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Biomedical subjects

J P Claudel

Publications and source records attributed to J P Claudel.

At least 19 recordsLinked to original sources
PubMed1996

Severe systemic cholesterol embolization after open heart surgery.

Cholesterol crystal embolization (CCE) may be triggered by various factors: intra-arterial angiographic procedures, aortic or vascular surgery, anticoagulant or thrombolytic treatments, or both. There are few previous reports of patients undergoing coronary artery bypass grafting (CABG) experiencing and therefore displaying severe systemic CCE. We describe four patients presenting, shortly after CABG, cutaneous, renal, neurological and hepatic signs related to severe CCE confirmed by skin biopsy. All patients died 11-92 days after surgery. As systemic CCE reveals severe atheromatous disease and is associated with a poor prognosis, it is advisable to avoid CABG in patients who present symptoms of CCE before surgery.

Aged↗
PubMed1996

Symptomatic pericardial disease associated with patch electrodes of the automatic implantable cardioverter defibrillator: an underestimated complication?

Constrictive pericarditis can be associated with ICD patch electrodes. During a mean follow-up of 24 months, in a population of 35 patients who received ICDs with a patch electrodes configuration, we identified three patients with clinical and hemodynamic signs compatible with this event. Patient 1, a 35-year-old male, underwent implantation of an ICD because of a primary electrical disease complicated by cardiac arrest. Fourteen months later he complained of exertional dyspnea without any signs of heart failure. Right heart catheterization showed high filling pressures and diastolic dip and plateau in pressure curves. Thoracotomy and pericardial exploration were performed. Three months after removal of the patches and insertion of an endocardial lead system, the patient had normal respiration. Patients 2 and 3, who suffered from coronary heart disease without heart failure, exhibited a hemodynamic profile suggestive of constrictive pericarditis: in one patient, 10 months after ICD implantation, associated with right heart failure; and in the other, 18 months after ICD implantation with left heart failure. Patch electrodes were removed in these two patients and replaced by endocardial lead electrodes with subsequent clinical improvement. It is concluded that constrictive pericarditis related to epicardial patch is not an uncommon occurrence during ICD therapy and should be considered in patients who show clinical signs of cardiac decompensation.

Adult↗
PubMed1995

[Cholesterol embolism in the lower limbs].

An atheromatous aorta may be the source of micro-emboli composed of cholesterol crystals. These cholesterol emboli presumably result from dislodgment of atheromatous material occurring either spontaneously, or consecutively to a coronary angiography, an aortic surgery or even an anticoagulant or thrombolytic treatment. Even if the best known clinical feature is the "blue toe" syndrome together with renal insufficiency, the spectrum of disease caused by cholesterol emboli ranges from asymptomatic to rapidly progressive multiple system failure. Therefore cholesterol embolism is a serious complication of aortic atherosclerosis and often holds a poor prognosis. Diagnosis is confirmed by skin or muscle biopsy and fundoscopic examination. The optimal treatment remains to be established.

Aged↗
PubMed1995

Subdiaphragmatic implantation of implantable cardioverter defibrillator generator.

Despite several improvements in the surgical technique and in the technologic design of cardioverter defibrillators made over the past years, abdominal placement of the generator device, done as Mirowski did it in his first implantation performed in 1980, remains the widely used method. Although smaller defibrillators are available, they remain bulky and are a source of local complications. To prevent such complications and to enhance patient comfort, we performed a subdiaphragmatic implantation in 31 patients.

Defibrillators, Implantable↗
PubMed1995

Sotalol: from "just another beta blocker" to "the prototype of class III antidysrhythmic compound".

Sotalol is a beta-blocking drug devoid of membrane stabilizing properties, as well as intrinsic sympathomimetic actions, or cardioselectivity. In addition, sotalol prolongs atrial and ventricular repolarization (Class III antiarrhythmic activity). It appears to have less myocardial depressant effect than other beta-blocking agents. Given orally, bioavailability of the drug reaches 100%. Sotalol's plasma half-life is 15 hours (range 7-18) and is dependent only on renal function. In clinical practice, it has been found effective in the suppression of nearly all supraventricular and ventricular dysrhythmias except those related to prolonged ventricular repolarization. Most common adverse effects are dyspnea, bradycardia, and fatigue, which results in drug termination in 16% of the cases. Torsades de pointes usually associated with bradycardia and drug induced QTc prolongation has been reported in 1.9%-3.5% of the patients receiving sotalol. This complication may be reduced by limiting the dose (< 640 mg/day) especially in patients with impaired renal function. In addition hypokalemia must be avoided. To sum up, the combination of Class II and Class III effects may carry additional benefits. However, further studies are required to test such hypotheses.

