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Biomedical subjects

M Payot

Publications and source records attributed to M Payot.

At least 19 recordsLinked to original sources
PubMed1996

[Fatal double tracheo-esophageal vascular compression and neurofibromatosis].

BACKGROUND: Vascular rings are a classical cause of tracheal and esophagus compression. We report the case of such an abnormality in an infant with neurofibromatosis. CASE REPORT: A 1 week-old male infant with a familial neurofibromatosis presented a stridor with severe respiratory distress. A vascular ring was demonstrated and operated on. The stridor persisted after surgery. A postoperative oesophagogram and tracheobronchoscopy showed an irregular compression of the oesophageal lumen, thought to be due to a residual extrinsic compression. Because the postoperative echocardiogram showed an extensive tumoral infiltration of both auricles, it was decided to not operate again the child. The postmortem examination revealed a disseminated neurofibromatosis infiltrating trachea, bronchi and also the wall of esophagus. CONCLUSION: Persisting stridor and oesotracheal compression postoperatively requires search for another cause. Association of vascular ring and neurofibromatosis is probably not fortuitous.

Aorta, Thoracic↗
PubMed1995

Cardiac perforation after surgical repair of pectus excavatum.

Five days after surgical repair of pectus excavatum, this 7-year-old boy had a right-sided Kirschner wire protruding beneath the skin. The wire was repositioned blindly. Severe congestive heart failure developed. Surgical exploration showed a pierced right atrium, a torn septal leaflet of the tricuspid valve and noncoronary aortic cusp, and a large traumatic ventricular septal defect. The outcome and the indications and possible complications of surgery are discussed.

Bone Wires↗
PubMed1995

Magnesium sulphate as an alternative and safe treatment for severe persistent pulmonary hypertension of the newborn.

Eleven newborns admitted consecutively to the neonatal unit with respiratory failure and severe persistent pulmonary hypertension (PPHN) were included in a clinical trial to assess the efficacy of magnesium sulphate (MgSO4) in the treatment of PPHN. A loading dose of 200 mg/kg MgSO4 was given over 20 minutes, followed by a continuous infusion of 20-150 mg/kg/hour to obtain a magnesium blood concentration between 3.5 and 5.5 mmol/l. Mean (SD) duration of treatment was 75.5 (19.8) hours. No other vasodilatory drug was administered before or during the treatment and patients were not hyperventilated. Mean (SEM) PaO2 values significantly increased from 42.6 (8.8) before treatment to 70.3 (24.1) mm Hg after 24 hours, with no change in pH or PCO2. Oxygen index and alveolar-arterial oxygen gradient (A-aDO2) were significantly lower after 24 hours; respectively, 46.8 (15.2) to 28.0 (9.0) and 624.3 (11.3) to 590 (58) mm Hg. Mean airway pressure could be significantly reduced from 19.5 (3.1) to 13.9 (3.9) cm H2O after 72 hours. Mean ventilatory time support was 131 hours and mean total oxygen dependency 10 days. No systemic hypotension nor any other adverse effect were noted. All infants survived and the neurodevelopmental assessment was normal at 6 and 12 months of age. It is concluded that magnesium sulphate is a non-aggressive and low-cost treatment of short duration which is easy to apply. It may have a role in the various treatment of PPHN.

Drug Administration Schedule↗
PubMed1993

[Childhood treatment of paroxysmal supraventricular tachycardia using i.v. adenosine].

Paroxysmal supraventricular tachycardia is the most frequent significant arrhythmia in the pediatric age group, especially in the first year of life. In neonates and infants there are important limitations for the commonly used drugs such as verapamil and digitalis. In an open Swiss multicentre study we treated 19 children with a total of 29 episodes of tachycardia by means of adenosine i.v. as the drug of first choice. 76% of all the tachycardias were converted, whereas the success rate was 87% if only tachycardias with atrioventricular reentry were considered. The important advantage of adenosine lies in its very short half-life of about 15 seconds, which means that the rare relevant, and the more common mild, side effects are quite limited in duration. A major disadvantage are recurrences in about one third of cases. We conclude that adenosine is an efficient and safe treatment for paroxysmal supraventricular tachycardia in the whole pediatric age group including neonates and infants.

