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Biomedical subjects

P Aubry

Publications and source records attributed to P Aubry.

At least 19 recordsLinked to original sources

[Cysticercosis in the province of Kayanza (Burundi)].

Prompted by the diagnosis of two cases of cysticercosis in patients from the same province of Burundi, we conducted a study in this area to determine the cysticercosis incidence rate in this area of Burundi. Patients having presented with more than two convulsive seizures were studied. All of them usually eat pork. Diagnosis was established with the 3 following criteria: positive ELISA reaction in blood and/or CSF; presence of cystercus in subcutaneous node. Cysticercosis was diagnosed in 40 of the 98 investigated patients, 25 presenting a neurocysticercosis.

Animals

[Intermdeiate forms of atrioventricular defects. Reflections apropos of 50 consecutively operated cases].

Fifty cases of intermediate forms of atrioventricular defect were treated surgically. The operation was performed in the traditional manner in all cases. One post-operative death and three cases of severe mitral incompetence leading to reoperation were observed. The authors emphasise that it is essential to look for and excise the chordae and abnormal fibrous bands, that it is generally unnecessary to touch the tricuspid valve and that there is a danger of obstructing the aortic canal if the correction of the asymmetry of some mitral clefts is attempted. Analysis of the results leads them to tend to respect the cleft mitral valve when the regurgitation is minimal and to suture it all along its length when the regurgitation is severe. Mitral annuloplasty may be a useful complementary procedure and a left atrial approach may be proposed with this in mind in certain cases. Conduction defects remain a serious problem in this type of surgery; not so much complete heart block, which is exceptional, but trifascicular block, often present preoperatively, whose prognostic is, to say the least, uncertain.

Adolescent

[Aortocoronary bypass for the threatened spread of acute myocardial infarction].

21 patients with unstable angina in the acute myocardial infarction period were treated by early surgery, on average on the 3th day after infarction. Resistance to medical therapy given in the coronary care unit, associating modern pharmacological agents and circulatory assistance, on the one hand, and the presence of lesions on the coronary arteries accessible to surgery on the other, were the surgical indications. The absence of operative mortality and of electrical changes after operation seem to be related to the many advances made in the various stages of the medico-surgical management. These results suggest that revascularisation surgery with an acceptable risk may be proposed to patients with unstable angina after a recent myocardial infarction.

Acute Disease

[Embolism in a fragment of the mitral papillary muscle to the left main coronary artery. A rare complication of valve replacement].

A 64-year-old man, who underwent double valve replacement for mitral and aortic incompetence due to infective endocarditis, presented with a coronary embolism of a fragment of mitral papillary muscle in the immediate post-operative period. The diagnosis, suggested by the sudden development of acute myocardial insufficiency during ventricular filling, was confirmed by the absence of clinical or electrical improvement during circulatory assistance and by surgical exploration of the left coronary artery. Complete recovery after embolectomy emphasises the value of the association of circulatory assistance and immediate myocardial revascularisation.

Aortic Valve

[Acute early mitral insufficiency following myocardial infarction].

Five cases of acute mitral incompetence complicating myocardial infarction at an early stage underwent early mitral valve replacement. The surgical indications were deterioration of the clinical and haemodynamic conditions or dependance on medical therapy and intra-aortic balloon pumping. The mitral lesion was haemorrhagic necrosis of the posterior papillary muscle in all cases, associated with rupture of the chordae or papillary muscle in 3 cases. The outcome was favourable in all cases and has been maintained after more than two years post operative follow-up. The problems of the surgical indications, the mitral valve replacement and coronary revascularisation are discussed.

Acute Disease

[Partial congenital deficiency in factor V associated with an intestinal malabsorption syndrome due to lambliasis. A familial survey (author's transl)].

Owren's disease is a rare hemorrhagic diathesis which can occur in infancy as a severe hemorrhagic disorder. It also appears in adult life when clinical manifestations are those of acquired deficiencies of other coagulation factors. A familial survey enables a definite diagnosis to be made as it demonstrates the presence of deficiency in factor V in one or several members of the family. Such a case is reported in a young adult with an associated intestinal malabsorption syndrome due to lambliasis. After administration of vitamin K the deficiency in factor V remained an isolated disorder, and the hemostatic anomaly was found in three other members of the family. The deficiency was a partial one, which explains why the Owren's disease only became evident during the course of the malabsorption syndrome due to lambliasis which caused a reduction in the level of vitamin K dependent factors II, VII, and X.

Adolescent

[Resections of the left ventricle in the surgical treatment of parietal sequelae of myocardial infarct].

Resection of left ventricular tissue seems to be playing an increasing part in the treatment of the sequelae of myocardial infarction. In a total of 700 patients who underwent surgery for some aspect of coronary atherosclerosis, 40 underwent resection of left ventricular tissue. In the majority of cases, diagnosis rested on left ventricular cine-angiography and in 3 cases this had to be carried out as an urgent procedure with circulatory assistance using diastolic counter-pressure (DCP) from an intra-aortic balloon. A selective contrast technique for the two coronary arteries was used whenever possible. The surgical anatomy of the lesions indicates a difference between a localised dyskinesia and diffuse dyskinesia, the latter having a severe effect on left ventricular function. In a group of localised dyskinesias, the territory supplied by the anterior descending artery was by far the most frequently affected. Resection of left ventricular tissue was associated with a myocardial bypass revascularisation procedure in 9 cases, valve repair in 7 cases, and closure of a septal perforation in 3 cases. The total inpatient mortality rate is still quite high (23.1%) because of the severity and widespread nature of the coronary disease. However, the mid-and long-term results are good, the criteria being functional improvement and the actuarial 4-year survival rate.

Adult

[The "small aortic ring." Hope for a surgical solution].

The "small aortic ring" was until recently an unresolved problem for surgeons operating on the aortic valves. It used to contraindicate valve replacement in the child, and sometimes led to the insertion of too small a valve in the adult. Some hope of a solution has appeared in the form of three new techniques: enlargement of the aortic ring over the mitral valve, aorto-ventriculoplasty, and apico-aortic shunt. Two adults have had the ring enlarged above the mitral valve with good results in both cases. Five children have had an aorto-ventriculoplasty with good results in two cases, post-operative atrio-ventricular block in one, and two deaths, one early and the other late. These deaths appear to be more closely related to the severity of the initial lesion and to the degree of decompensation of the myocardium than to the operation itself. There are advantages and problems with this technique. An attempt has been made to systematise indications for treatment as a function of the lesions and the state of the patient.

Adolescent