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Biomedical subjects

J C Demoulin

Publications and source records attributed to J C Demoulin.

At least 127 records · Page 7Linked to original sources
PubMed1975

Quantitative study of left bundle branch fibrosis in left anterior hemiblock: A stereologic approach.

Serial sectioning of the interventricular septum was carried out in 16 hearts, 8 from elderly subjects with no conduction disturbance and 8 from patients with chronic left anterior hemiblock. The histologic slides were studied stereologically, and the relative density of fibrosis was quantitatively assessed by the point counting technique at various levels of the main subdivisions of the left bundle branch system. Statistical analysis revealed the following: (1) Although some fibrosis was found in the control hearts, the density of fibrosis was consistently and significantly greater throughout the conduction system in patients with left anterior hemiblock. (2) In the group with hemiblock, the relative density of fibrosis tended to increase significantly from the posterior ramification to the midseptal fibers and, finally, to the anterior fascicle. (3) Among the eight patients with hemiblock, fibrosis appeared to be evenly distributed throughout the conduction system in four. It was predominantly located in the anterior and midseptal fibers in one patient and showed an increasing severity from the posterior to the midseptal and anterior fibers in the remaining three patients. From this quantitative study, it is concluded that left anterior hemiblock is a reliable sign of left bundle branch disease but that the underlying lesions are more widely distributed than would be from the expected electrocardiographic terminology since they were found predominantly in the anterior ramifications in only half of the studied cases.

Adult↗
PubMed1975

Left posterior hemiblock in acute myocardial infarction.

Fifteen cases of left posterior hemiblock associated with acute myocardial infaction were studied. In 5 cases the left posterior hemiblock was the only intraventricular conduction defect, while in the other 10 cases it was associated with complete right bundle-branch block. Left posterior hemiblock proved to be an early complication, appearing within a few hours from the onset of the acute episode, and an ominous sign, since hospital mortality rate was 87 per cent. Cause of death was mainly pump failure. In most of these cases ther was electrocardiographic evidence of infarction involving both anterior and inferior ventricular walls. Infarction of most or all of the ventricular septum was a common finding in the cases examined anatomically. Histologically, acute changes involving mainly the posterior septal and midseptal fibres were observed in 6 of the 8 cases studied. On the basis of these findings and of other published findings an alternative physiopathological mechanism for so-called left posterior hemiblock is proposed.

Acute Disease↗
PubMed1975

[Complete atrioventricular block in bacterial endocarditis].

A case of bacterial endocarditis complicated by complete auriculoventricular block is reported. The pathological findings and data from previously reported cases point to the fact that this complication is generally indication of very extensive cardiac and valvular damage. Surgery, although dangerous, should be attempted in the circumstances.

Aged↗
PubMedDate not supplied

Pathological aspects of carotid plaques. Surgical and clinical significance.

We examined 134 carotid plaques microscopically in 125 consecutive patients, and found 21 (15.7%) had simple fibrous plaques versus 113 (84.3%) complicated plaques. The following plaque characteristics were present: intraplaque hemorrhage (73 plaques), ulceration (83 plaques), fresh thrombus (93 plaques), and recanalized thrombus (22 plaques). An average of 2.4 characteristics were observed in each complicated plaque. The only significant (p less than 0.05) clinico-pathologic correlation was the presence of fresh thrombi, found in 80% of the plaques from patients with a previous transient ischemic attack, in 93% of those with nonfocal neurologic symptoms, and in 80% of those with amaurosis fugax. Analysing the localization of the fresh thrombus (mural or intraluminal), we found that fresh thrombus in symptomatic plaques was most frequently (NS) (71 to 77%) exposed to the vessel lumen. Ulceration without fresh thrombus, plaque hemorrhage and recanalized thrombus were also found in a considerable number of asymptomatic patients, of whom 85% (33/41) presented a form of complicated plaque.

Adult↗
PubMedDate not supplied

Cardiac transplantation in patients older than 55 years.

