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J M Chevalier

Publications and source records attributed to J M Chevalier.

At least 55 records · Page 3Linked to original sources
PubMed1991

[Mitral valve prolapse and angina with normal coronary arteries: research of a thrombogenic factor].

The potential thrombotic risk of mitral valve prolapse may, in certain circumstances, require preventive treatment. This study was aimed at determining whether the presence of angina in patients with mitral valve prolapse and healthy coronary vessels was accompanied by a high-risk thrombogenic profile. Forty two patients (19 women and 23 men) with anginal chest pain and angiographically normal coronary vessels were divided into two populations according to the presence (18 patients) or absence (24 patients) of mitral valve prolapse (MVP) shown by angiography. Before angiography, all patients underwent laboratory studies to detect any possible abnormality of plasma coagulation and of prothrombotic physiological fibrinolysis. Study of subgroups, according to sex and/or the presence of MVP, revealed no significant difference in the profile of laboratory parameters. Thus the presence of angiographic MVP in symptomatic patients free of atherosclerosis is not associated with the existence of any particular thrombotic profile and, theoretically, does not require preventive anti-thrombotic treatment.

Angina Pectoris↗
PubMed1991

[Acute aortic dissecting: contribution of transesophageal echography. Apropos of 10 cases].

The diagnostic value of combined transthoracic (TTE) and transesophageal echocardiography (TEE) was evaluated in 10 consecutive patients with acute dissecting aneurysm of the aorta and compared to aortography (10 cases) and computed tomography (7 cases). TEE seems to be highly superior to TTE because the intimal flap in always seen (versus 4 of the 10 TTEs) and the descending aorta and the entry site are better visualized. TEE is superior to X-ray computed tomography because it shows the direction of the flow in the false lumen (an advantage of a color Doppler), the entry site and aortic regurgitation. In spite of false-positives (1/10), TEE seems to be at least as good as aortography, the most reliable, but highly invasive, technique available. Thus, transesophageal echocardiography, performed at the patient's bedside, appears to be a promising non-invasive tool for diagnosing suspected dissecting aneurysms of the aorta.

Acute Disease↗
PubMed1991

[Pulmonary orifice stenosis: the medical solution. Apropos of 62 cases].

Sixty two patients with moderate or severe stenosis of the pulmonary orifice (SPO) underwent balloon catheter valvuloplasty. Thirty one were aged under 5 years. The mean right ventricle-pulmonary artery trunk (RV-PAT) gradient fell from 75 (+/- 26) to 23 (+/- 10) mmHg (p less than 0.001). All dilatations except one were effective with only a few incidents and no mortality. Six (+/- 2) months later, hemodynamic evaluation of 45 patients (70%) showed stability of the RV-PAT gradient at 26 (+/- 18) as compared with 23 (+/- 11) mmHg. Ten patients required a second dilatation because of a residual gradient of greater than 35 mmHg. The result was favourable in all ten cases, the RV-PAT gradient falling from 53 (+/- 17) to 13 (+/- 8) mmHg (p less than 0.001). This series confirmed the efficacy, reproducibility and safety of this technique which led to a lowering of ventriculo-pulmonary gradient, persistent at six months, to an infra-surgical level, at the price of pulmonary incompetence (27%) which was always well tolerated in the mid-term. This valvuloplasty may be suggested for all cases of SPO with a gradient of greater than 35 mmHg.

Adolescent↗
PubMed1991

[Efficacy of intra-arterial fibrinolysis in subacute atheromatous ischemia of the lower limbs].

The study of 44 patients treated with intra-arterial fibrinolysis is reported. All these patients had an impending subacute ischemia of the lower limbs, a major complication of atheromatous disease. The criteria for patient selection were clinical, hemodynamic and radiological. The procedure of the treatment associating Urokinase, Heparin and Naphthidrofluril are defined, as well as its follow-up. The results have been evaluated according to the clinical and radiological improvement. 2 patients died when the treatment ceased and 10 were amputated, ie 27% of failures. The fibrinolytic treatment allowed identifying the patients who might quickly receive an additional treatment. In our experience, this treatment seems to improve the prognosis of impending subacute ischemia.

Adult↗
PubMed1990

Stenotic intimal thickening of the external iliac artery in competition cyclists.

