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Biomedical subjects

H Warembourg

Publications and source records attributed to H Warembourg.

At least 19 recordsLinked to original sources
PubMed1992

[Primary Aspergillus endocarditis. Apropos of a case and review of the international literature].

The authors report a case of primary aspergillus endocarditis with endophthalmitis and vertebral osteomyelitis. No underlying disease and no predisposing factors were found. Valve replacement plus combined antifungal chemotherapy proved to be effective as the patient is asymptomatic 18 months after the first symptoms. 48 cases of aspergillus endocarditis, without prior cardiac surgery have been reported in the literature. Aspergillus endocarditis was valvular or mural. Extracardiac dissemination was common but endophthalmitis and osteomyelitis were infrequent. In 11 cases, the diagnosis was made by histologic examination of embolectomy or ocular, skin biopsy tissue. All patients were febrile. Blood cultures showed no Aspergillus species. Clinical manifestations of endocarditis were described in less than fifty per cent of cases. Echocardiographic visualization of vegetations was obtained in 5 cases. Many patients experienced embolic phenomena. Mortality from Aspergillus endocarditis is extremely high (96%). Surgery is the main treatment, consisting of valve replacement. Antifungal chemotherapy should be combined. The proper duration and dosage and the combination of antifungal drugs have not been clearly defined.

Amphotericin B↗
PubMed1991

Bipolar atrial triggered pacing to restore normal chronotropic responsiveness in an orthotopic cardiac transplant patient.

A not uncommon arrhythmia in cardiac orthotopic transplantation patients is sinus node dysfunction with chronotropic incompetence. This is a result of the surgical procedure that denervates the donor heart while the native sinus node may be normal but isolated in the remnant of the recipient atrial wall that serves as the anastomotic site. We were able to restore "normal sinus node function" in a heart transplant patient utilizing a bipolar single chamber pacemaker programmed to the triggered mode. A single unipolar active fixation lead was positioned in each atria. Both leads were connected to a bipolar AAT pulse generator utilizing a Y adaptator. The native atrium with its innervated intact sinus node effectively drove the donor atrium and thus the heart.

Arrhythmia, Sinus↗
PubMed1991

[Prognostic value and development of late potentials after aortocoronary bypass. A prospective study of 100 patients].

Ventricular late potentials are post-infarction markers of the risk of ventricular tachycardia and sudden death. In order to assess their prognostic value and evolution after coronary bypass surgery, 100 patients underwent signal-averaged electrocardiographic recordings 24 hours before and 9 days after surgery, and were then prospectively followed up for 40 +/- 8 months. Patients who displayed late ventricular potentials underwent an additional recording at 5 months with 24 hour Holter monitoring. The average age of the patients was 57.0 +/- 8.4 years; 55 had previous myocardial infarction; 32 had triple vessel disease; the mean left ventricular ejection fraction was 59.7 +/- 12.4%. Ventricular late potentials were recorded in 17 patients before surgery and their left ventricular ejection fraction was significantly lower (51.4 +/- 11.5% vs 61.4 +/- 11.9%: p less than 0.05). There was one operative death in a patient with late ventricular potentials. After surgery, late ventricular potentials were only recorded in 6 patients: at the 9th postoperative day in 3 cases and at the 5th postoperative day in 3 cases. Ventricular late potentials appeared postoperatively in 5 patients, 4 of whom had suffered perioperative myocardial infarction. The recordings became normal at the 5th month in 2 of these 5 patients. Holter monitoring at the 5th month compared with a control group, showed a significant correlation between left ventricular potentials and frequent repetitive or polymorphic ventricular extrasystoles. The 40 month survival rate was excellent: 2 patients were lost to follow-up; there were 3 cardiac deaths, one of which was sudden and 4 non-cardiac deaths. All patients with late ventricular potentials were still alive. These results show that late ventricular potentials persist after coronary bypass surgery in 2/3 of patients; their prognostic significance is not obvious. The low incidence of postoperative sudden death could be attributed to the favourable overall effects of revascularisation rather than on the arrhythmogenic substrate.

Adult↗
PubMed1991

[Circumferential laser thermo-exclusion of post-infarction ventricular tachycardia. Apropos of 11 cases].

