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Biomedical subjects

P Talard

Publications and source records attributed to P Talard.

At least 19 recordsLinked to original sources
PubMed2000

[Venous thromboembolism in pregnancy].

A DUAL CHALLENGE: Pregnancy is a physiological state favoring the development of venous thromboembolism and sometimes discloses a coagulation disorder. Due to the presence of the fetus, suspected venous thromboembolism in a pregnant woman raises a dual challenge for the clinician: confirmation of the clinically suspected diagnosis using imaging techniques exposing the fetus to as little radiation as possible, and adapted anticoagulant therapy taking into account the teratogenic risk. MILD TO MODERATE DISEASE: Excepting exceptionally severe cases, the only validated long-term treatment is continuous infusion heparin. However, because of the difficulties inherent in the use and control of this type of administration, most clinicians prefer low-molecular-weight heparins (LMWH) although these pharmaceutical products have not acquired official approval for this indication. PREVENTION: The optimal therapeutic approach for prevention of venous thromboembolism in a pregnant woman with an acquired or hereditary coagulation disorder or a history of venous thromboembolism remains to be defined. New clinical trials are needed to validate the use of LMWH in this indication and determine the therapeutic approach in certain risk situations and at delivery.

Adult↗
PubMed2000

[Inflammatory abdominal aortic aneurysm].

A 58-years-old man, with no medical past history, was examined for abdominal pain and weight loss. An enlarged kidney could be palpated, and abdominal echography showed left hydronephrosis due to ureteral compression by abdominal aortic aneurysm. Laboratory data showed an inflammatory syndrome. CT scan suggested the diagnosis of inflammatory abdominal aortic aneurysm. The use of corticosteroids brought about the regression of the symptoms and the resolution of the ureteral obstruction, permitting aneurysmectomy and prosthesis replacement without ureterolysis. This report shows the interest of preoperative radiological diagnosis of the inflammatory character of abdominal aneurysm. For uncomplicated cases, preoperative treatment using corticosteroids could allow partial regression of the periaortic inflammation and easier surgical repair.

Abdominal Pain↗
PubMed1999

[Acute complication of a composite graft replacement of the aortic root].

A 78-year old man operated for an acute aortic dissection 8 years ago was hospitalized for an unusual clinical presentation with acute cor pulmonale and superior vena caval syndrome. He had poorly controlled high blood pressure, and coronary artery disease with aorto-coronary by-pass 10 years ago. He underwent Bentall procedure 2 years later for type I acute aortic dissection, with vein graft reimplantation on the valvular conduit. A pseudoaneurysm was noted in the post-operative period, which remained stable at 45 mm during the follow-up. Thoracic CT-scan highlighted a 14.5 cm diameter pseudoaneurysm compressing the superior vena cava and right pulmonary artery. Detached right aorto-coronary by-pass, suspected on transesophageal echocardiography, was confirmed peri-operatively; the aortic anastomosis blood in the peri-prosthetic space, explaining the acute clinical picture. The severity of the lesions did not permit surgical repair and the patient died during operation. This observation evidences the complications observed after aortic root replacement and favors echographic and radiological follow-ups (J Mal Vasc 1999; 24: 381-383).

Acute Disease↗
PubMed1996

[Superior vena cava syndromes of benign etiology].

Superior vena cava syndromes are uncommon and usually caused by malignant diseases. In about 20% of the cases however, the cause is benign. Besides chronic mediastinitis, a growing number of cases are reported of thrombosis resulting from endovenous devices (central catheters, pacemaker leads...). Onset is often slow and insidious, good tolerance in the early stages being explained by the development of an effective collateral circulation. Bibrachial phlebography is still the reference exploration, but computed tomography and magnetic resonance imaging are contributive to diagnosis. Symptoms usually regress after medical treatment, sometimes requiring thrombolysis, however, in 10% of the patients, major functional impairment may require bypass surgery (autologous graft or endoprosthesis) or transluminal angioplasty. There is still some debate as to the precise indications for each method, but angioplasty, used recently, appears to be the most interesting technique for a disease in which prognosis is almost always favorable.

Humans↗
PubMed1996

[Bone marrow aplasia related to ticlopidine].

The authors report two cases of bone marrow aplasia observed 2 months after initiation of a treatment with ticlopidine. The outcome was favorable after discontinuation of therapy. The frequency of this severe drug-induced complication seems to have been underestimated. The absolute necessity of a careful haematological survey during the first 3 months of therapy is pointed out.