Twenty-three cases of an arterial disease that affects competition cyclists are reported. Patients complained of intermittent acute claudication appearing on one lower limb only at the time of a maximal strain while cycling. Doppler hemodynamic investigation on an ergometric bicycle revealed a collapse of the ankle systolic pressure. Arteriography showed a sinuous lengthening and moderate stenosis of the external iliac artery. Pathologic examination of the artery disclosed a stenotic intimal thickening due to moderately cellular loose connective tissue with a variable distribution of collagen and elastic fibers. The cells in the affected zone were readily labeled with anti-actin and anti-myosin antibodies, and electron microscopy revealed features of synthetic smooth muscle cells. The lesion observed differs from intimal fibrodysplasia and from artherosclerosis. Abnormal local hemodynamic conditions may lead to this type of lesion. Thus, stenotic intimal thickening of the external iliac artery appears to be a new arterial disease defined by clinical, arteriographic, and pathologic features.

Adult↗
PubMed1990

[Left atrial extension of bronchial cancer diagnosed by echocardiography. Report of 2 cases].

The authors report 2 cases of left atrial extension of bronchial carcinoma detected by echocardiography. There have only been ten previous reports of echocardiography. There have only been ten previous reports of echocardiography detection of this complication as echocardiography is not requested systematically in patients with bronchial carcinoma. Left atrial metastasis is not uncommon at autopsy and the diagnostic value of echocardiography is excellent : the tumour appears as a hyperdense mass invading the roof of the left atrium through the pulmonary veins. Echocardiographic detection of left atrial extension of bronchial carcinoma is important because it implies a poor prognosis and because it may lead to a different therapeutic approach.

Carcinoma, Bronchogenic↗
PubMed1990

[Recurrent hematemesis caused by paraprosthetic aorto-digestive fistula].

The authors report the observation of a paraprosthetic fistula revealed by three episodes of digestive haemorrhage, illustrating the diagnostic and therapeutic difficulties brought about by the erosion of the duodenum by a sub-renal aortic prosthesis. A review of the literature confirms the rarity and the gravity of this pathology, and underlines the per-operative preventive measures.

Aortic Aneurysm↗
PubMed1990

[Prognostic factors in vascular traumas of the popliteal region].

Injuries of the popliteal region remain a serious problem as far as the outcome is concerned. The role and the risks of revascularization have yet to be properly evaluated. It's always difficult to decide on a major amputation. A retrospective study was applied to 37 cases referred to the CHRU d'Angers, between 1976 and 1987. We were then able to establish a prognostic scale with 120 ischaemia, the contusion, the clinical context and the open wound. The scale is used before any decision and allows us to decide whether revascularization or amputation have to be performed. In this series, 2 patients (5%) eventually died; 11 (33%) underwent a major amputation and 24 (65%) were successfully revascularized. The results are analyzed in relation to the prognostic scale and the literature.

Adolescent↗
PubMed1989

The principal artery of the psoas major muscle.

The psoas major m. has a complex arterial supply, derived from the lumbar, iliolumbar, obturator, external iliac and common femoral a. The branches arising from the external iliac a., though quite often multiple and slender, are represented in 75% of cases by a single large-caliber vessel. This principal artery of the psoas m. is probably responsible for the curves of the external iliac a. in the aged and also in certain competitive athletes.

Age Factors↗
PubMed1987

Brachial artery entrapment: compression by the supracondylar process.

Ischemia occurring during hyperextension of the upper limb in a 25-year-old woman led to the discovery of a supracondylar spur responsible for compression of the brachial artery with anomalous insertion of the pronator teres muscle. Resection of all abnormal structures provided immediate relief of symptoms. When atypical arterial symptoms of thoracic outlet syndrome occur in the upper limb, the brachial artery entrapment syndrome should be considered.

Adult↗
PubMed1987

[Diagnostic contribution of ultrasonic diagnosis coupled with pulsed Doppler combined with continuous Doppler to the exploration of the vertebral arteries of atherosclerotic patients. Preliminary report].

Velocimetric exploration by continuous emission Doppler is still essential for non-invasive evaluation of vertebral circulation but it does not provide morphologic data. Results were compared of exploration with combined continuous emission Doppler and a Duplex examination (sectorial scanning ultrasound imaging coupled with pulsed emission Doppler) and data from arteriography of 186 vertebral arteries in patients, mean age 57 years, admitted for exploration of a cerebral ischemic accident or a cervical murmur. The Duplex examination allowed identification of proximal segment (VI) in 98% of permeable vertebral arteries. The ostium of the vertebral artery was more difficult to visualize because of possible tortuosities, of sometimes a too posterior or intrathoracic localization or of a short neck. Nevertheless the vertebral ostium was identified in 78% of cases on the right and 48% on the left. The Duplex examination demonstrated sensitivity of 72% and specificity of 98% for detection of proximal stenosis of vertebral artery, and its sensitivity was therefore twice as sensitive as continuous emission Doppler for detection of stenoses of less than 50%. The Duplex examination should complete data from continuous emission Doppler by providing an evaluation of vertebral artery diameter and information on presence and characters of an elongation or stenosis. In this way, 9 atheromatous plaques not identified on arteriography were detected by ultrasound imaging. Similarly, the Duplex examination is particularly useful for identification of a hypoplastic vertebral artery, to distinguish the specific lesions of the subclavian artery from those extending onto vertebral ostium, and to characterize ostial lesions when these are accessible to examination.(ABSTRACT TRUNCATED AT 250 WORDS)

Basilar Artery↗
PubMed1987

[Distal reimplantation of the extremities].

