Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 16 de 16
Filter
2.
Rev Mal Respir ; 34(9): 1011-1015, 2017 Nov.
Article in French | MEDLINE | ID: mdl-29033202

ABSTRACT

INTRODUCTION: Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting the joints but which frequently includes extra articular effects, including pulmonary nodules, which grow faster under immunosuppressive treatment. CASE REPORT: A 74 years old man, with mild asbestosis, underwent treatment with methotrexate then leflunomide (LEF) for seropositive RA. In February 2014, during monitoring of his asbestosis, chest CT scan showed the appearance of thick-walled cavitating lung nodules, with a central and sub pleural distribution. The patient was asymptomatic. Bronchoalveolar lavage excluded infection and tumor. LEF was stopped but in May 2014, the patient was admitted with respiratory infection and a pyopneumothorax which required surgical management. The postoperative course was complicated with a persistent pneumothorax. CONCLUSIONS: We describe a case of RA complicated by a pyopneumothorax after treatment with LEF. The risk of this complication could be reduced by regular chest imaging.


Subject(s)
Arthritis, Rheumatoid/complications , Pneumothorax/etiology , Aged , Arthritis, Rheumatoid/diagnosis , Arthritis, Rheumatoid/surgery , Asbestosis/complications , Asbestosis/diagnosis , Asbestosis/surgery , Diagnosis, Differential , Empyema, Pleural/diagnosis , Empyema, Pleural/etiology , Empyema, Pleural/surgery , Humans , Male , Multiple Pulmonary Nodules/diagnosis , Multiple Pulmonary Nodules/surgery , Pneumothorax/diagnosis , Pneumothorax/surgery
3.
Rev Mal Respir ; 32(5): 477-84, 2015 May.
Article in French | MEDLINE | ID: mdl-26072007

ABSTRACT

INTRODUCTION: Endobronchial resection is now the standard treatment for tracheobronchial narrowing due to malignancy. The clinical and functional respiratory improvement has been evaluated previously but only in heterogeneous population. METHODS: Between February 2009 and February 2011, we conducted a prospective single centre study at the University Hospital of Lille. Twenty-five patients with malignant tracheobronchial stenosis received a clinical and functional respiratory evaluation before and after a rigid bronchoscopy procedure to reduce the obstruction followed where appropriate by placement of an endobronchial stent. RESULTS: Thirteen patients (52%) had primary lung cancer and in 12 the tumor had another origin. Nineteen patients (76%) received a stent after bronchial unblocking. Clinically, all patients felt an improvement in their dyspnea estimated by the Borg score with a median improvement of -2 points [-1; -4] following the procedure (P<0.001). In 96% the dyspnea visual analogic scale improved by 40 mm [27; 67] (P<0.0001). The FEV1 increased significantly after unblocking by 9% [-3.5; 28.5] (P<0.05). The Rint decreased significantly by -0.19 kPa/L per second [-0.06; -0.023] (P=0.001). Correlations between scales of dyspnea and spirometric values were not significant (P>0.05). The survival rate at 1 year was 29%. CONCLUSION: Interventional bronchoscopy decreases dyspnea. It modestly improves respiratory function and decreases the Rint. However, lung function and dyspnea scales are not correlated. No spirometry factor can predict clinical dyspnea response but an elevated Borg dyspnea scale might be a good indicator.


Subject(s)
Airway Obstruction/surgery , Bronchoscopy/methods , Carcinoma/surgery , Lung Neoplasms/surgery , Aged , Airway Obstruction/etiology , Airway Resistance , Bronchoscopes , Bronchoscopy/instrumentation , Carcinoma/complications , Carcinoma/secondary , Constriction, Pathologic , Dyspnea/etiology , Esophageal Neoplasms/pathology , Female , Humans , Lung Neoplasms/complications , Lung Neoplasms/secondary , Male , Middle Aged , Palliative Care , Prospective Studies , Respiratory Function Tests , Severity of Illness Index , Smoking/adverse effects , Spirometry , Stents
4.
Ann Cardiol Angeiol (Paris) ; 56(6): 283-8, 2007 Dec.
Article in French | MEDLINE | ID: mdl-17961492

ABSTRACT

In the late 1980s, many alternative methods to coronary angioplasty were sought, among which rotational ablation was one of the most popular. With the huge development of coronary stents, this technique, however, was progressively left aside. More recently, though, rotational ablation has reappeared as a unique technique for the most calcified lesions and is used in a small but not negligible percentage of patients with success rates over 95% in recent series.


