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Biomedical subjects

J M Montely

Publications and source records attributed to J M Montely.

12 recordsLinked to original sources
PubMed2004

[Can bioprostheses be implanted at younger ages?].

The choice between mechanical prosthesis (MP) and bioprosthesis (BP) depends on the respective advantages and disadvantages of the two types of valves. MP theoretically have an indefinite life span but carry the risk of thromboembolic events that requires anticoagulant therapy, which itself is responsible for hemorrhages. BP bear a theoretically lower thromboembolic risk but have a limited life span that requires reintervention at a subsequent date, latter when the patient is older at implantation and operated on for aortic replacement. Actually MP is preferred before 60 years and BP after 70 years. Between 60 and 70 years there is not consensus. The limit recommended is around 65 years for aortic replacement and 70 years for mitral replacement. This limit can change either for upper or lower limit depending on patient's life expectancy, technological improvements of MP as well as BP, improvements of medical follow up of anticoagulant therapy (either self testing or use of anti thrombin). In the future the age limit of implantation of BP can be lowered but MP didn't have their last word.

Age Factors↗
PubMed2002

[Aortic stenosis with left ventricular dysfunction: evaluation and management].

Aortic stenosis is the most frequent valvulopathy in France today. Valve replacement has transformed the prognosis, when indications are present before the appearance of irreversible left ventricular dysfunction. However, some patients are still not seen before this time or their surgery was deferred. Thus, the postoperative prognosis depends on the reversibility of this dysfunction which can occur even when the stenosis is severe and essentially reflects the elevated afterload. The prognosis is less favorable once myocardial fibrosis has developed in response to left ventricular hypertrophy or when ischemic cardiopathy contributes to this dysfunction. The diagnosis and prognosis are based on the confirmation of the presence of a severe stenosis and that the removal of this obstacle will lead to regression of the dysfunction. For this, Doppler echocardiography is determinant, as combined with a dobutamine test, it is able to evaluate the tightness of the stenosis, the severity of the left ventricular dysfunction and its reversibility. When the stenosis is severe with contractile reserve, indicating a better postoperative prognosis, dobutamine does not induce an appreciable change of the aortic area, but the mean pressure gradient, often low prior to dobutamine administration, rises. Although the surgical risk remains higher in the presence of left ventricular dysfunction, the ultimate prognosis is more favorable when the test suggests regression is possible.

Aortic Valve Stenosis↗
PubMed1995

Inspiratory fall in systolic pressure in normal and asthmatic subjects.

We used a noninvasive monitor of arterial pressure to determine whether respiratory changes in arterial pressure were closely correlated with airflow obstruction in asthmatic patients during bronchial challenge with methacholine. To validate the noninvasive measurement of respiratory changes in arterial pressure, a preliminary study in 6 subjects with normal cardiovascular and respiratory systems was done during cardiac catheterization for suspected coronary artery disease. There were no significant differences between inspiratory falls in systolic pressure measured noninvasively and those measured from intraaortic pressure. In 11 otherwise healthy asthmatic patients we measured finger arterial pressure, end-expiratory lung volume (FRC), and forced expired volume (FEV1) during baseline and bronchial challenge in the supine posture. Finger arterial pressure was also measured in 11 normal control subjects seated and supine. Normal subjects had an inspiratory fall in systolic pressure (IFSP) of 3.2 mm Hg supine and 5.1 mm Hg seated (p < 0.01). Asthmatic patients when bronchodilated (seated FEV1 = 83 +/- 7% of predicted) had an IFSP of 5.9 mm Hg supine (p < 0.01 compared with supine normal subjects). During bronchial challenge (average fall in FEV1 = 22%), IFSP increased to 16.1 mm Hg (p < 0.001 compared with baseline). In asthmatic subjects, there was a significant correlation between IFSP and FEV1 (mean r = -0.92 +/- 0.05, p < 0.01), and the average change in IFSP/change in FEV1 was -0.38 mm Hg per percentage change in FEV1. During subsequent bronchodilation, IFSP decreased with a similar time course as relaxation of airway smooth muscle, assessed by the breath-to-breath fall in FRC.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Infective endocarditis of a valve prosthesis. Multicenter study (179 cases)].

Over a 5-year period (1982-1986) 176 cases of infective endocarditis on prosthesis (IEP) were recorded in 40 cardiology departments. 65 p. 100 of the patients were male, and the mean age of the population was 51 years. Mechanical prostheses were involved in 57 p. 100 of the cases and bioprosthesis in 43 p. 100. There was a high proportion of initial indications for bacterial endocarditis (18 p. 100) and for reoperation on prosthesis (10 p. 100). IEP developed early in 40 cases and late in 139 cases; 19 (48 p. 100) of the early IEPs were staphylococcal, while 31 p. 100 of late IEPs were streptococcal (p less than 0.01). 143 patients were reoperated upon within less than 1 month in 41 p. 100 of the cases, with a pre-operative antibiotic therapy of less than 10 days in 39 p. 100. Reoperation was performed in stage IV or as an emergency in 45 p. 100 of the cases. Abscesses were three times more frequent with aortic prostheses than with mitral prostheses (58 p. 100 vs 20 p. 100, p less than 0.001). Vegetations were more frequent on mechanical prostheses than on bioprostheses (43 p. 100 vs 31 p. 100, NS). The operative mortality rate was 25 p. 100; the mortality rate of unoperated patients was even higher (31 p. 100). The survival rate in operated IEP was 51 p. 100 at 30 months, as against 46 p. 100 at 12 months in unoperated IEP.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Echocardiographic-Doppler study of a case of subacute and incomplete parietal rupture after myocardial infarction].

