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Biomedical subjects

G Cellarier

Publications and source records attributed to G Cellarier.

At least 19 recordsLinked to original sources
PubMed2006

[Early myocardial infarction associated with chemotherapy for testicular cancer].

INTRODUCTION: In long-term survivors of testicular cancer, a greater risk of developing cardiovascular disease is reported. On the other hand, acute vascular event during chemotherapy is uncommon. CASE REPORT: We report on a case of acute myocardial infarction in a young man receiving chemotherapy (BEP) for testicular cancer. DISCUSSION: We suggest a causal association between chemotherapy and early myocardial infarction. The physiopathological mechanisms are discussed here.

Adult↗
PubMed2006

[Osborn J wave. A new "channel pathology"? A case report].

We report, at the time of a hypothermia major, the observation of an anomaly of the repolarisation on the electrocardiogram of surface, called "J wave", and described in an exhaustive way by Osborn, which attached its name there. It corresponds to the picking of the terminal section of the QRS, with heightening in dome, the J point is then elevated compared to the base line. It can be also seen among patients normothermic in physiological or pathological circumstances. Its physiopathology from now on is understood better, the J wave is the result of the difference of potential action between the epicarde and endocarde during phases 1 and 2 of the ventricular repolarisation. This gradient is related to the Ito current, also accused in the "channel pathologies", of which Brugada syndrome.

Aged, 80 and over↗
PubMed2003

[Infectious endocarditis. A study of 50 patients in a non-university hospital].

The authors report the results of a single centre study of 50 consecutive patients (average age 66 +/- 14 years; 36 men), admitted between 1992 and 2001 to a peripheral hospital for infectious endocarditis (IE). The median interval to diagnosis was 57 days. There was an underlying cardiac disease in 52% of cases, usually valvular (42%). The site of the IE was the mitral valve in 21 cases, the aortic valve in 19 cases, mitro-aortic valves in 5 cases, native tricuspid valves in 2 cases and pacing catheters in 4 cases (associated with valvular endocarditis in one patient). The causal organism was usually a streptococcus (60%, including 28% of streptococcus bovis), or a staphylococcus (22%): no organism could be found in 7 patients. The average follow-up was 33 +/- 30 months: surgery was indicated in half the patients and 3 patients were turned down because of their poor general condition. In all, 34% of patients died (24% of their IE) in a median interval of 6 months, mainly from infectious or haemodynamic complications. Poor prognostic factors were: age > 70 years, "blind" antibiotic therapy, large-sized vegetations, embolism and renal failure. These data, comparable to the results observed in large series in the literature, underline the importance of multi-disciplinary management of IE and strict prophylaxis.

Aged↗
PubMed2003

[Left atrial thrombus in multiple myeloma treated with thalidomide].

The occurrence of a left atrial thrombus without a haemodynamic predisposing factor (arrhythmia, mitral valvulopathy, severe left ventricular dysfunction) is a rare event. We report a case during the progression of refractory myeloma, four months after stopping treatment with thalidomide. The promoting haemodynamic factors for left atrial thrombosis in sinus rhythm, described in the literature, had been excluded. In our case the potential role of thalidomide is debatable, in the light of recent publications about venous and arterial thromboses observed with this treatment.

Aged↗
PubMed2000

[Venous thromboembolism in pregnancy].

A DUAL CHALLENGE: Pregnancy is a physiological state favoring the development of venous thromboembolism and sometimes discloses a coagulation disorder. Due to the presence of the fetus, suspected venous thromboembolism in a pregnant woman raises a dual challenge for the clinician: confirmation of the clinically suspected diagnosis using imaging techniques exposing the fetus to as little radiation as possible, and adapted anticoagulant therapy taking into account the teratogenic risk. MILD TO MODERATE DISEASE: Excepting exceptionally severe cases, the only validated long-term treatment is continuous infusion heparin. However, because of the difficulties inherent in the use and control of this type of administration, most clinicians prefer low-molecular-weight heparins (LMWH) although these pharmaceutical products have not acquired official approval for this indication. PREVENTION: The optimal therapeutic approach for prevention of venous thromboembolism in a pregnant woman with an acquired or hereditary coagulation disorder or a history of venous thromboembolism remains to be defined. New clinical trials are needed to validate the use of LMWH in this indication and determine the therapeutic approach in certain risk situations and at delivery.

Adult↗
PubMed2000

His-Purkinje system reentry as a proarrhythmic effect of flecainide.

