Biomedical subjects
Publications and source records attributed to A Ebagosti.
An observation of angina aggravated in a concomitant manner with the introduction of treatment with beta blockers is reported. The exacerbation of a vasospastic component with this treatment is evoked on clinical, electrical and coronarographic grounds.
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DDD pacing may be associated with certain problems similar to those of the pacemaker syndrome. In the absence of mechanical dysfunction, pacemaker-mediated tachycardias have occurred in the presence of VA conduction. The correction of this problem is found in more versatile programming capability. In addition, certain phenomena relating to intraatrial conduction times and the optimal AV delay are discussed.
The results of a survey carried out in Marseilles between 1972 and 1979 are reported. A common protocol was used to compare results with two other surveys performed conjointly in Paris and Brussels. The protocol was designed with special emphasis on the psychological factors with respect to the risk factors for ischaemic heart disease (IHD). Seven hundred and eighty six men in a Marseilles administrative department, aged 40 to 60 years (mean age 48.5 +/- 4.5 years) were followed-up for 74 months. Apart from cardiovascular clinical examination with measurement of height, weight, blood pressure and ECG recording, the initial check-up included serum cholesterol, triglycerides and glucose determination and a study of psychological risk factors based on the Bortner's scale for the evaluation of type A profile, and on a questionnaire : the SHEPI for evaluation of the N score (neuroticism). The annual IHD incidence was 9.5% with 4.2% of major events (death or infarction), and 5.3% of minor events (angina pectoris, suggestive ECG changes). Age, tobacco consumption, average systolic blood pressure, serum cholesterol and obesity index were higher in patients who became ill than in those who remained healthy, but overall and separate analysis of major and minor events showed no significant difference apart from age. On the other hand, the study of increased risk according to the level of each of these major factors gave significantly positive results except for the serum glucose level. The correlations between incidence of IDH and the value of each risk factor were not always the same according to the clinical expression (major or minor events). Psychological factors also differed according to the clinical expression of IHD : the Bortner scale was higher in patients developing IHD than in healthy subjects, and higher in those who suffered major events than in those who suffered minor events. On the other hand, the N score was higher in patients with minor events than in those suffering major events. These differences which were not statistically significant in the Marseilles study alone, became significant in the Franco-Belgian cooperative study. The increased risk with the number of associated factors (including psychological) is significant from the association of 2 factors, but only in the fifth decade.(ABSTRACT TRUNCATED AT 400 WORDS)
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The interpretation and significance of postextrasystolic responses obtained in human electrophysiological examinations of patients with sinus node dysfunction has long been a matter of controversy. We carried out programmed atrial stimulation by the method of Strauss et al. in 54 patients with sinoatrial disorder, before and after pharmacologic autonomic blockade (with propranolol 0.2 mg/Kg and atropine sulfate 0.04 mg/Kg intravenously). There were two responses, as follows: computable sinoatrial conduction times and chaotic patterns. Patients were divided into groups on the basis of their intrinsic heart rate (IHR). If the total estimated sinoatrial conduction time over greater than or equal to 200 msec and greater than or equal to 147 msec after autonomic blockade and chaotic pattern were considered to be pathologic, so the ratio of abnormal parameters decreased from 73 to 44% in patients of normal IHR, and increased from 70 to 90% in patients of abnormal IHR. The latter 90% was mostly to the expense of the incalculable chaotic patterns. Interpreting a postextrasystolic curve, the existence of reset zone refers to the functional integrity of the sinoatrial node, to the organisation and synchronism of sinus potentials, which depends on the balance of autonomic nervous system and on the intrinsic electrophysiological integrity of the pacemaker cells.
The authors address the two following questions: 1) Is detection of glycoregulation disorders possible from data yielded by routine annual examination (7,923 subjects)? 2) Do further investigations, carried out in a subdivision of subjects selected according to the risk of cardiovascular disease (n = 1,232), show a difference in the distribution of risk factors and risk indicators between patients and "healthy" individuals? Analysis of the results of this transversal study demonstrates a fact that is well-known concerning diabetes: even mild hyperglycemia (greater than or equal to 6 Mmol/l) is significantly correlated to age, excess weight and high systolic blood pressure. In both male and female subjects, there is a strong correlation between mean blood glucose concentration and the other biologic parameters that were studied (blood pressure, serum cholesterol, LDL/HDL cholesterol). Conversely, no correlation was found with smoking habits or with the intake of various dietary components. These results indicate that age, excess weight and increased blood pressure are simple data which are suggestive of abnormal glycoregulation. Comparison of risk factors and risk indicators in patients and "healthy" subjects showed significant differences for age, smoking habits and systolic blood pressure only. Glycemia, cholesterolemia and obesity were similar in both groups. These findings are evidence of the high risk in the subjects considered as "healthy", in whom the degree of atherosclerosis cannot be ascertained. Atherosclerosis in "healthy" individuals can certainly not be overlooked: in subjects with normal blood pressure, fundus examination showed a similar proportion of abnormalities in patients and "healthy" individuals.
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The authors report a new case of "sub optic" course of anterior cerebral arteries with an anterior communicating artery aneurysm controlled at surgery. The patient had also a distal Moya Moya, a median artery of the corpus callosum and an aortic coarctation. He underwent a first operation for cerebral aneurysm and in a second step another for aortic malformation. The authors discuss the anomaly by the way of Lasjaunia's embryologic scheme of ophthalmic arteries formation.
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Dopamine was used after open heart surgery in a group of 50 patients. The therapeutic indications were: diffuse coronary insufficiency in 27 cases, myocardial infarction in 12 cases and early septicaemic shock in 6 cases. In the other 5 cases, dopamine was prescribed for short lasting circulatory insufficiency. The dosage varied between 3-15 gammas/kg/min. The variations of different parameters were studied over 12 hours. Improvement of cardiac efficiency was an early feature (less than 3 h) and was observed for all dosages (above 3 gammas/kg/min). It was accompanied by a marked diuresis. The chromotropic effects were non-existent at these dosages. At medium-term dopamine was effective in 40 patients (80 p. 100). Dopamine is effective in over 3 out of 4 cases after cardiopulmonary bypass. Its effect is immediate, and is observed in dosages less than 10 gammas/kg/min.
The authors present a case of a continuous right lateral sternal murmur which led to the discovery of a systemic-to-pulmonary fistula at the origin of the internal mammary artery. The fact that the patient had a right pulmonary abscess with pyopneumothorax drained several years previously has led them to discuss the possible etiology of this fistula. The murmur disappeared after surgical treatment.