis were treated surgically in the Department of Thoracic and Cardiovascular Surgery of the Pitié Hospital. The diagnostic criteria of acute native valve endocarditis were the duration of treatment (antibiotic therapy for less than 40 days), the characteristic operative appearances of the lesions, and the results of anatomo-pathological examination of the excised valves. The infecting organism was not isolated in 35% of cases. The aortic valve was the commonest site of infection (65.2% with a high incidence of abscess of the aortic ring, irrespective of the causal organism. The operative mortality was 5.6%. This depended mainly on the preoperative haemodynamic status of the patient. The duration of antibiotic therapy prior to surgery did not seem to be relevant. The 3 years survival rate was 78%. The secondary reoperation rate was 7%. There was a higher incidence of secondary perivalvular regurgitation in patients who had previously had an abscess of the aortic ring.

Acute Disease↗
PubMed1985

[Choice of a valve prosthesis in patients between 25 and 70 years of age].

In patients over the age of 70, the choice is unanimously in favour of a bioprosthesis. In children and adolescents, the rapid deterioration of bioprostheses makes them unsuitable for these patients. However, between the ages of 25 and 70, the situation is much more open to discussion. In the aortic orifice, because of the low risk of thrombo-embolism, there is a preference for a mechanical valve, except in the case of a young woman wishing to have a child or in the case of a contraindication to anticoagulants. In the mitral orifice, the higher incidence and the greater severity of the thrombo-embolic complications present an argument in favour of bioprostheses, which should be selected in the case of anticoagulant risks (contraindication, exposure to trauma, impossibility of following a female patient who wishes to become pregnant), in the case of a high thrombogenic risk (ectatic thrombosed left auricle or replacement of a thrombosed prosthesis) and, finally, the preference of the patient and the doctor. The bioprosthesis is unequivocally indicated in the case of tricuspid valve replacement.

Adult↗
PubMed1985

[Surgical result of 48 Bigelow myotomies for obstructive myocardiopathy].

Bigelow's myotomy is one of the surgical options available for the treatment of hypertrophic obstructive cardiomyopathy (HOCM). The results of this operation were analysed in 48 cases operated between 1965 and May 1983. The average age of the patients was relatively low (38 years) but preoperative symptoms were severe (34 patients in Class III and 6 patients in Class IV of the NYHA Classification). The diagnosis was confirmed in all cases by echocardiography, carotid pulse tracings and cardiac catheterisation. 28 patients had associated lesions including 21 cases of mitral regurgitation (minimal in II cases, moderate in 6 cases and severe in 4 cases). All patients underwent Bigelow myotomy which was associated with a complementary procedure in 9 cases (including 2 mitral valve replacements and 2 semi-circular annuloplasties). The hospital mortality was 6 patients; surgical morbidity resulted from permanent intraventricular conduction defects (27 cases). At long-term, 3 more patients died, 2 from cardiac causes. Of the remaining 39 patients followed-up for an average of 32 months, functional improvement was marked, except in very advanced stages of the disease (Class IV) or forms with severe or uncorrected mitral regurgitation. The indications for Bigelow myotomy are discussed with reference to three parameters of HOCM (intraventricular pressure gradient, mitral regurgitation, decreased left ventricular compliance). This procedure has a beneficial effect on the subaortic stenosis and left ventricular compliance. It should be completed by mitral valve surgery in patients with significant regurgitation.

Adolescent↗
PubMed1985

[Value of myocardial revascularisation surgery before correction of sub-renal aortic aneurysms].

The value of aortocoronary bypass (ACB) before surgical correction of infrarenal abdominal aortic aneurysm (AAA) was studied in three groups of patients. Group I: 6 patients undergoing both procedures; group II: 14 coronary patients operated for AAA without prior ACB surgery; group III: 16 patients without coronary artery disease operated for AAA. The hospital mortality was nil in group I; 2 patients died of myocardial infarction in group II; 2 patients died of infection and of cerebrovascular accident respectively, in group III. The patients in group I were asymptomatic on follow-up (mean = 29.7 months) whilst 1 patient in group II developed angina. The essential problem associated with this type of patient remains the complexity of the diagnostic investigations which must include coronary and cervical arteriography. Although the indications for ACB before cure of AAA are obvious in symptomatic patients and/or with previous myocardial infarction, they remain debatable in other patients.

Angina Pectoris↗
PubMed1984

[Isthmic coarctation of the aorta: characteristics and results of surgical treatment in subjects surgically-treated after 35 years of age].

From 1965 to 1981, 27 patients over 35 years of age were operated for isthmic coarctation of the aorta. Surgery consisted of resection and direct suture in 16 cases, implantation of a Dacron prosthesis in 7 cases, isthmoplasty in 1 case, aortotomy-graft in 1 case, insertion of a Dacron tube between the left subclavian artery and the descending thoracic aorta in 1 case; finally, one patient presented with a rare form of coarctation in a double aortic arch and was treated by a bypass from the brachiocephalic trunk to the descending thoracic aorta. Ten patients had associated pathology. This was treated at the same time in 4 cases: closed heart mitral commissurotomy, cardiac plexectomy, section-suture of patent ductus arteriosus, and a resection of aneurysms of four intercostal arteries. A Bjork aortic valve prosthesis had been inserted nine months previously in a women with calcific aortic stenosis. There were 2 deaths (7,4%) in the immediate postoperative woman with calcific aortic stenosis. There were 2 deaths (7,4%) in the immediate postoperative period (one acute pulmonary oedema, one pulmonary embolism). There has been no operative mortality in the last 10 years. Twenty-three of the 25 survivors have been followed-up for an average period of 91,5 months (range 1 to 18 years). Two patients died of cardiovascular causes. Analysis of these results show: that the mortality rate is not prohibitive compared to that of the natural history of the condition (the average survival rate of unoperated patients is 35 years), good secondary results despite frequent technical difficulties, the possibility of residual hypertension (especially in older patients) which responds well to drug therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

[Open-heart surgery in patients over 65 years of age. Lesions encountered and immediate postoperative mortality].

Open heart surgery after 65 is more and more frequent (16% of our surgical cases). Between January 1971 and December 1982, 8 425 open heart operations were performed in this Department, 1 377 of them in patients over 65. Most were cases of aortic valvulitis (620), and calcific aortic stenosis in particular, but also dystrophic aortic insufficiency; 217 patients underwent surgery for mitral valvulitis (rheumatic or dystrophic in origin) and 84 for involvement of more than one valve. Of the 2 440 patients with coronary lesions who underwent surgery, 255 were over 65; beyond this age, a higher rate of association between coronary lesions and valvular disease was found (167 patients undergoing surgery). Surgical mortality (during the first postoperative month) was higher after 65: 11.1% in patients with valve disease, and 11.4% in those with coronary artery disease, whereas in patients under 65 the figures were 6.5% and 4% respectively. On the other hand, in those undergoing surgery for combined valve and coronary disease, mortality over 65 was hardly any higher than under 65 (13.7% as against 10.4%). This justifies screening for coronary artery disease in any candidate for valve surgery aged over 65. These results were achieved thanks to some technical and anaesthetic precautions, and though they may be less satisfactory than those for younger patients, they justify such surgery for all lesions that threaten survival in the short term.

Aged↗