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B Denis

Publications and source records attributed to B Denis.

At least 55 records · Page 3Linked to original sources
PubMed1994

[Feasibility and accuracy of pulmonary blood flow measurement by Doppler echocardiography. Apropos of 100 consecutive cases].

One of the main advantages of Doppler echocardiography is the possibility of non-invasive measurement of blood flow at each valvular orifice. This method enables quantification of valvular regurgitation, the measurement of Qp/Qs in cardiac disease with atrial or ventricular shunts, and the interpretation of gradients and functional surface areas in valvular stenosis or prosthesis with respect to the underlying haemodynamics. In each of these application, the measurement of pulmonary blood flow is valuable as the reference blood flow, and even indispensible in cases of shunts. The authors' objective was to study the feasibility and accuracy of pulmonary flow measurement in 100 consecutive patients (40 women and 60 men, average age 56.7 +/- 17.5 years) with cardiac disease (82%) or healthy hearts (18%). A grading from A to D was accorded depending on the technical difficulty of the examination, each grade having three degrees: 1) difficulty of recording and poor quality Doppler spectrum, 2) difficulty of measuring orifice diameter by 2D echocardiography, 3) necessity of analysis of color coded anterograde flow to measure the pulmonary valvular orifice. Grade A was distributed to easily recordable measurements with no difficulty; grade B for measurements with one difficulty; grade C for measurements with 2 difficulties and grade D for investigations judged to be impossible or unreliable (3/3 criteria). The feasibility of measurement of the cardiac output at the pulmonary orifice was 88% (A:55%, B:25%, C:8%). The correlation between the pulmonary flow and reference measurements at the aortic and/or mitral valve and/or mitral annulus was 0.96. The average difference between the pulmonary and reference flow was 51 +/- 273 cc/min.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

[Pneumatosis cystoides of the colon: knowing how to recognize it. Apropos of 8 cases].

Eight cases of pneumatosis cystoides intestinalis (PCI) affecting the descending colon at first misdiagnosed in seven of them, are reported. The mechanism of cyst formation remains unclear but certain specific endoscopic and X-ray findings should help in differentiating PCI from other intramural tumors, i.e. polyposis. Diagnostic investigations and management approaches are described. No treatment is necessary in most instances because of the benign nature of PCI.

Adenomatous Polyps↗
PubMed1993

[What studies should be done in syncope?].

Fainting (short loss of consciousness) is a frequent reason for a consultation in a general practitioner's or cardiologist's office. Four main causes are recognized commonly: cardial with auriculo-ventricular block and arrhythmias, vascular in particular vaso-vagal syncopes, neurologic and other causes. In 38 to 47% of the patients no etiology is found: these are syncopal attacks of unknown origin. The first diagnostic step comprises noninvasive investigations. A 24-hour recording of the ECG or a 'long strip' improve the diagnostic rate by 10%. They are particularly useful for sick sinus syndromes. The head-up tilt-test has been developed recently. It is very useful for detection of vagovasal syncope and permits to understand the pathophysiology and the therapeutic consequences of these disorders. This test plays a particular role for the diagnosis of syncopes of unknown causes and shows in 24 to 75% of the cases pathologic results. Patients at high risk for ventricular arrhythmia can be recognized by ECG with high amplification. Doppler investigation of the neck vessels, however, seems to be of low diagnostic value in syncopes. Invasive measures are the last line resort. Electrophysiologic studies provide criteria that are well defined. They are useful for detection of ventricular dysrhythmias and conduction disorders. This latter approach is reserved to patients with negative noninvasive tests and in particular with cardiopathy. The approach to syncope and the power of noninvasive and invasive tests is thus well established. However, in a certain number of patients the cause for fainting is not disclosed. Fortunately mortality is low in this particular group.

Adult↗
PubMed1993

Cost effectiveness of thrombolytic treatment for myocardial infarction: comparison of anistreplase, alteplase and streptokinase in 270 patients treated within 4 hours.

Two hundred and seventy patients, under 71 years of age and suffering from a less than 4 h infarction diagnosed according to clinical and electrocardiographic criteria, were included: two 90-patient groups were randomized and then treated with either anistreplase (30 mg iv over 5 min) or alteplase (10 mg bolus injection + 5000 IU heparin bolus injection, followed by 90 mg alteplase over 3 h), and compared with a consecutive control series of 90 patients treated with streptokinase (1.5 million U over 1 h). Intravenous heparin and aspirin (250 mg day-1) were then prescribed routinely. The three groups were comparable as regards age (55.2 +/- 10 years), male/female ratio (10.4), the site of the infarction (42% anterior, 55% inferior) and initial clinical seriousness (Killip I = 90%, II = 8%, III = 2%). The patients were thrombolysed in 17 community hospitals, and then referred to a university hospital with catheterization facilities. An efficacy score was determined, based on four parameters: two obtained from coronary angiography and left ventriculography performed on day 6 +/- 2 (N = 252) (asynergic score and patency of the infarct-related artery), one from Tl-tomography performed at rest (infarct size) and one from radionuclide angiography (global left ventricular ejection fraction) performed between day 15 and day 21 (N = 242). The score (range: 0-24 per patient) was 17.8 +/- 6.4 for alteplase, 17.7 +/- 6.0 for anistreplase and 18.1 +/- 6.0 for streptokinase respectively (NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Indapamide reduces hypertensive left ventricular hypertrophy: an international multicenter study.

