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Biomedical subjects

M Lefèvre

Publications and source records attributed to M Lefèvre.

At least 37 records · Page 2Linked to original sources
PubMed1990

[Comparison of magnetic resonance imaging, echocardiography and catheterization in the diagnosis of congenital heart diseases].

The authors compared the diagnostic value of magnetic resonance imaging (MRI), echocardiography and cardiac catheterisation with angiography in 66 patients with congenital heart disease, to determine a diagnostic strategy in the use of these methods of cardiac imaging. The patients were 8 days to 44 years old. The congenital cardiac malformations were classified in three groups: 29 isolated vascular malformations (Group 1), 17 isolated intracardiac malformations (Group 2) and 20 complex malformations (Group 3). MRI was performed in all patients using a high field (1.5 tesla) magnet and spin-echo sequences in multiple incidences. The results were compared with those of echocardiography in 60 patients and/or cardiac catheterisation in 39 cases. Technical evaluation of MRI showed images of diagnostic quality in 62/66 cases (93.9%). MRI provided a diagnostic contribution in 56 cases (85%) which was less important in intracardiac malformations than in the other groups (p less than 0.05). In comparison with other imaging techniques, globally, the diagnostic value of MRI was lower than that of cardiac catheterisation (p less than 0.005) but there was no significant difference between MRI and echocardiography. When the type of malformation was taken into account, MRI was not as useful as catheterisation and echocardiography for the diagnosis of isolated intracardiac malformations (p less than 0.01) but gave comparable results in other malformations. On the other hand, MRI associated with echocardiography was more useful (p less than 0.05) than catheterisation in the diagnosis of complex congenital lesions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

[Aortico-left ventricular tunnel. Long-term follow-up, therapeutic implications].

Aortico-left ventricular tunnel is a rare entity resulting in a communication between the ascending aorta and the left ventricle, with clinical signs of aortic incompetence. On the basis of two personal cases and a review of the literature including 57 patients, the operative mortality and long-term follow-up of these patients are analysed. 51 patients were operated upon with a mortality rate of 21.5% (11 cases). In this mortality group, 64% of the casualties were less than 2 years' old (7/11). Mortality was unrelated to the surgical technique. Aortic incompetence was the crucial factor of post-operative morbidity. 60% of the patients who were operated upon had significant post-operative aortic incompetence. Among the 21 patients with long-term follow-up (1.5 to 14 years), 17 have aortic incompetence (81%), 8 were reoperated and 7 underwent aortic valve replacement. Surgical repair of this malformation should be considered early in life, and the technique used should aim at consolidating the aortic annulus without deformation and at closing the aortico-ventricular window.

Angiocardiography↗
PubMed1989

[Echocardiographic monitoring of the left ventricle in infants and children presenting the primary form of acute cardiac failure].

A retrospective multicenter study was based on influential echocardiograms performed in 34 children, the majority (29/34) being under 2 years of age, and presenting with a primary form of acute congestive heart failure. Four died early. The average duration of serial echocardiographic monitoring was 25 months (9-72 months) in the others. During the acute stage, the left cardiac cavities were extremely dilated and the shortening fraction was reduced to 15 +/- 4%. The 4 decreased children belonged to a group of 17 children who had a shortening fraction less than 13%. From the 8th day significant improvement of the left ventricular function was observed. Recovery was faster during the first 6 months of evolution and became very low after 1 year. The age at onset, the severity of the initial left ventricular changes, and the speed of recovery during the first 15 days were not predictive of the degree of eventual recovery of left ventricular function. At the end of the study 28 of the 30 surviving children had recovered a normal shortening fraction. However 16 of 30 still showed some dilatation, albeit moderate in most cases, of this ventricle. These data show that most children presenting with a primary form of acute congestive heart failure recover satisfactory heart function and that the initial echocardiographic features are not predictive of the subsequent course.

Acute Disease↗
PubMed1989

[Removal of fixed prosthetics].