Animals↗
PubMed1995

[Radiofrequency ablation of intranodal tachycardia].

The first radical approach to the treatment of atrioventricular nodal reentrant tachycardia was surgical dissection of the perinodal region. This technique has been replaced by the delivery of radiofrequency energy by an ablation catheter to the region of the atrioventricular node. The aim of this report is to describe the authors' experience of atrioventricular nodal application of radiofrequency current. The study comprised 53 cases (32 women and 21 men, mean age 46 +/- 17 years) with frequent attacks of reciprocating tachycardia. Endocavitary electrophysiological investigation confirmed the intranodal reentrant mechanism. The region of application of the radiofrequency current was located radiologically and then the precise site determined by the recording of nodal electrical activity. The appearance of junctional rhythm during the procedure was also used as a means of identification of the zone of ablation. Dual conduction persisted after ablation in 35 patients. However, no episode of tachycardia could be induced after the procedure. The AH interval increased during application of radiofrequency current in 3 cases but this abnormality regressed in the 2 months following the procedure. Recurrences of nodal reentrant tachycardia were observed in 14 cases (26%), 24 hours to 2 months after ablation. The rate of recurrence was significantly higher in patients who did not have a junctional rhythm during application of the radiofrequency current (62% vs 4%, p < 0.05). The number of recurrences was also greater in the group of patients with persistence of slow intranodal conduction after the radiofrequency ablation (p < 0.04). A second session of radiofrequency ablation was undertaken in 14 patients and a third session was required for 2 of them.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Radiofrequency ablation of atrial flutter. Efficacy of an anatomically guided approach.

BACKGROUND: Previous reports have shown that radiofrequency ablation can terminate atrial flutter and prevent recurrences. However, different methods have been used, and the current experience remains limited. The objective of the present study was to determine the efficacy of radiofrequency ablation of atrial tissue in patients with atrial flutter using an anatomically guided approach. METHODS AND RESULTS: We treated 22 patients aged 30 to 73 years. Atrial flutter was recurrent for a mean of 5 years despite the administration of multiple antiarrhythmic drugs. Radiofrequency current was directed to the atrial isthmus between the inferior vena cava and the tricuspid ring, regardless of the morphology of local electrograms. Radiofrequency energy was applied during typical atrial flutter in 12 patients, atypical atrial flutter in 2 patients, and successively both forms in 8 patients. In 19 patients, atrial flutter abruptly terminated. In 3 patients, atrial flutter persisted despite 37, 48, and 25 applications, respectively. Atrial recordings demonstrated that atrial flutter termination occurred as a consequence of conduction block at the site of radiofrequency energy application, regardless of the type of atrial flutter. The number of applications before termination ranged from 1 to 82 (mean, 32). Atrial flutter could no longer be induced in every case. There were no complications. During a 13-month mean follow-up, atrial flutter recurred in only 2 of the 19 patients who had a successful ablation. Four patients experienced chronic atrial fibrillation, and 2 of them returned to sinus rhythm with antiarrhythmic therapy. CONCLUSIONS: Radiofrequency ablation of atrial flutter using anatomic guidance is feasible and effective. Further experience is needed to delineate its role as an alternative approach to the management of refractory atrial flutter.

Adult↗
PubMed1994

[Hemomediastinum caused by spontaneous rupture of the thoracic aorta].

The authors report the rare case of spontaneous rupture of the aortic isthmus in the absence of preexisting aortic aneurysm or dissection in a hypertensive woman presenting with chest pain and haemomediastinum. The history of trauma 30 years previously, could have been a predisposing factor. The diagnosis of this condition remains difficult and is often missed. The physiopathological, aetiological, clinical and diagnostic features are reviewed. Transoesophageal echocardiography showing an intraparietal haematoma confirmed the aortic origin of the haemomediastinum. Conventional angiography was of no value in the reported case because of the absence of rupture of continuity or of an intimal tear.

Aged↗
PubMed1994

[Long-term course after electric ablation of the bundle of His in the treatment of supraventricular tachycardia].

