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Biomedical subjects

P Neville

Publications and source records attributed to P Neville.

At least 19 recordsLinked to original sources
PubMed2006

[The role of aortic morphology in the occurrence of hypertension in patients undergoing surgery for coarctation of the aorta before the age of 1 year].

OBJECTIVE: Hypertension on effort can be observed following surgical treatment of coarctation of the aorta even if the operation has been performed early and has been judged to be satisfactory. The pathophysiology of this hypertension has not been completely elucidated. The aim of our study was to look for a residual morphological anomaly of the aortic arch which might be responsible. METHODS: This was a retrospective study of patients aged over 10 years who had undergone surgery for coarctation of the aorta before the age of 1 year, consecutively between 1979 and 1993, and free from re-coarctation clinically or with Doppler. All of them had a blood pressure effort test on a cycling machine, echocardiography and an MRI of the thoracic aorta. RESULTS: 61 patients were included. Their median age was 15 years, 59% were male, 15% were hypertensive at rest and 56% on effort. With univariate analysis, only the average blood pressure (p=0.03) and the resting pulse pressure (p=0.001) were associated with hypertension on effort. With multivariate analysis the only factors that correlated independently with maximum arterial pressure on effort were the height of the patient (p=0.02) and the pulse pressure (p<0.0001). The surgical technique and the age at intervention were not associated with hypertension on effort (p=0.96 and 0.69 respectively). The diameter of the horizontal aorta and the aorta at the site of repair, measured on MRI, added to the diameter of the descending aorta at the diaphragm were not lower in patients with hypertension on effort (p=0.77 and 0.38). There were proportionally more Roman type aortic arches than Gothic types in patients with hypertension on effort, but this difference was not significant (p=0.18). CONCLUSION: In our study, the patients with hypertension on effort following correction of coarctation of the aorta did not display any residual obstruction at the level of the aortic cross on MRI. However, they had a resting pulse pressure that was significantly higher than the non hypertensive patients, reflecting an increase in the aortic wall rigidity.

Adolescent↗
PubMed2006

[Quality of life of patients with total cavopulmonary anastomosis].

INTRODUCTION: Total cavo-pulmonary connection (TCPC) represents the current surgery standard for congenital univentricular heart disease (CUHD) patients. We studied the health related quality of life (HRQOL) expressed by TCPC operated patients. PATIENTS AND METHODS: This transversal study is based on 24 children and 10 adult TCPC patients aged from 5 to 41 years old. The HRQOL evaluation relies on generic self report instruments such as the PedsQL 4.0 for the children and their parents, and the Duke Health profile for the adult patients. Additional questions were specifically designed for this study as well. RESULTS AND DISCUSSION: The estimated HRQOL is 68.15 for the children and 68.71 for their parents. In these young cases, the global HRQOL or some specific score are altered when any comorbidity or scholar difficulties are present, or when TCPC was performed more than 10 years ago. The estimated HRQOL is 74.67 in adulthood. In these patients, the young age, the lifestyle, the onset of more than 2 early complications ans the necessity of anti-arrhythmia therapy decrease various HRQOL scores. The physical handicap is considered as the major limitation for children and adult patients. Thanks to adaptative and cognitive compensatory mechanisms, such as resilience, both groups express a satisfying HRQOL assessment. CONCLUSION: Our study indicates that TCPC provides a good HRQOL in CUHD patients despite the complex management and follow-up of these diseases, the risk of complication onset and the physical handicap usually observed.

Adolescent↗
PubMed2004

[Twelve years' experience with Carbomedics bileaflet valves].

The authors report long-term results of a cohort of patients who underwent valve replacement with a Carbomedics bileaflet mechanical prosthesis. The influence of patient age on the results was examined. Three hundred and ninety patients were operated between 1988 and 2000. Complete follow-up was available in 98.5% of cases. For aortic valve replacement, the total experience was 1,061 person-years. The hospital mortality was 2.3%. Global actuarial 12 year survival was 74 +/- 7%. The actuarial probability of absence of thrombo-embolic complications at 12 years was 95 +/- 3%, and of absence of haemorrhagic complications 89 +/- 4%. For mitral valve replacement, the total experience was 610 person-years. The hospital mortality was 3.4%. The global actuarial 12 year survival was 78 +/- 5%. The actuarial probability of absence of thrombo-embolic complications at 12 years was 79 +/- 9% and of absence of haemorrhagic complications 82 +/- 5%. The results of survival and prosthesis-related complications were comparable to those reported in the literature with second generation mechanical prostheses, with the exception of thromboses of the mitral valve for which a higher linear rate was observed. Multivariate analysis showed an increased (x 2.3) risk of haemorrhage after 60 years of age irrespective of the site of implantation of the prosthesis. In patients over 60 years of age, the risks of long-term anticoagulant therapy should raise questions concerning the modality of follow-up and the indications. The use of biological prostheses is a possible alternative.