Circumferential laser thermoexclusion was assessed in the treatment of postinfarction ventricular tachycardia resistant to drug therapy in 11 patients between December 1986 and April 1989. There were 10 men and 1 woman with an average age of 63.7 +/- 5.6 years whose ventricular tachycardia occurred 10.7 +/- 7.5 years after infarction. All had left ventricular aneurysm or an akinetic plaque. Circumferential thermoexclusion was carried out by Mesnildrey's method, systematically associated with resection of the aneurysm or, when this was not feasible, with coronary revascularisation. Programmed ventricular stimulation was performed before and after surgery in 8 patients. Sustained ventricular tachycardia remained inducible in 4 patients after surgery but the prescription of antiarrhythmic drugs in 2 of these cases resulted in tachycardia becoming non-inducible. The increase in the left ventricular ejection fraction after surgery was not statistically significant (36.9 +/- 9.4% to 44.4 +/- 12.8%). After an average follow-up of 16.7 +/- 10.6 months, there were 2 cardiac deaths not related to arrhythmias (18%), 1 early at the 20th postoperative day and 1 late, 10 months after surgery. There were 2 recurrences of tachycardia (18%) controlled by antiarrhythmic therapy. Late ventricular potentials were recorded in 9 out of the 11 patients before surgery but in only 3 of these cases (33%) after surgery. Circumferential laser thermoexclusion guided visually in the border zone of the infarct scar would seem to be a simple, safe, rapid and therefore attractive, surgical antiarrhythmic technique, the efficacy of which should be evaluated by programmed ventricular stimulation. This should be undertaken on a large scale in order to define the indications and results of this method.

Aged↗
PubMed1979

[Detection of coronary artery spasm by the methylergometrin test. Technic. Results. Indications].

Methylergometrine (Methergin) was given intravenously (0.4 mg) to 118 patients undergoing coronary arteriography. The electrocardiogramme and intraaortic pressure was continuously monitored whilst coronary arteriography was performed, 1,3, and 5 minutes after the injection of the ergot alkaloid. The test was positive if: 1) coronary spasm was observed; 2) if ST segment elevation was recorded with or without pain. Positive tests were obtained in 13 out of 14 patients with Prinzmetal angina. The test was negative in the other patients. However in 3 patients with Prinzmetal angina, the test produced typical coronary spasm without electrocardiographic changes. In Prinzmetal angina the sensitivity of this test was 93 p. 100 with a high specificity: 96-100 p. 100 depending on whether or not electrocardiographical changes associated with spasm are considered. Taking into account current therapeutic methods of treating Prinzmetal angina the indications of this test of coronary spasm are: 1) patients presenting with resting angina whatever the state of their coronary arteries; 2) patients with documented Prinzmetal angina with "angiographically normal" coronary arteries.

Angina Pectoris, Variant↗
PubMed1979

[Primary mycotic aneurysm of the abdominal aorta from salmonella injection. A new case successfully operated upon (author's transl)].

A double aneurism, located in the abdominal aorta and left common iliac was found complicating a salmonella typhimurium infection which had been present for 7 months. A by-pass operation between the inaffected iliac arteries was followed by resection of the two aneurisms. Cultures taken from the walls of the aneurisms showed the presence of salmonella typhimurium. The authors stress the particular seriousness of the spontaneous evolution of such mycotic aneurisms.

Aneurysm↗
PubMed1979

[Problems encountered by the anesthetist-intensive care specialist during aorto-coronary bypass surgery].

The authors analysed a series of 400 aorto-coronary bypasses performed between 1970 and April 1978. A notable improvement in the statistics was seen during the second period between 1976 and April 1978. During this period, 248 patients were operated upon with a mortality of 4 per cent. The progress made was in large part attributed to improved preoperative assessment, in particular a complete ventricular assessment, improved peroperative myocardial protection and the use of the intra-aortic counter-pressure balloon and of sodium nitroprussiate.

Anesthesia↗
PubMed1977

Pathology of sinoatrial node. Correlations with electrocardiographic findings in 111 patients.