We report a case of tachycardia due to reentry within the His-Purkinje system (HPS) occurring after introduction of flecainide. The patient presented with a mild mitral regurgitation and normal left ventricular function. He had incomplete left bundle branch block with left-axis deviation. At the electrophysiology study, a prolonged HV interval was observed at baseline, and the tachycardia could be reproduced after ajmaline infusion. Six months after interruption of flecainide, the patient remains free of arrhythmia recurrence. The authors emphasize that proarrhythmic effects of flecainide may include reentry within the HPS in patients with underlying HPS disease.

Administration, Oral↗
PubMed2000

[Inflammatory abdominal aortic aneurysm].

A 58-years-old man, with no medical past history, was examined for abdominal pain and weight loss. An enlarged kidney could be palpated, and abdominal echography showed left hydronephrosis due to ureteral compression by abdominal aortic aneurysm. Laboratory data showed an inflammatory syndrome. CT scan suggested the diagnosis of inflammatory abdominal aortic aneurysm. The use of corticosteroids brought about the regression of the symptoms and the resolution of the ureteral obstruction, permitting aneurysmectomy and prosthesis replacement without ureterolysis. This report shows the interest of preoperative radiological diagnosis of the inflammatory character of abdominal aneurysm. For uncomplicated cases, preoperative treatment using corticosteroids could allow partial regression of the periaortic inflammation and easier surgical repair.

Abdominal Pain↗
PubMed2000

[Hospital management of atrial fibrillation. Epidemiologic data and therapeutic strategy. Report of 100 consecutive patients].

Despite recent large scale trials, the management of atrial fibrillation remains very variable. The authors report the results of a prospective study of the management of atrial fibrillation in their department. One hundred consecutive patients admitted for atrial fibrillation were included in the study. The epidemiological and clinical data and the results of the therapeutic strategy were recorded prospectively. Three embolic complications occurred before hospital admission. The hospital stay was marked by spontaneous reduction of atrial fibrillation in 14 cases in the 6 hours following admission. The therapeutic strategy was the following: 40 arrhythmias were respected (well tolerated, > 1 year or with a left atrium 60 mm). Oral amiodarone (30 mg/Kg and 15 mg/Kg the next day) was given to 22 patients. Only 9 patients (41%) were converted (average delay of 12 hours). Four patients received intravenous amiodarone, reducing two arrhythmias. Twenty patients were treated by external electrical cardioversion of first intent and 14 after failure of pharmacological reduction. All of these procedures, early (after 48 hours anticoagulation and transoesophageal echocardiography), or late (after 1 month of anticoagulation), restored sinus rhythm without complications, especially embolic. This register showed a relatively low efficacy of oral amiodarone in the reduction of atrial fibrillation and underlines the efficacy and safety of external electrical cardioversion, even when performed early.

Administration, Oral↗
PubMed1999

[Post-traumatic vena cava thrombosis].

BACKGROUND: Post-traumatic thrombotic events are exceptional in the caval system. We report a case of inferior vena cava thrombosis in a traffic accident victim. CASE REPORT: A 53-year-old male victim of a traffic accident suffered multiple trauma including blunt trauma of the abdomen. Three months after the accident, the patient was hospitalized with signs of pulmonary embolism proven by angiopneumography. Phlebocavography evidenced a thrombus floating in the inferior vena cava. DISCUSSION: We found 9 other cases of caval thrombus secondary to abdominal trauma in the literature. Tht thrombus usually developed due to endothelial damage secondary to shear forces. Computed tomography of the abdomen with contrast injection contributes greatly to diagnosis. Treatment is a matter of debate due to the prognosis dominated by the risk of massive embolism.

Abdominal Injuries↗
PubMed1999

[Youthful popliteal aneurysm].

Popliteal artery aneurysms are not so clinically frequent but are the most common site of peripheral aneurysms. They usually affect men aged over sixty and are caused by atherosclerosis. Whenever they concern younger men, other more unusual aetiologies such trauma, infection, inflammatory arteritis or popliteal entrapment are responsible. The authors report the first written observation of small size popliteal aneurysm, revealed by intermittent claudication in a 33 years old subject, of which the origin is accelerated atherosclerosis. The evolution after resection of the popliteal aneurysm and end-to-end anastomosis with saphenous vein was favorable. This observation reminds us of various popliteal aneurysm aetiologies, not excluding atherosclerosis due to young age and also underlines that the small size of these aneurysms does not protect against embolism risk.

Adult↗
PubMed1999

[Acute complication of a composite graft replacement of the aortic root].

