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Y Jobic

Publications and source records attributed to Y Jobic.

At least 19 recordsLinked to original sources
PubMed1998

[Spontaneous ventilation in positive expiratory pressure in cardiogenic pulmonary edema. Prospective study].

New equipment facilitating the use of spontaneous ventilation with positive expiratory pressure (PEP) has become available in France since January 1996. This technique was applied in 38 patients with severe cardiogenic pulmonary oedema and persistent respiratory distress despite high flow classical oxygen therapy and standard treatment. After 1 hour of ventilation with a flow of 220 l/min of 100% oxygen with an average PEP of 7.7 cm H20, a significant improvement of clinical (heart and respiratory rate) and biological parameters (arterial gases) was observed. There were no side effects. Four patients died during the hospital period and only 1 was intubated. Spontaneous ventilation with PEP is a simple technique for coronary care units and, compared with conventional oxygen therapy, it rapidly improves arterial oxygenation, reduces respiratory work and improves conditions of cardiac load. Acute severe cardiogenic pulmonary oedema seems to be an indication of choice, especially in the elderly, where it may help avoid an often controversial intubation.

Aged↗
PubMed1998

[Can the results of large-scale clinical trials be applied to clinical practice?].

The management of a patient in cardiac failure should lead the physician to ask if the patient might benefit from treatment with an angiotensin converting inhibitor. Meta-analyses give a positive reply but often lack detail. Analysis of large scale therapeutic trials is the only way to determine whether the results are applicable in an individual case. This analysis starts with validation of the methodology (correct randomisation, respect of double blind protocol, identity of groups) and synthesis of results expressed, if possible, in absolute values. In a second stage, the criteria of inclusion, exclusion, and the comorbidity of enrolled patients, should be compared with those of the patient under consideration. In addition, the amplitude of the therapeutic benefit and the importance of undesired effects must be taken into account in the therapeutic decision. This approach allows a reasoned prescription based on documented facts.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1997

[Torsades de pointe with spiramycine and metiquazine therapy. Apropos of a case].

The authors report the case of a 21 year old woman with a congenital long Q7 syndrome who had several syncopal attacks at least one of which was caused by torsades de pointe. This sudden complication was attributed to the simultaneous prescription of Spiramycine and Mequitazine over a 48 hour period. These two drugs are not considered to be predisposing factors for torsades de pointe despite the fact that they belong to two families of drugs which can trigger this type of arrhythmia. The withdrawal of this treatment led to the complete regression of the syncopal episodes with a follow-up of two years and a significant shortening of the initial QTc interval which remained, nevertheless, longer than normal. This case underlines the potential risks of drug associations of these two families of drugs, especially in patients with the congenital long Qt syndrome.

Adult↗
PubMed1997

[Angiographic course over 10 years of giant aneurysm of the circumflex artery].

Pathological dilatations of the coronary arteries are not exceptional and are called megadolichoartery, aneurysm or ectasia. Cases of marked arterial dilatation, although much rarer, are regularly reported following their discovery due to the impressive angiographic, echocardiographic or autopsy findings. However, their course, particularly in the long term, remains unclear. The authors report the case of a patient with a very large spindle-shaped aneurysm of the circumflex artery whose course was able to be followed over a period of ten years on three successive angiographic assessments performed for clinical coronary events. This follow-up was dominated by thrombosis of the aneurysm, extension of the aneurysmal disease and severe deterioration of left ventricular function.

Coronary Aneurysm↗
PubMed1997

[Endocoronary ultrasonography and quantitative coronary angiography. Correlations before and after transluminal coronary angioplasty].

A comparative study of the results of quantitative coronary angiography and endocoronary ultrasonography was performed in 37 patients undergoing percutaneous transluminal coronary angioplasty to determine the correlations between the two methods. The analyses were made before and after angioplasty at the site of stenosis and on a reference segment. A complete study before and after angioplasty using both techniques was only possible in 24 cases. The quantitative ultrasonographic analysis consisted of measurement of two orthogonal diameters, total surface area of the vessel, the endoluminal surface area and surface area of plaque. Transluminal coronary angioplasty acts mainly by forcing the plaque outwards. Ultrasonography showed a decrease in plaque area, from 10.5 +/- 6 mm2 to 9.8 +/- 5.5 mm2 and the total surface area of the vessel increased from 12.8 +/- 0.7 to 15.3 +/- 6.9 mm2 (p < 0.05). This accounted for the gain in main surface area of the stenosed lumen, from 2.28 +/- 1.28 to 5.9 +/- 2.65 mm2 (p < 0.001). The correlations between quantitative coronary angiography and ultrasonography at the site of stenosis were only significant after angioplasty both the vessel diameter (r = 0.67; p < 0.0002) and endoluminal surface area (r = 0.63; p < 0.0001). A correlation was not observed before angioplasty because of the complexity of the plaque and its excentric location. At the reference site, the correlations between ultrasonography and angiography before and after angioplasty were significant but not very close (Spearman coefficient 0.53 and 0.82 respectively, p < 0.001). Therefore, correlations between quantitative data obtained by coronary angiography and ultrasonography are modest in patients undergoing transluminal coronary angioplasty. The ultrasonographic information is more qualitative, enabling a better understanding of the mechanism of the therapeutic procedure and allowing optimal choice of the appropriate tool.