Aged↗
PubMed1996

Sudden death as a presenting symptom of hypertrophic cardiomyopathy: treatment with an implantable cardioverter defibrillator.

Aborted sudden death as the presenting manifestation of hypertrophic cardiomyopathy in a 14-year-old child is reported. Documented ventricular fibrillation was the cause of cardiac arrest. No ventricular arrhythmia was induced during programmed electrical stimulation. An implantable cardioverter-defibrillator was indicated. As the patient had a family history of myocardial disease, he had undergone a cardiovascular evaluation 4 years before the major event, and was found normal. It is suggested that normal physical examination, ECG, echocardiogram should not rule out the diagnosis of hypertrophic cardiomyopathy when a family history is present. Left ventricular hypertrophy may develop during childhood in patients with hypertrophic cardiomyopathy.

Adolescent↗
PubMed1996

[Atresia of the left coronary artery: a case in a marathon runner. Review of the literature].

The authors report the case of a very rare coronary malformation: atresia of the left main coronary artery. This anomaly was discovered in a marathon runner who presented effort angina with a positive exercise stress test. At coronary angiography, it was not possible to catheterise the left coronary artery and only a minuscle dimple could be visualised. Selective right coronary catheterisation showed a very large right coronary artery with retrograde injection of the whole of the left coronary network, as far as the left main stem. The authors did not suggest revascularisation because of the good functional tolerance of this malformation.

Adult↗
PubMed1996

[Treatment of amiodarone-induced hyperthyroidism by carbimazole with maintenance of amiodarone].

The authors report the case of a patient treated with amiodarone for syncopal ventricular tachycardia complicating idiopathic dilated cardiomyopathy in whom symptomatic hyperthyroidism led to a discussion of the different therapeutic options available in this type of case. Neomercazole treatment was prescribed with success enabling maintenance of the antiarrhythmic drug. The reputation of inefficacy of carbimazole should be reconsidered ; high dose therapy should probably be tried in patients with hyperthyroidism when withdrawal of the antiarrhythmic drug does not seem to be possible.

Amiodarone↗
PubMed1995

[Acute ischemic liver].

Ischaemic hepatitis, a condition to be distinguished from cardiac liver or stasis cirrhosis, can occur as an acute episode in patients with advanced stage congestive heart failure. The mechanism is massive necrosis in the central lobules resulting from acute hypoxia when low cardiac output reduces oxygen supply further aggravating the underlying condition of congestion due to poor venous outflow. We report 4 cases which illustrate the difficulties in diagnosis and treatment. All four patients (age range 79-86 years) were seen in an emergency situation caused by an acute drop in cardiac output aggravating their underlying heart failure. Clinical signs included jaundice, oligouria, abdominal pain and cardiovascular shock. The first element suggesting the diagnosis of ischaemic hepatitis was a sudden and massive peak in transaminase levels (> 20 times normal) which rapidly returned to normal. Prothrombin and fibrinogen levels fell rapidly and functional renal failure was present in all cases. Viral serology was negative and no hepatotoxic drugs could be incriminated. Despite symptomatic intensive care one patient died on day 15 due to cardiovascular shock. Enzyme movements, together with the lack of evidence for another cause, is the key to diagnosis of acute ischaemic hepatitis which thus is often established after the emergency situation has been controlled. Initially, viral hepatitis or drug-induced hepatotoxicity may be suspected, especially if the episode of low cardiac output goes unrecognized. Cases with signs of encephalopathy may also be difficult to distinguish from fulminating hepatitis and would be the only indication for needle biopsy in this acute situation. Outcome is generally unfavourable with mortality at 6 months estimated at 50%.

Acute Disease↗
PubMed1995

[Acute myocarditis in non-typhoid Salmonella infection].

The authors report a case of myocarditis secondary to a Salmonella Virchow infection in a 20 year old non-immunodeficient man without a previous medical history. The outcome was favourable after treatment with fluoroquinolone. The features of this rare complication of non-typhic salmonella infection are discussed with respect to this and four other recently published cases.

Acute Disease↗
PubMed1993

[Medical phlebitis. A rational approach of the etiological evaluation].