The authors report the long term results of His bundle ablation for supraventricular tachycardia in a series of 49 patients. This retrospective study was based on a patient population of 27 men and 22 women with an average age of 59 at the time of ablation, between 1984 and 1993. The indication for His bundle ablation was invalidating supraventricular tachycardia resistant to antiarrhythmic therapy in all cases. One group of patients (Group I, n = 31 patients) underwent high energy electrical shock and the second group (Group II, n = 18 patients) recruited after 1991, underwent radiofrequency catheter ablation. Complete atrioventricular block was obtained in the first group in 1 to 4 sessions whereas 17 patients of Group II were treated in a single session. During a follow-up period of an average of 40 months, 2 patients were lost to follow-up and 6 died, 3 of cardiac failure, 1 of a cerebrovascular accident, 1 of pulmonary carcinoma and 1 of unknown cause. In Group I, atrioventricular conduction persisted in 1 patient (primary failure) and reappeared in one other patient, but, in Group II, complete atrioventricular block persisted even in the patient in whom the interruption was not obtained with a single session of radiofrequency ablation. The patients were generally physically improved and satisfied not to have any palpitations. A decrease in exercise capacity estimated by the NYHA classification was observed in 38% of patients without apparent cardiac disease who developed dyspnea. On the other hand, 43% of patients with cardiac disease and in NYHA class > or = 2 were improved.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Diagnosis of acute infectious epidural inflammation. Role of magnetic resonance imaging].

External pachymeningitis, usually caused by Staphylococcus aureus, is a rare pathological entity which is difficult to diagnose at an early stage, has a poor functional prognosis and often requires an emergency surgical treatment. We report three cases in which magnetic resonance imaging provided an early diagnosis of the epidural space infection before severe neurological deficits, such as paraparesis and/or paraplegia, set in. Following an anti-staphylococcal treatment with fluoroquinolone and beta-lactamase-resistant beta-lactam antibiotics with good bone penetration administered intravenously during 4 to 6 weeks, then orally for 5 to 6 months cure without functional sequelae was obtained in all three patients.

Acute Disease↗
PubMed1993

Primary cardiogenic shock during acute myocardial infarction: results of emergency cardiac transplantation.

Fifteen patients with acute myocardial infarction and cardiogenic shock underwent emergency cardiac transplantation after medical treatment failed to improve their haemodynamic status. Their mean age was 49 +/- 7 years. The infarction was anterior in 12 cases, inferoposterior in two cases, and septal in one. Shock occurred within 3 days after the onset of chest pain in nine patients, and during the first day in six of them. Mechanical circulatory assistance was used in six patients as a bridge to transplantation when their haemodynamic status could not be stabilized pharmacologically. Orthotopic cardiac transplantation was performed an average of 15.6 +/- 14 days after onset of infarction. Three patients died during the early post-operative period. Another died 7 months after transplantation. During the mean follow-up period of 30.6 +/- 20.3 months, there were three acute rejections, all successfully treated, and one chronic rejection. The survival rate for this series is 70%. Thus, emergency cardiac transplantation may be the best option for selected patients with acute myocardial infarction and cardiogenic shock refractory to conventional therapy.

Adult↗
PubMed1993

[Long-term results of implantable automatic defibrillator in 43 patients. Analysis of predictive factors of the first electric shock].

In order to identify patients who will receive an electric shock after implantation of an automatic fibrillator, the relationship between the time to the first shock and clinical and paraclinical characteristics were studied in 43 patients treated at the Lyon Cardiological Hospital between July 1987 and September 1991. The age of the patients was 49.5 +/- 16 years (mean + SD). Eighty two percent of patients were men and the average left ventricular ejection fraction was 38.5 +/- 16.8%. Four patients died in the peri-operative period. The average follow-up of the survivors was 22 months. During this period, 21 patients (53.8%) received an appropriate electric shock. Three patients died. The causal role of a malignant ventricular arrhythmia is discussed in one case. A second patient, who never had automatic fibrillation, died of cardiac failure. Finally, the third patient died of non-cardiac pathology. The 22 month actuarial survival rate was 86%. The probability of receiving an appropriate electric shock was 60%. Analysis of clinical and paraclinical features identified left ventricular dysfunction (ejection fraction less than 38%) and cardiac symptoms (Stage III dyspnoea of the NYHA classification) as being associated with earlier electric shocks. This association was even more clear cut in the group of patients with previous myocardial infarction. Therefore, patients with implantable automatic defibrillators for malignant ventricular arrhythmias receive appropriate electric shocks in over 50% of cases. Patients with symptoms of cardiac failure and low ejection fraction are particularly exposed especially when they have previous myocardial infarction.

Actuarial Analysis↗
PubMed1993

[Ablation of accessory pathways by radiofrequency current. Towards a simplified approach of Wolff-Parkinson-White syndrome?].

