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Biomedical subjects

A Sacrez

Publications and source records attributed to A Sacrez.

At least 55 records · Page 3Linked to original sources
PubMed1989

[A european multicenter and randomized study of APSAC versus streptokinase in myocardial infarction].

In a multicentre randomized open study conducted on two parallel groups the effectiveness of APSAC was compared with that of streptokinase (SK) in 116 cases of myocardial infarction treated during the first 2.75 hours. APSAC (30 IU) was administered by intravenous bolus injection over 2 to 5 minutes, and SK (1.5 million IU) by intravenous infusion over 60 minutes. The patency of the coronary artery responsible for myocardial infarction was evaluated by coronary arteriography performed 1.74 h on average after the beginning of treatment; it was 70 p. 100 in the APSAC group and 51 p. 100 in the SK group (p less than 0.05). The fall in plasma fibrinogen was similar in both groups (mean minimum level; 0.2 g/l). Haemorrhages occurred in 9/58 patients treated with APSAC (15.5 p. 100) and in 13/58 patients treated with SK (22.4 p. 100); these haemorrhages took place during the first 24 hours in 4 patients of the APSAC group and in 10 patients of the SK group. Five patients died: 2 in the APSAC group and 3 in the SK group. In a subgroup of 38 patients who underwent 3 control coronary arteriographies (at 90 min, 24 hours and 3 weeks), the patency rates were 63 p. 100, 82 p. 100 and 93 p. 100 respectively with APSAC and 44 p. 100, 86 p. 100 and 92 p. 100 respectively with SK (NS). No coronary reocclusion occurred in the APSAC group, as against 3 (1 early, 2 delayed) in the SK group. It is concluded that APSAC seems to be more effective than intravenous streptokinase; it is easier to administer (bolus injection) and does not carry a higher risk of haemorrhage.

Anistreplase↗
PubMed1989

[Value of transesophageal auricular stimulation for evaluating the accessory pathway and effect of treatment in Wolf-Parkinson-White syndrome].

In order to assess the value of the various atrial pacing techniques employed to evaluate the anterograde conduction of the accessory pathway and the effect of antiarrhythmic agents in Wolff-Parkinson-White syndrome, transesophageal atrial pacing was performed in 12 patients before and during treatment with oral flecainide acetate in doses of 200 mg per day. Before treatment, the shortest interval conducted with a 1/1 atrioventricular conduction by the accessory pathway ranged from 225 to 600 ms (mean 311 +/- 98 ms), and the effective refractory period of the accessory pathway, measured by the extrastimulus method in 11 patients, varied from 240 to 320 ms (mean 273 +/- 22 ms). These two values were very close in each patient and correlated well with each other (r = 0.90; p less than 0.001). Atrial fibrillation could be induced in 3 patients. Three patients were considered "at risk" since their effective refractory period or minimal R-R interval in atrial fibrillation was 250 ms or less. Tachycardia was induced in 8 patients, and it was possible to induce arrhythmias in the 6 patients for whom we had recordings in spontaneous tachycardia. Under treatment with flecainide acetate, an anterograde conduction block appeared in 3 patients. In the remaining 9 patients the shortest interval conducted with a 1/1 atrioventricular conduction by the accessory pathway was longer in every case: it ranged from 270 to 540 ms (mean 407 +/- 84 ms; p less than 0.001), which corresponded to a 20 to 240 ms prolongation (mean 133 +/- 78 ms).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Value of cine magnetic resonance imaging in the diagnosis and quantification of valvular regurgitation. Comparison with angiography and Doppler echocardiography].

Thirty-three patients presenting with regurgitation of the mitral valve (19 cases), tricuspid valve (14 cases) or aortic valve (11 cases) documented by angiography (n = 20) and/or doppler-echocardiography (n = 28) were examined by cine-MRI in order to test this method in valvular regurgitation. Sixteen ECG-synchronized cine-MRI images were acquired by the GRASS technique every 40 ms on appropriate projections, with a resistive 0.28 Tesla Bruker magnet. The semiology of normal and pathological blood flow images at cine-MRI is described. Valvular regurgitations present as "signal void" jets the chronology and spatial extension of which depend on the severity of the lesion. The differential diagnosis with physiological flows is discussed. The diagnostic sensitivity of the method was 29/29 when compared with angiography and 29/33 when compared with doppler-echocardiography (2 cases of 1/4 mitral regurgitation and 2 cases 1/4 tricuspid regurgitation were not visible at cine-MRI). The specificity of this method, as can be judged from 104 patients explored, also seems to be satisfactory. The severity of regurgitation was graded from 1 to 4 with the three methods, on the basis of strict criteria. The differences in grade evaluation exceeded +/- 1 point in only one case of mitral regurgitation which was greatly underestimated by the doppler method as compared with angiography and cine-MRI. Thus, cine-MRI is a reliable method to evaluate valvular regurgitations and their severity. It solves the practical problem raised by non-echogenic patients when catheterization is to be postponed or avoided.

