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Biomedical subjects

N Jolly

Publications and source records attributed to N Jolly.

At least 19 recordsLinked to original sources
PubMed2003

Increased production of interferon-gamma by Leishmania homologue of the mammalian receptor for activated C kinase-reactive CD4+ T cells among human blood mononuclear cells: an early marker of exposure to Leishmania?

A prospective study was undertaken to define early predictive immunological marker(s) of exposure to Leishmania in naïve subjects who have never been exposed to any Leishmania and who were also free of any cutaneous leishmaniasis lesions. These naïve subjects could have been exposed to Leishmania in a rain forest where Leishmania guyanensis and their natural vectors and mammalian host are cocirculating. The production of interferon (IFN)-gamma in response to the Leishmania homologue of the mammalian receptor for activated c kinase (LACK), a candidate for vaccine against leishmaniasis was analysed. At the end of their stay in the rain forest, LACK-specific CD8+ T cells were detected in subjects whose peripheral blood mononuclear cell (PBMC) produced IFN-gamma in response to soluble Leishmania antigens (SLA) and in those whose PBMC remained unresponsive to SLA. However, LACK-specific CD4+ T cells were detected only in PBMCs from individuals who became IFN-gamma responders to SLA. In subjects whose PBMC became positive to SLA, LACK-reactive CD4+ T cells producing high level of IFN-gamma were detectable before the SLA-reactive IFN-gamma producing CD4+ T cells, suggesting that the former readout assay could be used as an early predictive immunological marker of exposure to Leishmania in subjects who remained disease free.

Animals↗
PubMed2001

Percutaneous suture closure for management of large French size arterial puncture in aortic valvuloplasty.

Percutaneous aortic valvuloplasty produces acute hemodynamic and clinical improvement in patients with aortic stenosis who are poor candidates for surgical valve replacement. The benefits of this procedure are mitigated by the high restenosis rates and 1--2 year mortality, in addition to significant vascular complications associated with the large arterial puncture necessary for retrograde arterial approaches. We describe the use of suture closure techniques to reduce the vascular morbidity associated with this procedure. We reviewed 31 consecutive patients who underwent percutaneous aortic valvuloplasty and suture closure with the Perclose device between April 1998 and September 2000. After diagnostic catheterization using 6--8 French (Fr) sheaths, an 8 or 10 Fr Perclose device was preloaded into the artery and the untied sutures left in place. A 12.5 or 14 Fr sheath was passed over the wire, through the sutures. The sutures were tied at the conclusion of the procedure, in conjunction with sheath removal. Twenty-seven out of 31 patients (87%) had successful suture closure of the arteriotomy and did not require prolonged bed rest, manual compression or a compression device. There were 4 failures of percutaneous suture closure, requiring conventional manual compression and bed rest for hemostasis. No patient required surgical repair of the arteriotomy, nor were there any limb complications. Compared to 39 consecutive prior patients who had their arterial puncture managed with manual compression, length of stay was shorter (2.2 days versus 5.3 days) and fewer patients received blood transfusions (0% versus 29%). Preloaded suture closure of the arterial puncture is a useful technique for achieving hemostasis after removal of the large sheaths used for percutaneous valvuloplasty, and reduces the post-procedure patient discomfort and prolonged bed rest associated with this procedure.

Aged↗
PubMed1999

Mother-to-child transmission of human T-cell-leukemia/lymphoma virus type I: implication of high antiviral antibody titer and high proviral load in carrier mothers.

In order to gain new insights into the risk factors influencing human-T-cell-leukemia/lymphoma-virus-type-I (HTLV-I) mother-to-child transmission, a retrospective study of HTLV-I infection among children born to HTLV-I-seropositive women was carried out in a highly HTLV-I-endemic population of African origin living in French Guyana. The study covered 81 HTLV-I-seropositive mothers and their 216 children aged between 18 months old and 12 years old. All plasma samples were tested for the presence of HTLV-I antibodies by ELISA, immunofluorescence assay and Western blot. HTLV-I provirus was detected, in the DNA extracted from peripheral-blood mononuclear cells, by polymerase chain reaction (PCR) using primers specific for 3 different HTLV-I genomic regions (LTR, gag and pX) and quantified by a competitive PCR assay. Out of the 216 children, 21 were found to be HTLV-I-seropositive, giving a crude HTLV-I transmission rate of 9.7%, while among the 180 breast-fed children 10.6% were HTLV-I-seropositive. Perfect concordance between serological and PCR results was observed, and none of the 195 HTLV-I-negative children was found HTLV-I-positive by PCR. In conditional (by family) logistic-regression models, HTLV-I seropositivity in children was associated with an elevated maternal anti-HTLV-I-antibody titer (OR 2.2, p = 0.0013), a high maternal HTLV-I proviral load (OR 2.6, p = 0.033) and child's gender, girls being more frequently HTLV-I-infected than boys: OR 3.6, p = 0.0077 in the model including maternal anti-HTLV-I-antibody titer and OR 4.1, p = 0.002 in the model including the maternal HTLV-I proviral load.

