Biomedical subjects

J R Lusson

Publications and source records attributed to J R Lusson.

At least 19 recordsLinked to original sources

PubMed1997

Effect of the direct nitric oxide donors linsidomine and molsidomine on angiographic restenosis after coronary balloon angioplasty. The ACCORD Study. Angioplastic Coronaire Corvasal Diltiazem.

BACKGROUND: Nitric oxide (NO) donors, in addition to their vasodilator effect, decrease platelet aggregation and inhibit vascular smooth muscle cell proliferation. These actions could have beneficial effects on restenosis after coronary balloon angioplasty. METHODS AND RESULTS: In a prospective multicenter, randomized trial, 700 stable coronary patients scheduled for angioplasty received direct NO donors (infusion of linsidomine followed by oral molsidomine) or oral diltiazem. Treatment was started before angioplasty and continued until 12 to 24 hours before follow-up angiography at 6 months. The primary study end point was minimal lumen diameter, assessed by quantitative coronary angiography, 6 months after balloon angioplasty. Clinical variables were well matched in both groups. However, despite intracoronary administration of isosorbide dinitrate, the reference diameter in the NO donor group was significantly greater than in the diltiazem group on the preangioplasty, postangioplasty, and follow-up angiograms. Pretreatment with an NO donor was associated with a modest improvement in the immediate angiographic result compared with pretreatment with diltiazem (minimum luminal diameter, 1.94 versus 1.81 mm; P = .001); this improvement was maintained at the 6-month angiographic follow-up (minimal lumen diameter, 1.54 versus 1.38 mm; P = .007). The extent of late luminal narrowing did not differ significantly between groups (loss index in the NO donor and diltiazam groups, 0.35 +/- 0.78 and 0.46 +/- 0.74, respectively; P = .103). Restenosis, defined as a binary variable (> or = 50% stenosis), occurred less often in the NO donor group (38.0% versus 46.5%; P = .026). Combined major clinical events (death, nonfatal myocardial infarction, and coronary revascularization) were similar in the two groups (32.2% versus 32.4%). CONCLUSIONS: Treatment with linsidomine and molsidomine was associated with a modest improvement in the long-term angiographic result after angioplasty but had no effect on clinical outcome. The improved angiographic result related predominantly to a better immediate procedural result, because late luminal loss did not differ significantly between groups.

Aged↗

PubMed1996

[Outcome of cardiac valve ring abscesses after medical treatment: attempt to identify criteria of favorable prognosis].

OBJECTIVES: Identify factors predicting favorable outcome after medical management of valve ring abscesses in order to propose a surveillance schedule for conservative treatment. METHODS: A multicentric study conducted from July 1989 to February 1996 included 28 patients (mean age 64 +/- 16 years, range 26-83) hospitalized for active endocarditis and valve ring abscesses diagnosed at transthoracic or transesophageal echography. Conservative medical therapy was given because of a decision of the medico-surgical team (n = 9), high surgical risk (n = 12), or patient refusal of surgery (n = 7). Outcome was favourable in 18 patients (Group I) and unfavorable in 10 (Group II) due to death (n = 9) or subsequent surgery (n = 1). Univariate and multivariate analysis were used to determine differences between the groups in terms of clinical and laboratory data. RESULTS: Mean follow-up in Group I was 33 +/- 18 months and 15 +/- 10 months in Group II. Univariate analysis showed significant differences between Group I and II respectively for age (59 +/- 18 yr vs 72 +/- 10, p = 0.04), delay to apyrexia after antibiotics (4.3 +/- 2.8 vs 8.3 +/- 2.4 days, p < 0.0008), heart failure (5% vs 70%, p = 0.003), grade III or IV valvular regurgitation (5% vs 60%, p < 0.04), and mean surface area of the abscess (1.5 +/- 1.2 vs 5.4 +/- 6.4 cm2, p < 0.03). Independent factors at multivariate analysis were by decreasing order: lack of heart failure at admission, delay to apyrexia, abscess surface area, and age. Outcome was favorable (mean follow-up 33 +/- 10 months) in all patients with an abscess surface area < 1.5 cm2, no signs of heart failure, no grade III or IV valvular regurgitation, apyrexia after less than 8 days on antibiotics and no staphylococcus positive blood culture. CONCLUSION: Medical management of valve ring abscesses may be indicated in selected patients in care units with rigorous surveillance facilities. Further studies are needed to precisely identify surveillance and treatment criteria.