Adenosine↗
PubMed1993

[Exertion syncope disclosing supravalvular mitral stenosis in an infant].

An infant with frequent upper airways infections presented syncopes during meals and weeping since the age of eleven months. Cardiac examination was always normal. At 14 months of age, an echocardiogram with colour Doppler demonstrated a severely stenotic isolated supramitral membrane with severe pulmonary hypertension. The membrane was immediately excised curing the malformation and suppressing definitively the syncopes, probably due to decreased cerebral blood flow during exertion. An echocardiogram should always be performed when syncopes remain unexplained in small children. It allows early diagnosis and treatment of congenital heart defects which do not have auscultatory findings especially those resulting in severe pulmonary venous obstruction.

Echocardiography↗
PubMed1992

[Cardiac rhabdomyomatosis and Bourneville's tuberous sclerosis in the fetus. Apropos of 2 cases].

Two cases of cardiac rhabdomyoma discovered fortuitously at foetal ultrasonography gave rise to no obstructive cardiac signs or arrhythmias either in the antenatal or postnatal periods. These multiple tumours often observed in Bourneville's tuberous sclerosis orientated the clinical investigations to the diagnosis of this disease from the outset. MRI demonstrated cortical tubers and subependymal nodules in both cases. A retinal hamartoma was present in one case. No renal involvement could be detected by ultrasonic examination. No neurological or cardiovascular symptoms appeared during follow-up (20 and 4 months after birth). Investigations in the parents were negative, these two cases being sporadic forms of Bourneville's tuberous sclerosis. The functional prognosis is related to the neurological outcome. Doppler echocardiography would appear to be the best method of following up cardiac rhabdomyomas, and enabled the demonstration of partial regression of the largest tumour in one of these two cases. Cardiac MRI is also an excellent diagnostic tool. As it is usually performed at the same time as cerebral MRI, essential in the follow-up of Bourneville's tuberous sclerosis, it does not represent additional discomfort to the patient.

Adult↗
PubMed1991

[Transesophageal echocardiography. Indications and clinical usefulness].

To optimize the clinical applications of transesophageal echocardiography (TOE), we have compared the contribution of TOE with that of transthoracic echocardiography (TEE). TOE and TTE were performed in 19 outpatients, 17 hospitalized patients and 16 surgical patients (33 males and 19 females, mean age 53.3 +/- 16.8 years). TOE obtained a diagnosis unsuspected from TTE in 12 cases, and additional useful clinical information was obtained by TOE in 15 cases. Surgical treatment was decided on the basis of TOE alone in 8 cases. Patient tolerance of TOE was excellent and no major complications occurred. In conclusion, additional information obtained by TOE was clinically useful in about half of patients (52%), in particular in the diagnosis of cardiogenic embolism and in clinically suspect endocarditis, valvular dysfunction or aortic dissection.

Adult↗
PubMed1991

Imaging of neonatal arterial thrombosis.

The case of a neonate who presented with symptoms of upper limb ischemia related to spontaneous multiple arterial and venous thromboses that were demonstrated by colour Doppler sonography and digital subtracted angiography is reported. The presentation of limb ischaemia at birth may be the warning sign of simultaneous cerebral infarction.

Angiography, Digital Subtraction↗
PubMed1990

[Patent foramen ovale and cerebral infarct in young patients].

Over a six months' period we prospectively studied the prevalence of patent foramen ovale (PFO) in patients under 50 years of age admitted for cerebral infarction as assessed by cerebral computed tomography. The study recruited 16 patients (9 male, 7 female, mean age 39 +/- 10 years). Before the contrast study, 5 patients had other identifiable sources of stroke after neurologic investigations and 2-D echocardiography with color-Doppler, whereas 11 had no precise origin. The overall prevalence was 50% with 8 PFO demonstrated, 6 during normal breathing and two during a coughing test. All were in the sub-group of 11 patients without a predetermined source of stroke (prevalence 73%) and in 83% of patients aged under 40. In accordance with the literature, we found a high prevalence of PFO in the ischemic cerebral infarction population aged under 50 years and without another possible source of stroke; this prevalence is higher in patients under 40 years old. This observation confirms the suspicion of paradoxical embolism in these cases.

Adult↗
PubMed1988

Migraine stroke.

