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Biomedical subjects

J Fouchard

Publications and source records attributed to J Fouchard.

At least 19 recordsLinked to original sources
PubMed1999

[Pericardial and myocardial adiastole in rheumatoid polyarthritis].

The authors describe a case of clinical, echocardiographic and haemodynamic adiastole in a man with severe rheumatoid arthritis with a previous history of pericardial effusion. The adiastole was mixed, fibrous pericarditis, confirmed by ultra fast CT scan and at surgery; myocardial adiastole was suspected on finding thickening of the ventricular walls (in the absence of hypertension and coronary artery disease) and, unfortunately, confirmed by the persistence of adiastole despite very satisfactory pericardectomy. The authors underline the involvement of the three cardiac tunics in rheumatoid arthritis and the value of different diagnostic methods in the differentiation between constrictive pericarditis and restrictive cardiomyopathy.

Arrhythmias, Cardiac↗
PubMed1998

[Bartonella quintana endocarditis. Aortic localization and mitral valve abscess].

Bartonella Quintana is an exceptionally rare cause of endocarditis. The frequency of this condition is increasing and is probably underestimated because of the difficulty in diagnosing. The clinical context is that of socially deprived classes, the agent of transmission of the germ being body lice. The commonest valve affected is the aortic valve. This infection may also give rise to a mitral annulus abscess, as in this particular case. The diagnosis should be suspected in all cases of endocarditis with negative blood cultures in socially deprived patients as special diagnostic methods are required. Bartonellosis serology and drainage of effusions to perform a Gimenez stain to show intra-cellular bacteria and a polymerase chain reaction to sequence the nucleic acids, will give an accurate diagnosis. Similarly, the operative specimens should be sent to a specialised department for the culture of these bacteria (in France, the Marseille Ricketsioses Institute). The treatment of Bartonella endocarditis is very controversial. The usual recommendations are an association of betalactamines and an aminoside for one month and macrolides or tetracyclines. There is lack of consensus about follow-up. It would seem prudent to perform a clinical examination to search for a relapse of the infection and monthly serologies until they return to normal values.

Abscess↗
PubMed1997

[Mitral surgery: prognostic and survival factors. Value of the French score].

OBJECTIVES: Conservative mitral surgery is the preferred treatment for mitral regurgitation whatever the etiology. Morbidity and mortality figures, both during hospitalization and after long-term follow-up, are better than for mitral valve replacement. This difference could result from a selection bias or express a specific effect of conservative mitral surgery on survival. In addition, concerns about cost-containment justify rigorous analysis of treatment quality. The "French" score can be used for preoperative assessment of individual and population operative risk and for inter-institution comparisons. Its value for assessing overall survival is unknown. METHODS: Using the French score, we compared the clinical features and laboratory data in 100 patients who underwent conservative mitral valve surgery and in 35 patients who had valve replacement. We looked for independent factors predicting overall survival. RESULTS: Overall survival tended to be better after conservative mitral surgery, reaching 86% at 4 years versus 72% after replacement (p = 0.08). The populations were different as the valve replacement group included more women, was more symptomatic (p = 0.022), had heart failure more often (p = 0.003) and tended to have a higher French score (p = 0.06). Inversely, the hemodynamic and echocardiographic parameters were not different between the two groups. DISCUSSION: Independent factors predicting late mortality were preoperative heart failure and the French score. The type of mitral surgery did not have any predictive value. CONCLUSION: In addition to its value for assessing operative risk, the French score appears to be useful for predicting overall survival after mitral surgery.

Aged↗
PubMed1996

[Coxiella burnetti endocarditis on bioprosthesis. Apropos of a case].

A patient with two bioprostheses was admitted to hospital with pyrexia and a small vegetation on the aortic bioprosthesis visible only on transoesophageal echocardiography without aortic incompetence. Blood cultures were negative. Serology to Coxiella burnetti was positive at high dilution and confirmed the diagnosis of infectious endocarditis. Medical therapy with doxycycline and chloroquine was instaured without surgery. A Coxiella burnetti infection should be systematically searched for in all cases of endocarditis with negative blood cultures. The features of this infection, particularly the aetiological circumstances, diagnosis, history and treatment are reviewed.

Aged↗
PubMed1994

Sexual behaviour of gay and bisexual men in eight European countries.

To compare the sexual behaviour and HIV risk reduction strategies of gay and bisexual men in Europe, a survey, disseminated via the gay press and gay associations, was conducted amongst gay and bisexual men in Austria, Switzerland, Germany, Denmark, France, Great Britain, Italy and the Netherlands during the autumn and winter of 1991. By end March of 1992, 12,347 completed questionnaires had been obtained. A preliminary analysis shows striking similarities in patterns of sexual behaviour of gay men in the 8 European countries but indicates that strategies of risk management concerning HIV and AIDS vary widely. While the majority of gay men have multiple partners, and intercourse is more common with stable partners than with causal partners. The proportion of men who, during the past 12 months, engaged in unprotected anal intercourse with a partner with different or unknown HIV-status ranged from 1/3 in East Germany to 1/6 in UK. However, reported incidence over the past 12 months of STDs, other than HIV infection, was similar in all countries (2%-3%). The reported HIV antibody prevalence varied from less than 7% in East Germany, Italy and the United Kingdom to 15% in Denmark and 17% in France. HIV risk reduction strategies appear to be most common in those countries where the gay community had been included in targeted prevention campaigns during the early phase of the AIDS epidemic. Considering the high proportion of gay men engaging in high risk activities it is imperative that prevention efforts are sustained and improved.

Acquired Immunodeficiency Syndrome↗
PubMed1993

[Atrial flutter and tachy-systole].