Adult↗
PubMed1997

[Myocardial infarction caused by acute left main coronary artery occlusion. Apropos of 4 cases and review of the literature].

Between 1979 and 1996, 4 acute occlusions of the left main coronary artery (LMC) were treated by primary transluminal coronary angioplasty. They were 4 men with a mean age of 43 +/- 5 years, admitted to hospital less than 8 hours after the clinical onset of symptoms of anterior myocardial infarction in Killip class 4 with complete right bundle branch block on the initial electrocardiogramme. All cases had a previous history of unstable angina over 2 to 15 days. Angioplasty was undertaken immediately in view of the haemodynamic instability. The coronary circulation was of a dominant right coronary type in the 4 cases: significant stenoses were discovered after recanalisation, on the left anterior descending artery (LAD) in 2 cases and the circumflex or marginal arteries in 3 cases. The right coronary artery was atheromatous in all cases but without significant stenosis. Angioplasty was completed by implantation of a stent in 3 cases (LAD : 1 case, LMC : 2 cases). The outcome was rapidly fatal in 3 cases. Only one patient survived 6 months in functional class 3. These results show that myocardial infarction due to occlusion of the left main coronary artery is a very severe condition which justifies rapid recanalisation. Primary angioplasty with stent implantation in an immediate therapeutic option which enables the patient to survive the acute stage, though only in a limited number of cases.

Adult↗
PubMed1997

[Systemic embolism in a renal transplant patient. Echocardiographic demonstration of bronchial carcinoma with intracardiac invasion].

A 45 year old female renal transplant patient was admitted for subacute ischaemia of a lower limb. Echocardiography was performed and showed the presence of bronchial carcinoma with intracardiac invasion. The tumour was confirmed by thoracic computerised tomography and by bronchoscopy. Histological investigation of bronchial biopsies and of the arterial embolism extracted at surgery showed large cell malignant disease. The tumour partially responded to chemotherapy and the patient survived for 5 months. Extension of a bronchial carcinoma to the left atrium is a classical complication in autopsy reports but rarely a source of systemic embolism. Echocardiographic diagnosis of this condition is very rare. The incidence of malignant diseases is higher in renal transplant patients than in the general population but this has not been verified for bronchial carcinoma. Echocardiography played an essential role in this case, detecting the tumour and its extension, indicating a poor prognosis and guiding treatment.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1994

[Elastic recoil after transluminal coronary angioplasty; implications of clinical and angiographic data].

Secondary elastic recoil after transluminal coronary angioplasty is a constant and immediate phenomenon after successful coronary angioplasty. It was studied by quantitative coronary angiography in 75 consecutive patients undergoing transluminal coronary angioplasty. This procedure was performed on lesions presumed to be responsible for the clinical presentation. The population was divided into 3 groups: stable angina (25 patients), unstable angina (25 patients) and recent post-infarction ischaemic syndromes (25 patients). There were 57 men and 18 women (mean age 59 +/- 11 years) with 31 left anterior descending (LA), 29 right coronary (RC) and 15 left circumflex (Cx) dilatations. The lesions dilated were eccentric in 29 cases and calcified in 37 cases whereas only one thrombus was detected at coronary angiography. The elastic recoil appreciated 10 mn after the last balloon inflation was 0.97 +/- 0.28 mm for the whole population. There was no significant difference between the 3 groups studies (respectively 0.94 +/- 0.24 mm; 0.96 +/- 0.26 mm; 0.99 +/- 0.33 mm). This appeared to be greater than the RC (1.06 +/- 0.30 mm) with respect to the Cx (0.86 +/- 0.23: p < 0.02) or LAD (0.92 +/- 0.25 mm: p < 0.04). Overall, a balloon to vessel diameter ratio > 1 and a lesion length > 10 mm were parameters predicting greater secondary elastic recoil (p < 0.07 and p < 0.001 respectively), whereas the degree of eccentricity only played a role in the post-infarction ischaemic syndromes and calcification only in unstable angina (p < 0.01 and p < 0.001 respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Doppler echocardiographic evaluation of valve regurgitation in healthy volunteers.