Adult↗
PubMed1989

[Relation of an increase of von Willebrand factor in the blood, acute myocardial infarction, unstable angina and coronary thrombosis].

Forty six patients admitted for precordial chest pain were included in this study. The clinical, electrocardiographic, enzymatic and angiographic features allowed retrospective identification of 6 subgroups (nos 1 to 6): all transmural myocardial infarction (Q-MI) (Group 1), Q-MI without intracoronary thrombus (Group 2), Q-MI with intracoronary thrombus (Group 3), acute non-Q wave infarction (non Q-MI) (Group 4), unstable angina (Group 5) and atypical chest pain (Group 6). Several blood clotting factors were studied; von Willebrand factor (VWF), fibrinogen, tissue plasminogen activator (t-PA) and its inhibitor (PAI-1) and factor VII. There was no significant difference in the fibrinogen, t-PA, PAI-1 or factor VII levels between the 6 groups. On the other hand, the VWF was increased in the all transmural myocardial infarction (Q-MI) groups (n. 1). In Group 3 with visible intracoronary thrombus the VWF was high or very high in all patients, attaining three times the normal values. The values were lower in Group 5 (unstable angina) patients in whom no thrombus was observed on coronary angiography. The differences between Group 1 and Groups 4, 5 and 6 were statistically significant (p less than 0.05). The VWF was higher in the Q-MI group with intracoronary thrombus than in the group without thrombus, but the difference was not statistically different. In conclusion, the VWF may be considered to be a marker for thrombus and/or endothelial activation but a larger study population would be required to identify more accurately the subgroups with thrombosis or risk of thrombosis.

Adult↗
PubMed1989

[Comparison of the left ventricular stroke volume and fraction measured with MRI and contrast ventriculography].

27 patients who underwent a contrast ventriculography in right anterior oblique at 30 degrees (for various cardiopathies) were studied by MRI with a mean delay of 5.7 +/- 6.2 days. After location of the medio-ventricular area, a diastolic horizontal section (apex of the R wave) and a systolic section (descending portion of the T wave) are carried out using the spin ultrasound technique. The same calculations are used for MRI au X-Ray contours (modified area-length method) by two strictly independent operators. With MRI, the LVSF is under estimated (40.4 +/- 19%) as compared angiography (46.1 +/- 18%). The linear correlation is 0.79 and in half of the patients (13 in 27) the deviation of the LVSF exceeds 10 p. cent. The volumes also tend to be underestimated with MRI (97 +/- 50 and 64 +/- 51 ml for the diastole and systole respectively) compared with angiography (123 +/- 66 and 73 +/- 62 ml), but the difference is only significant for the diastole and the linear correlation coefficients are improved at 0.82 and 0.90. Underestimation of the parameters measured with MRI is the consequence of multiple factors including the imprecise determination of the true telesystole, the marked effect of the partial volume related to the thickness of the section, and especially the obliquity of the plane studied on MRI, compared with the long axis of the heart. The error made by using a calculation algorithm, conceived for projective methods showing the long axis of the modeled ellipsoid, also explains the underestimation of volumes obtained with MRI, tomographic method. The simple technique used here seems especially interesting in the analysis of segmental contraction. Finally, the development of cine-MRI will undoubtedly be extremely beneficial in the study of ventricular contraction and relaxation.

Adult↗
PubMed1989

[Isolated ST-segment depression in precordial leads V2 to V4. An early electrocardiographic sign of posterolateral myocardial infarction].

The authors report the cases of two men, 62 and 66 years-old, who both presented a posterolateral myocardial infarction which, in the first two days, as only electrocardiographic sign, consisted in a baseline offset of the ST segment in precordial leads V2 to V4. Necrosis and its topography were confirmed in each case by elevated myocardial enzymes, the progression of the electrocardiogram and bidimensional ultrasound cardiography exploration. Coronary angiography performed in both cases, revealed, in the first case, an isolated narrow stenosis of a first marginal artery, and in the second case, significant stenoses of the circumflex and right coronary artery without lesion of the anterior interventricular artery. These cases, along with those recently published in the literature, suggest that such alterations of ventricular repolarization which represent the reciprocal projection of a high posterior sub-epicardiac lesion current, could complete the electrocardiographic criteria of really thrombolysis in a context of prolonged precordial pain.

Arrhythmias, Cardiac↗
PubMed1988

[Systematic ultrasensitive determination of thyroid-stimulating hormone in 50 cases of atrial fibrillation].

