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Biomedical subjects

H Joly

Publications and source records attributed to H Joly.

At least 19 recordsLinked to original sources

The overexpression of NADPH-producing enzymes counters the oxidative stress evoked by gallium, an iron mimetic.

Gallium (Ga), an iron (Fe) mimetic promoted an oxidative environment and elicited an antioxidative response in Pseudomonas fluorescens. Ga-stressed P. fluorescens was characterized by higher amounts of oxidized lipids and proteins compared to control cells. The oxidative environment provoked by Ga was nullified by increased synthesis of NADPH. The activity and expression glucose 6-phosphate dehydrogenase (G6PDH) and isocitrate dehydrogenase-NADP (ICDH) were stimulated in Ga-cultures. The induction of isoenzymes of these dehydrogenases was also evident in the Ga-stressed cells. Although superoxide dismutase (SOD) activity was significantly enhanced in Ga-stressed cultures, catalase activity experienced a marked diminution. Fe metabolism appeared to be severely impeded by Ga toxicity. This is the first demonstration of the oxidative stress evoked by Ga to be neutralized by a reductive environment generated via the overexpression of NADPH-producing enzymes.

Catalase↗

[Implantation of mechanical pulmonary and tricuspid valve prostheses at a distance from complete repair of Tetralogy of Fallot].

The authors report the case of a 39 years old woman operated for tetralogy of Fallot at the age of 6. Multiple complications due to postoperative atrioventricular block and a poor surgical result on the pulmonary outflow tract led to several reoperations. Right ventricular dysfunction with pulmonary regurgitation and mitral tricuspid valve disease in a context of endocarditis on the pacing catheter led to double pulmonary and tricuspid valve replacement with mechanical prostheses. The outcome at follow-up at 3 years is good. To the authors' knowledge, this is the first reported case of double mechanical valve replacement of the right heart after complete repair of tetralogy of Fallot.

Adult↗

[Sudden transformation of pulmonary stenosis to trilogy of Fallot in a 65 year old patient].

The authors report the case of a 64 year old woman with typical valvular pulmonary stenosis in whom spontaneous and sudden reopening of the foramen ovale resulted in cyanosis. Transthoracic echocardiography with injection of contrast provides a complete diagnosis: valvular pulmonary stenosis with a mean pressure gradient of 83 mmHg and massive right-to-left interatrial shunt. The malformation was treated by interventional catheterisation in a two-stage procedure: pulmonary valvuloplasty followed by closure of the foramen ovale because of the persistence of a right-to-left interatrial shunt. The functional improvement was followed by the appearance of effort angina. Coronary angiography showed single vessel disease of the left anterior descending artery treated by stenting. The long-term outcome was satisfactory.

Cardiac Catheterization↗

[Ventricular septal defect of the neonate].

Ventricular septal defect is the commonest congenital cardiac lesion and represents 30-40% of all congenital heart disease with a prevalence of 1.8 to 6.5 per 1000 births. The aim of this study was to evaluate the outcome of neonates with ventricular septal defects and to deduce from the echocardiographic appearances in the first year of life a relationship between the initial anatomy and the outcome. Between January 2001 and July 2003, 89 children from the Auvergne region were followed up prospectively for an average period of 7.6 months. The study showed that the majority of muscular ventricular septal defects with a diameter of 3 mm and less progress to a reduction in size and spontaneous closure more commonly and at an earlier stage than perimembranous ventricular septal defects.

Female↗

[Double aortic and mitral valve replacement in an 18 year old patient with Hunter's disease].

Hunter's disease, a type II mucoplysaccharidosis, a disease of lysosomal overload, may cause cardiovascular disease. This mainly affects the valves of the left heart which are infiltrated, and results in regurgitation rather than stenosis of the aortic and mitral valves. The general context of this disease explains the fact that only one case of mitral valve replacement was found in a review of the literature. The authors report the case of a young patient who was very symptomatic because of mitral and aortic regurgitation and who underwent double valve replacement of the aortic and mitral valves with mechanical prostheses at 18 years of age. The skeletal involvement and respiratory function led to much discussion before surgical referral but the indication was finally retained in view of the patient's practically normal intellectual functions. Seven years later, the patient is asymptomatic from the cardiac point of view and has been included in a protocol of enzyme therapy.

Adolescent↗

[Congenital aortic stenosis in the adult].

Congenital aortic stenosis is a common pathology in adults. The valvular lesion, usually secondary to a bicuspid valve, is dominant. Dilatation of the ascending aorta, the result of a jet lesion or structural wall abnormalities, is often observed in association with the valvular stenosis. Subvalvular stenosis is progressive and may only present late, after surgery of another congenital lesion. Supravalvular stenosis is much less common and is usually diagnosed in a dysgenetic context. Echocardiography is usually diagnostic and enables quantification of the stenosis and evaluation of secondary left ventricular changes. Exercise stress testing is decisional in asymptomatic severe stenosis. Percutaneous valvuloplasty is a good palliative procedure. Other surgical techniques comprise valvular commissurotomy, supravalvular valvuloplasty, valvular replacement (autograft, homo- or heterograft or mechanical prostheses). The indications depend on the quantification of the stenosis, symptoms, the results of exercise testing, the valvular lesion secondary to subaortic stenosis and the progression of the aneurysm of the ascending aorta.