Abscess↗

PubMed1996

Safety and efficacy of Xenetix, a new iodinated contrast agent, in pediatric angiocardiography.

PURPOSE: The aim of this work was to study the safety and efficacy of iobitridol 350 in pediatric angiocardiography compared to iopamidol 370. MATERIAL AND METHODS: 40 children participated in each test group. Each examination was rated as diagnostic or nondiagnostic and the image quality was noted. Nature,onset,intensity as well as outcome of each adverse reaction was reported. RESULTS: There was no significant difference in either image quality or clinical safety between the 2 groups. CONCLUSION: Iobitridol is a safe and effective contrast agent for pediatric angiocardiography.

Angiocardiography↗

PubMed1995

Systemic-pulmonary shunt with a right retroesophageal subclavian artery.

A 19-day-old child suffering from cyanosis due to tetralogy of Fallot was palliated by using his right retroesophageal subclavian artery. It was anastomosed side-to-side onto the ascending aorta and end-to-side onto the right pulmonary artery. The palliation obtained with this systemic-pulmonary shunt was satisfying. The right brachial vascular flow was normal.

Aorta↗

PubMed1995

[Mechanisms of cardiac involvement in systemic scleroderma. Apropos of 3 cases].

To investigate myocardial manifestations in progressive systemic sclerosis, we studied three patients with transthoracic echocardiography, cardiac catheterization with coronary angiography, thallium scans with dipyridamol completed by thoracic cold exposure and endomyocardial biopsy with immunohistology. Two patients were symptomatic. In the three cases, abnormalities of myocardial perfusion were detected without coronary stenosis. Two patients had myocardial fibrosis with a coronary spasm in one case. The immunohistological study always showed an unusual expression of HLA class II antigen on cardiac fibroblasts.

Aged↗

PubMed1995

[Valve ring abscesses: apropos of 59 cases. A multicenter study].

The authors report the results of a multicenter study which recensed 59 cases (46 men, 13 women, average age 59.8 +/- 14 years) of valve ring abscesses defined by echocardiographic criteria alone (20 cases) or by echocardiographic and/or operative criteria (39 cases). The site of abscess was aortic (53 cases), mitral (5 cases) and tricuspid (1 case). The abscess complicated a prosthetic valve in 34 cases, occurred with a non-pathological valve in 11 cases or a pathological valve in 14 cases. Taking the 39 operated patients as a reference, the diagnostic sensitivity of transthoracic echocardiography was 25% and that of transoesophageal echocardiography: 88%. Bacterial vegetations were diagnosed with a sensitivity of 55% for transthoracic and 88% for transoesophageal echocardiography. The mediocre results of transthoracic echocardiography make transoesophageal echocardiography mandatory when there is a clinical suspicion of abscess: transoesophageal echocardiography should be systematic in prosthetic valve endocarditis and widely employed in native aortic valve endocarditis. The clinical outcome of these cases was: 39 cases were operated: global mortality of 23%, and 18 cases were treated medically, surgery having been declined for various reasons: old age (2 patients), operative risk (1 patient), patient refusal (4 patients), general condition considered to be too good to justify surgery (11 cases, including 6 sterilised abscesses diagnosed some time after the acute infectious phase). The outcome of these 18 patients, who form the biggest non-operated series of valve ring abscesses to date, was studied in detail: 4 died (18% mortality), 1 was operated secondarily for progressive valve dehiscence and 13 had a favourable outcome with an average follow-up period of 2 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Abscess↗

PubMed1995

[Congenital pulmonary arteriovenous fistula. Apropos of 2 cases].

The authors discuss echocardiographic diagnosis and endovascular treatment of two different anatomical types of pulmonary arteriovenous fistula. Transoesophageal echocardiography in a cyanotic 3 year old boy revealed a direct right pulmonary artery left atrial fistula, treated by surgical ligation of the anomalous feeding artery. A cerebral abscess in a 22 year old man with hereditary haemorrhagic telangiectasia revealed pulmonary and cerebral arteriovenous malformations, which were both treated successfully by embolization. The value of echography is the demonstration of the right to left shunt at pulmonary level and, in some cases, the direct visualization of the arteriovenous malformation. Embolization should be considered as the therapeutic method of choice in all pulmonary arteriovenous fistula, except for direct pulmonary artery left atrial fistula.

