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Biomedical subjects

A Millaire

Publications and source records attributed to A Millaire.

At least 37 records · Page 2Linked to original sources
PubMed1996

Pericardioscopy in the etiologic diagnosis of pericardial effusion in 141 consecutive patients.

BACKGROUND: Although previous small series have documented the utility of pericardioscopy for accurate etiologic diagnosis of pericardial effusion, this technique remains underused. The aim of our study was to assess the benefits and risks of surgical pericardioscopy in a large prospective series. METHODS AND RESULTS: One hundred forty-one consecutive patients with unexplained pericardial effusion underwent 142 pericardioscopies with a rigid mediastinoscope. For each patient, the etiologic data obtained by pericardioscopy (visualization of pericardium, guided biopsies, subxiphoid window biopsy, and fluid analysis) were compared with the results that would have been obtained with only conventional surgical drainage and biopsy (subxiphoid window biopsy and fluid analysis). After complete workup, a specific cause was found in 69 cases (48.6%); the other 73 cases were considered idiopathic effusions (51.4%). Procedural and in-hospital mortality was 8 of 141 patients (5.6%). No death was directly attributable to pericardioscopy. During long-term follow-up (median duration, 24 months; range, 6 to 96), a previously unrecognized cause was discovered in 6 patients (4%). By comparing the areas under the receiver-operating characteristic curves, the diagnostic advantage of pericardioscopy was significant for the whole series (pericardioscopy, 0.98 +/- 0.011; conventional surgical drainage, 0.89 +/- 0.029; P < .001). The increase in sensitivity was more marked for some types such as neoplastic (21%), radiation-induced (100%), or purulent (83%) effusions. CONCLUSIONS: Our data demonstrate that pericardioscopy increases the diagnostic sensitivity of surgical pericardial drainage and biopsy without specific risk.

Adolescent↗
PubMed1996

Usefulness of diltiazem in the acute management of supraventricular tachyarrhythmias in the elderly.

Acute management of supraventricular tachyarrhythmias is often difficult in elderly patients. Diltiazem was given intravenously (loading dose of 0.25 mg/kg over 2 minutes followed by a 4 mg/kg/24 hr infusion) in 37 elderly patients (mean age 70 years, range 60-91). Fifteen out of the 37 patients (41%) had left ventricular cardiac disease, 12 (32%) had cor pulmonale, and 10 (27%) had no obvious cardiac disease. Hemodynamic tolerance of the supraventricular tachyarrhythmia was poor in 12 patients. A good result was defined as a return to sinus rhythm after bolus or infusion, or as a slowing of the ventricular rate (VR) to less than 100 beats/min. Of the 23 patients in atrial fibrillation, about half reverted to sinus rhythm after diltiazem, and in most of the others the ventricular rate decreased to less than 100 beats/min. Side effects occurred in 10 patients (bradycardia in 6, cutaneous rash in 2, hypotension in 2). They rapidly reversed after cessation of diltiazem. They were responsible for 2 out of the 5 poor results. Thus, diltiazem appeared effective and safe when used carefully in elderly patients with supraventricular tachyarrhythmia.

Aged↗
PubMed1996

Kinetics of oxygen consumption during and after exercise in patients with dilated cardiomyopathy. New markers of exercise intolerance with clinical implications.

OBJECTIVES: This study analyzed the kinetics of oxygen consumption during and after a maximal cardiopulmonary exercise test in patients with dilated cardiomyopathy. The prognostic information derived from indexes of recovery was also studied. BACKGROUND: Previous studies have examined the kinetics of oxygen consumption during a short recovery period in a limited number of patients. To our knowledge, no study has examined the prognostic information derived from indexes of recovery. METHODS: We studied 153 patients and 55 control subjects. We calculated the ratio between total oxygen consumption during exercise and recovery, the half-recovery time of peak oxygen consumption, the time constant of recovery, the recovery time and the ratio between duration of exercise and recovery time. RESULTS: Recovery of oxygen consumption was significantly delayed in patients, and this delay was related to the degree of exercise intolerance. After a median follow-up period of 439 days, for the total study group, percent of predicted peak oxygen consumption (p = 0.003) and ejection fraction (p = 0.03) were independent predictors of survival. In a subgroup of patients with moderate exercise intolerance (percent peak oxygen consumption > 40%), the ratio between total oxygen consumption during exercise and recovery (p = 0.013) and the ejection fraction (p = 0.013) were independent predictors of survival. CONCLUSIONS: The kinetics of oxygen consumption during recovery was delayed in patients with dilated cardiomyopathy. Although indexes of recovery were not prognostic markers in the total study group, the ratio between total oxygen consumption during exercise and recovery was an independent prognostic marker in patients with moderate exercise intolerance.