Atrial flutter and tachysystoles may complicate the course of all heart diseases or may be discovered independently of any detectable cardiopathy. Functional tolerance mainly depends on the presence and severity of the associated heart disease, if any. A regular cardiac rhythm of 150 beats/minutes at rest suggests a 2:1 block flutter. Electrocardiographic identification of the disorder is usually easy and may lead, in certain cases, to vagal manoeuvres to recognize the atriogramme and the atrium-ventricle relationship. In all cases, 2:1 flutters must be reduced with amiodarone, by electrical stimulation or by electric shock. A prophylactic treatment of recurrences is often, but not always, indicated. The treatment of tachysystoles must take into account the cause of the ventricular rate.

Atrial Flutter↗
PubMed1993

[Left pulmonary artery originating from the ascending aorta in tetralogy of Fallot. Therapeutic strategy].

The authors report the rare case of a 12 year old child with an anomalous origin of the left pulmonary artery from the ascending aorta associated with Tetralogy of Fallot. This complex congenital malformation was treated surgically by a Deleval anastanosis between the right subclavian and right pulmonary arteries. The result was good with a 9 year follow-up, the patient having only Grade II effort duspnoea and cyanosis. The authors discuss the advantages and drawbacks of the different possible surgical approaches to this problem in the light of the outcome of this case and a review of the literature.

Anastomosis, Surgical↗
PubMed1992

[Isolated atrial fibrillation. The risk of embolism and its prevention].

Whether or not atrial fibrillation is alone, if not idiopathic, is difficult to determine. The risk of embolization in lone atrial fibrillation is distinctly higher in healthy subjects over 60 years of age when the left atrium is dilated. In chronic atrial fibrillation this risk is higher than in paroxysmal fibrillation, especially within the year following the onset of the arrhythmia. In most patients anticoagulant therapy is effective in the primary or secondary prevention of embolic accidents. In subjects older than 75 aspirin given in daily doses of 325 mg seems to give similar results. The risk of antithrombosis therapy must not be underevaluated. The alternative is to maintain or restore the sinus rhythm, even at an advanced age, if the arrhythmia is recent and the left atrium is moderately dilated.

4-Hydroxycoumarins↗
PubMed1992

[Primary leiomyosarcoma of the pulmonary artery. Apropos of a case. Review of the literature].

A 59-year-old woman hospitalised because of dyspnea and a heart murmur in a context of pyrexia was found to have evidence of obstruction of the pulmonary arterial system, clearly defined by ultrasonography, catheterisation and angiography and Imatron scan. The particular feature of this fifth reported case of pulmonary artery leiomyosarcoma is its documentation by transesophageal ultrasonography and tumor biopsy during catheterisation. Surgery with partial excision of the tumor was followed by survival for 6 months, bearing in mind the absence of chemo- or radiosensitivity of this type of tumor. Cases from the literature are reviewed.

Angiography↗
PubMed1991

[Effect of sinorphan, an endopeptidase inhibitor on severe congestive cardiac insufficiency].

Sinorphan is a powerful inhibitor of enkephalinases or endopeptidases 24-11, enzymes implicated in the degradation of the atrial natriuretic factor (ANF). In healthy volunteers, it increases plasma concentrations of endogenic ANF and increases diuresis and natriuresis. In order to study the tolerance and biological effects of pharmacological increase of plasma concentrations of endogenic ANF in severe congestive cardiac failure, 12 patients (in functional Classes III or IV of the NYHA classification) were given a single oral dose of 10, 20 or 40 mg of Sinorphan. Sinorphan was clinically well tolerated. The diastolic blood pressure decreased slightly (- 10 +/- 9 mmHg) but significantly (p less than 0.05). Systolic blood pressure and heart rate were unchanged. Despite spontaneously high plasma ANF concentrations (on average 15 times higher than normal subjects), Sinorphan induced an additional increase of 80 to 100% of plasma ANF concentration compared to the initial values (p less than 0.01) with no dose-dependent response for the dosages used. The inhibition of plasma endopeptidase activity attained 47% at the 30th minute. Urinary cyclic GMP excretion increased by 30% at the second hour (p less than 0.05). In addition, a statistically non significant tendency to increase diuresis and natriuresis was observed. These results show that Sinorphan increases plasma ANF concentrations by inhibition of its degradation in severe congestive cardiac failure and that this increase seems to be associated with potentially beneficial biological changes. The concept of endopeptidase inhibition should constitute a new therapeutic approach in cardiac failure, a situation in which the ANF seems to exert a favourable effect.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Dilated cardiomyopathy with deep, completely reversible dysfunction of the left heart in alcoholic patients. Report of 2 cases].

Two cases of dilated, hypokinetic cardiomyopathy complicated by cardiac failure, are reported in a 29 year old woman and a 55 year old man, with no etiological factors other than chronic major alcoholism (consumption of over 100 ml of alcohol per day for over 5 years). This was completely reversed 10 and 14 months after cessation of alcohol consumption. The isotopic left ventricular ejection fraction increased from 22 to 70 p. 100 and from 12 to 73% respectively. These cases are are and are evidence in favour of an alcoholic cardiomyopathy rather than alcohol being an aggravating factor in patients with cardiomyopathy.

Adult↗
PubMed1990

[Non-ruptured calcified aneurysm of the Valsalva's sinus with angina pectoris and aortic insufficiency. Surgical treatment].

We report a case of aneurysm of the straight frontal, and not coronary, aortic sinus, non ruptured and calcified, responsible for a refractory angina pectoris and a massive aortic failure in a 71 year old woman. The surgical treatment consisted in the exclusion of the aneurysm of the aortic sinus by a tubular prosthesis in which only two thirds of the circumference have been used, associated with the replacement of an aortic valve by a bioprosthesis, without associated coronary by-pass.

Aged↗