Adult↗

PubMed1995

[Transesophageal echocardiography in cardiac and paracardiac tumors. A multicenter study].

A multicentre study was undertaken to determine the diagnostic value of transoesophageal echocardiography (TOE) in tumours of the heart and pericardium. Forty-five cases were recensed: 24 myxomas, 1 fibroma, 1 hydatid cyst, 2 lymphomas, 3 sarcomas, 1 pleuropericardial cyst, 1 branchogenic cyst and 12 cardiac metastases. The diagnosis was made in all 45 cases by TOE but only in 35 cases by conventional transthoracic echocardiography which failed to recognise 2 myxomas, 1 hydatid cyst, 1 sarcoma, 2 paracardiac cysts and 4 cardiac metastases. The site of the tumour was identified 45 times by TOE compared with only 12 times by transthoracic echocardiography. However, the anatomical investigation of mediastinal tumours requires complementary computerised tomography. Moreover, TOE, like all other imaging techniques, is unable to predict the benign or malignant nature of the tumour, 1 leiomyosarcoma having been confused with a myxoma.

Adult↗

PubMed1994

[Interruption of the left aortic arch with right descending thoracic aorta disclosed in adulthood].

Evaluation of hypertension, in a 30 years old man, revealed an interruption of a left aortic arch beyond the origin of the left subclavian artery, associated with a right descending thoracic artery. Surgical restoration of the continuity between the ascending aorta and the low descending aorta was successfully achieved by interposition of a graft. Survival in adulthood without bronchial compression, is explained by the absence of ventricular septal defect and patent ductus arteriosus.

Adult↗

PubMed1993

[Mechanisms of cardiac involvement in systemic scleroderma, apropos of 3 cases].

We studied myocardial manifestations of systemic sclerosis in three patients. Two patients were symptomatic. A transthoracic echocardiography, a coronary angiography, a cardiac catheterization, thallium scans with dipyridamol completed by thoracic cold exposure and endomyocardial biopsy with immunohistological study were performed. None of them have coronary stenosis. In the three cases abnormalities of myocardial perfusion were detected, two of them have fibrosis. The immunohistological study always showed an anusual expression of HLA DR on cardiac fibroblasts.

Aged↗

PubMed1993

[Rapid efficacy of preoperative chemotherapy in nephroblastoma involving cardiac cavities].

BACKGROUND: Tumors involving the inferior vena cava and cardiac cavities are rare in nephroblastoma. When they do occur, the standard treatment is primary surgery; but this is often technically difficult. CASE REPORT: A 3 year-7-month-old girl was admitted because of an abdominal mass and signs of heart failure. Ultrasonography showed that this mass involved the right renal vein and the inferior vena cava including the right atrium. A CT scan showed no metastases. Echocardiography showed that the mass occupied two thirds of the right atrium and had blocked the tricuspid valve. The patient was given heparin (2 mg/kg/day), vincristine (1.5 mg/m2 on day 1) and actinomycin D (15 micrograms/kg on day 1 to 3). The heart failure disappeared and the abdominal mass decreased in volume. This improvement was confirmed by successive ultrasonographies. Chemotherapy was then completed and the patient was operated on six weeks later: right nephrectomy and removal of the cavoatrial tumoral thrombus. Pathological examination confirmed the nephroblastoma and the patient was given radiotherapy and chemotherapy for 28 weeks. She was also given aspirin for 17 weeks. Pulmonary metastases were detected 1 year after onset and were treated by a combination of surgery and chemotherapy. The patient is well 20 months after the onset of the disease. CONCLUSION: Preoperative chemotherapy seems to be effective in nephroblastoma extending to cardiac cavities; it allows subsequent surgery and facilitates postoperative radiotherapy.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1992

Comparison between thallium-201 and technetium-99m methoxyisobutyl isonitrile defect size in single-photon emission computed tomography at rest, exercise and redistribution in coronary artery disease.