Adult↗
PubMed1996

Prevalence and clinical significance of antiphospholipid antibodies in heart valve disease: a case-control study.

The purposes of this study were (1) to assess the prevalence of antiphospholipid (aPL) antibodies in patients with non-specific heart valve disease referred for valve replacement and (2) to determine whether the presence of aPL antibodies carries a risk for thrombotic events during a postoperative follow-up in a prospective cohort. The sera of 89 consecutive patients and 80 matched control subjects were tested for antibodies to cardiolipin (immunoglobulin G and immunoglobulin M) and for lupus anticoagulant. The prevalence of aPL antibodies was significantly higher in patients (19 [21%] of 89) than in control subjects (7 [9%] of 80) (p < 0.05). Patients were divided into two subgroups according to the presence (subgroup A) or the absence (subgroup B) of aPL antibodies. No significant difference in age or sex ratio was observed between the two subgroups. A history of arterial thrombosis was more frequent in subgroup A (8 [42%] of 19) than in subgroup B (8 [11%] of 70) (p < 0.01). No significant difference with respect to the occurrence of thrombotic events was observed during a median follow-up period of 8.7 months. Thus a high prevalence of aPL antibodies was found in patients referred for heart valve replacement compared with matched control subjects. No increased risk has been demonstrated in the patients with aPL antibodies.

Antibodies, Anticardiolipin↗
PubMed1996

[Sneddon syndrome and mitral valve disease].

The authors report the case of a 37-year-old woman with widespread livedo and transient cerebral ischaemia (Sneddon's syndrome). The patient had also mitral valve disease who required commissurotomy two years ago. The research of anticardiolipin antibodies was negative. The relations between Sneddon's syndrome, antiphospholipid antibodies and valve lesions are discussed.

Adult↗
PubMed1996

[Value of spiral computed tomography with three-dimensional reconstruction in the investigation of renal arteries. An initial clinical experience apropos of 16 cases].

Renovascular hypertension represents 1 to 2% of all causes of hypertension. It is important to make the diagnosis as radical treatment may be proposed. Digitised arteriography is the reference diagnostic method. Spiral angiotomography is a new diagnostic technique for the investigation of the aorta and its branches. The examination was performed with a Siemens Somatom Plus S spiral scanner. The images were acquired after intravenous injection of 140 ml of iodine contrast medium in the forearm. Three dimensional reconstruction of the renal arteries may be performed secondarily. The results of 16 examinations were compared with those of arteriography. Nine stenoses were suspected after spiral angiotomography and confirmed in 7 cases by arteriography (sensitivity 100%; specificity 77%); two adrenal abnormalities were also detected by spiral tomography. In this series, spiral angiotomography detected all cases of renal artery stenosis with good specificity. Moreover, this investigation also allowed evaluation of the adrenal glands. The simple, non-invasive and polyvalent nature of this method should, if the results are confirmed in a large series, lead to its use as the investigation of first intention for suspected secondary causes of hypertension.

Female↗
PubMed1996

[Acute myocarditis caused by toxoplasmosis simulating infarction. Apropos of a case].

Acute myocarditis due to toxoplasmosis infection has been previously reported, usually in patients suffering from immuno-depression. Cardiac involvement by toxoplasmosis is rare in subjects with a normal immunological status. The authors report the case of a 16-year-old patient without immuno-depression with acute myocarditis caused by toxoplasmosis simulating myocardial infarction.