Breast Feeding↗
PubMed1999

Coronary artery stent restenosis responds favorably to repeat interventions.

One hundred sixty patients who underwent a percutaneous intervention for treatment of in-stent restenosis were evaluated on clinical follow-up to determine the predictors of reintervention, and also to compare rotational atherectomy with repeat percutaneous transluminal coronary angioplasty (PTCA) for this condition. Current smoking and saphenous vein graft location were the independent predictors of target vessel revascularization (TVR), and there was no difference in the rate of TVR between rotational atherectomy and re-PTCA.

Angioplasty, Balloon, Coronary↗
PubMed1998

Prevalence and causes of amblyopia in an adult population.

OBJECTIVE: The study aimed to determine the prevalence, causes, and associations with amblyopia in a defined older population. DESIGN: In a population-based study, 3654 persons 49 years of age or older from an area west of Sydney, Australia, underwent a detailed eye examination and history, including objective and subjective refraction, cover testing, and retinal and lens photography. Amblyopia was diagnosed in eyes with reduced best-corrected visual acuity in the absence of any other cause. RESULTS: Amblyopia was diagnosed in 118 participants, or 3.2% of the population using a visual acuity criterion of 20/30 or less and 2.9% using a visual acuity criterion of 20/40 or less. Using a two-line visual acuity difference between the eyes, the amblyopia prevalence was 2.6% and 2.5%, respectively, for the above criteria. The underlying amblyogenic causes assessed were anisometropia (50%), strabismus (19%), mixed strabismus and anisometropia (27%), and visual deprivation (4%). The visual acuity of the amblyopic eye was 20/200 or worse (19%), 20/80 to 20/160 (19%), 20/40 to 20/63 (52%), and 20/30 (11%). No statistically significant associations were found between amblyopia and gender or eye affected. The most frequent pattern of strabismus was esotropia, whereas hypermetropia was the most frequent refractive error in amblyopic eyes. The mean age at diagnosis was earlier for strabismic and mixed amblyopia (7.4 years) than for anisometropic amblyopia (12.7 years). CONCLUSION: This study has provided prevalence and cases of amblyopia in an older population. Amblyopia is a frequent cause of lifelong unilateral visual impairment.

Aged↗
PubMed1996

Effects of prolonged sequential balloon inflations on results of coronary angioplasty.

In percutaneous transluminal coronary angioplasty (PTCA), prolonged balloon inflations using perfusion balloon catheters have shown a higher procedural success rate and fewer in-hospital complications than short balloon inflations. However, perfusion balloons have well-recognized limits for routine use. This study assessed the effects of a prolonged cumulative occlusion time obtained with sequential balloon inflations using a routine balloon catheter, applicable to all lesions, and compared these results with those obtained with standard short balloon inflations. Three hundred ten lesions (in 289 patients) were randomized to either standard (3 to 5 inflations < or = 1 minute each; n = 161) or prolonged (3 to 5 inflations of 3 to 5 minutes each; n = 149) balloon inflations. Angiographic success (residual stenosis <50% and no dissection > or = D1) was assessed at the end of this "protocol" phase. Further dilatation was performed if required ("adjunctive" phase). Systematic repeat catheterization was scheduled 4 to 6 months later. Cumulative inflation time was 198 +/- 58 seconds in the "standard" group versus 782 +/- 303 seconds in the "prolonged" group. At the end of the protocol phase, the success rate was higher after prolonged than after standard dilatation (92% vs 80%; p <0.002), with less frequent dissections (14% vs 30%; p = 0.0009). At the end of the adjunctive phase, required for 12 patients in the prolonged group and 32 patients in the standard group (p = 0.003), results were comparable in the 2 groups and the restenosis rate was similar at 6 months. The prolonged cumulative occlusion time achieved with sequential balloon inflations using a routine balloon catheter improves the immediate results of PTCA. Repeat catheterization shows no effect of prolonged sequential inflations on the restenosis rate.

Aged↗
PubMed1996

Components of visual acuity loss in strabismus.