The incidence of hyperthyroidism in patients with continuous arrhythmia due to atrial fibrillation was evaluated prospectively by means of the "ultrasensitive" assay of thyroid-stimulating hormone (TSH). When the result was abnormal, free thyroxine fractions (FT4) and free triiodothyronine fractions (FT3) were measured, and in some cases a thyrotropin-releasing hormone (TRH) test and a thyroid gland scintigraphy were performed. Among 50 unselected patients with continuous arrhythmia due to atrial fibrillation, 12 had a low TSH baseline level. In 7 of them, high FT4 and/or FT3 levels provided evidence of hyperthyroidism. In the remaining 5 patients FT4 and FT3 levels were normal, but TSH response to TRH was suppressed and scintigraphy showed a high nodular or lobular uptake. In a control series of 50 age- and sex- matched subjects without thyroid disorders or dysrhythmia, TSH level was low in only one case with insufficient response to TRH, but the scintigraphic image did not suggest nodular hyperthyroidism. It is concluded that systematic TSH assays can detect those atrial fibrillations which are consecutive to, or aggravated by hyperthyroidism, even asymptomatic. We regard this assay as indispensable to evaluate continuous arrhythmia due to atrial fibrillation, even when an apparently causative underlying heart disease is present.

Adult↗
PubMed1988

Detection of myocarditis during the first year after discovery of a dilated cardiomyopathy by endomyocardial biopsy and gallium-67 myocardial scintigraphy: prospective multicentre French study of 91 patients.

The purpose of this study was to assess the frequency of inflammatory lesions in the myocardium of subjects with dilated cardiomyopathy and to determine if there was any correlation between the results of two methods of evaluation, one (endomyocardial biopsy) invasive and the other (gallium-67 scintigraphy) noninvasive. Of 115 subjects recruited in seven centres, 91 met the inclusion criteria (left ventricular dilatation greater than or equal to 100 ml m-2 and ejection fraction less than 55% with normal coronary arteriography) and had endomyocardial biopsy (mean five specimens) and Ga-67 myocardial scintigraphy after several days. Scanning was considered doubtful 19 times and positive 13 times. The histologic count of mononuclear cells in the myocardial interstitium in 20 fields was greater than 5 cells field-1 in only four cases. No correlation was found between the two methods. Subjectivity in the choice of the criterion of positivity of Ga-67 scintigraphy and difficulties in identifying lymphocytes upon pathological examination were the major problems encountered. Despite limitations, both techniques suggest that cellular infiltrates are minimal and quite infrequent in dilated cardiomyopathy.

Adolescent↗
PubMed1988

[Idiopathic bi-auricular dilatation manifested by total cardiac failure. Apropos of a case confirmed by nuclear magnetic resonance].

Idiopathic bilateral atrial dilatation is extremely rare. We are reporting a case in a 79 year-old patient, presenting a picture of total cardiac insufficiency. The positive diagnosis was established by bi-dimensional sonography and right angiography. Nuclear magnetic resonance confirmed the diagnosis and specified the size of the various cavities. From a rhythm standpoint, there was an atrial fibrillation without conduction disorders. The main factor of the cardiac insufficiency seems to be a low atrio-ventricular output, since the valvular insufficiency due to annular dilatation is only a secondary factor. The etiology is unknown, but a congenital origin seems most probable without excluding the possibility of an acquired structural disorder.

Aged↗
PubMed1988

[Revascularization in the acute phase of myocardial infarction. Study of left ventricular function in the 3d week and 6th month].

27 patients with primary myocardial infarction are treated, in the first 6 hours, with intravenous thrombolysis with immediate coronary angiographic control showing a patent artery in 76 p. cent of the cases. The treatment is completed with intracoronary thrombolysis (5 times) and transluminal angioplasty (6 times), enabling to obtain a patency rate of 88 p. cent. The overall left ventricular function is evaluated at D21 and in the 6th month (M6). Among anterior infarctions, those treated during the first three hours have a better ejection fraction (EF) at D21 than those treated later (40.3 p. cent +/- 6 versus 33.2 p. cent +/- -NS); this functional benefit is confirmed at M6 (42.8 p. cent +/- 12 versus 30.6 p. cent +/- 8; p less than 0.06). On the contrary, among inferior infarctions, the EF is comparable at D21 and M6 regardless of the early nature of the treatment. One patient died prematurely from a cerebral vascular accident which occurred during the thrombolysis. These results are in favor of a significant myocardial salvation in anterior infarctions revascularised at an early stage and of an active approach in order to obtain the most complete possible revascularisation.

Angioplasty, Balloon↗
PubMed1988

[Detection of recent myocardial infarction by spin-echo MRI. Value of the third echo].

