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Biomedical subjects

A Grand

Publications and source records attributed to A Grand.

At least 55 records · Page 3Linked to original sources
PubMed1993

[Does female coronary insufficiency lead to any peculiar therapeutic problems?].

The diameter of the coronary arteries is smaller in women than in men and this phenomenon enhances the difficulty of surgical anastomosis. Atheromatous stenosis is more often confined to a single vessel and, in one out of three female anginal patients, the coronary arteries are angiographically normal. The incidence of spasm is the same in both sexes. However, the prognosis of myocardial infarction is worse in women than in men. In women, smoking is by far the commonest atheromatous risk factor and oral contraception is also significant when associated with smoking and hypertension. Drug therapy of coronary artery disease is the same in both sexes although thrombolysis of acute myocardial infarction gives in women less favourable results in terms of mortality. On the other hand, coronary angiography is less commonly undertaken in women than in men. When operated, women are more difficult to revascularise completely than men and operative mortality is higher. Angina regresses less frequently but survival is the same. Early results of coronary angioplasty are usually poorer in women with a higher incidence of complications and a significantly higher immediate mortality: however, at medium-term, the efficacy of angioplasty is the same in both sexes although more women continue to suffer of anginal attacks. Suppression of smoking and prescription of hormone replacement therapy for menopausal women delay the apparition and limits the severity of female coronary artery disease.

Aged↗
PubMed1993

[Pregnancy and cardiac drugs].

Any treatment used in pregnant women must take into account the effects of the substance in question of the fetus and the particular sensitivity of the latter during the first three months of development. The majority of drugs used in cardiology can be prescribed during pregnancy: digitalis preparations, furosemide, certain beta-blockers, verapamil, nifedipine (except during the first three months), quinidine, disopyramide, lignocaine, flecainide, amiodarone, heparins (non-fragmented and low molecular weight), central antihypertensive agents, dipyridamole and aspirin. In contrast, some drugs should be avoided because of insufficient information regarding their maternal and fetal consequences (bumetamide, modamide, the most recent beta-blockers, cibenzoline, ticlopidine) or because of harmful adverse effects on the fetus (spironolactones, bipyridines, diltiazem) or the newborn infant (angiotensin converting enzyme inhibitors). Finally, with certain medications (propafenone, oral anticoagulants), it is important to be able to compare maternal risks due to the disease and fetal risks induced by the drug. Modification of the conditions of use of these drugs and very careful monitoring of the patient most often suffice to avoid untoward events or complications with potentially serious medicolegal consequences and which may implicate the liability of the prescriber.

Cardiovascular Agents↗
PubMed1992

[Pregnancy and cardiovascular agents].

Any treatment used in pregnant women must take into account the effects of the substance in question of the fetus and the particular sensitivity of the latter during the first three months of development. The majority of drugs used in cardiology can be prescribed during pregnancy: digitalis preparations, furosemide, certain beta-blockers, verapamil, nifedipine (except during the first three months), quinidine, disopyramide, lignocaine, flecainide, amiodarone, heparins (non-fragmented and low molecular weight), central antihypertensive agents, dipyridamole and aspirin. In contrast, some drugs should be avoided because of insufficient information regarding their maternal and fetal consequences (bumetamide, modamide, the most recent beta-blockers, cibenzoline, ticlopidine) or because of harmful adverse effects on the fetus (spironolactones, bipyridines, diltiazem) or the newborn infant (angiotensin converting enzyme inhibitors). Finally, with certain medications (propafenone, oral anticoagulants), it is important to be able to compare maternal risks due to the disease and fetal risks induced by the drug. Modification of the conditions of use of these drugs and very careful monitoring of the patient most often suffice to avoid untoward events or complications with potentially serious medicolegal consequences and which may implicate the liability of the prescriber.

Anticoagulants↗
PubMed1992

[Vasospastic angina with angiographically normal coronary vessels of iatrogenic origin. Apropos of 2 cases].

Two cases of angina pectoris, induced by methylergometrine (Methergin) and by an association of ergotamine tartrate (Gynergene) and methysergide (Desernil) respectively, are reported. In both patients, angiography revealed spontaneous spasm in a coronary system free from any significant atheromatous stenosis. In the second case, a test administration of i.v. Methergin, administered during calcium-channel antagonist treatment a few days after the "guilty" drugs had been stopped was found to be negative. The outcome was favorable in both cases: the angina disappeared and the base-line and exercise ECG returned to normal. The hypothesis of coronary spasm induced by the treatment was adopted in both cases. In this context, the major iatrogenic etiologies of vasospastic angina are recalled, together with the prophylactic and therapeutic measures they call for.

Adult↗
PubMed1992

[Effect of tobacco smoking on the incidence of recurrent myocardial infarction. A retrospective study of 208 cases].

