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J L Leclerc

Publications and source records attributed to J L Leclerc.

At least 19 recordsLinked to original sources
PubMed1996

Corticosteroids increase blood interleukin-10 levels during cardiopulmonary bypass in men.

BACKGROUND: Interleukin (IL)-10 is a potent antiinflammatory cytokine inhibiting the release of tumor necrosis factor--alpha (TNF-alpha) and IL-8 by activated macrophages and polymorphonuclear leukocytes. Cardiopulmonary bypass (CPB) represents a unique situation where an inflammatory reaction is predictably induced. The present study examined the influence of CPB on the release of TNF-alpha, IL-1 beta, IL-8, and IL-10 and also defined the effects of pretreatment with corticosteroids on the release of these cytokines. METHODS: The study included 22 patients undergoing coronary artery bypass graft operations, including eight control patients and seven patients who received dexamethasone, and seven patients who received methylprednisolone 4 hours before the operation. Cytokines were measured with the enzyme-linked immunosorbent assay technique before treatment, before anesthesia induction, immediately before heparin administration, before aorta declamping, 10 minutes and 90 minutes after aorta declamping, and 4 hours after the end of CPB. RESULTS: In the control patients the TNF-alpha levels and especially the IL-8 levels increased during CPB and reached their maximal levels 4 hours after CPB. IL-10 levels rose moderately and transiently, reaching peak values 90 minutes after aorta declamping. Notably, administration of corticosteroids prevented IL-8 release but increased IL-10 levels, which were tenfold higher than in the control group 90 minutes after aorta declamping (dexamethasone, 271 +/- 128 pg/ml; methylprednisolone, 312 +/- 213 pg/ml; control, 17 +/- 12 pg/ml, p < 0.05). IL-1 beta was not detected in any group of patients. CONCLUSIONS: The present data indicate that IL-10 is released together with proinflammatory cytokines during and after CPB and that pretreatment with corticosteroids markedly enhances this release. The release of IL-10 may play an important role in the antiinflammatory effects of corticosteroids.

Aged↗
PubMed1994

Nature of pulmonary hypertension in congestive heart failure. Effects of cardiac transplantation.

Pulmonary hypertension associated with congestive heart failure carries a risk of right ventricular failure after cardiac transplantation. Few data, however, are available on the hemodynamic behavior of the pulmonary circulation in these patients. We therefore studied mean pulmonary artery pressure minus left atrial pressure (estimated by pulmonary artery occluded pressure) versus cardiac output relationships in 20 patients with congestive heart failure evaluated for orthotopic cardiac transplantation, and we repeated this study either within the first 3 days postoperatively (n = 10) or 1 month postoperatively (n = 11). Cardiac output was increased by physical exercise or (in the early postoperative period) by an infusion of dobutamine. Reversibility of pulmonary hypertension was tested by an infusion of prostaglandin E1. At preoperative evaluation, the extrapolated pressure intercept of pulmonary vascular pressure:flow plots was negative in 10 of the patients, suggesting active exercise-induced pulmonary vasoconstriction. In the other 10 patients, the extrapolated pressure intercept was positive, suggesting that an increased closing pressure contributed to pulmonary hypertension. However, transplantation was constantly associated with proportional decreases of pulmonary artery pressure and left atrial pressure. On the other hand, pulmonary vascular pressure:flow plots were displaced to equal or lower pressures and to higher flows by prostaglandin E1 before as well as after transplantation. We conclude that in patients with congestive heart failure evaluated for cardiac transplantation, an increased pulmonary venous pressure more than a reversible increase in closing pressure determines the severity of pulmonary hypertension.

Adolescent↗
PubMed1993

Administration of nebivolol after coronary artery bypass in patients with altered left ventricular function.

This prospective, double-blind study used invasive monitoring and echo-Doppler techniques to compare the hemodynamic effects of nebivolol, a new beta 1-selective beta-blocking agent with those of atenolol in patients recovering from coronary artery bypass grafting surgery. Five milligrams nebivolol and 50 mg atenolol equally decreased heart rate (HR) and blood pressure (BP) but, nebivolol, in contrast to atenolol, caused no decrease in stroke index (SI), cardiac index (CI), and right ventricular ejection fraction (RVEF). These differences appeared to be related in part to different peripheral effects of the two agents because nebivolol administration was associated with a reduction in systemic vascular resistance (SVR). After < or = 10 days of treatment, acceleration of aortic flow velocity increased and isovolumic relaxation time decreased with nebivolol but not with atenolol treatment. Both drugs were equally well tolerated. Therefore, nebivolol shares most of its effects with classical beta 1-blockers but is devoid of the potentially harmful effects on cardiac output (CO) and peripheral resistance.

Adrenergic beta-1 Receptor Antagonists↗
PubMed1993

Dextroposition of the left lower lobe after heart-lung transplantation.