Because the cause of stroke during migraine is not known, we studied 22 (17 females, 5 males; mean age, 32.7 years) classic migraine sufferers who had an ischemic stroke during an attack of migraine, with CT, Doppler ultrasound, cerebral angiography, and two-dimensional echocardiography. We found no cardiac or arterial lesion in 91% of the patients, as compared with 9% of age- and sex-matched migraineurs with stroke remote from a migraine attack and 18% of age- and sex-matched nonmigraineurs with stroke (p less than 0.00001). Mitral valve prolapse, arterial dissection, and vasospasm were not significant causes of stroke during migraine. These patients had longer previous attacks of migraine and their infarct was more frequently in the territory involved during the attacks than the controls, supporting the hypothesis that a prolongation of the migrainous process beyond usual limits may explain most migraine strokes.

Adult↗
PubMed1987

Myocardial injury after electrical burns: short and long term study.

Miscellaneous cardiac abnormalities can occur after electrical burns. The long term outcomes are still unknown. We studied 10 patients, 9 of whom suffered high-voltage electrocution, and one of whom was struck by lightning. Serial electrocardiograms (ECG) and serum MB creatine phosphokinase isoenzyme (MB-CPK) activities were obtained during their stay in hospital. ECG and thallium 201 cardiac scintigraphy at rest, as well as echocardiograms were obtained in all patients 4 to 48 months after discharge. In hospital, 9 patients showed one or more abnormal findings at physical examination (4 cases), ECG (8 cases), MB-CPK (1 case). At long term follow-up, 5 patients had one or more myocardial functions or conduction abnormalities, with or without symptoms. One patient had compensated heart failure. Nine patients were asymptomatic. Abnormal ECG findings persisted in 3 patients. Three cardiac scans showed evidence of regional myocardial hypoperfusion. Decreases in left ventricular indices measured by echocardiogram were found in 3 patients. We conclude that high-voltage electrocution is associated with a high incidence of cardiac abnormalities, which may persist. Long term evaluation, requiring cardiac T1 201 scintigraphy and echocardiogram, may be justified.

Adult↗
PubMed1986

[An unusual protodiastolic bruit: the click of an aberrant mitral cord].

An asymptomatic adult woman without clinical cardiac disease had an unusual early diastolic heart sound. All usual causes of this finding were excluded: it was not a delayed pulmonary component of the second heart sound, a mitral or tricuspid opening snap, an early diastolic third heart sound or a pericardial vibration. The only apparent cause was a left ventricular false tendon extending from the septal endocardium to the left ventricular free wall, demonstrated by 2D echocardiography. This type of aberrant intracardiac band has already been described but the possibility of early diastolic stretching of this structure giving rise to an abnormal early diastolic sound does not seem to have been previously reported.

Female↗
PubMed1985

[St Jude's Medical prosthesis in patients over 65].

Between September 1979 and December 1982, 56 St Jude Medical valvular prostheses were implanted in 54 patients over 65 years of age. Surgery consisted in simple aortic valve replacement (35 cases), simple mitral valve replacement (12 cases), double aortic and mitral valve replacement (2 cases), valve replacement and coronary artery bypass surgery (3 cases), aortic valve replacement and replacement of the ascending aorta (1 case) and mitral valve replacement and tricuspid annuloplasty (1 case). The operative mortality (within 30 days of surgery) was 3.5% (2 cases). Patients were assessed by clinical examination, ECG, chest X-ray, echocardiogram and laboratory investigations on average 19 months after surgery. There were 3 late deaths (1 endocarditis, 1 cardiac failure and 1 subdural haematoma). No cases of significant haemolysis were observed. There were no cases of thrombosis of the valve or any deaths directly related to the valve. Four patients had cerebral embolism (4.9% per patient/year). None were fatal and only 1 patient had sequellae. Clinical improvement was very significant; 96% of the patients are now in the NYHA Classes I and II whilst 80% were in Class III or IV before surgery. The cardiothoracic ratio decreased significantly from 0.56 to 0.51 (p less than 0.01). The authors conclude that elderly patients may derive great benefits from valvular cardiac surgery and that age in itself is not a contraindication to this type of surgery. The St Jude Medical prosthesis is an excellent prosthesis but thromboembolism remains a major problem as with other mechanical prostheses. Anticoagulation for life is essential.

Age Factors↗