From 1985 to 1990, 27 patients older than 55 years (extremes 55-65 years; 21 men and 6 women) received a cardiac transplant. The cause of cardiopathy was ischemic in 70%. Postoperative immunosuppressive therapy consisted of Cyclosporin A, steroids, azathioprine and antilymphocytic serum. Rejection episodes were monitored by endomyocardial biopsies and treated by pulses of steroids or monoclonal antibodies (OKT3). The operative mortality is 7.4% (n = 2). The one and two year survivals are 71% and 62% respectively. The incidence of infection and/or rejection were 0.71 +/- 0.4 and 1.4 +/- 0.7 episodes/patient year. Age beyond 55 years does not contraindicate heart transplantation. This change in recipient selection policy should lead to parallel changes in donor selection criteria.

Age Factors↗
PubMedDate not supplied

[Anatomo-clinical correlations of carotid plaques].

Recently, much attention has been focused on pathologic plaque characteristics and their importance in producing cerebrovascular symptoms. There remains much controversy on the significance of plaque ulceration, mural thrombi, and intraplaque hemorrhage in symptomatic and asymptomatic patients. We investigated 110 plaques, and the only significant correlation with preoperative symptoms was the presence of fresh mural thrombus, mostly intraluminal, associated with stenosis. Exulceration without fresh thrombus, intraplaque hemorrhage with intact endothelium and recanalized thrombus were also found in a considerable number of asymptomatic patients.

Adult↗
PubMedDate not supplied

Surgical management of left heart endocarditis.

Between 1981 and 1987, 29 patients (20 men and 9 women, mean age 46 +/- 15) underwent a valvular replacement for endocarditis (19 aortic and 10 mitral). There were 25 native and 4 prosthetic valves. In 85% of cases, underlying valvular lesions were present. The oropharyngeal and the respiratory tracts were the most common sources of infection. In 81%, the infecting microorganism was gram-positive. In 21% of cases, a gram-negative was detected, always mixed with a gram-positive. One infection was caused by a Candida. Indications for surgery were severe valvular insufficiency or cardiac failure (90%), refractory sepsis (21%), thromboembolic events (11%). In 22%, multiple factors were present. A biologic valve was chosen in 12 cases (40%). Simultaneously with the valvular replacement, 4 ventricular septal perforations were occluded and 3 valvular annulus abscesses debrided. The operative mortality was 10% (3/29). The one-year survival is 96%. Two patients required reoperation at 6 months and 2 years, for partial dehiscence, with good subsequent evolution. The authors concluded that surgical operation is the most suitable treatment for unstable or complicated endocarditis, in case of cardiac failure, iterative thromboembolic events or refractory sepsis.

Adult↗
PubMedDate not supplied

[Intrapericardial rupture of an aneurysm of the right anterior sinus of Valsalva: clinical case and review of the literature].

Intrapericardial ruptured aneurysm of the right anterior sinus of Valsalva. A intrapericardial ruptured aneurysm of the right anterior sinus of Valsalva is presented. An infectious origin was suspected. The aneurysm was treated by plication, which allowed to correct the preoperative insufficiency. Aneurysms of the Valsalva sinus can remain asymptomatic. When they are small, a conservative treatment is conceivable. Many complications can occur: rupture (more often in right cavities), aortic insufficiency, coronary insufficiency, cardiac failure, rhythm disturbances. This complications necessitate a surgical treatment. Aortic valvular replacement is indicated only when the structure of the valve is altered.

Aortic Rupture↗
PubMedDate not supplied

[Cardiac amyloidosis. Report of 11 autopsy cases and review of the literature].

The authors report 11 cases cardiac amyloidosis discovered on autopsy. The routine examination of the artrial of 20 patients over the age of 60 revealed the presence of these deposits in 10 per cent of cases. Three cases of secondary amyloidosis were discovered with minimal cardiac involvement. There was one case of senile amyloidosis and five cases of primary amyloidosis, two of which were associated with multiple myeloma. The clinical manifestations of these last six cases were cardiac decompensation (congestive in one case) and angina with normal coronary arteries, but involvement of the small vessels. Two cases of anterior pseudo-sequelae are reported and there were 4 cases of disturbances of intraventricular conduction and one case of atrial fibrillation. Amyloid deposits are rarely localized to the heart alone. Associated immunological disorders were present in 3 of the 6 cases. The authors compare this series to a review of the literature.

Adult↗