Defect size on myocardial tomograms was measured in 30 patients who underwent 2 separate studies, 1 with thallium-201 (TI-201), the other with technetium-99m-methoxyisobutyl isonitrile (MIBI). A group of 15 patients with myocardial infarction was studied at rest and received both tracers on the same day. The other 15 patients had documented coronary artery disease. They were were given injections of TI-201 at peak exercise and underwent imaging immediately after exercise and again 4 hours later. They then received a dose of MIBI for imaging at rest. A week later they underwent a second exercise test with the same work load and received a second dose of MIBI. Defect size on single-photon emission computed tomographic images was measured and repeated twice. Results were expressed in percentage of the volume of the whole myocardium. Reproducibility of the defect size measurement was high for TI-201 (r = 0.978; SEE = 1.59) as well as for MIBI (r = 0.981; SEE = 0.80). In patients with coronary artery disease the mean size of the defects was significantly larger with TI-201 than with MIBI at exercise (6.7 +/- 5.2 vs 4.6 +/- 5.2%, respectively, p less than 0.05) and at redistribution (5.1 +/- 4.4 vs 2.8 +/- 3.2%, respectively, p less than 0.05), where no difference was seen in patients with myocardial infarction studied only at rest (11.2 +/- 10.4 vs 12.0 +/- 11.5%, respectively, p = not significant). Smaller MIBI defect sizes, when compared with TI-201, in the exercise and redistribution studies were not due to technical artefacts since there was no difference when they were compared at rest.

Adult↗

PubMed1992

[Amiodarone and fetal supraventricular tachycardia. Apropos of a case with neonatal hypothyroidism].

BACKGROUND: Fetal tachycardia can be a cause of in utero death. Its detection is not always easy and its treatment is still controversial. CASE REPORT: Paroxysms of supraventricular tachycardia were detected on echocardiography at the 25th week of a second pregnancy. The mother was given sotalol, but the supraventricular tachycardia became permanent. At the 27th week of gestation, sotalol was stopped and the mother was given digoxin and the foetus received 2 injections of digoxin, 10 micrograms/kg, via the umbilical cord. As this treatment was only partially effective, the mother was also given amiodarone 800 mg/day at week 28, then the dose was reduced to 400 mg/day. However, at the 31st week, the mother showed signs of digoxin intolerance, and it was replaced by sotalol. Fetal blood tests at week 34 showed a high placental transfer of digoxin and sotalol and a low fetal level of amiodarone. The newborn, a girl, was born at the 36th week having a sinus rhythm. She developed signs of hypothyroidism (T4: 4 micrograms/ml; TSH:325 microliters U/ml at 5 days of life). CONCLUSION: The placental transfers of sotalol, digoxin and amiodarone are in the range of values known to be effective. The amiodarone responsible for hypothyroidism was given to the mother because she was intolerant to digoxin. Its use must be limited to arrhythmias that are resistant to other drugs or complicated by hydrops fetalis. When used, amiodarone should not be given for more than 6 weeks, and at the lowest possible dose.

Amiodarone↗

PubMed1992

[Study of new thrombolytic agents in myocardial infarction: a multicenter randomized trial (APSAC versus rt-PA)].

A hundred and eighty three patients with a primary myocardial infarction less than 4 hours old were included in a double blind trial versus placebo comparing an isolated plasminogen streptokinase activator complex (APSAC: 30 mu in 5 mn) and tissue type plasminogen activator (rt PA: 10 mg bolus followed by 90 mg in 130 mn). Clinical evolution, side effects, patency of the artery responsible for infarction, left ventricular contractile function (contrast angiography on the 7th day and angioscintigraphy on the 21st day) and infarct size were studied. The two groups were comparable in age (54 +/- 11 years), delay in randomisation (170 +/- 50 mn), infarct site and severity of cardiac failure. There was no significant difference in hospital mortality (7 in the rt PA group and 5 in the APSAC group) or in adverse effects (haemorrhage: rt PA: 9 patients, APSAC: 11 patients). The patency was 72% in the APSAC and 76% in the rt PA group. Left ventricular function and infarct size were comparable in the two groups: angiographic EF (0.50 +/- 0.1 in the APSAC and 0.52 +/- 0.1 in the rt PA group: NS); asynergic score (11.3 +/- 1.7 in the APSAC and 10.5 +/- 1.8 in the rt PA group: NS); infarct size (10.9 +/- 8.0 in the APSAC and 9.4 +/- 7.2 in the rt PA group: NS). This trial shows that these two thrombolytic agents have the same efficacy. The authors recommend adaptation of the dosage of rt PA to body weight.