Subject(s)
Atherectomy/methods , Catheter Ablation/methods , Aged , Aged, 80 and over , Angioplasty, Balloon/instrumentation , Angioplasty, Balloon/methods , Angioplasty, Balloon, Coronary/instrumentation , Angioplasty, Balloon, Coronary/methods , Atherectomy/adverse effects , Atherectomy/instrumentation , Calcinosis/surgery , Catheter Ablation/adverse effects , Catheter Ablation/instrumentation , Coronary Artery Disease/surgery , Coronary Restenosis/surgery , Female , Graft Occlusion, Vascular/surgery , Humans , Male , Rotation , Saphenous Vein/transplantation , Shock, Cardiogenic/etiology , Stents
5.
EuroIntervention ; 1(1): 85-92, 2005 May.
Article in English | MEDLINE | ID: mdl-19758882

ABSTRACT

BACKGROUND: Fractional flow reserve (FFR) is correlated with angiographic and intravascular ultrasound assessments of stent placement. Post-stenting FFR has been described as a good predictor of clinical events after 6 months. OBJECTIVE: To evaluate the feasibility and clinical impact of targeting an FFR > 0.95 via incremental in-stent inflation pressures. METHODS: In this multicenter prospective study, 100 consecutive patients underwent FFR measurement at baseline, after balloon predilatation, and after stenting with 4-atm inflation pressure increments from 8 to 20 atmospheres. Inflations were stopped when FFR increased above 0.95 and angiographic stenosis was less than 20%. RESULTS: FFR > 0.95 was achieved in 81% of cases; this FFR target was reached at 8 atm in 47% of patients, 12 atm in 16 %, 16 atm in 15%, and 20 atm in 3%. Fifty percent of patients with adequate angiographic result had an FFR less than 0.95 and needed further higher inflations. FFR was correlated with residual stenosis when the total procedure was evaluated, and this correlation persisted when in-stent inflations alone were considered. Final FFR was significantly correlated with anginal status after 6 months. CONCLUSIONS: Angiography guided PCI does not allow optimization of FFR. Since optimal post stenting FFR is correlated to better anginal status at 6-months, this suggests that FFR guided PCI is required to achieve optimal functional results of PCI.

6.
Heart ; 86(3): 302-8, 2001 Sep.
Article in English | MEDLINE | ID: mdl-11514483

ABSTRACT

BACKGROUND: The SWIBAP (stent without balloon predilatation) prospective randomised trial was designed to compare direct coronary stenting with stenting preceded by lesion predilatation with an angioplasty balloon. OBJECTIVE: To determine the feasibility and safety of direct stenting in non-complex coronary lesions in a prospective study. PATIENTS AND DESIGN: All patients < 76 years of age scheduled to undergo angioplasty of a non-complex, non-calcified lesion in a coronary artery of > 3.0 mm, who granted their informed consent, were randomised into the trial. In group I, the stent was placed without balloon predilatation, while in group II stent implantation was preceded by balloon predilatation. The primary end point was the angiographic result according to procedure assigned by randomisation. An intravascular ultrasound substudy was performed in 60 patients. RESULTS: Stent implantation was successful without predilatation in 192 of the 197 group I patients (97.5%), and with predilatation in 197 of the 199 group II patients (99%) (NS). No in-hospital stent thrombosis or death occurred. Overall procedural times, fluoroscopy times, and volumes of contrast agent given (mean (SD)) in group I v group II were 23.50 (13.54) min v 27.96 (15.23) min (p = 0.002), 6.04 (4.13) min v 6.67 (3.65) min (NS), and 135 (65) ml v 157 (62) ml (p < 0.001), respectively. No major adverse cardiovascular events had occurred by 30 days. CONCLUSIONS: The feasibility and safety of direct stenting of selected and non-complex coronary lesions is confirmed. This technique was as successful as the conventional approach and was associated with a minor reduction in fluoroscopic exposure and procedure time and the administration of less contrast agent.