Immediately after heart-lung transplantation for cystic fibrosis, a patient had development of a right lower lobe retrocardiac density that persisted on all postoperative chest radiographs. A computed tomographic examination of the thorax performed 3 weeks after surgery showed that there was partial collapse of the left lower lobe in the right hemithorax. The patient required a posterolateral thoracotomy for cure.

Adult↗
PubMed1992

Prostaglandin E1 infusion for right ventricular failure after cardiac transplantation.

The infusion of prostaglandin E1, a vasodilating substance with predominant effects on the pulmonary vasculature, has been found effective in the management of pulmonary hypertension associated with various diseases. The reported experience with prostaglandin E1 after cardiac transplantation is, however, limited. We used prostaglandin E1 in 18 patients in whom acute right ventricular failure developed after orthotopic cardiac transplantation. The infusion was started within 24 hours after operation in 16 patients and was continued for up to 7 days. Maximal doses of prostaglandin E1, administered via a central venous catheter, ranged from 30 to 120 ng/kg/min. Norepinephrine was simultaneously infused via a left atrial catheter in 10 patients to prevent a reduction in systemic arterial pressure. The prostaglandin E1 infusion resulted in significant reductions in mean arterial pressure and pulmonary vascular resistance and simultaneous increases in cardiac index and stroke index. Mean arterial pressure was stable and left ventricular stroke work increased. The alveolar oxygen tension/forced inspiratory oxygen index tended to decrease during the infusion. Three patients died, two of right heart failure and one of multiple organ failure associated with cardiac allograft rejection. In patients in whom right ventricular failure associated with pulmonary hypertension develops after cardiac transplantation, prostaglandin E1, combined with norepinephrine whenever the arterial pressure declines, can effectively reduce pulmonary artery pressures and improve global cardiac function without compromising systemic perfusion.

Adult↗
PubMed1988

Liver-function studies in heart-transplant recipients treated with cyclosporin A.

Cyclosporine (CsA) hepatotoxicity has been reported but has not been studied systematically. This study includes 17 patients undergoing heart transplantation (HTx) and being treated with CsA, azathioprine, and corticosteroids. We assessed liver function in these patients before HTx and during the following month by five biological tests: total bile acids (BA), alkaline phosphatase (AP), gamma-glutamyltransferase (GGT), and total bilirubin in serum, and the aminopyrine breath test (ABT). With these tests we could classify the patients into three groups before HTx: normal (group I), mildly altered (group II), and severely altered (group III) liver function. During CsA therapy we did not observe any changes in any test results except for BA and GGT, and these only in group III. The ABT improved significantly in this group. During kinetic studies in patients without liver dysfunction, we confirmed a direct interference of CsA on BA secretion mechanism, but not the GGT increase, which remains to be explained.

Adolescent↗
PubMed1986

Mitral valve aneurysm formation documented by cross-sectional echocardiography.

We report a case of mitral valve aneurysm secondary to Streptococcus viridans endocarditis of the mitral valve. Cross-sectional echocardiography demonstrated an initial thickening of the anterior mitral leaflet which evolved further into an aneurysm. Surgery showed that this lesion had subsequently perforated. This case highlights the ability of echocardiography to detect gradual anatomic changes in the course of bacterial endocarditis. The diagnosis of such abnormalities might have important therapeutical implications and might lead to a more aggressive surgical approach.

Adult↗
PubMed1986

[Effects of physical training on the denervated human heart after orthotopic cardiac transplantation].

Three patients who had undergone an orthotopic cardiac transplantation followed a course of supervised intermittent physical training (60 to 80 per cent of the maximum load) involving three weekly sessions of thirty minutes, for a period of 150 +/- 80 days. During maximal effort, we observed increases of 50 per cent in the load in watts (0.05 less than p less than 0.1), 40 per cent in oxygen consumption (0.1 less than p less than 0.2), 10 per cent in heart rate (p = 0.5) and 21 per cent in systolic blood pressure (0.7 less than p less than 0.8). The respiratory equivalent for oxygen decreased by 21 per cent (0.025 less than p less than 0.05) and the respiratory quotient by 5 per cent (0.4 less than p less than 0.05). For a given submaximal effort (30 watts) the following decreases were observed: 9 per cent in oxygen consumption (V'O2) (0.1 less than p less than 0.2), 32 per cent in the minute ventilation (V'E) (0.05 less than p less than 0.1), 22 per cent in the respiratory equivalent for oxygen (REO2) (0.025 less than p less than 0.05), 8 per cent in the respiratory quotient (RQ) (0.2 less than p less than 0.3) and 11 per cent in the heart rate (HR) (0.1 less than p less than 0.2). The systolic blood pressure (SBP) increased by 6 per cent (0.2 less than p less than 0.3). No changes were observed in these parameters in the postoperative follow-ups (10 to 24 months) of two patients who did not undergo physical training. Physical training is, therefore, necessary in the process of physical readaptation of patients after orthotopic cardiac grafts.

Adult↗
PubMed1986

[Early exercise test after revascularization and rehabilitation].

