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J Helou

Publications and source records attributed to J Helou.

15 recordsLinked to original sources
PubMed2001

Comparative clinical outcomes with St. Jude Medical, Medtronic Hall and CarboMedics mechanical heart valves.

BACKGROUND AND AIM OF THE STUDY: Whether the St. Jude Medical (SJM), Medtronic Hall (MH) or CarboMedics (CM) heart valves confer any relative benefits to patient outcome remains controversial. While numerous studies have analyzed clinical results with a single brand, and a few studies have compared two brands, there are no single-center trials comparing all three valves. METHODS: Our experience with patients who had either a SJM, MH or CM mechanical valve in isolated aortic valve (AVR) or mitral valve (MVR) replacement was reviewed. AVR was performed in 953 patients (SJM = 394, MH = 314, CM = 245) and MVR in 591 patients (SJM = 193, MH = 264, CM = 134). Survivors were assessed annually; follow up consisted of 3336 patient-years (pt-yr) after AVR and 1693 pt-yr after MVR. RESULTS: Preoperatively, in the AVR group, more MH patients had previous valve surgery (p = 0.001) or were in NYHA class III/IV (p = 0.03), and more CM patients had a concomitant surgical procedure (p = 0.005). The hospital mortality after AVR with SJM, MH and CM valves was 3.8, 4.7 and 5.3%, respectively (p = 0.65). In the MVR group, there were more males in the CM group (p = 0.011), more CM patients had concomitant surgery (p = 0.001), and more MH patients had previous surgery (p = 0.006). The hospital mortality after MVR with SJM, MH and CM valves was 8.3, 10.2 and 6.0%, respectively (p = 0.35). There was no late survival advantage in either the AVR or MVR group according to the valve used (p = 0.24 and p = 0.90, respectively). For the AVR group the five-year actuarial freedom from thromboembolism was: SJM 85.8 +/- 2.5%, MH 80.1 +/- 2.7% and CM 85.9 +/- 3.5% (p = 0.04), and for MVR it was: SJM 84.2 +/- 4.0%, MH 77.5 +/- 3.4% and CM 86.9 +/- 5.2% (p = 0.27). Bleeding occurred with a similar frequency in the AVR (p = 0.36) and MVR (p = 0.70) groups. No cases of structural failure were identified in this study. At follow up, among AVR patients NYHA class III/IV was present in: SJM 5%, MH 6% and CM 3% (p = 0.50), while among MVR patients this was identified in: SJM 7%, MH 10% and CM 4% (p = 0.22). CONCLUSION: It is concluded that the SJM, MH and CM mechanical valves offer similar clinical results when used for isolated AVR or MVR. While there is a suggestion of an advantage with bileaflet valves, any differences detected may simply reflect differences in the preoperative patient variables.

Aortic Valve↗
PubMed1999

Ochronosis: an unusual finding at aortic valve replacement.

The condition known as ochronosis refers to the accumulation of oxidized homogentisic acid in the connective tissues of alkaptonuric patients. The diagnosis is usually made from the triad of degenerative arthritis, ochronotic connective tissue pigmentation and urine that turns dark brown or black on alkalinization. Cardiovascular disease is a less well appreciated aspect of this disorder. A patient with ochronosis of his stenotic aortic valve is reported. The role of the pigment in the genesis of the valve degeneration is discussed.

Alkaptonuria↗
PubMed1998

Mechanisms of cardiomyoplasty: comparative effects of adynamic versus dynamic cardiomyoplasty.

BACKGROUND: The apparent paradox seen in patients who have undergone dynamic cardiomyoplasty and shown substantial clinical and functional improvements with only modest hemodynamic changes may be due to inappropriate end points chosen for study, a result of incomplete understanding of mechanisms involved. The purpose of this study was to compare the relative role of the passive "girdling effect" and the dynamic "systolic squeezing effect" of the wrapped muscle in cardiomyoplasty. METHODS: The control group of 6 dogs underwent 4 weeks of rapid pacing (250 beats/min) to induce severe heart failure followed by 8 weeks of observation without rapid pacing. The trajectory of recovery in hemodynamics and cardiac dimensions was followed with echocardiography and Swan-Ganz catheters. In the "adynamic" cardiomyoplasty group (n=4), the left latissimus dorsi muscle was wrapped around the ventricles and allowed to stabilize and mature for 4 weeks. This was followed by rapid pacing and recovery as in the control group. In the "dynamic" cardiomyoplasty group (n=3), the same protocol for the adynamic group was followed except that a synchronizable cardiomyostimulator was attached to the thoracodorsal nerve of the muscle wrap. This allowed the latter to be transformed during the rapid-pacing phase and permitted dynamic squeezing of the muscle wrap to be generated by burst stimulation synchronized with cardiac contraction in a 1:2 ratio. RESULTS: Baseline data were comparable in all groups prior to rapid pacing. After 4 weeks of rapid pacing, the left ventricular ejection fraction was higher in the adynamic (27.0%+/-3.9%; p < 0.05) and dynamic (33.3%+/-2.3%; p < 0.02) cardiomyoplasty groups compared with controls (18.8%+/-8.3%). Similarly, ventricular dilatation in both systole and diastole was less in the adynamic (51.8+/-8.7 mL, [p < 0.002] and 38.2+/-7.2 mL [p < 0.001], respectively) and dynamic (62.0+/-7.2 [p < 0.02] and 41.3+/-3.5 mL [p < 0.005], respectively) cardiomyoplasty groups compared with controls. In the dynamic group, on and off studies were carried out after cessation of rapid pacing while the heart was still in severe failure, and they demonstrated a systolic squeezing effect in stimulated beats. Only this group recovered fully to baseline after 8 weeks. CONCLUSIONS: By reducing myocardial stress, both the passive girdling effect and the dynamic systolic squeezing effect have complementary roles in the mechanisms of dynamic cardiomyoplasty.