Adult↗

[Does general paralysis still exist in non-AIDS patients?].

A 33 year-old man was twice admitted in psychiatry for a non typical depression. He was later hospitalized for a convulsive seizure. Then, the discovery of dementia, neurologic trouble, positivity of syphilitic reaction in blood and in cerebro-spinal fluid allowed to diagnose general paralysis. General paralysis is a late complication of syphilis and it has become exceptional because of efficacy of detection and treatment of early state of syphilis. Now, most of cases affects AIDS patients. Nevertheless, this case shows that realisation of syphilitic reaction is always justified by any dementia or any non typical depression.

Adult↗

[Neurologic complications in a case of Werner syndrome].

A 39 year old caucasian man was admitted in 1994 to the neurological department with a left pure motor hemiplegia that appeared suddenly. This patient showed typical features of Werner's syndrome. He had a hoarse voice, a diffuse muscle weakness and atrophy in the upper and lower limbs with chronic ulcers on the legs. His scalp and public hair were sparse. Cranial MRI revealed several lesions in the white matter, low signal intensity on T1 weighted images and high signal on T2 weighted images. Cerebrospinal fluid (CSF was inflammatory with hypercytosis and proteinorachia was 0.50 g/l with synthesis of IgG. Sural nerve biopsy revealed muscle atrophy and the loss of myelinated fibers. Thus, central and peripheral nervous systems were affected in this case.

Adult↗

[Motor and staged sensory conduction velocities of the ulnar nerve in normal subjects].

Normative data of ulnar motor and orthodromic sensitive conduction velocities are performed at different levels on 68 (19 to 49 year old) adult population which included 35 men and 33 women. In fact, 102 ulnar nerves are tested, 51 nerves for female population and male population respectively. For motor conduction velocities, the ulnar nerve is stimulated at five levels: at the wrist level, below elbow, at the elbow, above elbow, and at the axillary point; the motor responses were picked up on the hypothenar muscles (surface electrodes). For orthodromic sensitive conduction velocities, the fifth finger is stimulated and the electrical activities are picked up by surface electrodes which are placed at the same points. The difference between the conduction velocities values measured on the below elbow/wrist segment and the above elbow/wrist segment proved to be satisfactory for the possible detection of a compression of the ulnar nerve at the elbow.

Adult↗

[Postnatal development of central motor pathways. An electrophysiological study].

The percutaneous electrical stimulation of the brain and spinal cord has been used to study the central motor pathways in 19 healthy full-term newborns and in 19 infants. The evoked compound muscle action potential were recorded by bipolar surface electrodes fixed on the skin overlying the thenar eminence muscles and the tibialis anterior muscle. In full-term newborns, the responses of lower limb muscles to cortical stimulation are more difficult to obtain that those of upper limb muscles. At birth, the conduction velocity of central motor fibres along the spinal cord are around 10 m/s, 4 or 5 times lower that the lowest values published for adult subjects. Thus, as has been demonstrated in animals, there seems to exist in man a very clear dissociation between myelination of central motor pathways and that of peripheral motor fibres.

Action Potentials↗

[Pharmacokinetics and pharmacodynamics of a new 80 mg oral delayed-action isosorbide dinitrate preparation].

A new galenic form of isosorbide dinitrate (consisting of a hydrophilic matrix which allows very slow release of the active drug) was studied from the pharmacokinetic and pharmacodynamic view points in 11 patients with stable angina pectoris under betablocker therapy. After testing their sensitivity to nitrates with a sublingual trinitrin test causing a fall greater than or equal to 20 mmHg in systolic and greater than or equal to 10 mmHg in diastolic blood pressure, the patients were given a single tablet of Risordan LP 80 daily for 7 days. The equilibrium plasma concentrations of isosorbide dinitrate and its mononitrate metabolites (2-isosorbide mononitrate and 5-isosorbide mononitrate) over 24 hours were measured on the 6th treatment day. A method of measuring these nitrate derivatives has been developed and validated. The concentrations measured enabled the study of the pharmacokinetics of this new form, showing an average minimal concentration of 5-isosorbide mononitrate (principal metabolite) of 85 +/- 41 micrograms/l and an amplitude of fluctuation over the 24 hours period of 296 +/- 102 micrograms/l. From the pharmacodynamic point of view, the evaluation of the sensitivity to a single dose of 0.75 mg of trinitrin 24 hours after the first dose of Risordan LP 80, just before the second dose and 24 hours after the seventh dose, showed a significant difference (average decrease of 40 +/- 19 mmHg in systolic blood pressure) with respect to the values observed during the selection phase.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

[Diagnosis of atrial septal defects by contrast echocardiography with sensitivity increased by coughing].