Strabismus, the misalignment of the visual axis of one eye relative to that of the other eye, reduces visual acuity in the affected eye. Several processes contributing to that loss are: amblyopia, which results in a chronic acuity loss whether or not the fellow eye is viewing; strabismic deviation, which shifts the image of an acuity target onto more peripheral, and therefore less acute, retina when the fellow eye fixates; interocular suppression and binocular masking, which reduce visibility in the strabismic eye due to neural influences from the other eye. We measured the losses due to these processes in nine small-angle strabismic subjects. Amblyopia reduced acuity by a median of 34% relative to its value in subjects with normal binocular vision, and strabismic deviation produced a loss of 44%. Suppression and masking together reduced acuity by 20%, and therefore had substantially less effect than the other factors.

Adolescent↗
PubMed1995

Angioscopic evaluation of prolonged vs standard balloon inflations during coronary angioplasty. A randomized study.

UNLABELLED: To study the immediate effects of prolonged total balloon inflation during PTCA, 41 patients (44 lesions) with chronic stable angina were randomized for prolonged sequential inflations (three to five inflations of 3 to 5 min each, for a total duration of > or = 12 min, group 1, n = 20 lesions) or 'standard' sequential inflations (three to five inflations of < or = 1 min each, for a total duration of < or = 3 min, group 2, n = 24 lesions). The mean duration of total balloon inflation time was 958 +/- 129 s in group 1 vs 205 +/- 46 s in group 2. Results of angioplasty were assessed on both angiography and percutaneous transluminal coronary angioscopy performed immediately after the procedure. High quality imaging of the coronary lumen and lesion morphology was possible on angioscopy in all patients without any complications. Post-PTCA angiographic percent diameter stenosis was significantly less in group 1 compared to group 2: 26 +/- 10% vs 36 +/- 8% (P < 0.05). On angioscopy, flaps were seen in 16 patients in group 2, but in only six in group 1 (P < 0.02). There was no difference in the incidence of thrombi on angioscopy between the two groups (group 1: nine cases, group 2: 10 cases). Sensitivity of angiographic detection of flaps and thrombi was poor: 10% and 12% respectively. One patient in each group developed a longitudinal dissection, detected on both angiography and angioscopy. CONCLUSIONS: (1) prolonged sequential balloon inflations lead to less residual luminal stenosis after PTCA, with a decreased incidence of intimal flaps in comparison with standard inflations. (2) Post-PTCA transluminal coronary angioscopy is safe and offers better assessment of luminal effects of PTCA than angiography.

Adult↗
PubMed1994

Visual loss during interocular suppression in normal and strabismic subjects.

Visual acuity was measured in one eye during monocular vision, and while the fellow eye viewed stimuli not including the acuity target. The aim was to find how acuity in one eye is reduced by going from monocular to binocular viewing. In normal subjects, acuity was at its lowest during the suppressive phase of binocular rivalry, was reduced less when the fellow eye viewed a contoured nonrivalrous stimulus, and was not reduced at all when the stimulus to the fellow eye consisted of a uniformly lit field. In strabismic subjects, by contrast, acuity was markedly reduced in going from monocular to binocular viewing no matter what stimulus was viewed by the fellow eye. Pathological suppression is therefore largely independent of the inducing stimulus. It was also shown that acuity in the nonstrabismic eye of some of the strabismic subjects was improved by allowing the strabismic eye to view; these were the subjects with the greatest depths of amblyopia.

Adolescent↗
PubMed1994

Percutaneous transatrial mitral commissurotomy: immediate and intermediate results.