Ergospirometry was performed on 51 patients before their discharge from hospital, that is between the seventh and tenth days after myocardial revascularization by cardiac bypass surgery. The aim of our study is to show that this type of measurement can be performed with reasonable safety and that it gives an accurate assessment of the patient's ability to withstand exercise. It employs a metabolic approach: study of oxygen consumption (V'O2), carbon dioxide release (V'CO2), the respiratory quotient (RQ), the minute ventilation (V'E) and the respiratory equivalent for oxygen (REO2). The patients withstood a mean load of 82 +/- 17.7 watts for a mean V'O2 of 1.186 +/- 0.258 l/min STPD and a mean V'E of 46.5 +/- 10 l/min BTPS. Changes in respiratory and metabolic parameters as a function of load are discussed, as is the advice that can be given to the patient regarding physical rehabilitation.

Adult↗
PubMed1985

Hypophosphatemia after cardiothoracic surgery.

The incidence of hypophosphatemia during the first 48 h following cardiothoracic surgery was prospectively studied in 74 patients. Hypophosphatemia, defined by a serum phosphate below 2.50 mg/dl, was observed in 19 of 34 (56%) patients after thoracic surgery and in 20 of 40 (50%) patients after cardiac surgery. As a whole, hypophosphatemia occurred earlier after thoracic than after cardiac surgery. After thoracic surgery, hypophosphatemia was milder for patients in whom bleeding was more severe. The anticoagulant solution CPD used in stored blood was identified as an important source of phosphate. These results indicate hypophosphatemia is a common finding after cardiothoracic surgery. Since severe hypophosphatemia can be related to phosphate depletion, phosphate supplements could be warranted especially during thoracic surgery when blood transfusions are less than 1000 ml.

Adult↗
PubMed1985

Cyclosporine nephropathy after heart and heart-lung transplantation.

Cyclosporine nephrotoxicity after heart transplantation can lead to acute renal failure requiring haemodialysis. In four long-term heart-transplant survivors, cyclosporine nephropathy was characterised by extensive fibrosis, with uraemia, hypertension and/or anaemia. In contrast, the long-term survivor of heart-lung transplantation who had received her graft for accelerated respiratory failure, did not develop chronic renal disease. Thus, chronically reduced renal perfusion before heart transplantation may play a critical role in the development of chronic cyclosporine nephropathy.

Adult↗
PubMed1985

Combined heart-lung transplantation for terminal pulmonary lymphangioleiomyomatosis.

Combined heart-lung transplantation with cyclosporine is reported in a 26-year-old patient who presented with end-stage pulmonary lymphangioleiomyomatosis. The operation was successful and the patient's rehabilitation excellent over the first 7 postoperative months. She then developed obliterative bronchiolitis of unknown origin. To our knowledge, this is the first published report of an out-hospital survival after heart-lung transplantation for terminal nonvascular lung disease.

Adult↗
PubMed1984

Normally and abnormally functioning left-sided porcine bioprosthetic valves after long-term implantation in patients: distinct spectra of histologic and histochemical changes.

This morphologic study (X-ray examination of gross specimens, histologic study and histochemical staining) compares two groups of explanted left-sided bioprosthetic valves: group I, 6 valves with normal cusp function and group II, 10 valves with significant dysfunction. Implantation periods ranged from 26 to 79 months. A computerized descriptive statistical method (principal component analysis) is used to analyze the qualitative results. Although qualitatively identical alterations are observed in both groups, the findings in the deep layers of the cusps of severe collagen breakdown, intensive fibrin penetration and various degrees of calcification are restricted to group II. Other findings of interest in both groups include amyloid deposits (four cases) and layering of fusiform host cells on the cusp surface (three cases). The computerized study shows that individuals of one clinical group are morphologically different from those of the other. Mechanical stress may contribute to surface alterations early after implantation, while further collagen breakdown and macrophagic activity result in deep penetration of plasma components and fibrin. Subsequent calcification is likely to be dystrophic rather than metabolic. Colonization of the cuspal surface by endothelial cells after long-term implantation of bioprosthetic valves expresses a new type of relation between host and bioprosthesis.

Adolescent↗
PubMed1984

Histopathology of the aortic valve in patients with a previous history of acute rheumatic fever. An analysis of 63 surgical specimens.

In a series of 63 surgical patients with a positive history of rheumatic fever and whose aortic valve was removed either singly or in combination with other valves, the histological examination of the aortic valves showed functional lesions in 22 cases (35%). Organic lesions of inflammatory origin, destruction of the architecture with scarring and presence of hypertrophic vessels, were observed in 19 valves (30%). The other cases were doubtful. This ratio was identical in uni- and plurivalvular involvement. Anatomic aspects and significance of microscopic lesions of the aortic valves were discussed. The role of microthrombi and turbulent flow in the pathogenesis of the functional lesions is stressed. The authors conclude that there is no correlation between the anatomic aspects of the aortic valve deformity and the presence of histologically proven organic lesions of inflammatory origin. This provides support to the current opinion that rheumatic carditis is mainly a disease of the mitral valve.

Acute Disease↗