Over the last two years, 15 patients have undergone revascularization surgery to a total of 17 distal extremities at the level of or distal to the last phalangeal joint. Operations were performed by three surgeons trained in microsurgical techniques, making the series a homogeneous one. Results were analyzed using Tamai and Nakamura's scores. Determinant factors, social and economic costs and effects on occupation are emphasized. The mean success rate of 65% is influenced by the total or partial nature of the section, its localization to the thumb or long fingers and the mechanism of section. The good functional results obtained were due to distal forms of amputation, recognized despite the technical difficulties as being an indication of choice for this reimplantation surgery. All patients in this group were able to return to work, with or without adaptation, within a variable lapse of time.

Adolescent↗
PubMed1986

Endofibrosis of the external iliac artery in bicycle racers: an unrecognized pathological state.

Since December 1985, we have operated upon seven bicycle racers for endofibrosis of the external iliac artery. In all instances, the athletes had started cycling early in life and were engaged in top level competition by the age of 17. The principal complaint was intermittent claudication of one lower limb at "near-maximal" exercise. Pain could be reproduced by exertional tests on an ergometric bicycle, and in all cases except one, measurement of ankle systolic pressure of that limb compared with the opposite side and brachial pressures showed a marked decrease on the involved side. Arteriography, performed with multiple views and positions, documented a 5 to 6 cm moderately stenotic (less than 40% diameter) segment, associated with arterial lengthening. Surgical treatment consisted of endarterectomy and shortening of the artery. Four patients were able to return to competition. The origin of this pathology is discussed, based on gross and histologic findings. Under certain predisposing anatomic conditions, abnormal hemodynamics, probably due to a high flow arterial state and an aerodynamic position on the bicycle, provoke repeated trauma which eventually produces the lesion. Practically unrecognized until now with only two previous publications on the subject in the literature, this entity is probably not uncommon.

Adult↗
PubMed1986

Extrinsic arterial supply of the great saphenous vein: an anatomic study.

The extrinsic arterial supply to the great saphenous vein was studied by dissection following latex injection, diaphanisation and contrast roentgenograms. Arterial supply arises from the external pudendal, superficial femoral, superior genicular and posterior tibial arteries. These branches ensure the irrigation of the vasa vasorum. The role they play in the outcome of bypass with the great saphenous vein is a further argument pleading in favor of the in situ technique.

Cadaver↗
PubMed1986

Naftidrofuryl in chronic arterial disease. Results of a six month controlled multicenter study using Naftidrofuryl tablets 200 mg.

The study was carried out on patients with intermittent claudication (Fontaine's stage II). The arterial and atheromatous origin of the disease was confirmed and localized by angiography or Doppler velocimetry examination. One hundred eighty-six patients were selected initially. Their pain-free walking distance on a treadmill (at a speed of 3 km/hour and an inclination of 10%) had to be 150-300 m. During the first month all patients received 3 placebo tablets daily. At the end of this run-in period (D-30; D 0) and after checking walking distance stability (allowed variation: +/- 20% between the two measurements) the patients were included in the study. One hundred fifty-four patients were selected and 118 remained during the whole study. The study was designed as a double-blind, using two parallel randomly selected groups. Sixty-four patients received for six months Naftidrofuryl (3 X 200 mg tablets daily with meals); 54 patients received placebo under the same conditions. During this period, clinical and paraclinical examinations were carried out every quarter (D 90 and D 180). After checking the initial homogeneity of the Naftidrofuryl and placebo-groups, the comparison between groups indicates a significant improvement in Naftidrofuryl group after 3 and 6 months of treatment. At the end of the study the observed differences in walking distance with Naftidrofuryl are approximately twice the difference in the reference group (D 90: p less than 0.05; D 180: p less than 0.02). The results of this study indicate that Naftidrofuryl is an efficient pharmacological tool for treatment of patients with chronic arterial disease (Fontaine's stage II).

Administration, Oral↗