OBJECTIVES: The purpose of this study was to evaluate the immediate and follow-up results of percutaneous transatrial mitral commissurotomy in 600 patients with rheumatic mitral stenosis. BACKGROUND: Percutaneous transatrial mitral commissurotomy has emerged as an effective nonsurgical technique for patients with symptomatic mitral stenosis. Several studies have shown that the immediate results are comparable to closed and open mitral valvotomy. METHODS: Percutaneous transatrial mitral commissurotomy was performed in 600 patients with rheumatic mitral stenosis by the double-balloon (290 patients [48.3%]) and flow-guided Inoue balloon (310 patients [51.7%]) techniques. There were 154 male (25.6%) and 446 female (77.4%) patients with a mean [+/- SD] age of 27 +/- 8 years (range 8 to 60). Atrial fibrillation was present in 26 patients (4.3%), mitral regurgitation < or = grade 2 in 62 (10.3%) and densely calcific valve in 12 (2%). All patients had clinical and echocardiographic (two-dimensional, continuous wave Doppler, color flow imaging) follow-up at 3-month intervals. RESULTS: Percutaneous transatrial mitral commissurotomy was successful in 589 patients (98.1%), and optimal commissurotomy was achieved in 562 (93.6%), with an increase in mitral valve area from (mean +/- SD) 0.75 +/- 0.18 to 2.2 +/- 0.38 cm2 (p < 0.001) and a decrease in transmitral end-diastolic gradient from 27.3 +/- 6.1 to 3.8 +/- 4.2 mm Hg (p < 0.001). Mitral regurgitation developed or increased in 208 patients (34.6%). Six patients (1%) with mitral regurgitation required mitral valve replacement. Cardiac tamponade occurred in 8 patients (1.3%). Six patients (1%) died. Restenosis developed in 10 patients (1.7%) during a mean follow-up period of 37 +/- 8 months (range 6 to 66). CONCLUSIONS: Percutaneous transatrial mitral commissurotomy is an effective, safe procedure with gratifying intermediate results. It should be considered the treatment of choice for rheumatic mitral stenosis.

Adolescent↗
PubMed1994

[Angioscopic evaluation of the immediate result of coronary angioplasty in relation to balloon inflation time].

The aim of this study was to assess the effects of coronary angioplasty on the intima with respect to the duration of balloon inflation by percutaneous angioplasty. Twenty-seven patients were randomized according to the total duration of balloon inflation: Group I "standard" duration (total duration < or = 3 min, N = 13) and Group II: prolonged duration (total duration > or = 12 min, N = 14); the type and distribution of the lesions were comparable in the two groups. The results of angioplasty were evaluated immediately after dilatation by angiography and angioscopy. Angioscopy was performed without failure or complications with perfect definition of the images in all cases. Angioscopy showed 1) intimal tears, 2) thrombi, 3) longitudinal dissections. A classification in three grades was used taking the apparent gravity of the lesions into consideration. The mean duration of balloon inflation in Group I was 205 +/- 45 s and 958 +/- 129 s in Group II. The residual stenosis was 36 +/- 8% in Group I and 26 +/- 10% in Group II (p < 0.05). Angioscopy showed the frequency of intimal tears to be twice greater in Group I (9 cases) than in Group II (4 cases) (p = 0.05). Intravascular thrombi were observed in 13 cases, 6 in Group I and 7 in Group II. One case of longitudinal dissection was observed in each group: only one of these two cases was detected at angiography. The authors conclude that repeated and prolonged balloon inflations improve the immediate results of angioplasty with less residual stenosis at angiography and a lower incidence of intimal tears at angioscopy.

Aged↗
PubMed1994

[Effects of repeated and prolonged inflations on immediate angiographic results and complications of coronary angioplasty. Prospective and randomized study].

The effects of the duration of balloon inflation on the immediate and mid-term results of angioplasty were assessed in a randomized study initiated in June 1992. To date, 239 lesions in 224 consecutive patients were allocated randomly into 2 groups according to the duration of balloon inflation: short duration (123 lesions): 3 or 4 successive inflations, each < or = 1 mn, for a total duration < or = 3 min; long duration (116 lesions): 3 to 5 inflations, each of 4 to 5 minutes each for a total duration > or = 12 min. Patients with acute myocardial infarction, restenosis and lesions of bypass grafts were excluded. Stenosis (% of reduction of the internal diameter) was calculated with a digitalised Philips DCI system. Success was defined by < 50% residual stenosis in the absence of severe complications: death, emergency bypass surgery, infarction and extensive and/or occlusive dissection. The baseline clinical, haemodynamic and angiographic parameters of the two groups were comparable. The residual stenosis after angioplasty in the "short duration" group was 33 +/- 11% and 29 +/- 11% in the "long duration" group (p < 0.05). The primary success rate was 75% in the "short duration" compared to 89% in the "long duration" group (< 0.001). Angiographic dissection after angioplasty was observed in 38 cases in the "short" but only in 17 cases in the "long duration" group (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Atrial septal defect after balloon mitral valvuloplasty: a transesophageal echocardiographic study.

