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Biomedical subjects

A Rimailho

Publications and source records attributed to A Rimailho.

54 records · Page 3Linked to original sources
PubMed1984

Effects of captopril on pulmonary haemodynamics.

The effects of oral captopril on pulmonary haemodynamics were studied in two groups of 6 patients, one of subjects with chronic respiratory failure (PaO2 52 +/- 5.1 mmHg, PaCO2 54 +/- 2.1 mmHg), and the others with chronic heart failure and high plasma renin activity. Two potential mechanisms of its actions were assessed, namely inhibition of hypoxic vasoconstriction and inhibition of the possible effects of angiotensin II on the pulmonary circulation. There were significant (p less than 0.05) decreases in mean arterial pressure, pulmonary wedge pressure and in systemic arterial resistance associated with improvement in cardiac index in both groups. In the chronic respiratory failure group there was no change in blood gases, mean pulmonary arterial pressure or pulmonary vascular resistance. An increase in driving pressure (p less than 0.05) indicated that captopril had had no effect on pulmonary haemodynamics. In chronic heart failure, mean pulmonary arterial pressure and pulmonary capillary wedge pressure were decreased by a similar extent, so that driving pressure and pulmonary vascular resistance were not changed. It is concluded that oral captopril did not inhibit hypoxic vasoconstriction, and that it modified pulmonary haemodynamics in chronic heart failure patients with high renin activity only as a consequence of reduction in systemic afterload.

Adult↗
PubMed1983

[Value of captopril in the treatment of systemic arterial and pulmonary hypertension with increased plasma renin in scleroderma].

The effects of the converting enzyme inhibitor captopril (Lopril) were studied in a 53 year old woman with acute exacerbation of scleroderma. In addition to her chronic symptoms of Raynaud's syndrome, the patient presented with severe hypertension, cardiac failure and oligoanuria. Right heart catheterisation with a Swan-Ganz catheter confirmed the systemic hypertension with cardiac failure, and also demonstrated precapillary pulmonary hypertension with raised pulmonary arterial resistance. The organic renal failure was an indication for renal biopsy which showed segmental and focal fibrinoid necrosis with microthrombosis and chronic ischemic changes. Due to raised plasma renin activity, treatment with captopril was instituted, leading to a rapid normalisation of systemic and pulmonary hypertension, the regression of cardiac failure and a transient improvement in the Raynaud's syndrome. The renal failure did not improve and the patient had to undergo chronic hemodialysis. These spectacular initial results should be interpreted in the context of the poor prognosis of acute exacerbations of scleroderma despite the encouraging data published recently after well-controlled antihypertensive therapy.

Adult↗
PubMed1983

Combined hemodynamic effects of dopamine and dobutamine in cardiogenic shock.

In eight mechanically ventilated patients in cardiogenic shock, we assessed the hemodynamic effects of an infusion of dopamine and dobutamine and evaluated its role in preventing the deleterious effects of administering each amine alone. Each patient received three infusions in a randomly assigned order: dopamine, 15 micrograms/kg/min; dobutamine, 15 micrograms/kg/min; and a combination of dopamine, 7.5 micrograms/kg/min, and dobutamine, 7.5 micrograms/kg/min. Stroke volume index increased similarly with the three infusions, but dopamine alone increased oxygen consumption (p less than 0.05 vs dobutamine alone and dopamine-dobutamine combined). The dopamine-dobutamine combination increased mean arterial pressure (p less than 0.05 vs dobutamine), maintained pulmonary capillary wedge pressure within normal limits (p less than vs dopamine), and prevented the worsening of hypoxemia induced by dopamine (p less than 0.05). The dopamine-dobutamine combination appears to be useful in the management of mechanically ventilated patients in cardiogenic shock.

Aged↗
PubMed1983

[Fatal pulmonary embolism with a normal PaO2].

A case of massive pulmonary embolism confirmed by angiography and necropsy, without arterial hypoxemia (PaO2 = 109 torr while the patient breathing room air) was reported. The onset of hypoxemia and increase in venous admixture secondary to cardiac output improvement with dobutamine was discussed.

Aged↗
PubMed1982

[Non-surgical pneumoperitoneum complicating status epilepticus. Two cases (author's transl)].