One-hundred and four records of ambulatory deep venous thrombosis were studied retrospectively to determine the usefulness of an aetiological evaluation based on a rational approach. Among these 104 patients, 27 were known to have a cancer at the time of admission, and 77 had a presumably idiopathic deep venous thrombosis. The discovery of 10 cancers in the second group (13 percent) confirmed that the aetiological research was useful. Statistical analysis of the two populations and the different parameters of the thrombus and its course failed to show any significant difference in the patients whose cancer was revealed. The aetiological evaluation pointing to the diagnosis was always simple and not very costly; it consisted of careful physical examination with vaginal and/or rectal palpation, standard laboratory tests, X-ray films of the chest and abdomino-pelvic ultrasonography. Although these cancers were at an advanced stage when discovered, the aetiological research was justified by the finding of a few tumours amenable to curative surgical treatment.

Adult↗
PubMed1993

[Myocarditis of pseudo-infarctoid onset].

The authors report two cases of myocarditis in young individuals in whom clinical and electrocardiographic findings during the acute phase could have led to an erroneous diagnosis of myocardial infarction. The problem in such cases is that of a differential diagnosis with infarction with normal coronary arteries. Few clinical or paraclinical arguments are of diagnostic value, endomyocardial biopsy remaining the reference investigation. Proof of viral infection is not always obtained. It is often the retrospective argument of "complete return to normal" which supports the clinical impression. This usual benign outcome is not always the case, since cases of cardiogenic shock have been reported. The dual nature of the pathogenesis ("myositis" and/or "vasculitis" with thrombus and actual MI) is stressed.

Acute Disease↗
PubMed1993

[Severe pulmonary embolism and thrombus of the right atrium. Success of the thrombolytic treatment combining Rt PA and streptokinase].

The authors report the case of a patient with a serious recurrence of pulmonary embolism with echocardiographic evidence of a floating serpentine thrombus of the right atrium. The outcome was rapidly satisfactory with disappearance of signs of acute cor pulmonale and lysis of the right atrial thrombus after infusion of two thrombolytic agents: Rt PA and streptokinase. There is no evidence in the literature to indicate that one form of treatment, i.e. surgical thrombectomy or thrombolysis, is markedly superior to the other. Thrombolysis appears to be a useful alternative to surgery. The use of Rt PA and of the combination of two thrombolytics has not been published previously and merits confirmation.

Aged↗
PubMed1993

[Subxiphoid pericardiostomy and pericardioscopy. Value and indications apropos of a series of 25 cases].

An experience of 25 subxiphoid pericardial windows with pericardioscopy in eleven cases is reviewed and presented. The operative indications in pericardial effusions result from hemodynamic compromise or from the need for etiologic criteria. Validated in its technical simplicity, its safety, its etiologic findings, its efficacy on immediate and delayed no recurrence of pericardial effusion, the low rate of late constrictive changes, this operative procedure is worth listing in the therapeutic know-how of a general surgeon. Indications in patients with suspected traumatic pericardial tamponade by chest wound are related.

Adult↗
PubMed1993

[Isolated pericardial metastasis of digestive cancer disclosed by tamponade].

The authors report a case of a single secondary tumour of the pericardium presenting as tamponade and occurring three years after sigmoidectomy for an adenocarcinoma of the colon. Gastrointestinal investigations confirmed the absence of any local tumour recurrence. The originality of this case lies in the presentation and isolated nature of this metastasis. Attempted surgical excision failed which, in view of the patient's good general condition, led to suggestion of FUFOL type chemotherapy.

Adenocarcinoma↗
PubMed1993

[Angiosarcoma of the aorta revealed by an intestinal metastasis].

We report a case of aortic endothelioma revealed by intestinal metastasis in a man who was admitted for severe anemia, left heart failure, and fatal ileo-mesenteric infarction. This is the 13th published case of aortic endothelioma, and the first case revealed by intestinal metastasis. It illustrates the value of the magnetic resonance imaging for the detection of an aortic tumor when intestinal angiosarcoma has been diagnosed. The surgical treatment could improve an otherwise very poor prognosis.

Aorta, Thoracic↗
PubMed1992

[Myocardial infarction and coronary artery aneurysm].

Two cases of aneurysm of the right coronary artery are reported. These atheromatous aneurysms not associated with tight coronary stenosis were responsible for myocardial infarctions treated by early intravenous thrombolysis with a resultant limited area of necrosis. According to the literature, coronary aneurysms associated with stenosis are not rare. Aneurysms not associated with significant stenosis appear to be much less common and the prognosis of patients with such lesions would not seem to be worse than that of those with neither aneurysm nor significant coronary stenosis. From a pathophysiological standpoint, the development of local thrombosis appears to play a determinant role in terms of the clinical manifestation of these aneurysms and its prevention justifies the long term combined prescription of platelet antiaggregants and oral anticoagulants.

Aged↗