From December 1990 to April 1992, 41 consecutive patients (22 men and 19 women with an average age of 35 +/- 16 years -6-72) underwent ablation of accessory atrioventricular conduction pathways (Bundles of Kent) for poorly tolerated and/or medically resistant supraventricular tachycardias. In 33 cases, the arrhythmia was a paroxysmal SVT, in 7 cases atrial fibrillation, and in 1 patient incessant junctional tachycardia causing left ventricular dysfunction. The Wolff-Parkinson-White syndrome was apparent in 30 patients and concealed in 11 cases. The location of the Kent bundle was left lateral in 22 cases (53.7%), posterior paraseptal in 9 cases (21.9%), right lateral in 5 cases (12.2%) and anterior paraseptal in 5 cases (12.2%). The Kent bundles were ablated by radiofrequency currents in 38 cases (92.7%); in 2 patients (4.9%) in whom radiofrequency could not be used (increased impedance) high energy electrical shock was successful. In one patient (2.4%), it was not possible to suppress the Kent bundle. A single session of radiofrequency ablation was sufficient in 33 cases: 7 cases (17.5%) required 2 (4) or 3 (3) sessions. The average number of sites of application per patient was 8.8 +/- 8.8. The duration and intensity were respectively 32.2 +/- 9.3 (5-60) seconds and 25 +/- 15 (20-30) watts. With an average follow-up of tachycardia or of ventricular preexcitation have been observed in the 40 patients. In addition, in 36 patients, electrophysiological control studies confirmed the initial result with absence of any disturbance of nodohisian conduction.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

[Prognosis and long-term development of arrhythmogenic dysplasia of the right ventricle].

The authors studied the clinical, angiographic and electrophysiological features, and the long-term outcome of patients with arrhythmogenic right ventricular dysplasia (ARVD). The study was retrospective and involved 22 patients (3 women and 19 men) with an average age of 36 years at the time of their first documented ventricular tachycardia (VT) and admitted to hospital between 1971 and 1989. The diagnosis of ARVD was based on the association of monomorphic VT with a left bundle branch block morphology and right ventricular abnormalities on angiography. Fifteen patients were treated by antiarrhythmic drugs alone, 5 by antiarrhythmic drugs and tachycardia ablation and 2 by antiarrhythmic drugs and cardiac transplantation. An automatic defibrillator was implanted in one patient. After the first episode of VT, the beginning of follow-up, the criteria of evaluation were mortality, right heart failure and the evolution of the arrhythmia. The study population had the following characteristics. Familial forms or ARVD were observed in 18%. The mitral ventricular arrhythmia was often induced by exercises (45%). Twenty-one patients had a sustained VT and 1 patient had non-sustained VT. The resting ECG in sinus rhythm was abnormal in all cases. Thirty-two different VT morphologies were recorded. The abnormalities of the right ventricular wall motion on ventriculography were localised in 45% of cases and diffuse in 55% of cases. Seventy per cent of patients undergoing electrophysiological investigation had inducible sustained VT. The clinical outcome after an average of 10.7 years' follow-up was: 17 survivors, 3 sudden deaths and 4 cases of right ventricular failure. The 10 year actuarial survival rate was 75%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

Laser immunonephelometry for routine quantification of urinary albumin excretion.

We describe a laser-immunonephelometric method for quantifying urinary albumin excretion (UAE) in large numbers of samples. For a 150-microL sample incubated at room temperature for 45 min with 40 microL of antiserum specific for human serum albumin, the assay range for albumin was 0.34 to 43.0 mg/L. For samples analyzed undiluted and diluted 10-fold, the range of measurable albumin was from 0.34 to 430.0 mg/L. With an automated version of this method, one can assay 240 samples per hour. Intra- and interassay CVs were less than 6% and 9%, respectively. Measurements by this method (y) correlated well with those obtained by a RIA method (x): y = 1.00x + 0.163 mg/L (n = 233; r = 0.996). The day-to-day CV for UAE was determined for three consecutive determinations done on each of 60 controls according to the time of collection and in 212 diabetics according to the amount of 24-h UAE. For controls, UAE was 8.0 +/- 8.1 mg/24 h (mean +/- SD), CV 44 +/- 23%. The CV was similar for diurnal (50 +/- 28%) and overnight (58 +/- 32%) collections from controls; and for diabetics with normal values for UAE: 35 +/- 32%, with slight albuminuria (25-300 mg/24 h):37 +/- 28%, or with macroalbuminuria (greater than 300 mg/24 h): 47 +/- 42%.

Adult↗