Seventeen patients underwent MRI spin-echo imaging (Magniscan 5000) 7 to 21 days after acute myocardial infarction (10 anterior, 7 inferior--average 13.1 +/- 3.7 days). The success rate of visualisation of AMI evaluated independently by a qualitative score (from 0 to 4) based on the brilliance of the myocardial signal after taking steps to eliminate the brillance of pericardial fat and subendocardial flow signals, was 3.1 +/- 0.87 in anterior AMI (10 out of 10) and 1.28 +/- 1.25 (4 out of 7) in inferior AMI (p less than 0.007). The diagnostic sensitivity was increased when images of the third echo were used (13 out of 17) compared to those of the second echo (8 out of 17, p less than 0.016). The value of the 3rd echo is explained and emphasised. Abnormal intramyocardial signals were not recorded in a control group of 10 patients under similar conditions of multi-echo imaging. Finally, significant correlations were observed between peak CPK concentrations and the MRI score (r = 0.62; p less than 0.01) and between peak CPK and the number of sections in which the hyperbrilliant signal was observed (r = 0.74; p less than 0.001): this may open the day to quantification of myocardial necrosis by MRI.

Adult↗
PubMed1988

[Modifications in the contraction and relaxation of the left ventricle in chronic ischemic cardiopathies. Study using equilibrium angio-scintigraphy].

Our purpose was to confirm that abnormalities of left ventricular filling, which are associated with abnormalities of contraction, play an important part in the genesis of cardiac failure in chronic ischaemic heart disease. We used equilibrium radionuclide angiography of the cardiac cavities to study the behaviour of the left ventricle during contraction and relaxation in three groups of patients: a control group of 15 patients without cardiac disease (G2), and a group of 28 patients with chronic ischaemic heart disease complicated by cardiac failure (G3). From the overall activity-time curves and their first derivatives were calculated the ejection fraction, the peak ejection rate and the peak filling rate, as well as the time in the cardiac cycle when these appeared, the reference point in time being the end-diastole. Separately, an analysis of spatial distribution, pixel by pixel, of the elementary values of these times was developed with the help of new functional images constructed, pixel by pixel, from the first derivatives of the activity-time curves. These functional images were exploited by calculating histograms of times, and the width of the bars at mid-height was taken as the dispersion parameter expressed as a percentage of the cardiac cycle. There was a significant reduction of ejection fraction in groups G2 (49.8 +/- 11.6 p. 100) and G3 (36.3 +/- 15.4 p. 100) as compared to control group G1 (60.3 +/- 8.4 p. 100) (G1-G2 p less than 0.05; G2-G3 p less than 0.001; G1-G3 p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

[Magnetic resonance imaging in the diagnosis of myxedematous pericardial effusions].

Two cases of myxedematous pericardial effusions studied by magnetic resonance imaging (MRI) are reported. After a reminder of the place of pericardial involvement in this disease, the advantage of MRI which provides original semiologic factors on the analysis of topographic extension and on the approach of the cellular characteristics of the effusion, is presented. Concerning the latter, difficulties of interpretation and current imprecisions are discussed but we will especially remember the advantage of this recent technique in the diagnosis of an effusion, even moderate, in hypothyroidism, mainly in patients with poor sonographic response.

Adult↗
PubMed1987

Intravenous anisoylated plasminogen streptokinase activator complex versus intravenous streptokinase in evolving myocardial infarction. Preliminary data from a randomised multicentre study.

The efficacy of a single intravenous bolus of anisoylated plasminogen streptokinase activator complex (APSAC 30U in 4 to 5 minutes) versus an intravenous infusion of streptokinase (1.5 X 10(6) U in 60 minutes) was assessed in 86 patients with evolving myocardial infarction of less than 6 hours duration in a cooperative randomised study. The patency of the infarct-related artery was assessed by coronary angiography at, on average, 90 minutes after therapy (mean time: APSAC 95 minutes, streptokinase 105 minutes). The treatment groups were similar with respect to sex, age, location of myocardial infarction and the delay from onset of pain to treatment. The 90-minute patency rate (grade 2 to 3) was 71.8% in the APSAC group and 55.8% in the streptokinase group; the difference was not statistically significant. There was no difference between the drop in fibrinogen concentrations in the 2 groups at 3 or 24 hours. The minimal concentration obtained at the first assessment was +/- 0.2 g/L in the streptokinase group and 0.5 g/L in the APSAC group. One patient in the APSAC group, who had a previous meningeal bleeding, had a non-fatal cerebrovascular accident. In a subgroup of 38 patients who had 3 control coronary angiograms at 90 minutes, 24 hours and 3 weeks, the patency rate was 63, 82 and 93%, respectively, in the APSAC group and 48, 88 and 92%, respectively, in the streptokinase group (the difference was not statistically significant). None of the patients in the APSAC group presented with reocclusion, whilst 3 patients in the streptokinase group had reocclusions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