Acute Disease↗
PubMed1996

[Aortitis in Horton disease. Review of the literature].

First described in 1937, giant cell aortitis (aortitis associated with giant cell arteritis) occurs in 20 to 40% of patients with giant cell arteritis and is often clinically silent. Temporal involvement usually precedes aortic involvement. The process may involve the entire aorta, but complications are usually related to thoracic involvement. Patients with giant cell aortitis may be asymptomatic, or present with aortic arch syndrome, dilation of the aorta, aortic aneurysm, aortic dissection, sudden rupture of the aorta, or aortic valve incompetence. Thoracic aneurysms are usually fusiform and can be complicated by dissection in up to 50% of patients. Aortic involvement may be the presenting feature of giant cell arteritis: it may also occur in patients with preexisting temporal arteritis, often when corticosteroid therapy is reduced or discontinued. Aortic rupture complicating aortitis may be the cause of death in 3-12% of patients with giant cell arteritis. Clinical follow-up with assessment of disease activity by chest X-ray and biological markers of inflammation should be performed yearly in giant cell arteritis. Aortic involvement should be suspected if cardiac or vascular echo-Doppler shows evidence of an aortic arch syndrome, aortic dilation, aneurysm, or of aortic valve incompetence. Corticosteroid therapy, beginning with a dose of 1 mg/kg/day remains the key point of therapy. The dose is subsequently adjusted based on the clinical course and the results of ancillary tests. This treatment might prevent fatal outcome with aortic rupture. Long-term follow-up of all patients with giant cell arteritis or polymyalgia rheumatica is essential, as complications may develop late in the course of the disease.

Aortitis↗
PubMed1995

RF-transmitted CsI radio-isotopic ambulatory recorder for left ventricular ejection fraction monitoring.

We have developed a CsI multidetector probe in order to produce a nuclear ambulatory recorder to study simultaneously cardiac electric activity and the left ventricular ejection fraction. To make the device lighter, the electronics were designed with surface-mounted technology, and a serial data RF transmission system was used. The data are processed on a real-time basis using a portable microcomputer. Unlike other commercially available devices, this monitor avoids the problems of volume, weight, recording time capacity and slow off-line data processing. Our device permits global and regional analysis of the ejection fraction for a moderate manufacturing cost. It is intended primarily for ambulatory use and can easily be adapted to perform a monitoring function. The first tests on patients conducted using the prototype demonstrate the technical reliability and satisfactory operation of the device.

Cesium↗
PubMed1995

Plasma levels of endothelin-1 at rest and after exercise in patients with moderate congestive heart failure.

Plasma levels of endothelin-1 are increased in patients with severe congestive heart failure related to various etiologies. However, conflicting data have been published in patients with moderate congestive heart failure. Moreover, the effect of exercise on plasma levels of endothelin-1 is not precisely known. We determined the plasma levels of endothelin-1 in a homogenous group of patients with idiopathic dilated cardiomyopathy in stage II of the New York Heart Association functional classification at rest and at peak exercise. In this group of patients, plasma levels of endothelin-1 were increased compared to a control group (2.9 +/- 0.27 vs. 1.96 +/- 0.24 pmol/l, P < 0.01, mean +/- S.E.M.), as were plasma levels of atrial natriuretic peptide (26.3 +/- 6.3 vs. 2.95 +/- 0.7 pmol/l, P < 0.001), plasma renin activity (12.6 +/- 2.98 vs. 1.75 +/- 0.23 ng/ml per h, P < 0.001) and plasma levels of aldosterone (217 +/- 29.3 vs. 154 +/- 18.8 pg/ml, P < 0.05). In contrast to the other hormones, exercise did not increase plasma levels of endothelin-1. There was no correlation between plasma levels of endothelin-1 and plasma levels of atrial natriuretic peptide, and no correlation between left ventricular ejection fraction, peak oxygen consumption and hormonal values. In conclusion, plasma levels of endothelin-1 are increased in a homogeneous group of patients with idiopathic dilated cardiomyopathy and moderate congestive heart failure. Endothelin-1 could participate in the progression of heart failure. Exercise did not increase the plasma levels of endothelin-1 in contrast to the other hormones.