Two hundred and eight patients, less than 60 years of age at the time of their first myocardial infarction (MI), which occurred between 1 July 1976 and 30 September 1982, and with a mean recurrence-free follow-up period of 3450 +/- 142 days, were included in a retrospective survey. This concerned the outcome of their coronary artery disease and the persistence of vascular risk factors, notably their tobacco consumption, the extent and forme of which was detailed. This study showed: 1) the mortality rate was 8.8%, 2) 78.4% of the patients smoked before their infarction, 3) 76% of the smokers stopped smoking after this event. The risk of recurrence of infarction was higher amongst smokers. After 5 years, 51.6 +/- 15% of the subjects who had not reduced their daily tobacco consumption had suffered another MI, versus 21.5 +/- 3% of those who had reduced it by 1 to 50%, 16.9 +/- 6% of those who had never smoked and only 10.5 +/- 6% of those who had reduced it by more than 50% or had stopped smoking (p less than 0.02). The relative risk of recurrence of infarction in persistent smokers was 4.4 times that in subjects who had stopped smoking. However, no significant difference was found between the mortality in the various subgroups. In addition to smoking, only two factors were found to significantly promote the onset of a fresh MI: an initial infarction with no Q wave (p = 0.007), and the persistence of spontaneous angina pectoris (p = 0.0009).

Adult↗
PubMed1992

[Cerebral embolism disclosing a left intraventricular thrombus 6 years after atypical infarction].

The authors report a case which is unusual because of the late presentation, as a cerebral embolism, of a left intraventricular thrombus six years after an infarction. This thrombus was absent at the acute stage of the infarction. The conditions surrounding the development of a thrombus after an infarction are reviewed. This is a common complication at the acute stage of an anterior infarction, notably when there is apical akinesia. The late onset of these thrombi has not been extensively studied in the literature. This would appear to be a fairly rare event but which, as shown by our case, pleads in favour of very prolonged anticoagulant treatment after certain myocardial infarctions.

Adult↗
PubMed1992

[Cardiovascular risk after menopause].

It is highly probable that the menopause, spontaneous or above all artificially induced, is a cardiovascular risk factor. However, it is less important than other conditions (hypertension, smoking, obesity, diabetes, hypercholesterolemia) with which it is often associated and which it may favourise or worsen. In this respect, hormone replacement therapy is probably beneficial, probably by an action on the arterial endothelium itself, and certainly by opposing the factors which favourise the development of atheroma (metabolic and hemostasis disorders). Its aims and techniques, and hence its cardiovascular consequences, are very different from those of hormonal contraception, with which it must neither be compared nor confused. It would be reasonable, on the basis of these advantages, to extend the indications of post-menopausal hormone replacement therapy to an increasing number of women and for a longer period.

Aged↗
PubMed1991

X-ray structure of the (2,2,6,6-tetramethylpiperidin-1-oxyl-4-yl)2,3,4,6- tetra-O-acetyl-beta-D-glucopyranoside.

The crystal structure of (2,2,6,6-tetramethylpiperidin-1-oxyl-4-yl)2,3,4,6-tetra-O-acetyl-b eta-D- glucopyranoside, C23H36NO11, is orthorhombic, P2(1)2(1)2(1), with Z4, a 6.207(1), b 14.219(1), and c 30.986(2) A. It was solved by use of the MULTAN program and refined to a RW value 0.044, for 2874 observed reflections. It has a head to tail arrangement, each piperidine heterocycle being located between the carbohydrate residues of each neighboring molecule.

Crystallography↗
PubMed1990

Disability, psychosocial factors and mortality among the elderly in a rural French population.

The purpose of this work is to identify risk markers of mortality in a cohort of 645 people aged 60 and over. The study was carried out in rural areas in south west France. Data were collected by questionnaire in 1982. Mortality was determined 4 years later; 111 deaths were registered. The analysis of age-adjusted odds ratios (OR) showed strong relationships between mortality and disability (OR = 7.75), compared health (OR = 3.94), self-rated health (OR = 2.47), home comfort (OR = 0.52), physical activity (OR = 0.32), sociability (OR = 0.43) and two subjective well-being items: the feeling of uselessness (OR = 3.51), and the lack of projects for the future (OR = 2.35). By contrast, no significant association was observed with reported morbidity and social support. Two multivariate analyses were performed: the first on longevity using Cox's regression model, the second on mortality using a linear discriminant analysis. The results of these analyses were translated into a simple set of 8 independent risk markers for the identification of a "high risk group" of mortality within 4 years. The sensitivity of this mortality risk indicator was 73% and its specificity 77%.

Age Factors↗
PubMed1990

[Value of the assay of serum myoglobin in recent myocardial infarction].