Subject(s)
Angioplasty, Balloon, Coronary/methods , Coronary Disease/therapy , Stents , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prospective Studies , Treatment Outcome
7.
Am J Cardiol ; 82(12): 1539-43, A8, 1998 Dec 15.
Article in English | MEDLINE | ID: mdl-9874064

ABSTRACT

A prospective registry of 187 patients who underwent percutaneous coronary angioplasty with attempted long NIR stent delivery was performed. A successful stent delivery was achieved in 93% of cases with a low rate of major cardiovascular events, and 6-month follow-up showed low rates of clinical events, new revascularization procedures, and angiographic restenosis.


Subject(s)
Angioplasty, Balloon, Coronary , Coronary Artery Disease/therapy , Stents , Aged , Coronary Angiography , Coronary Artery Disease/diagnostic imaging , Female , Follow-Up Studies , France , Humans , Male , Middle Aged , Prospective Studies , Treatment Outcome
8.
Arch Mal Coeur Vaiss ; 83(2): 159-66, 1990 Feb.
Article in French | MEDLINE | ID: mdl-2106849

ABSTRACT

The results of immediate percutaneous transluminal coronary angioplasty (PTCA) (260 +/- 167 minutes after onset of pain and an average of 56 minutes after thrombolysis) and deferred PTCA (average 9.6 days, range 1 to 30 days after infarction) were compared in 118 consecutive patients with acute myocardial infarction. The overall primary success rate of PTCA was 82.2 per cent; it was higher in those patients undergoing deferred angioplasty (96% vs 78%; p less than 0.05). The primary success rate of immediate PTCA was related to the severity of the stenosis before dilatation: 75 per cent success in occluded compared to 84 per cent in suboccluded vessels (over 90% stenosis) and 100 per cent success in vessels with under 90 per cent stenosis. Eighty one per cent of failed angioplasties occurred in patients with occluded arteries, the majority being left anterior descending (LAD) arteries (71.4%). The incidence of restenosis was 13.4 per cent. This complication was diagnosed at coronary arteriography performed 40 days after PTCA in 1 case, 47 days after PTCA in another case and at the 6 month control in 11 cases. Reocclusion was observed in 21 patients (21.7% of immediate successes). The occlusion was diagnosed at the first control after an average of 8 days in 15 cases. The interval between the onset of pain and thrombolysis and dilatation was significantly longer in the group with reocclusion compared with patients without reocclusion (314 minutes vs 193 minutes for thrombolysis, p less than 0.01; and 356 minutes vs 204 minutes fort PTCA, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)


Subject(s)
Angioplasty, Balloon, Coronary , Myocardial Infarction/therapy , Thrombolytic Therapy , Adult , Aged , Coronary Angiography , Female , Humans , Male , Middle Aged , Myocardial Reperfusion , Recurrence , Retrospective Studies , Time Factors
9.
Int J Clin Pharmacol Res ; 9(1): 15-9, 1989.
Article in English | MEDLINE | ID: mdl-2707921

ABSTRACT

Twenty patients in a stable condition suffering from congestive heart failure were treated with digoxin for at least three weeks and then with nicardipine concomitantly for five days. No statistically significant variation in serum digoxin concentrations determined at seven control times during a 24-hour period or in its mean concentration was found in the two groups of values examined before and after the concurrent nicardipine treatment. The mean increase of 6.8% in the AUC0----24h was not significant either. Since the maximum increase in serum digoxin concentrations at the steady state never exceeded 0.5 ng/ml, a toxic effect is not likely to occur in patients whose digoxin levels are normally monitored.