The authors report the case of a 55 year old man who suffered a silent, laterobasal myocardial infarction which was complicated by a subacute pseudo-false aneurysm of the lateral wall of the left ventricle. They underline: The importance of two-dimensional echocardiography in the diagnosis of a neo-para left ventricular cavity showing systolic expansion and communicating with the left ventricle by a narrow neck indicating rupture of the free ventricular wall; The value of two-dimensional color coded Doppler which enables the operator to distinguish the active nature of the neo-left ventricular cavity before surgery and its inactivity after surgery. The surgical indication for emergency resection of the pseudo aneurysm was based on these preoperative non-invasive observations. This case confirms the value of cardiac two-dimensional echo-Doppler studies in the investigation of ischaemic heart disease.

Aged↗
PubMed1982

[Nodoventricular Mahaim fibres. 2 cases confirmed by electrophysiological study].

Two adolescents with no obvious cardiac were investigated for paroxysmal tachycardia at a rate of about 200/mn with wide QRS complexes showing left bundle branch block, reduced by vagal manoeuvres. Atrial pacing showed shortening of the HV interval associated with widening of the QRS complex to appearances identical to those of the tachycardia, suggesting right ventricular preexcitation masked in sinus rhythm. The progressive prolongation of the atrio-ventricular conduction time with increasing prematurity of the extrastimulus and atrioventricular block after intravenous injection of ATP were more in favour of right nodo-ventricular Mahaim fibres (NV) than a Kent bundle. These properties of the NV pathway and the recording of a "gap" phenomenon during the measurement of the refractory period of the accessory pathway are explained by the proximal part of the AV node not being short-circuited. Paroxysmal tachycardia was easily induced by atrial and ventricular stimulation; the tachycardia QRS complexes always showed appearances of left bundle branch block with a His potential at the onset of the ventricular complex. The NV pathway therefore always depolarised in the anterograde direction in tachycardia; the retrograde pathway is discussed: His, latent Kent bundle or purely intranodal reentry.

Adolescent↗
PubMed1981

[The clinical diagnosis of aorto-coronary bypass occlusion (author's transl)].

The clinical profile of aorto-coronary bypass occlusion was drawn from a study of 49 patients with 56 occluded bypasses and 69 patients with 123 patent bypasses. All patients had undergone postoperative coronary arteriography or post-mortem examination. An anatomical cause of occlusion was retrospectively detected on the basis of pre-operative arteriographic findings or operation records in 82% of the cases, and on account of post-operative myocardial infraction (particularly significant when of late occurrence), residual angina and positive exercise tolerance test in 35%, 55% and 40% respectively of the cases. The last three criteria are of absolute diagnostic value when the arterial defects have been fully corrected by surgery.

Angina Pectoris↗
PubMed1979

[Myocardiopathy from a new anthracyclic derivative (author's transl)].

A 58-year-old man with subcutaneous metastases from a naevocarcinoma was prescribed 1 138 mg/m2 of a new anthracylic derivative, dietoxy-acetoxy-daunorubicine, at doses of 180 mg every three weeks. Irreversible cardiac failure occurred nine months after starting treatment, and was considered to be due to the toxic effects of the compound. He improved for a short period after very high doses of vasodilatators but death occured very shortly afterwards. Histological examination revealed severe subendocardial fibrosis, disseminated interstitial fibrosis, and degenerative and necrotic lesions of the myocytes. The authors discuss the factors involved in the cardiotoxicity of the anthracyclines: total dose, intervals between doses, associated risk, factors (age, radiotherapy). Even at usual doses signs of myocardial dysfunction are found in one third of patients treated, with the presence of histological lesions in all these cases, but clinical cardiac failure is rarely observed.

Cardiomyopathies↗
PubMed1976

[Intestinal lesions induced by radiotherapy of malignant pelvic tumors. Apropos of 2 cases].

Intestinal lesions after radiotherapy for pelvic malignant tumours are of two types: ulcerative colitis with stenosis and hemorrhage sometimes sevre and repeated, and ileal involvement with focal ischemic lesions and malabsorption responsible for nutritional disorders. It is difficult to distinguish them from a recurrence of the tumour in spite of endoscopy, arteriography and biopsy. The course in 3 stages is of great value in diagnosis. A reduction in the frequency of such complications may be hoped for by assessment and exclusion of predisposing factors, by strict observance of therapeutic rules. They are serious owing to the marked irreversible conjunctivo-vascular changes and the fragility of the irradiated tissues during operation.

Adult↗
PubMed1975

[Diffuse articular chondrocalcinosis and Paget's disease].

At the time of a personal observation of Paget's disease associated with a diffuse articular chondrocalcinosis (ACC) in a 75-year-old man suffering from diabetes and hyperuricaemia, the authors re-examined 61 patients suffering from Paget's disease to look for this association which had been previously mentioned by Radi et al. with the unusual frequency of 42 percent of cases. In 52 percent of their patients, who had undergone complete radiological examination of the skeleton, the authors found only one case of ACC, or 1.9 percent. Taking into account the respective frequencies of Paget's disease and of diffuse ACC in the general population aged more than 40 years, the results of this careful study led the authors to conclude that an association of ACC and Paget's disease is due to chance.

Adult↗