Actuarial Analysis↗
PubMed2003

Indications of coronary artery bypass graft in 2003.

UNLABELLED: During the last 3 decades, coronary artery bypass grafting (CABG) emerged, was developed and has progressed. Additionally, recent surgical innovations have been introduced aimed at reducing the trauma without deviating from the efficiency of conventional procedure. At the same time significant evolution in preventive, medical treatment and percutaneous procedures has been observed. The introduction of new treatment has improved the result in medically treated patients. Percutaneous procedures emerged and were developed. New technologies and advances available to adjunctive medical therapies have appeared and have impacted the effectiveness initially established for percutaneous coronary intervention (PCI). Larger use of stent permits a significant decrease in restenosis and the introduction of coated stent will probably improve the RESULTS: Indication is a moving field. Continuing improvement in medical treatment, technical procedure and development of less invasive surgery modifies the place of each treatment and continuing evaluation and comparison are necessary. Introduction of new treatment, aimed at treating ischemic cardiomyopathy like transmyocardial revascularization, cell transplantation or gene therapy will probably modify indications in the future.

Angioplasty, Balloon, Coronary↗
PubMed2001

Levels of malondialdehyde-deoxyguanosine in the gastric mucosa: relationship with lipid peroxidation, ascorbic acid, and Helicobacter pylori.

Helicobacter pylori infection is associated with elevated gastric mucosal concentrations of the lipid peroxidation product malondialdehyde and reduced gastric juice vitamin C concentrations. Malondialdehyde can react with DNA bases to form the mutagenic adduct malondialdehyde-deoxyguanosine (M(1)-dG). We aimed to determine gastric mucosal levels of M(1)-dG in relation to H. pylori infection and malondialdehyde and vitamin C concentrations. Patients (n = 124) attending for endoscopy were studied. Levels of antral mucosal M(1)-dG were determined using a sensitive immunoslot-blot technique; antral mucosal malondialdehyde was determined by thiobarbituric acid extraction, and gastric juice and antral mucosal ascorbic acid and total vitamin C were determined by high-performance liquid chromatography. Sixty-four H. pylori-positive patients received eradication therapy, and endoscopy was repeated at 6 and 12 months. Levels of M(1)-dG did not differ between subjects with H. pylori gastritis (n = 85) and those with normal mucosa without H. pylori infection (n = 39; 56.6 versus 60.1 adducts/10(8) bases) and were unaffected by age or smoking habits. Malondialdehyde levels were higher (123.7 versus 82.5 pmol/g; P < 0.001), gastric juice ascorbic acid was lower (5.7 versus 15.0 micromol/ml; P < 0.001), and antral mucosal ascorbic acid was unchanged (48.0 versus 42.7 micromol/g) in H. pylori gastritis compared with normal mucosa. Multiple regression analysis revealed that M(1)-dG increased significantly with increasing levels of malondialdehyde, antral ascorbic acid, and total antral vitamin C. M(1)-dG levels were unchanged 6 months (63.3 versus 87.0 adducts/10(8) bases; P = 0.24; n = 38) and 12 months (66.7 versus 77.5 adducts/10(8) bases; P = 0.8; n = 13) after successful eradication of H. pylori. M(1)-dG thus is detectable in gastric mucosa, but is not affected directly by H. pylori.

Adult↗
PubMed2001

[Secondary displacement of an Amplatz occluder for atrial septal defect. 2 case reports].