OBJECTIVE: To study the prevalence and the characteristics of physiological valve regurgitation. DESIGN: Pulsed wave Doppler echocardiography, continuous wave Doppler echocardiography and Doppler colour flow mapping were performed prospectively in healthy volunteers. SETTING: Echocardiography laboratory in a city hospital. PATIENTS: 32 consecutive healthy volunteers (age 21-49 years, mean age 29.4). MAIN OUTCOME MEASURES: Identification of regurgitation with colour Doppler flow mapping and measurement of the jet area, jet length, and maximal velocity of the regurgitation. RESULTS: Regurgitation was recorded at the pulmonary (100%), tricuspid (100%), mitral (56%), and aortic valves (6%). The velocity of pulmonary and tricuspid regurgitation was similar to that predicted from the pressure gradient calculated from the Bernoulli equation. The jet area and jet length were generally small. CONCLUSION: Trivial regurgitation from the pulmonary, tricuspid, and mitral valves is common in healthy people. It is important to take such regurgitation into account when valve disease is diagnosed.

Adult↗
PubMed1993

[Intracardiac ectopic thyroid].

Intracardiac ectopic thyroid tissue was removed in a 51 years old woman, after echography has discovered a tumor in the right ventricle. There was a normal thyroid gland in the neck and thyroid function tests were normal. Intra-cardiac ectopic thyroid tissue is very rare; it is due to an abnormality of embryological development, when thyroid anlage is in close contact with the embryonic heart.

Cardiomyopathies↗
PubMed1993

[Spontaneous and isolated dissection of the coronary arteries, apropos of 8 cases with favourable outcome].

Spontaneous coronary artery dissection is rare compared with the high incidence of atheromatous coronary artery disease. Eight new clinical and angiographic cases diagnosed between 1984 and 1990 are reported. The patients were 6 men and 2 women with an average age of 44.1 +/- 10.7 years. The initial presentation is angina in half the cases, and myocardial infarction in the other half. Clinical signs and the results of non-invasive investigations are non-specific. Diagnosis is made by coronary angiography. The dissection is usually observed on a proximal segment of one of the main coronary arteries. In 5 cases, the disease was confined to a single vessel left anterior descending (3) and right coronary arteries (2). One patient had double vessel disease (left anterior descending and left retroventricular arteries); one patient had triple vessel disease (left anterior descending left circumflex and right coronary arteries), and finally, one patient had left main stem disease extending to the left anterior descending and first diagonal arteries. There was no aetiological factor in 5 cases whereas 3 had coronary atherosclerosis. After a period of 25 months all patients are alive. Five have drug therapy and 3 have undergone coronary bypass surgery. Six patients are asymptomatic and 2 have mild angina. One patient's coronary circulation has returned to normal. The extension of the indication of coronary angiography explains the diagnosis of an increasing number of spontaneous coronary artery dissection. The condition is serious but there are more and more long-term survivors as in our series.

Adult↗
PubMed1993

[Current etiologies of chronic or subacute surgical, pure aortic insufficiencies in adults. Apropos of 91 medico-surgical cases].

Ninety one patients (78 men, mean age 53; 13 women, mean age 50) from a geographically stable and ethnically homogeneous population (Eastern Brittany) underwent surgery for chronic or subacute aortic insufficiency (AI), present alone, between 1986 and 1992 (72 aortic valve replacements, 17 Bentall type (Cabrol modification) operations, 2 ascending aorta reduction plasties combined with aortic valve replacement). Preoperative clinical and paraclinical findings were reviewed in the context of peroperative and pathological findings. Etiologies were as follows in decreasing order of frequency: 1) degenerative: 40 cases (44%): 34 men and 6 women, with aneurysm of the ascending aorta (19 cases); 2) sequelae of infectious endocarditis: 20 cases (22%): 14 men, 6 women; 3) post-inflammatory (rheumatic): 16 cases (18%): 16 men; 4) congenital bicuspid valves: 15 cases (16%): 14 men, 1 woman. Chronic (or subacute) surgical AI is currently an essentially male disorder, presenting mainly during the 6th decade of life, the foremost cause of which, identifiable in the majority of cases on the basis of simple preoperative findings, is degenerative disease of the aorta of or the aortic valve itself.

Adult↗
PubMed1991

[Current anatomical and etiological aspects of chronic or subacute, surgical, pure mitral valve insufficiency in adults. Apropos of 75 medicosurgical cases].