Fifty patients with rheumatic mitral stenosis aged twelve to thirty-six (twenty +/- six) years were studied by two-dimensional, pulsed and color Doppler echocardiography during, seventy-two hours after, and biweekly for three months after balloon mitral valvuloplasty (BMV). Transesophageal echocardiography (TEE) done immediately after BMV (in the catheterization laboratory) detected a new atrial septal defect (ASD) in 46 (92%) patients. These measured 1 to 2 (mean 1.2 +/- 0.3) mm in diameter. Doppler color flow mapping guided the location of the ASD in most of the cases. A narrow jet of left-to-right shunt could be evaluated by pulsed Doppler studies. Velocity time integral (VTI) of the jet across one cardiac cycle and the diameter of the ASD were used to calculate the left-to-right shunt (shunt = VTI x pi (D/2)2 x heart rate). The estimated shunt was 0.04-0.39 (mean 0.20 +/- 0.10) L/minute. A repeat study at seventy-two hours revealed the defect in 40 (80%) patients. At three months, the defect persisted in only 5 (10%) cases. The mean interval of closure of ASD was 4.6 +/- 2.2 weeks. The authors conclude: (1) ASD occurs commonly after BMV, (2) the septal defect and the resultant left-to-right shunt are insignificant, and (3) ASD disappears in the majority of cases by three months after BMV.

Adolescent↗
PubMed1992

Pulmonary venous flow dynamics before and after balloon mitral valvuloplasty as determined by transesophageal Doppler echocardiography.

The pattern of left atrial filling was studied in 14 patients with severe mitral stenosis in sinus rhythm before and immediately after successful balloon mitral valvuloplasty by transesophageal pulsed Doppler echocardiography of the left superior pulmonary vein. Mean mitral valve orifice area increased from 0.8 +/- 0.1 to 2.2 +/- 0.3 cm2 (p less than 0.0001), and left atrial mean pressure decreased from 30 +/- 5 to 12 +/- 4 mm Hg (p less than 0.0001) after the procedure. After balloon mitral valvuloplasty, significant increases in peak systolic pulmonary velocity (35 +/- 16 to 44 +/- 10 cm/s; p less than 0.01), systolic flow velocity time integral (3.3 +/- 1.5 to 5.9 +/- 2.0 cm; p less than 0.001) and the ratio of systolic/diastolic pulmonary venous flow velocity time integrals (0.8 +/- 0.4 to 1.4 +/- 0.5; p less than 0.001) were observed. An acute increase in mitral valve orifice area caused no significant changes in peak diastolic forward flow velocity (40 +/- 7 to 41 +/- 9 cm/s; p = not significant [NS]), diastolic forward flow velocity time integral (4.3 +/- 1.7 to 4.6 +/- 1.8 cm; p = NS) and atrial flow reversal velocity (30 +/- 3 to 35 +/- 3 cm/s; p = NS) compared with at baseline. The results suggest that in patients with severe mitral stenosis and sinus rhythm, left atrial filling is biphasic with a diastolic preponderance, and successful mitral valvuloplasty is associated with an immediate increase in pulmonary venous systolic forward flow.

Adult↗
PubMed1992

Transoesophageal Doppler pulmonary venous flow pattern and left atrial spontaneous contrast in mitral stenosis.

The relationship between transoesophageal Doppler pulmonary venous flow pattern and spontaneous left atrial contrast was studied in 23 patients with isolated severe mitral stenosis (mitral valve area = 0.8 +/- 0.2 cm2). The patients with none or minimal (1+) spontaneous contrast (n = 15, group I) were compared with those with significant spontaneous contrast (grade 2+, n = 8, group II) with regard to peak systolic velocity (33 +/- 14 cm/s vs 28 +/- 12 cm/s, p = NS), peak diastolic velocity (36 +/- 14 cm/s vs 28 +/- 8 cm/s, p = NS) and peak atrial reversal velocity (19 +/- 4 cm/s vs 19 +/- 8 cm/s, p = NS), systolic forward flow velocity time integral (3.37 +/- 1.73 cm vs 2.78 +/- 0.9 cm, p = NS), diastolic forward flow velocity time integral (2.85 +/- 1.2 cm vs 2.65 +/- 1.87 cm, p = NS), ratios of peak systolic and diastolic velocity (0.91 +/- 0.21 vs 0.95 +/- 0.29, p = NS) and duration of diastolic deceleration (117 +/- 59 ms vs 132 +/- 106 ms, p = NS). The results show that the occurrence of spontaneous contrast in the left atrium in patients with mitral stenosis is not related to the Doppler-estimated pulmonary venous flow.

Adolescent↗
PubMed1991

Right atrial thrombus over eustachian valve--successful lysis with streptokinase.

Patients with pulmonary thromboembolism have occasionally been seen to have thrombi in the right atrium, either free floating or attached by a narrow pedicle. An echocardiographic description of a thrombus attached to the eustachian valve has, however, never been made in the literature. One such case is described in which streptokinase successfully lysed the thrombus.

Child↗