Subject(s)
Digoxin/blood , Heart Failure/drug therapy , Nicardipine/pharmacology , Aged , Digoxin/pharmacology , Drug Synergism , Female , Humans , Male , Middle Aged , Nicardipine/therapeutic use
10.
Eur Heart J ; 9 Suppl E: 155-62, 1988 Apr.
Article in English | MEDLINE | ID: mdl-2456931

ABSTRACT

Recently, percutaneous aortic valvuloplasty has been considered as a possible palliative procedure in elderly patients with critical valvular stenosis in whom valve replacement is deferred or contra-indicated because of high operative risk. However, the demonstration of the efficacy of such a procedure is based on immediate post dilatation haemodynamic data and clinical improvement. The purpose of this study was to evaluate the haemodynamic consequences of this procedure on the eighth day after a post procedure haemodynamic control. Thirty consecutive patients (mean age 75 +/- 8.4 years) with long-standing aortic stenosis were treated at the time of cardiac catheterization with balloon dilatation. Of these 30 patients, 24 (mean age 76 +/- 8) underwent haemodynamic evaluation eight days after the procedure. Prevalvuloplasty examination revealed a mean aortic valve gradient (MAVG) of 82 +/- 19.9 mmHg, a mean thermodilution calculated cardiac output (CO) of 3.6 +/- 0.9 l min-1 and a mean aortic valve area (VA) of 0.37 +/- 0.14 cm2. Immediate postvalvuloplasty control showed a fall in MAVG to 44.5 +/- 16.7 mmHg (P less than or equal to 0.001), a decrease in CO to 3.3 +/- 1.4 l min-1 (NS) and an increase in VA to 0.60 +/- 0.35 cm2 (P less than or equal to 0.01). Eighth-day haemodynamic control revealed an increase in MAVG to 71 +/- 18.8 mmHg (P less than or equal to 0.001), an increase in CO to 4.1 +/- 1.3 l min-1 (P less than or equal to 0.001) and a decrease in VA down to 0.47 +/- 0.10 cm2 (P less than or equal to 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)


Subject(s)
Angioplasty, Balloon , Aortic Valve Stenosis/therapy , Hemodynamics , Palliative Care , Aged , Aged, 80 and over , Angioplasty, Balloon/adverse effects , Aortic Valve Stenosis/physiopathology , Calcinosis/therapy , Female , Femoral Artery/injuries , Humans , Injections, Subcutaneous , Male , Reference Values , Time Factors
11.
Arch Mal Coeur Vaiss ; 80(12): 1773-83, 1987 Nov.
Article in French | MEDLINE | ID: mdl-3128221

ABSTRACT

Numerous studies have been devoted to the effect of slow calcium channel inhibitors on plasma digoxin concentrations. The principal drugs tested, verapamil and nifedipine, were found to increase significantly plasma digoxin levels mainly by reducing digoxin total clearance. Very few studies on the nicardipine-digoxin interaction have been reported. The dual purpose of the present study was to evaluate the influence of orally administered nicardipine on plasma digoxin concentrations over 24 hours and to measure possible variations in the pharmacodynamic effects of digoxin in 9 patients with chronic congestive heart failure. The pharmacodynamic assessment involved simple and cross-sectional echocardiography, systolic time interval measurements and cardiac catheterization. In these patients under chronic digoxin treatment, oral nicardipine had little effect on plasma digoxin concentrations which increased but not significantly; no sign of digitalis toxicity was observed. Nicardipine improved left ventricular function and myocardial contractility by reducing after-load, the nicardipine-induced peripheral vasodilatation tending to counteract the digoxin-induced vasoconstriction.


Subject(s)
Cardiomyopathy, Dilated/metabolism , Digoxin/pharmacokinetics , Hemodynamics/drug effects , Nicardipine/pharmacology , Aged , Cardiomyopathy, Dilated/drug therapy , Digoxin/blood , Digoxin/pharmacology , Drug Therapy, Combination , Echocardiography , Humans , Male , Middle Aged
12.
Br Heart J ; 58(2): 142-7, 1987 Aug.
Article in English | MEDLINE | ID: mdl-3620253