Seventy five medico-surgical cases (52 men, with a mean age at surgery of 59, and 23 women, with a mean age at surgery of 59) collected between 1983 and 1989, in an ethnically homogeneous and geographically stable population (West Brittany) confirmed that the current anatomical and etiological aspects of chronic (or subacute) pure mitral incompetence (MI) have changed radically. While rates for bacterial and ischemic etiologies remain stable, the share of rheumatic MI (14 cases) has fallen considerably, to the advantage of degenerative MI (51 cases) with a heavy male predominance (39 men) with in 33 cases rupture of the main chordae, and tending to affect the lesser mitral cusp more often. A precise diagnosis in terms of lesions and etiology is possible in almost all cases on the basis of clinical history and echocardiographic findings. In a perfectly homogeneous population, chronic surgical pure MI is currently essentially a male disease, of dystrophic origin, in patients in the 6th and 7th decades of life.

Adult↗
PubMed1990

[Evaluation of the normal bioprosthetic Intact aortic valve by Doppler echocardiography].

The Medtronic Intact is a recently commercialized porcine bioprosthesis. Its function and ultrasonic characteristics have not been widely studied. The authors performed a prospective Doppler echocardiographic study of 38 patients with Intact bioprosthesis (n. 19:1, n. 21:10, n. 23:9, n. 25:14, n. 27:3, n. 29:1) implanted in the aortic position and without clinical signs of dysfunction over a period of 8 +/- 5 months after surgery. The following parameters were measured: maximum and mean velocities, maximum and mean transprosthetic pressure gradients, permeability index (PI) or the ratio of subaortic to transprosthetic velocities, and the effective prosthetic surface area (S) calculated using the continuity equation. The PI and S were calculated by two methods, the first using the ratio of maximum velocities (PI1 and S1) and the second using the ratio of the velocity-time integrals (PI2 and S2). The global results were: Vmax 2.65 +/- 0.4 m/s range 1.9 to 3.7 m/s), maximum pressure gradient 29 +/- 9 mmHg (range 15-55 mmHg), mean pressure gradient 16.8 +/- 5.6 mmHg (range 9-32 mmHg), PI1 37.8 +/- 4.5 p. 100 (range 26-48%), PI2 39.1 +/- 5.5 p. 100, S1 1.25 +/- 0.19 cm2 (range 0.96-1.7 cm2) and S2 1.29 cm2 +/- 0.17 cm2. Minimal central prosthetic valve regurgitation was observed in 2 cases (5%). No correlations were found between the size of the prosthesis and blood flow velocities, pressure gradients or permeability indices. On the other hand, a correlation was observed between S and the size of the prosthesis (r = 0.88, p less than 1.10(-6) (S1); r = 0.80, p less than 1.10(-6) (S2)).(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗
PubMed1989

[Demonstration by Doppler echocardiography of multiple valvular involvement in carcinoid cardiopathy].

We report a case of carcinoid heart disease which was remarkable on three scores: --the value of echocardiography which enabled us to diagnose the disease; --the usefulness of cardiac doppler examination which provided non-invasive haemodynamic evaluation of lesions of the four valves; --the presence of moderate involvement of the right heart, which is classical from the point of view of anatomopathology but is often missed clinically and was ascertained in that case by doppler-echocardiography.

Carcinoid Heart Disease↗
PubMed1989

[Hemodynamic effects of intravenous magnesium sulfate in man].

The haemodynamic effects of a single 3 g dose of magnesium sulfate administered by slow (1 min) intravenous injection were evaluated in 16 patients with coronary disease about to be explored by coronary arteriography. The haemodynamic effects were transient, with maximal values at the end of the injection and return to baseline values within less than 3 min. They consisted of peripheral vasodilatation with a decrease in systolic aortic pressure (128 +/- 18 mmHg versus 113 +/- 17 mmHg, p less than 0.05), an increase of cardiac index (3.0 +/- 0.4 versus 3.8 +/- 0.06 1/min/m2, p less than 0.001) and a fall in peripheral arterial resistance (1168 +/- 203 versus 919 +/- 29 dyn/s/cm-5, p less than 0.01). This action was accompanied by a moderate increase in contractility (Vmax) (1.63 +/- 0.34 versus 1.87 +/- 0.47 CIR/s, p less than 0.01) without changes in the relaxation index T (37 +/- 8 versus 67 +/- 9 s-1, NS), but with concomitant increase in heart rate (80 +/- 12 versus 67 +/- 10 beats/min, p less than 1.10(-4]. It is concluded that the haemodynamic effects of magnesium sulfate are moderate and transient and that this substance can be used safely as antiarrhythmic agent, even in case of marked deterioration of the left ventricular function.

Adult↗