The authors report two cases of secondary displacement of an Amplatz occluder of isolated ostium secundum atrial septal defects. The displacement was observed at 1 month and the prosthesis removed at 3 months. To the best of the authors' knowledge, these are the first two reported cases of secondary displacement of this type of device. The main risk factor in the two cases was the absence of a subaortic septal remnant observed at surgical removal. This anatomical characteristic can be identified by transoesophageal echocardiography, but was poorly assessed by transthoracic echocardiography. Three-dimensional transoesophageal echocardiography should improve selection of atrial septal defects suitable for percutaneous treatment by better identification of their form and anatomical characteristics.

Adolescent↗
PubMed2000

Analysis of the distribution of histologic myocardial lesions during acute cardiac rejection. Experimental study in rodents.

BACKGROUND AND METHOD: Asymmetric distribution of histologic lesions have been reported in grafted hearts that could hamper the interpretation of right ventricular endomyocardial biopsy. Heterotopic heart transplantations were performed in rats (n=59) and guinea pigs (n=20). Grafted hearts were examined by a pathologist who established the degree of cardiac rejection in the four cardiac cavities. RESULTS: Forty cardiac rejections were diagnosed in rats and ten in guinea pigs. An asymmetric distribution of histologic lesions was observed in 34 (68%) rejected hearts with greater lesions in the auricular myocardium than in the ventricular myocardium (n=25, 50%). One (n=18) or two degrees (n=7) differentiated the severity of rejection between atria and ventricles. Cardiac rejection score was significantly greater in atria than in ventricles (3.12+/-0.18 vs. 2.6+/-0.2 (P<0.01) in rats and 2.35+/-0.37 vs. 1.6+/-0.47 (P<0.001) in guinea pigs. There were histologic lesions of rejection in the auricular myocardium in seven cases, although the ventricular myocardium was completely normal. In nine (18 %) other grafted hearts the degree of rejection was equal in the auricular myocardium and ventricular septum but was greater than the degree of rejection noted in the right and left ventricular free walls. CONCLUSION: The distribution of histologic lesions of acute cardiac rejection in rodents was heterogeneous in grafted hearts which exhibited greater lesions in the atria than in ventricles. This should be taken into consideration in the evaluation of new methods of detection of cardiac rejection and in the diagnosis of acute cardiac rejection in humans.

Animals↗
PubMed2000

[Mid-term complications of automatic implantable cardiac defibrillators].

The incidence and the nature of medium-term complications of automatic implantable cardiac defibrillators (AICD) were studied. Seventy-nine AICD were implanted in 50 consecutive patients (42 men, aged 54.5 +/- 13.7 years). Forty-six patients had spontaneous ventricular arrhythmia. These arrhythmias were resistant to treatment (N = 9), reproducible with treatment (N = 28). In 4 patients, the indication was prophylactic, in 2 a Brugada syndrome, in 2 syncope with reinducible ventricular tachycardia and in 1 patient, torsades with a short coupling interval. Forty-six patients had underlying cardiac disease (ischaemic, N = 28, primary dilated cardiomyopathy, N = 10, others, N = 8). The ejection fraction was > 40% in 32 patients. The average follow-up was 41.3 +/- 34.9 months. Eight patients died, 2 from cardiac failure. Twenty-one patients (42%) had 1 or more complications related to their AICD. These occurred: in the operative period (N = 3): 1 post-shock atrioventricular block, 1 ruptured electrode and 1 increased threshold with amiodarone; in the postoperative period (N = 6): infection in 3 cases, cerebrovascular accident in 1 case, deep venous thrombosis of the left arm in 1 case, pneumothorax in 1 case. In the medium-term, the complications were mainly inappropriate electrical shocks observed in 14 patients related to atrial arrhythmias in 7 cases, sinus tachycardia in 1 case, over-detection of myopotentials in 2 cases and electrode dysfunction in 4 cases. In addition, the authors observed complications related to the material: AICD failure in 1 case, electrode displacement in 1 case, and electrode rupture in 3 cases. The authors conclude that AICD are effective for the treatment of malignant ventricular arrhythmias which justify strict specialist follow-up given the incidence and diversity of their complications.

Adult↗
PubMed1999

A descriptive survey of acute bed usage for dementia care in old age psychiatry.