Animals↗
PubMed1998

[Werner's syndrome].

BACKGROUND: Werner's syndrome associates early aging in young adults, small height, cataract, glucose intolerance, hypogonadism, skin ulcers, vascular calcifications and osteoporosis. CASE REPORT: We report a new case of Werner's syndrome in a 34-year-old man with suggestive alterations of the skin and endocrine anomalies in addition to hypospadias, urethral stenosis, bilateral mega-ureter and chronic renal failure. DISCUSSION: The diagnosis of Werner's syndrome in our patient was unquestionable because of the clinical presentation and the familial context. However, the urology anomalies have not been reported in this syndrome. A simple coincidence cannot be excluded.

Adult↗
PubMed1996

[Association of bacterial vaginosis in pregnancy with preterm delivery].

In a prospective study we examined the correlation between bacterial vaginosis (BV) during pregnancy and preterm labor. Direct vaginal smears were obtained during the 15th to 20th gestational weeks, and the subsequent delivery records were evaluated for the occurrence of preterm labor. BV was found in 15% of pregnant women at 15-20 gestational weeks, and in 8% at 27-32 gestational weeks. No correlation was found between BV and preterm labor.

Adult↗
PubMed1995

Optimizing "delay period" for burst stimulation in dynamic cardiomyoplasty.

Hemodynamic evidence of systolic assist after dynamic cardiomyoplasty remains inconsistent. One of the relevant factors may be how the burst stimulator is programmed. In 3 patients who underwent cardiomyoplasty for idiopathic dilated cardiomyopathy, we examined the modes used to determine the delay period between the R-wave sensing and the onset of burst stimulation during cardiac systole. These modes include the fixed time mode, the valve-synchronized mode, and the flow-optimized mode. The rationale for choosing these modes and the benefits conferred by each are discussed.

Aged↗
PubMed1995

Accuracy of indirect immunofluorescence testing in the diagnosis of paraneoplastic pemphigus.

BACKGROUND: Paraneoplastic pemphigus (PNP) is an autoimmune disease defined in part by autoantibodies with unique specificity. Initial reports suggested that indirect immunofluorescence with rodent bladder epithelium was highly reliable in detecting these autoantibodies. OBJECTIVE: We compared the sensitivity and the specificity of indirect immunofluorescence in the diagnosis of PNP in a large number of cases. METHODS: Indirect immunofluorescence was performed on stratified squamous epithelium of monkey esophagus and mouse tongue, bladder, liver, and myocardium. Sera were obtained from 28 patients with PNP and from 29 control subjects with autoimmune blistering diseases. RESULTS: The sensitivity of murine bladder as a substrate was 75%, with a specificity of 83%. Indirect immunofluorescence on liver was specific (96.5%) but insensitive (43%). Sensitivity and specificity with myocardium were intermediate. CONCLUSION: Indirect immunofluorescence on murine bladder epithelium is an adequate screening test for PNP but is negative or indeterminate in as many as one fourth of patients. Negative indirect immunofluorescence does not exclude the diagnosis of PNP, and immunochemical techniques such as immunoprecipitation must be performed.

Animals↗
PubMed1994

[Colonic carcinoma during pregnancy].

A case of adenocarcinoma of the splenic flexure during pregnancy is reported. A 27-year-old woman was admitted at 34 weeks of pregnancy with abdominal pain and vomiting. 36 hours after normal delivery an emergency exploratory laparotomy was performed for intestinal obstruction. A huge tumor of the splenic flexure with retroperitoneal extension was found. She died 1 year later of metastatic disease. Delay in diagnosis and complications of colonic cancer are more prevalent in pregnancy. While colonic carcinoma during pregnancy is extremely rare, it should be included in the differential diagnosis of colonic symptoms. The 24th case of this type is reported.

Adenocarcinoma↗
PubMed1994

Postpartum thrombotic thrombocytopenic purpura: report of a case and review of the literature.

Thrombotic thrombocytopenic purpura (TTP) is a severe multisystem disease of unknown etiology that reaches its peak incidence when the patient is between ages 20 and 40 years; it is more common in women than in men. Since 1966 there have been six reported cases of TTP occurring in the puerperium. A patient who developed TTP 24 hours after cesarean delivery is described, and the literature regarding TTP occurring in the puerperium is reviewed. Although this patient responded to plasma infusion, the recent literature suggests that plasmapheresis is the treatment of choice for TTP.

Adult↗
PubMed1988

[Consumption of legal and illegal drugs by school students from the region of Doubs].

Two surveys were carried out among high school students from the Doubs region in 1982 and 1985. Their objective was to determine how legal and illegal drugs were used and their importance among the target population. Alcohol was found to be more common among the male population and its consumption remained stable during the 1982-1985 period. The use of tobacco, however, increased dramatically, especially among females attending vocational schools. The surveys also revealed that the age at which smoking was attempted for the first time has lowered, family and school environment playing an important role. Of those students who smoked, 69% had parents and a close friend who smoked, whereas 16% had none in their immediate environment who smoked. It was noted that young girls used more often psycho-active medicines than boys. A noticeable increase in their use became evident especially in vocational schools. Of those students questioned, 43% of junior high school students, 10.3% of vocational school students and 14.8% of senior high school students, stated that they used illegal drugs and that their accessibility permitted a wide use of these products. Whatever the age or sex the following associations were the most significant: drugs-tobacco, drugs-alcohol, tobacco-alcohol. Health education must therefore make the promotion of preventive strategies, concerning legal and illegal drugs, a priority in the education of adolescents.

Adolescent↗