The serum myoglobin (MG) was assayed by the radio-immunological method in 30 patients, all victims of a recent myocardial infarction (MI) and in 30 tests subjects suffering (21 cases) or not (9 cases) from heart diseases, but none from myocardial infarction (MI). The blood samples have been collected on hospital admission of the patient, then every four hours during the first 48 hours and finally, every 12 hours from the 48th to 72nd hour. The normal value is less than 85 micrograms/l. The creatine-kinase (CK), the aspartate aminotransferase (ASAT), the alanine aminotransferase (ALAT) and the lactate dehydrogenase (LDH) were also assayed each time. In MI, there is a significant increase in the serum MG level (731 +/- 323 micrograms/l against 174 +/- 198 micrograms/l in the test subjects; p less than 0.001). The sensitivity of this assay reaches 97%, its specificity 80%, its positive predictive value 83% and its negative predictive value 96%. Starting from the beginning of the characteristic pain of infarction, the MG level exceeds the normal values after 3.3 +/- 1.6 hours, reaches its maximum after 9.3 +/- 3.7 hours and comes back to normal after 38 +/- 8.1 hours. On the other hand, the MG level does not enable any conclusion regarding either the transmural/not transmural nature, or the site, or the acuteness of the MI.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

[Coronary insufficiency caused by atherosclerosis. Current pathogenic concepts, clinical, angio-anatomic correlations and therapeutic deductions].

The multiplicity of clinical expressions of coronary artery failure results from the interaction between three processes which varies from one patient to another and from one time to another in a given patient. The three processes involved are: atheromatous coronary stenosis, arterial spasm and the development of a fibrino-thrombocytic thrombus. In stable angina pectoris, atheromatous narrowing, with smooth, regular outlines, no endothelial injury and little likelihood of complication by thrombosis predominates. In contrast, labile angina and myocardial infarction give rise to the same lesions: usually irregular stenoses, with a narrow neck and irregular outline. They correspond histologically to the rupture of an atheroma plaque, frequently complicated by the appearance in situ of a clot. In the authors' experience, complete arterial occlusion ensues in three out of four cases. The rate at which aggravation progresses and the variable degree of collateral circulation explains why a whole range of intermediate clinical expressions are possible, ranging from labile angina to sudden death of ischemic origin, and including various forms of infarction (both with and without the Q wave). Healing of these lesions may also be observed, usually resulting in progression of the coronary stenosis and sometimes of modification of left ventricular function of variable duration (myocardial stunning or hibernation). The importance of thrombotic phenomena in triggering the most serious forms of coronary artery failure (labile angina and myocardial infarction) provides a more precise identification of the place of thrombolytic treatment. In addition, it appears that there is no point in emergency revascularization of the ischemic myocardium. However, despite recent clinical progress, coronary artery disease remains a worrying illness which calls for primary prevention measures. Such measures must be undertaken as soon as possible if they are to be effective.

Angina Pectoris↗
PubMed1990

[Value of echocardiography in aged patients with presumed idiopathic auricular fibrillation].

Thirty seven patients (mean age = 80.2 years with extremes from 66 to 98 years), presenting atrial fibrillation (AF), presumably idiopathic (non known heart disease, completely normal cardiac auscultation, good quality chest X-ray and electrocardiogram, no laboratory test anomaly), and paroxystic (n = 7: 19 p. cent) or permanent (n = 30: 81 p. cent), were given an electrocardiogram TM and bidimensional. In only 9 of them (24.3 p. cent), this examination is completely normal. Three other patients (8.1 p. cent) present an isolated dilatation of the left atrium. The 25 remaining patients present various cardiopericardic anomalies: valvular pathologies (n = 2: 59.4 p. cent): mitral (n = 15: 40.5 p. cent) more often than aortic (n = 7: 18.9 p. cent); myocardiopathies (n = 8: 21.6 p. cent), hypertrophic (n = 2), dilated (n = 4) or hypertrophic and dilated (n = 2); moderate pericardial effusion (n = 1: 2.7 p. cent). The mean left and right ventricular diameters, measured in TM mode, are normal as well as the mean contractility indexes (percentage of shortening of the small axis, stroke volume) and the mean filling index (mitral gradient EF) of the LV. Overall, the transverse diameter of the LA is moderately increased (41.9 +/- 9.7 mm); it is not significantly different from the AF, either paroxystic (41.5 +/- 4.9 mm) or permanent (42 +/- 9.93 mm) and whether it is (40.5 +/- 9.9 mm =) or not (42.5 +/- 8.8 mm) complicated by a systemic embolism, especially cerebral. Therefore, the sonocardiogram demonstrates a latent cardiopathy in two-thirds of the patients over 65 presenting a presumably idiopathic AF.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

[Angiographic morphology of the coronary arteries after a recent myocardial infarction treated by intravenous thrombolysis].