Two cases of pneumoperitoneum following status epilepticus are reported. In both patients perforation of a hollow viscus was excluded by laparotomy and status epilepticus had been accompanied by haematemesis. An increase in upper digestive tract pressure resulting from high abdominal pressure during seizures might have caused leakage of air into the peritoneum through lacerations in the lower oesophageal mucosa. Awareness of this mechanism of non-surgical peritoneum would avoid unnecessary exploratory laparotomy in these seriously ill patients.

Female↗
PubMed1981

[Idiopathic aneurysm of the left ventricle. Apropos of 4 cases operated on with success].

Over a period of 3 years, 4 cases of idiopathic left ventricular aneurysm, 3 white females and one coloured male aged 34, 53, 29 and 47 years respectively, were observed. All presented with paroxysmal ventricular or supraventricular tachycardia, which, in one case, was severe enough in itself to justify surgery. On angiography, large left ventricular aneurysms bordering the mitral annulus and responsible for moderate mitral regurgitation in two patients were demonstrated. Aneurysmectomy was only possible in 2 cases, the other two having pericardial adhesions with a risk of uncontrollable haemorrhage during dissection being managed by suture of the neck of the aneurysm. The surgical results were very satisfactory, especially with respect to the arrhythmias with a follow-up of 48, 24, 15 and 9 months respectively. In a review of the literature, 93 cases of idiopathic left ventricular aneurysm were analysed, less than 20 of which have been managed surgically. Left ventricular aneurysms seem to be large fibrotic structures located at the border of the mitral, or, less commonly, below the aortic annulus. It is important to differentiate them from congenital left ventricular diverticuli which are usually located at the apex, have muscular walls and are therefore contractile. The aetiology of these aneurysms is unknown: the possible role of myocardial infarction may be excluded as the coronary arteries are always normal on angiography and at autopsy. The relatively young age of the patients is also an argument against this hypothesis. Other suggested causes such as syphilis, tuberculosis, Chagas' disease, non-specific myocarditis, sarcoidosis and thoracic trauma may also be excluded. Surgery seems to be indicated in cases complicated by resistant arrhythmias, peripheral embolism or when the aneurysm increases rapidly in size.

Adult↗
PubMed1981

[Mitral incompetence as presenting feature of idiopathic left ventricular aneurysm (author's transl)].

A further case of the exceptionally rare condition of idiopathic left ventricular aneurysm is reported in which the lesion was detected in a most unusual manner. The patient, a young 22-year-old negro woman, had been admitted for investigation of a mitral incompetence. The true diagnosis was established by angiography, which demonstrated a large multilobular left ventricular aneurysm, also communicating with the left auricle, this being the cause of the mitral incompetence. Surgical correction of the lesion suppressed the mitral leak without touching the normal mitral apparatus.

Adult↗
PubMed1979

[Severe drug complications: current prevalence amongst patients admitted to adult intensive care units (author's transl)].

A retrospective study involving nine teaching hospital mixed intensive units provided information concerning severe drug complications amongst patients admitted to these departments over the past ten years. Amongst a total of 63717 patients admitted, there were 1132 drug complications (1.8%) without any predominance in terms of sex. Mortality was high (252 patients, i.e. 22.2%), being all the greater in older patients. Details concerning the various drug complications are given, the most common being anaphylactic shock and haemorrhage due to anticoagulants. These statistics are compared withthose already published by hospital departments of internal medicine.

Age Factors↗
PubMedDate not supplied

[Hepatic and renal toxicity of paracetamol in chronic alcoholic patient].

After taking paracetamol regularly in therapeutic doses, a non-cirrhotic alcoholic subject developed hepatic necrosis and acute renal failure. This case is compared with 13 others found in the literature, and the clinical, biochemical and histological characteristics of such accidents are described. The severity of the acute renal failure is proven by the fact that 50% of the patients had to be put under dialysis. The potentiation of acetaminophen renal and hepatic toxicity by alcohol toxicity is discussed. The principal mechanism of enhancement is the activation of the cytochrome P 450 system associated with depletion of intracellular glutathione.

Acetaminophen↗