Unscaling a fixed prosthesis can be dangerous for the supporting tissue. However a careful examination of the clinical situation and the proper use of correct technics described in the following article, may prudence a successful result most of the time.

Crowns↗
PubMed1989

[Diagnostic models. 2. Fabrication].

After describing in Part I the preparation of diagnostic cast, the authors describe the Wax Up preparation. Most of the definition of centric relation agree that the position of the mandible is slightly behind its position in centric occlusion. The Hinge axis position is used for mounting the cast on articulator. The final restauration must reconstruct both position and the occlusion should be established in front the centric occlusion. After equilibration anterior guidance is studied and restaured if necessary. After creating the different curve of occlusion, the final Wax Up is settled. The use of the diagnostic cast so obtained will be presented in Part III.

Dental Articulators↗
PubMed1986

[Fatal form of pericardo-myocarditis in Wissler-Fanconi syndrome].

The Wissler-Fanconi syndrome is an inflammatory disease of unknown origin, similar to Still's disease, a systemic form of juvenile arthritis. The long-term evolution is marked by recurrent febrile exacerbations, sometimes complicated by pericardo-myocarditis which usually resolves without sequellae. The authors report a case with chronic pericardo-myocarditis progressing over a 7 year period to refractory congestive cardiac failure.

Adult↗
PubMed1985

[Treatment of hypertrophic cardiomyopathy].

The treatment of hypertrophic cardiomyopathy is first and foremost symptomatic, its aim being to counteract dyspnea, angina pectoris, syncopes and lipothymias, palpitations. In therapy, use is made of beta-blockers, propranolol in particular at moderate or high doses, which are often efficacious but readily cause muscular asthenia. Calcium antagonists, especially verapamil, are a therapeutic alternative, often more efficacious but exposing the patient to the risks of iatrogenic effects which are sometimes serious and may even be fatal. Surgical myomectomy is another alternative, the functional results of which are remarkable, more often than not, but the mortality at surgery, although declining progressively, is not negligible and leads to this approach being used only in cases not responding to medical treatment as when infra-aortic septal hypertrophy is accompanied by an "obstruction". The second type of therapeutic approach is the treatment and prevention of rhythmic disorders which are an integral part of the risk of sudden death. Reduction of auricular fibrillation must play a role in the prevention of thrombo-embolic disease. Ventricular arrhythmias, especially sustained attacks of ventricular tachycardia systematically detected by ambulant ECG, ought to be prevented by anti-arrhythmics: beta-blockers, in combination or not with anti-arrhythmics of class I, amiodarone, propafenone, etc.

Adrenergic beta-Antagonists↗
PubMed1985

[Ergospirometry after repair of Fallot's tetralogy].

Ergospirometry was performed in 19 children and adolescents operated for tetralogy of Fallot (TOF) to assess their exercise capacity compared to an active non sportive control group. The test was carried out on a treadmill with measurement of oxygen consumption cycle by cycle throughout exercise. In comparison with the control group, the patients had: a working capacity which was normal or reduced by 30 to 40 p. 100; a decrease d'oxygen consumption (-30 to 40 p. 100) throughout exercise and at maximal effort: this corresponds to a lower stroke volume secondary to the absence of physical activity during childhood and/or residual cardiac lesions; abnormal chronotropism: the test was stopped at a lower heart rate corresponding to a fall in oxygen uptake during exercise, or to an increase in the systolic ejection period probably due to right ventricular dysfunction or to the patient reaching maximal ventilation; decreased maximal ventilation capacity due to a lower tidal volume and a higher respiratory rate. This type of ventilation increases to role of the dead space and may be related to progressive "pulmonary dysfunction" or secondary to residual cardiac lesions. These different parameters cannot be assessed by simple ergospirometry: the test must be coupled with an evaluation of ventilatory function on effort in order to control and evaluate the long term functional results and the aptitude of these patients to regular physical activity.