Adult↗
PubMed1995

Outcome after thrombolytic therapy of nine cases of myopericarditis misdiagnosed as myocardial infarction.

Anecdotal reports have suggested that cardiovascular complications may occur if thrombolytic therapy is performed in cases of pericarditis misdiagnosed as acute myocardial infarction. From 1980 to 1993, 47 cases of myopericarditis mimicking myocardial infarction have been admitted to our institution. The misdiagnosis was made because of clinical onset characterized by a typical chest pain, and/or localized ST segment elevation. Since 1987, nine (9/9 males, age 40 +/- 14 years) out of the 47 patients (19%) have been treated with a thrombolytic agent (streptokinase 4/9, rt-PA 5/9) followed by intravenous heparin. This treatment was started during the pre-hospital phase (2/9) and while in hospital (7/9). No pericardial rub was present; ST segment elevation was mainly localized in inferior and lateral leads; no Q wave developed; median creatine kinase rise was 268 units (range 38 to 1280), and only one patient had a small pericardial effusion. The mean level of fibrinogen after thrombolysis was 1.72 g.l-1 (range 0.10 to 4.50). In all cases, typical ECG changes were present suggesting pericarditis with a subsequent return to a normal ECG. No severe cardiac or pericardial complication or arrhythmia occurred; only one patient developed a non-compressive and resolvable pericardial effusion. Cardiac catheterizations (coronary and left ventricular angiographies) were normal when performed (5/9). Long-term follow-up (mean 46 +/- 29 months) was favourable without any coronary events. In conclusion, thrombolytic therapy was uncomplicated in our patients with myopericarditis simulating evolving myocardial infarction.

Adolescent↗
PubMed1995

Doppler echocardiography in familial hypertrophic cardiomyopathy: the French Cooperative Study.

UNLABELLED: Familial hypertrophic cardiomyopathy (HCM) has been poorly studied, although it may represent 50% of all HCM. We studied 346 subjects belonging to 20 unrelated families. Patients were considered affected in view of left ventricular (LV) wall thickness. One hundred twenty-seven adults were considered affected, id est. had a left ventricular wall thickness (LVWT) > 13 mm, whereas 123 had a LVWT > 15 mm, suggesting that the cut-off value is usually not critical. Within affected patients, 95% had an asymmetrical HCM (interventricular septum/left posterior wall thickness > 1.3 mm), whereas 84% had a ratio > 1.5. Distribution of the affected patients according with Maron's classification are in keeping with published studies about sporadic forms. Doppler derived isovolumetric relaxation time was prolonged in HCM (105 +/- 23 vs 88 +/- 16 msec, P < 0.001), and the ratio peak velocity of A wave over peak velocity of E wave was significantly lower in affected individuals (0.99 +/- 0.56 vs 0.83 +/- 0.46, P < 0.05). None of the 24 children studied (10 +/- 3 years) were considered affected according to echocardiographic criteria. CONCLUSION: Echocardiography is the obligatory first step during genetic study for recognizing familial HCM. It allows classification in adults but not in children. Doppler estimate of diastolic function may be helpful in the future to recognize genetically affected subjects with normal or subnormal echocardiographic examination.

Adult↗
PubMed1995

Comparative diagnostic value of ankle-to-brachial index and transcutaneous oxygen tension at rest and after exercise in patients with intermittent claudication.