Adult↗

PubMed1992

[Takayasu's disease disclosed by isolated involvement of the ascending aorta].

The authors report the histological discovery of a case of Takayasu syndrome affecting the ascending aorta. This involvement appearing to concern only the aorta, with no symptomatic complaints nor any laboratory abnormalities indicative of an inflammatory syndrome, corticosteroids were not prescribed. Management consisted of biennial monitoring by transthoracic and transesophageal ultrasonography of the aorta and the supra-aortic main vessels together with monitoring of laboratory parameters.

Adult↗

PubMed1992

[Results of the surgical repair of branch pulmonary artery stenosis in tetralogy of Fallot].

This study was based on the follow-up of 55 patients with tetralogy of Fallot and operated for branch pulmonary artery stenosis. Twenty two patients were followed up clinically (Group I): 91% of the patients were asymptomatic at the end of the first operative year. Thirty three patients (Group II) underwent control catheter studies after an average of 2.5 years after complete repair: only 70% of these were asymptomatic at 1 year; 8 were reoperated after an average of 3.6 years. The surgical result could only be evaluated by control catheter studies. The results were therefore based on the data obtained from Group II: this selection resulted in a pessimistic bias as the outcome in the two groups was significantly different. The stenoses were congenital and/or iatrogenic. They were located on the left branch (55%), the right branch (9%), the bifurcation (24%), separately on the two branches (12%). The diversity of the operative techniques and materials used reflects the difficulty of this surgery. The cumulative results were good in 33% of cases, average in 28% and poor in 39%. The results were better in isolated branch stenosis than in stenosis of the bifurcation, though not statistically significant. The results were related to age, body weight, the type, the site, the length, the association of stenoses and the material used. Significant predictive factors for a good result were: Gore-Tex (p less than 0.05) and pericardial pedicle (p less than 0.005). The average follow-up of patients with the latter type of patch was only 2 years. These results require confirmation by studies of larger numbers of patients followed up for a longer period.

Cardiac Catheterization↗

PubMed1992

[Thrombolytic treatment of myocardial infarction. Data on the limitation of infarction size and left ventricular function].

Since its introduction in cardiovascular therapeutics, thrombolysis has established itself as an effective procedure of coronary reperfusion during the acute phase of myocardial infarction. Large scale clinical trials have demonstrated a clear cut reduction in mortality providing that the treatment is administered sufficiently early after the onset of symptoms. This reduced mortality is probably related to the limitation of infarct size and the conservation of ventricular function even though this relationship is not always analysed. Studies of infarct size and left ventricular function are difficult to perform and this is reflected in the number of different methods proposed. Apart from coronary reperfusion and its timing, other factors influence the definite size of the infarct, such as the development of a collateral circulation, the existence of cellular reperfusion lesions and the occurrence of reocclusion. The infarct size may be assessed by a number of methods, some simple (enzymes, electrocardiogram) but relatively inaccurate, others more promising but difficult to perform and more costly. Thallium 201 scintigraphy seems to be the best available method and our experience is based on these results. The reference method for the evaluation of left ventricular function is angiography but angioscintigraphy also provides information on global and regional function, the regional study being particularly valuable in the analysis of thrombolytic drug efficacy. A review of the literature shows that thrombolysis is associated with a reduction in infarct size compared with conventional therapy and with conservation of left ventricular function whichever thrombolytic agent is used.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗

PubMed1992

[Vasospastic angina with angiographically normal coronary vessels of iatrogenic origin. Apropos of 2 cases].

Two cases of angina pectoris, induced by methylergometrine (Methergin) and by an association of ergotamine tartrate (Gynergene) and methysergide (Desernil) respectively, are reported. In both patients, angiography revealed spontaneous spasm in a coronary system free from any significant atheromatous stenosis. In the second case, a test administration of i.v. Methergin, administered during calcium-channel antagonist treatment a few days after the "guilty" drugs had been stopped was found to be negative. The outcome was favorable in both cases: the angina disappeared and the base-line and exercise ECG returned to normal. The hypothesis of coronary spasm induced by the treatment was adopted in both cases. In this context, the major iatrogenic etiologies of vasospastic angina are recalled, together with the prophylactic and therapeutic measures they call for.

Adult↗