A 78-year old man operated for an acute aortic dissection 8 years ago was hospitalized for an unusual clinical presentation with acute cor pulmonale and superior vena caval syndrome. He had poorly controlled high blood pressure, and coronary artery disease with aorto-coronary by-pass 10 years ago. He underwent Bentall procedure 2 years later for type I acute aortic dissection, with vein graft reimplantation on the valvular conduit. A pseudoaneurysm was noted in the post-operative period, which remained stable at 45 mm during the follow-up. Thoracic CT-scan highlighted a 14.5 cm diameter pseudoaneurysm compressing the superior vena cava and right pulmonary artery. Detached right aorto-coronary by-pass, suspected on transesophageal echocardiography, was confirmed peri-operatively; the aortic anastomosis blood in the peri-prosthetic space, explaining the acute clinical picture. The severity of the lesions did not permit surgical repair and the patient died during operation. This observation evidences the complications observed after aortic root replacement and favors echographic and radiological follow-ups (J Mal Vasc 1999; 24: 381-383).

Acute Disease↗
PubMed1997

[Gouty encephalopathy: myth or reality?].

Case report is a 75-year old woman who presented an unexplained febrile encephalopathy with diffuse myoclonic jerks and a gout's polyarthritis. None of these etiologies was found: infectious, toxic, vascular, metabolic, hormonal, immunologic. The spectacular effect on neurologic symptoms of a treatment by colchicine alone lead us to consider that gout encephalopathy probably exists.

Aged↗
PubMed1997

[Non-invasive management of a serious acute pulmonary embolism].

Prompt diagnosis of a large pulmonary embolus is essential in order to initiate appropriate treatment early. We report a case of a large pulmonary embolus in which management was aided solely by noninvasive investigations. Transthoracic echocardiogram showed elevated right heart pressures which together with the patient symptoms suggested a major pulmonary embolus. Spiral computed tomography of the chest confirmed the diagnosis. The source of the embolus was shown by echodoppler. This case illustrates that a diagnosis of a major pulmonary embolus can be made using noninvasive techniques. Pulmonary angiography should be reserved for those rare cases in which diagnostic uncertainty remains rather than being used as a routine examination prior to consideration of therapeutic decision.

Acute Disease↗
PubMed1996

[Superior vena cava syndromes of benign etiology].

Superior vena cava syndromes are uncommon and usually caused by malignant diseases. In about 20% of the cases however, the cause is benign. Besides chronic mediastinitis, a growing number of cases are reported of thrombosis resulting from endovenous devices (central catheters, pacemaker leads...). Onset is often slow and insidious, good tolerance in the early stages being explained by the development of an effective collateral circulation. Bibrachial phlebography is still the reference exploration, but computed tomography and magnetic resonance imaging are contributive to diagnosis. Symptoms usually regress after medical treatment, sometimes requiring thrombolysis, however, in 10% of the patients, major functional impairment may require bypass surgery (autologous graft or endoprosthesis) or transluminal angioplasty. There is still some debate as to the precise indications for each method, but angioplasty, used recently, appears to be the most interesting technique for a disease in which prognosis is almost always favorable.

Humans↗
PubMed1996

Sudden death as a presenting symptom of hypertrophic cardiomyopathy: treatment with an implantable cardioverter defibrillator.

Aborted sudden death as the presenting manifestation of hypertrophic cardiomyopathy in a 14-year-old child is reported. Documented ventricular fibrillation was the cause of cardiac arrest. No ventricular arrhythmia was induced during programmed electrical stimulation. An implantable cardioverter-defibrillator was indicated. As the patient had a family history of myocardial disease, he had undergone a cardiovascular evaluation 4 years before the major event, and was found normal. It is suggested that normal physical examination, ECG, echocardiogram should not rule out the diagnosis of hypertrophic cardiomyopathy when a family history is present. Left ventricular hypertrophy may develop during childhood in patients with hypertrophic cardiomyopathy.

Adolescent↗
PubMed1996

[Atresia of the left coronary artery: a case in a marathon runner. Review of the literature].

The authors report the case of a very rare coronary malformation: atresia of the left main coronary artery. This anomaly was discovered in a marathon runner who presented effort angina with a positive exercise stress test. At coronary angiography, it was not possible to catheterise the left coronary artery and only a minuscle dimple could be visualised. Selective right coronary catheterisation showed a very large right coronary artery with retrograde injection of the whole of the left coronary network, as far as the left main stem. The authors did not suggest revascularisation because of the good functional tolerance of this malformation.

Adult↗