OBJECTIVE: To examine the reasons why patients are admitted to acute dementia care assessment beds in one large district health authority (Leicestershire). DESIGN: A prospective questionnaire was completed by the RMO for every admission to dementia care assessment beds over a 6-month survey period. RESULTS: The most common reasons for admission were behavioural problems (most frequently aggression). Other common reasons included self-neglect, psychotic symptoms and comorbidity with functional psychiatric illness. Classification of patients by their social circumstances before admission indicated different patterns of presenting features, length of stay and place of discharge. CONCLUSIONS: The need for acute beds is demonstrated by the large number of emergencies, with a significant proportion admitted under the Mental Health Act, the type and complexity of reasons for admission and the preceding involvement of community mental health services. Multi-axial classifications including presenting problems and social circumstances, rather than the traditional method of looking purely at diagnosis, may offer some advantage in assessing outcomes.

Acute Disease↗
PubMed1999

Increased expression of IL-10 and IL-12 (p40) mRNA in Helicobacter pylori infected gastric mucosa: relation to bacterial cag status and peptic ulceration.

AIMS: To investigate interleukin (IL)-12 (p40) and IL-10 mRNA expression levels in the gastric mucosa in relation to H pylori cag status, peptic ulceration, and histopathology. METHODS: In 81 dyspeptic patients, antral and corpus biopsies were taken for reverse transcriptase polymerase chain reaction (RT-PCR) and histology. G3PDH (control) and IL-10 and IL-12 were coamplified in a duplex PCR and the ratios of cytokines to G3PDH were determined. Bacterial ureA and cagA status was determined by RT-PCR. RESULTS: IL-10 mRNA expression in both the antral and corpus mucosa was greater (p < 0.01) in cagA positive infection than in H pylori negative patients with histologically normal mucosa. No increase in IL-10 mRNA expression was observed in cagA negative infection. Both in the antral and corpus mucosa, IL-12 mRNA expression was greater (p < 0.05) in cagA positive than in cagA negative infection and uninfected patients with normal gastric mucosa. In cagA positive infection, there was a correlation between IL-10 and IL-12 mRNA expression in both the antral mucosa (r = 0.515, p < 0.01) and the corpus mucosa (r = 0.6, p < 0.005). IL-12 mRNA expression in the antral mucosa was significantly more frequent in H pylori positive patients with duodenal ulcer than in those with gastric ulcer or nonulcer dyspepsia. No difference was observed in IL-10 mRNA expression in relation to endoscopic diagnosis. CONCLUSIONS: CagA positive H pylori infection is associated with increased IL-10 and IL-12 mRNA expression. The increased expression of IL-12 mRNA in the majority of patients with duodenal ulcer suggests that Th1 responses may predominate and play a role in the pathogenesis of duodenal ulceration.

Adolescent↗
PubMed1999

[Immediate and mid-term results of surgery for aortic coarctation in children under 6 months of age].

The aim of this study was to assess the impact of medical and surgical advances on the results of surgery of coarctation of the aorta without major associated cardiac malformations in children aged under 6 months, operated by the surgical team of Tours over a period of 17 years. A retrospective analysis of patients' files allowed inclusion of 75 children: 34 in group I (1980-1988) and 41 in group II (1989-1996). The age at diagnosis, mode of presentation, clinical and echocardiographic parameters, initially and at surgery, were comparable in the two groups. In group II, the surgical procedure of choice changed to the Crafoord procedure (p = 0.0001), the peroperative haemodynamic complications were less common (p = 0.04), patients were operated sooner after diagnosis (p = 0.002) with a higher number of neonates (p = 0.04). There were two early deaths in group I and two late deaths in group II. Six children (8.2%) had recurrence of coarctation. This was more common in children operated before 1 month of age (p = 0.0001) and in cases of hypoplasia of the aortic arch (p < 0.01). The risk of recoarctation in neonates was lower in group II than in group I (p < 0.02). At medium term, the coarctation was considered well repaired in 93.7% and 92.6% of patients in group I and II respectively. However, hypertension on exercise was observed in 8 of the 19 children studied. Finally, secondary surgical or instrumental procedures were required in 9 children to treat associated cardiovascular abnormalities. The authors conclude that in recent years, aortic coarctation was repaired earlier, mainly by a modified Crafoord procedure, with fewer haemodynamic complications, without early mortality. The risk of recoarctation remains low but persistent in neonates. At medium term, hypertension on exercise is a common problem even in children with excellent repairs.

Age Factors↗
PubMed1999

[Evolution of ventricular septal defects. Relation to echocardiographic anatomy].