BACKGROUND: Few studies have compared sensitivities of ankle-to-brachial index (ABI) and transcutaneous oxygen tension (TcPO2) in a large group of patients with Leriche stage II intermittent claudication. METHOD AND RESULTS: 111 patients (138 limbs) with a stable chronic (> three months) intermittent claudication and significant peripheral vascular disease (PVD) proved by angiography were studied. They performed a treadmill test (10%, 3 km/hr) limited by limb pain. ABI and TcPO2 were measured before, just after exercise, and after three and ten minutes of recovery in supine position. Sensitivities per patient for ABI and TcPO2 were respectively at rest: 82.9% and 28.8%, and after exercise: 88.3% and 62.2%. Sensitivities per leg (n = 138) for ABI and TcPO2 were respectively at rest: 73.9% and 26.8%, and after exercise: 82.6% and 34%. The sensitivity of TcPO2 increased to 56.5% after three minutes of recovery but was always less than that of ABI, which was maximal just after exercise (82.6%). The sensitivity of the regional perfusion index was similar to that of TcPO2. The sensitivity of TcPO2 increased with respect to the Leriche stage and the number of lesions but was always lower than that of ABI. There was a weak correlation between TcPO2 and ABI after exercise, but no correlation was noted between maximal walking distance, ABI, and TcPO2. CONCLUSION: TcPO2 is not required in patients with Leriche stage II intermittent claudication but might be useful either in severely affected patients (Leriche stage III or IV) or in selected patients.

Aged↗
PubMed1995

[Clinico-pathological polymorphism of hypertrophic cardiomyopathy in echocardiography].

An echocardiographic Study of 322 adults (age: 40 +/- 16 years), belonging to 20 families with hypertrophic cardiomyopathy (HCM), was undertaken. Affected subjects had a LV diastolic wall thickness > 13 mm. The patients were classified according to the distribution of left ventricular hypertrophy (LVH) and by Maron's classification: 189 subjects were normal, 127 were affected and 6 could not been classified. By Maron's classification: 3% were type I, 33% were type II, 58% were type III and 6% were type IV. LVH was asymmetrical in 95% of cases (septum/posterior wall ratio > 1.3). The familial distribution of LVH of the 4 families in which HCM was genetically related to different loci (chromosome 11, 14 exon 13, 14 exon 8, fifth locus); the LVH was analysed from two short axis LV parasternal views and each plane was divided into 5 segments. The distribution of LVH was said to be identical between two first degree relations when all the same segments were affected, similar when they differed by only 1 or 2 segments and different when they differed by 3 or more segments. In the 26 pairs studied, LVH was identical in 2/26 (8%), similar in 11/26 (42%) and different in 13/26 (50%). Familial HCM usually gives rise to asymmetrical LVH affecting the septum and free wall. An identical distribution in 50% of affected first degree relatives.

Adolescent↗
PubMed1995

[Surgical treatment of hypertrophic cardiomyopathy; techniques, indications and results].

Many techniques have been proposed for the treatment of hypertrophic cardiomyopathy over the last 35 years: myotomy, septal myotomy-myectomy, isolated mitral valve replacement with a low profile prosthesis, cardiac transplantation. Usually, the patients referred for surgery are those who do not respond or are resistant to medical therapy (patients in NYHA classes III or IV). The usual indication for myomectomy is a significant subaortic gradient and major septal hypertrophy (> 18 mm). When mitral regurgitation is severe or organic, mitral valve replacement is associated. When septal hypertrophy is moderate (< 18 mm) or not evenly distributed, or after ineffective myomectomy, mitral valve replacement may be proposed. Cardiac transplantation is only considered when all medical and surgical possibilities have been exhausted. Analysis of the results of surgery (over 1,000 published cases) is hindered by the variability of the techniques employed, the indications and experience of the different groups. The operative mortality has significantly decreased (25% in the 1960s to 2 to 11% at present). The complications of myomectomy are mainly postoperative ventricular septal defects and atrioventricular block, some of which require implantation of a pacemaker. Peroperative transoesophageal echocardiography could help to reduce the operative risk even further. Surgery improves symptoms and increases exercise capacity. The benefits seem greater, more frequent and longer lasting than with medical therapy. Surgery should not, however, be considered to be curative as some patients remain at risk of developing symptoms related to physiopathological phenomena other than intraventricular obstruction (poor left ventricular filling, myocardial ischaemia, arrhythmias). Although some workers suggest improved survival, there have been no controlled trials on this subject.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