Adolescent↗
PubMed1984

[Long-term evaluation, physical and sports activities after correction of Fallot's tetralogy].

The aim of this study was to assess the result of surgical repair of Fallot's tetralogy (FT) and to advise physical and sporting activities. Thirty-two patients (20 boys and 12 girls) underwent correction of FT either before 4 years of age (14 cases) or after (18 cases). The patients were assessed on average 7.5 years postoperatively (range 4 to 13 years). All but one were class I of the NYHA classification. Radiological cardiomegaly was observed in 3 cases (CTI greater than 0.55). Sinus rhythm was present in all cases: 27 out of 30 had complete right bundle branch block without bifascicular block. Holter monitoring was performed in 22 cases: occasional monomorphic VES (1 to 15/hour) were observed in 7 cases. Frequent polymorphic VES were observed during exercise in one adult. Echocardiography and cardiac catheterization revealed pulmonary regurgitation and right ventricular dilatation in over half the cases, with an infundibular aneurysm in 2 cases and a residual pressure gradient of 55 and 66 mmHg in 2 other cases requiring reoperation. Left ventricular function was satisfactory in all cases. Treadmill exercise testing was performed in 28 patients. However, for statistical analysis 12 boys aged 7 to 15 years were compared with 11 controls of the same age. There was a significant decrease in maximal O2 consumption, of CO2 excretion, of ventilation, of heart rate, of work developed and total work in the operated patients. Clinical assessment and complementary investigations are essential 5 to 10 years after correction of FT to detect latent abnormalities and to better advise patients on physical and sporting activities.

Adolescent↗
PubMed1984

[Aortic sigmoid cusp anomaly: rare cause of myocardial infarction in children].

A three and a half year old child with no previous medical history died, 20 hours after extensive anterior myocardial infarction. Post-mortem examination showed an abnormal aortic valve: the cusps were thick, indurated and white in colour. The free edge of the left antero-lateral cusp was higher than that of the other two cusps and presented a discrete thickening which overlapped the superior border of the left coronary ostium, obstructing the orifice at its thickest part. The other two cusps were tipped by fibrous spurs, one of which partially obstructed the right coronary ostium which was slightly narrowed at its origin. A review of the literature on aortic pathology causing coronary obstruction revealed rare cases of malignant disease and, more commonly, malformations usually associated with supravalvular aortic stenosis. This case might illustrate a partial and atypical form of supravalvular aortic stenosis.

Aortic Valve↗
PubMed1980

[Exercise testing in probable primary hypokinetic cardiomyopathies].

50 patients with primary congestive cardiomyopathy underwent one or several exercise tests at yearly intervals in order to evaluate exercise capacity and to assess the prognosis. Three parameters were studied: the workload, the elevation of the systolic blood pressure (SBP) on exercise and the appearance of premature ventricular beats (PVB) on exercise or during the recovery phase. The results show that when the work loads > 120 watts, an elevation of SBP greater than or equal to 50 mmHg and the appearance of less than 3 PVB per minute were compatible with a moderate degree of physical exertion. On the other hand these same poor prognostic factors were associated with a higher mortality rate after 20 months follow-up.

Adult↗
PubMed1978

Serum and cerebrospinal fluid IGM in 203 neurological patients.

Simultaneous serum and CSF IgM determinations were made by electroimmunodiffusion in 5 normals and 203 patients. Absent from normal CSF, IgM was found in 56 patients (27%): (1) A blood-CSF transudation was present in 25 patients (12%). IgM seems of no diagnostic value in these cases. (2) A purely local synthesis was demonstrated in 17 patients (8%), concerning proved (bacterial, viral, parasitic) or supposed (multiple sclerosis) persistent infectious aggressions. (3) In the last 14 patients with IgM in CSF, a transudation was associated with a local synthesis of IgG (meningitis pattern). (4) A ratio IgM .10(3)/albumin above 10 seems an argument for multiple sclerosis.

Encephalitis↗