The aim of this study was to analyse the outcome of membranous ventricular septal defects (VSD) with respect to the echocardiographic data obtained during the first year of life. This retrospective series included patients born between January 1st 1986 and December 31st 1995, in the Indre et Loire department, with membranous ventricular septal defects alone or associated with minor abnormalities. The initial echocardiography, an echocardiography performed 2 to 6 months later, one a year later and the final echocardiography were compared. Three groups of VSD were constituted according to their diameter: group I (< or = 3 mm), group II (3-6 mm), and group III (> 6 mm). Depending on the outcome, the patients were classified as spontaneous closure (group A), surgical closure (group B) or persistent VSD (group C). The population comprised 84 children. There were 6 spontaneous deaths, three of which were unexplained, and 7 children were lost to follow-up. After the initial echocardiography, the VSD were classified as group I (38%), group II (26.2%) and group III (35.7%). After the second echocardiogram, 24 VSD changed group (31.5%), by increase (N = 10) or decrease (N = 14) in diameter. Aneurysms of the membranous septum were observed during the first two echocardiographies in 31.2% and 79.3% of VSDs of group I, 31.8% and 70% of VSDs of group II and 6.6% and 3.3% of VSDs of group III (p < 0.01). The average follow-up was 3.1 years (range 1 month-10 years). In group A (N = 22), the mean age of closure of the VSD was 26 months (3 months-7 years). In group B (N = 28), surgery was undertaken at an average age of 10 months (range 3 months-5 years). In group C (N = 21), the VSDs were classified as group I (N = 19) or group II (N = 2) at the last echocardiography. The frequency of aneurysms of the membranous septum in groups A, B and C were respectively 100%, 7.1% and 66.6% (p < 0.01). At the second echocardiographic examination, a significant relationship (p < 0.001) was observed between the diameter of the VSDs and their outcome. The VSDs of group A were associated with aneurysms of the membranous septum more often than those of group C (p < 0.005). The authors conclude that surgery is required in about one third of membranous VSD. At medium term, the others either close spontaneously or become smaller in comparable numbers. The outcome is directly related to the diameter of the VSD and the development of an aneurysm of the membranous septum. During the first 6 months, the dimensions of membranous VSDs change in about 30% of cases with an increase in frequency of aneurysms of the membranous septum.

Female↗
PubMed1998

[Late-occurrence hemolytic anemia after mitral valve bioprosthesis. 2 cases].

The authors report the cases of two patients admitted to hospital for investigation of haemolytic anaemia. Both had undergone, 10 and 12 years previously, mitral valve replacement with a Ionescu-Shiley bioprosthesis. In both cases, in the absence of signs of cardiac failure, Doppler echocardiography showed mitral regurgitation. The association of haemolytic anaemia and dysfunction of the bioprosthesis led to redux valve replacement and correction of the anaemia. Haemolytic anaemia was the presenting sign of bioprosthetic valve dysfunction requiring replacement of the prosthesis. This complication is common with mechanical valve prostheses but much more rare in bioprosthetic valves.

Aged↗
PubMed1998

[Clinical, hemodynamic and angiographic results of total cavo-pulmonary connection].

The aim of the study was to assess the short and medium term results of total cavo-pulmonary connection based on analysis of the functional status, the cavo-pulmonary circulation and the surgical techniques, and the hepatic consequences. Fifteen patients with congenital defects beyond repair were treated by total cavo-pulmonary connection at Tours between March 1st 1992 and July 30th 1996. There were 12 children (mean age: 6.3 years) and 3 adults aged 25 to 28. Results were assessed by clinical examination, hepatic function tests and cardiovascular investigations including right heart catheterisation with angiography in 14 patients. There were no fatalities. Seven patients were in functional Class I and 8 in Class II at medium term (average follow-up of 33 months). Hepatic function was mildly abnormal in all patients with an increase in serum bilirubin and gamma GT, and a decrease in the coagulation factors. The mean pressures in the atrial channel were 12 mmHg (9-16 mmHg), in the superior vena 13.2 mmHg (10-18 mmHg), in the right pulmonary artery 9.5 mmHg (7-15 mmHg) and 11.6 mmHg (8-16 mmHg) in the left pulmonary artery. Significant residual stenosis of a pulmonary branch was observed in 2 cases. The cavo-pulmonary anastomoses were out of line, one from the other, in all cases. The atrial channel was tubular in 9 cases and dilated with slight stagnation of the contrast medium in its inferior region in 5 cases. Total cavo-pulmonary connection transformed the clinical status of these patients but was associated with minor abnormalities of liver function. The quality of the cavo-pulmonary circulation and the surgical anastomoses was estimated to be satisfactory in the majority of cases.