ABSTRACT

Three patients with rheumatic mitral stenosis were treated with percutaneous mitral valvotomy. A Brockenbrough catheter was advanced transseptally into the left atrium and then into the left ventricle over a long guide wire. An angle wire loop retriever was advanced through a 10 Fr straight catheter via the femoral artery into the left ventricle. The retriever was used to catch the flexible end of the long guide wire. This end of the long guide wire was then drawn out of the right femoral artery by the retriever through the straight catheter. The straight catheter was left in the descending aorta; the Brockenbrough catheter was removed and a 7 Fr balloon catheter was introduced percutaneously over the long guide wire through the femoral vein. This balloon catheter was used for interatrial septal dilatation and right femoral venous dilatation. In two patients this catheter was replaced over the long guide wire with a 9 Fr Schneider-Medintag Grüntzig catheter (3 X 12 mm diameter when inflated) and in the other by a Mansfield (18 mm diameter when inflated). The procedure was well tolerated in these three patients and there were no complications. Haemodynamic function improved, there was appreciable decrease in dyspnoea, and exercise tolerance was increased. This procedure has several advantages: the balloon is more easily positioned through the mitral valve; the stability of the balloon during inflation is improved by traction at both ends of the long guide wire; and there is the option of rapidly exchanging one balloon for a larger one over the long guide wire. This technique seems to be less arrhythmogenic and results in less blood loss because manual compression of the femoral vessels after the procedure is easier.


Subject(s)
Mitral Valve Stenosis/therapy , Rheumatic Heart Disease/therapy , Adult , Dilatation/methods , Female , Hemodynamics , Humans , Male , Middle Aged , Mitral Valve Stenosis/physiopathology , Rheumatic Heart Disease/physiopathology
13.
Presse Med ; 15(28): 1323-5, 1986 Sep 06.
Article in French | MEDLINE | ID: mdl-2950393

ABSTRACT

In about 50% of the cases, the carcinoid syndrome is complicated with cardiac lesions. These predominate in the right heart and consist of tricuspid and/or pulmonary valve disease, and endocarditis of the right atrium or ventricle. Two-dimensional echocardiography provides and early and accurate diagnosis of these lesions, so that surgical correction, if possible, can be performed before right cardiac failure with its high mortality rate develops.


Subject(s)
Carcinoid Heart Disease/pathology , Malignant Carcinoid Syndrome/pathology , Carcinoid Heart Disease/surgery , Echocardiography , Humans , Liver Neoplasms/metabolism , Myocardium/pathology , Tricuspid Valve/pathology , Tricuspid Valve Insufficiency/diagnosis
15.
Can J Cardiol ; 1(6): 373-80, 1985.
Article in French | MEDLINE | ID: mdl-3841835

ABSTRACT

Identification of auricular activity is important for the diagnosis of arrhythmias. P waves however are often difficult to recognize. Using M-mode and 2-D echocardiographic techniques, it is often possible to recognize atrial contraction at the level of the atrial septum or of the free wall of the right atrium. Diagnosis can be made in cases of sinus tachycardia, supra ventricular tachycardia with and without aberrancy and ventricular tachycardia with dissociation. Ventricular tachycardia with one to one retrograde conduction or with atrial fibrillation cannot be recognized by this method.


Subject(s)
Arrhythmias, Cardiac/diagnosis , Echocardiography/methods , Heart Atria , Humans , Myocardial Contraction
16.
Arch Mal Coeur Vaiss ; 78(12): 1815-9, 1985 Nov.
Article in French | MEDLINE | ID: mdl-3936429

ABSTRACT

Two rare mechanical complications of right ventricular infarction are reported: myocardial dissection and rupture of the RV free wall. The diagnosis was made by 2D echocardiography in both cases. Myocardial dissection resulted in the formation of an oblong, expansive, intraparietal space. The rupture of the RV free wall was visualised as a breach of the continuity of the ventricular wall. These cases underline the importance of 2D echocardiography in the acute phase of myocardial infarction for the diagnosis of these complications.


Subject(s)
Echocardiography/methods , Heart Rupture/etiology , Myocardial Infarction/complications , Aged , Heart Rupture/diagnosis , Humans , Male
SELECTION OF CITATIONS
SEARCH DETAIL
...