Histological study of the sinoatrial node (SAN) was performed in 111 patients in order to estabilsh correlations between the ECG findings and the anatomical lesions. This series includes both patients with sinus rhythm and patients with atrial arrhythmias. The results are as fololows: (a) the amount of nodal cells in the SAN was found to be inversely proportional to the age of the patients (p less than 0.001); (b) normal sinus rhythm was present in some cases with severe fibrosis of the SAN; (c) the present study does not support lesions of the SAN as responsible for atrial fibrillation; (d) chronic sinoatrial block was associated with extensive lesions of the approaches of the AV node or the AV node itself; (e) the auricular tachycardia-bradycardia syndrome was associated in most cases with both lesions of the main feature of the SAN lesion. The pathogenesis of these fibrotic lesions are discussed.

Adolescent↗
PubMed1977

[Atrioventricular blocks of bacterial endocarditis. 8 cases comprising histological study of the conduction system].

The authors report 8 cases of complete atrio-ventricular block (AVB) which came on during bacterial endocarditis. The aortic valve was more frequently affected (6/8). The conduction disorder is necessarily unstable. The prognostic significance of AVB is always very grave--all the patients have died. The valve lesions are often severe. A histological study of the conducting pathways has been carried out. The classically described aneurysm of the membranous septum was not responsable for any cases of AVB in this series. The most frequent cause of the AVB (5/8) was an infiltration of the prenodal area and the A-V nod itself, starting from the posterior aortic cusp and, in one case, from the tricuspid valve. The bundle of His is affected either by extension of the A-V node lesion or by the focus on the right cusp. Strings of inflammatory cells may follow the sheath of the bundle branches. Haematogenous micro-abscesses are sometimes found in the conducting tissues.

Adult↗
PubMed1977

[Coronary arteriography in recent myocardial infarct].

Sixty patients with a recent transmural acute myocardial infarction had seletive coronary arteriography carried out between the 7th and the 29th day (mean 17 +/- 2 days) after the onset of the condition. The anterior infarction (n = 25 cases) had a total obliteration in 36% of cases, and most often (64%) a stenosis of the anterior descending artery with an excellent distal bed (80%). The collateral circulation is often zero (76% of cases); 80% have adjacent lesions on the right coronary or circumflex artery, but 7 patients out of 25 would have been able to have a preventive bypass operation. The posterior infae lesions are often sited electively at the level of the artery of the S/A node or in the middle of the second vertical segment in the region of the right ventricular branch. Thus the infarct is the result of a complex lesion of the right coronary and circumflex arteries, because the latter is affected in three cases out of four. 63% of patients with a postero-inferior infarction have diffuse lesions, and 13 out of 35 could have had a preventive bypass procedure. This study shows: 1. That this investigation is well-tolerated after a recent infarction; 2. The high incidence (43%) of stenoses at the edge of the area of necrosed myocardium; 3. The importance of this investigation in finding the nearby lesions which are very frequently associated: in 33% of cases, preventive bypass would have possible.

Acute Disease↗
PubMed1977

[Coronary artery spasms].

In a series of 2000 coronary arteriographies, spasm of the coronary artery was found in 52 cases, which were divided into three groups: 41 cases of "iatrogenic" spasm caused by stimulating the ostium of the coronary artery (usually the right) with the tip of the catheter; 8 cases of spasm on top of an organic fixed lesion; 4 cases of coronary spasm on a coronary artery which was reported as "radiologically normal". The study includes a review of the circumstances which favour or impede discovery of coronary spasm, as well as a provocation test using methyl ergometrine. This test seems to be specific in that it only produced coronary spasm in patients with Prinzmetal's syndrome, and excluded the cases of angina with normal coronary arteriography. The patients with spasm on top of a fixed organic lesion underwent a successful aorto-coronary bypass graft together with resection of the pre- and sub-aortic nerve plexus. Patients with a spasm in an artery which was "arteriographically normal" were treated medically by nitrate compounds and vaso-dilators. Three of these patients had an excellent result with medical treatment. Treatment failed in the fourth patient, who then obtained benefit from straight-forward resection of the pre- and sub-aortic nerve plexus with an excellent result which has been maintained for over six months.

Adult↗