Adult↗
PubMed1998

[Videoscopic resection of a thrombosed aneurysm of a patent ductus arteriosus in a neonate].

Aneurysmal dilatation of a patent ductus arteriosus is a rare condition. One hundred and fifty three cases have been reported, of which 59 (39%) were operated, with an operative mortality of 16%. The authors report a case detected in a premature neonate on chest X-ray showing a mass in the mid-mediastinal region. Surgical resection was undertaken by video-thoracoscopy. Peroperative analysis of the resected specimen suggested a vascular structure and this was confirmed by histological study, which showed spontaneous aneurysm of a thrombosed patent ductus arteriosus or cystic residue of a patent ductus arteriousus. The authors underline the importance of peroperative puncture of structures of uncertain origin and the possibility of conversion of such a procedure to that of an extreme emergency.

Aneurysm↗
PubMed1997

Influence of age on valve related events with Carpentier-Edwards pericardial bioprosthesis.

UNLABELLED: Age is the most important factor for the durability of biological valves. With an original design the Carpentier-Edwards pericardial valve showed improved results at 10 years. The influence of age on valve related complications is studied with a 10 year follow up on 807 valvular replacements. METHODS: Between January 1984 and December 1993, 807 patients underwent valve replacements with a Carpentier-Edwards pericardial bioprosthesis. Patients, 193 were younger than 60 years, 284 between 60 and 70 years and 330 patients were older than 70 years. All patients but seven were followed up for an average of 4.18 years after their operation and total follow up was 3373 patient years. Patients were divided into three groups of age: group I, less than 60 years; group II, 60-70 years; group III, over 70 years. A retrospective comparison was made between age groups. RESULTS: At 11 years, valve related complications included 97 patients with 27 valve related deaths. Rates of valve related death increase with age linearized rate were 0.3, 0.6 and 1.2%, respectively. No difference was observed for rates of all valve related morbidity: 2.6, 2.4 and 3.5%, respectively. Risk of thromboembolism increased with age, linearized rates were: 0.3, 0.7 and 1.3%. Risk of deterioration and reoperation decreased with age, rates of deterioration were 0.8, 0.1 and 0%. Other valve related events had the same incidence in all groups. No statistical difference was observed between group II and group III for deteriorations and reoperations. CONCLUSIONS: The performance of the Carpentier-Edwards pericardial valve is the same at 10 years in group II and III. This study supports the clinical use of this tissue valve in patients over 60 years. The results in group I are satisfactory, nevertheless, a more durable biological valve is needed for young patients.

Actuarial Analysis↗
PubMed1997

[Treatment of congenital heart diseases with pulmonary artery cerclage. Immediate and medium term results in 51 patients].

The aim of this study was to assess the results of pulmonary artery banding in a retrospective study of 51 consecutive children treated from January 1980 to December 1993. The study population was 24 girls and 27 boys with an average age of 6.2 months, of average weight of 4.01 kg. The cardiac conditions treated were ventricular septal defects in 24 cases (isolated and associated with one or more cardiovascular malformations or multiple), complete atrioventricular canal in 12 cases (isolated or associated with several cardiovascular malformations), single ventricle in 7 cases, double outlet right ventricle in 3 cases, transposition of the great arteries with ventricular septal defect in 2 cases, tricuspid atresia in 2 cases, and a complex lesion with double discordance in one case. The average duration of banding was 2.35 years (n = 49). Hospital morality of banding was 1.9% (1/51). Late mortality was 14.8% (7/47). Twenty-one patients (42.8%) had complications of banding. The survival rates of children who underwent banding was 86.8% at 1 year and 80.6% at 11 years. The low hospital mortality leaves a role for pulmonary artery banding as a palliative procedure in congenital heart disease in which early correction is impossible or carries and unacceptable risk. Complications of banding justify attempts to improve the technique, by making adjustable bands.

Child↗