Thirty patients (26 men, 4 women) aged from 32 to 73 years (mean 54 years) who developed anterior (14 cases) or posterior (16 cases) myocardial infarction received intravenous streptokinase in doses of 1,500,000 units 2 to 10 hours (mean 4 hours) after the onset of infarction. Coronary angiography, performed 18.6 days on average after thrombolysis, showed a distinct predominance of asymmetrical stenosis with irregular walls and a narrow neck (10 cases, 33 p. 100) or of complete occlusion (12 cases, 40 p. 100) in the artery responsible for the infarction. Complete occlusion probably was the ultimate stage of stenosis. In contrast, the various angiographic images observed in arteries unrelated to the infarction were evenly distributed. The radiological morphology of coronary arterial lesions after a recent infarction is suggestive of ruptured atheromatous plaque, sometimes complicated by thrombosis in situ. Identical images are seen in unstable angina. These findings indicate that one single therapeutic approach should be applied to the most severe types of coronary disease due to atherosclerosis.

Adult↗
PubMed1989

[Disabilities during aging: descriptive approach and risk factors. 4-year longitudinal study of an aged rural population].

A longitudinal survey has been conducted from 1982 to 1986 in a rural population of 645 persons aged 60 and over. The aim of this study is to analyse the evolution of disabilities in this population and the main risk factors. The incidence of disabilities within 4 years is more important in the oldest birth-cohort groups and this result suggests a cumulative effect of the ageing process and chronic diseases. Indeed, the assessment of predictive factors shows that age and reported morbidity are related to the incidence of disabilities, but two other factors are strongly related to the loss of functional abilities after age adjustment: socioeconomic status and the feeling of uselessness. We conclude that disability in the elderly is not an inevitable consequence of the physiological ageing process and that a preventive approach should be based on a multidimensional concept: physical, social and psychological.

Aged↗
PubMed1988

Predictive value of life events, psychosocial factors and self-rated health on disability in an elderly rural French population.

Increasing evidence suggests that exposure to stressful life events and a variety of psychosocial factors are related to different health outcomes in the elderly. Our purpose is to study the predictive value of each of these items on the ability deterioration of a panel of 645 rural adults, aged 60 and over, living at home and followed for 4 years (1982-1986). This survey was carried out in five rural areas of Haute-Garonne (South-West France). Data were collected from the elderly themselves by questionnaire in 1982 and 1986. An indicator of ability evolution (1982-1986) was constructed for all those surviving and reviewed in 1986. Our study concerned 470 elderly people. Ability deterioration was 55.3% (260 elderly people). The analysis of age-adjusted relative risks (RR) of ability deterioration showed a significant impact of economic level (RR = 2.3), self-rated health (RR = 2.2) and reported morbidity (RR = 2.2). Among the psychosocial factors, we noted the predictive role of a lack of project for the future (RR = 1.7) and mostly of a feeling of uselessness (RR = 9.8), but also of non-participation in association activities for people aged less than 75. All these relationships remain significant after adjustment according to reported morbidity. In contrast, no significant effect was found for social support and life events which occurred during the follow-up period. Logistic discriminant analysis and segmentation analysis were performed. They confirmed the independence of the predictive roles played by age, economic level, reported morbidity and the feeling of uselessness. These results, discussed with bibliographic data, should give a better knowledge of the processes which underlie pathological ageing.

Activities of Daily Living↗
PubMed1987

Angiographic morphology and intraluminal coronary artery thrombus in patients with angina pectoris: clinical correlations.

A prospective study was conducted in 104 consecutive patients who underwent coronary angiography for the evaluation of angina pectoris. 50 patients experienced unstable symptoms, while the rest of them were stable. Coronary lesions reducing the luminal diameter by at least 50% were compared between both groups according to localization, grade, length, type and collateralization. Eccentric irregular lesions (EIL) appeared more frequently in the unstable group of patients (27% vs 3%, P less than 0.01), while the incidence of concentric lesions was higher in stable group (45% vs 26%, P less than 0.02). There was no significant difference in localization, grade, length, or collateralization. EIL were most frequently identified as spontaneous AP producing lesions (55%, P less than 0.001) in 29 patients in the unstable group. Spontaneous angina was associated in 86% with EIL, occlusions, or filling defects--all of these lesions might contain occlusive or nonocclusive thrombi. EIL with a narrow neck appeared on angiograms earlier than EIL with a wall irregularity. We conclude that EIL is a sensitive and very specific angiographic marker of unstable AP. The morphologic details of EIL may help one to choose appropriate therapy.

Angina Pectoris↗