The aim of this study was to assess the sensitivity of contrast echocardiography in the diagnosis of permanent (atrial septal defects, ASD) and transient (patent foramen ovale, PFO) interatrial communications under basal conditions, after Valsalva manoeuvres and coughing. Sixty-four patients suspected of having defects of the interatrial septum were studied. The results of echocardiography were compared with those of cardiac catheterisation, the classical method of reference. The sensitivity of contrast echocardiography was significantly improved in the diagnosis of PFO by the cough test (100%) compared with contrast echocardiography during spontaneous respiration (55%). Similarly, the cough test increased the sensitivity of contrast echocardiography in the diagnosis of ASD (96% compared to 83%). The specificity was good in both cases, about 90%. The cough test was a better method (98%) than Valsalva manoeuvres (59%) for the potentiation of interatrial right-to-left shunts. The results of echocardiography and catheterisation explain the mechanism of the right-to-left shunt during spontaneous respiration, Valsalva manoeuvres and coughing. The passage of the microbubbles from the right to the left atrium occurs during early systole when the atrioventricular valves are closed. The right-to-left shunt is potentiated by provocative manoeuvres. The demonstration of a right-to-left shunt by contrast echocardiography therefore indicates the presence of an interatrial communication; our results show that this non-invasive technique is a reliable method of diagnosing ASD and PFO.

Adolescent↗

[New methods for computerized classification of psychopharmaceutical agents (author's transl)].

We describe a statistical technique for achieving unbiased classification of 111 psychopharmaceutical agents from computerized clinical data. Three different methods were used: the reciprocal averaging method describes and pictures the clusterings of the numerous clinical datum available; the cluster analysis method corroborates the arrangement of the drugs and their effects into groups; the discriminating analysis method assigns the remaining drugs to their groups. The drugs were ultimately classified into six different groups. One of these groups, which included many of the antidepressant drugs, was reanalyzed with the reciprocal averaging method. This led to separating the monoamine oxidase inhibitors from the other antidepressants. Our technique will be immediately useful for classifying new psychopharmaceutical agents. If biologic data are included, this technique will be helpful for studying correlations between the structure and the effects of drugs.

Antidepressive Agents↗

[Spontaneous and post-surgical outcome of incomplete forms of atrio-ventricular canal].

125 patients with an incomplete type of atrioventricular canal defect (AVC) were followed up over a very long period. A study of the changes in parameters which are not open to great variability has allowed a more precise approach to the spontaneous and postoperative course of this congenital cardiac defect. The fact that the condition is usually well during the first three decades is not a justification for witholding operation; complications occur after the thirtieth year, and the operative risk becomes greater. Although only 41 patients in this series underwent surgery, we have been able to assess the surgical results and, as has been reported in the literature, these appear to be good. It is therefore necessary to extend the indications for surgery to include all the incomplete forms of AVC defect, and especially to operate during childhood or adolescence in order to minimise the risks of surgery.

Heart Septal Defects, Atrial↗

[Attempt at classification and orientation of prescriptions using an index of psychotropic drugs in computers].

We designed a method of rational classification of psychotropic drugs belonging to neuroleptic class. Standard profiles were determined along BELSON'S Method (partially modified). Neuroleptic population is analysed according to two leading variables : desinhibiting action and powerful sedative action. The remaining variables are graded depending upon their binding with leading variable, we called them explanatory variables. Profile of drug is found along these explanatory variables. Results are set out with : list of decomposition with clauses, list of variables selected by method, dichotomic graphic, identification of drugs. Our purpose is to find objective tests, for classification of these therapeutic drugs. It must enable a best evaluation of indications and contra-indications, practice in every day.

Computers↗

[Study of interventricular septal defects with equal aortic and pulmonary artery pressures. Classification by clinical and computer methods of 70 cases].

Application of various methods of classification to a group of 70 cases of ventricular septal defect with high pulmonary artery hypertension allowed a comparative study between the various methods aiming at distinguishing the forms with low from high pulmonary artery resistance. The reference clinical classification provides supplementary informations derived from the natural or post-operative course and eventually from the microscopic examination. The first automatic classification relies on the study of a single criterion: the pulmonary arteriolar resistance and the systemic resistance ratio. A second classification is based on the attribution of points to some clinical or haemodynamic signs resulting in a score orienting the classification of every individual. Multifactorial analysis methods deal with all the available informations for the overall group, and suppose the use of a computer. The informatic methods make it possible to study the classifying value of every sign. Correlations were established between these various techniques and the medical classification.

Adolescent↗