The effect of 6 months of treatment with indapamide (IND, 2.5 mg/day) on regression of left ventricular hypertrophy (LVH), an independent predictor of poor prognosis in hypertension, was compared by echocardiography to that of nifedipine (NFD, 40 mg/day), enalapril (ENL, 20 mg/day), atenolol (ATL, 100 mg/day), and hydrochlorothiazide (HCTZ, 25 mg/day) in four parallel double-blind studies in 151 hypertensive patients with a diastolic blood pressure between 95 and 120 mm Hg and a raised left ventricular mass index (LVMI) (mg/m2) (Devereux). Patients were randomized to IND or comparator following a 2-week washout (1 month in the IND vs. ATL study). Respective baseline and 6-month LVMI values (mg/m2) were: IND (n = 20) vs. HCTZ (n = 20): 151.4 +/- 6.3 and 125.70 +/- 4.6 (p < 0.001) vs. 141.3 +/- 6.6 and 135.6 +/- 8.3 (p = N.S.); IND (n = 22) vs NFD (n = 19): 144.1 +/- 5.3 and 125.1 +/- 4.3 (p < 0.001) vs. 170.4 +/- 6.6 and 148.2 +/- 6.2 (p < 0.001); IND (n = 9) vs. ENL (n = 9): 155.1 +/- 6.3 and 143.4 +/- 5.2 (p < 0.001) vs. 142.0 +/- 6.7 and 130.0 +/- 5.9 (p < 0.001); IND (n = 17) vs. ATL (n = 12): 146.2 +/- 5.1 and 130.8 +/- 6.5 (p < 0.001) vs. 156.7 +/- 8.4 and 142.9 +/- 10.3 (p < 0.01). All drugs significantly reduced diastolic blood pressure, and all except HCTZ induced a significant and similar reduction in left ventricular mass.

Adult↗
PubMed1993

[Evaluation of prognosis and myocardial ischemia using thallium in myocardial tomoscintigraphy].

Thallium scintigraphy holds a unique position amongst the methods available for evaluating the prognosis of coronary patients: it enables quantification of underperfused myocardium and evaluates already constituted ventricular damage (irreversible necrosis) and areas at risk of future coronary events (viable but ischemic myocardium). In a series of 1,926 patients who underwent exercise stress or dipyridamole Thallium myocardial scintigraphy for angina pectoris and followed up fort an average of 34 months, the following features were observed: the long-term prognosis in patients with normal myocardial scintigraphy (715 patients) was identical to that of a normal population of the same age (0.11% cardiovascular deaths per year) whereas the cardiovascular mortality was 15 times higher in cases with a pathological scintigraphy: finally, the long-term prognosis (cardiovascular deaths, infarcts or secondary revascularisation) was directly related to the severity of the initial lack of Thallium uptake. This method was used to assess the prognosis and evaluate the myocardial ischaemia in 75 patients who underwent complete surgical revascularisation fort ischaemia, 50 of whom had previous myocardial infarction: all patients had at least one arterial bypass graft: 39% of the myocardium was underperfused before revascularisation; this procedure reduced by 80% (p < 0.0001) the zones of reversible underperfusion but also zones of irreversible underperfusion by 17% (p = 0.04). The results were particularly impressive in patients who underwent revascularisation with an arterial pedicle (left and right internal mammary, gastroepiploic alone or in association) as 91% of the ischemic territories recovered on average 13 days after revascularisation.(ABSTRACT TRUNCATED AT 250 WORDS)

Dipyridamole↗
PubMed1993

[Myocardial infarction treated within 4 hrs: comparison of the cost-benefit ratio of 3 thrombolytic treatments: APSAC, rt-PA and streptokinase in 270 patients].

Two hundred and seventy patients under 71 years of age with myocardial infarction less than 4 hours old, defined by clinical and electrocardiographic criteria, were included in this trial and followed up for 1 year: two groups of 89 and 92 patients were randomised to receive APSAC (30 mg i.v. over 5 minutes) or rt-PA (10 mg bolus + 5000 IU of heparin as a bolus, followed by 90 mg rt-PA over 3 hours) and compared with a control series of 89 consecutive patients treated with streptokinase (1.5 MU in 1 hour). Heparin and aspirin (250 mg/day) were prescribed systematically. A score of efficacy was established from the following 4 parameters: patency of the infarct-related artery on coronary angiography at day 6 +/- 2 (N = 252), dyssynergic score on radiological ventriculography, infarct size on resting Thallium myocardial scintigraphy performed between day 15 and 21 (N = 242) and radionuclide ejection fraction performed at the same time. This score (0-24) was respectively 17.8 +/- 6.4 for rt-PA, 17.7 +/- 6.0 for APSAC and 18.1 +/- 6.0 for streptokinase (NS). The costs of hospital treatment were assessed by including: the cost of thrombolytic therapy (ranging from 1.7% of total cost for streptokinase to 16% for rt-PA), the cost of other treatments and biological investigations (10% of total cost); the cost of followed coronary angiography, in 33% of patients, by an angioplasty (21% of total cost), the cost of hospital stay averaging 17 days (49% of total cost in the rt-PA and APSAC groups and 56% in the streptokinase group NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Cost-Benefit Analysis↗
PubMed1993

[Mid-term follow-up after transluminal coronary angioplasty. Clinical results, mortality, morbidity apropos of 500 consecutive procedures].

The aim of this study was evaluation of mid-term results, with a mean follow-up of 23 months (range: 6 months to 6 years), in 449 patients undergoing 500 consecutive angioplasty procedures before 1989. All of these 449 patients underwent primary angioplasty, and not dilatation after restenosis. Data processing of information, based upon a questionnaire filled out by the patient's own cardiologist, enabled 100 per cent follow-up. In these patients with a mean age of 56 (range: 32-83), angioplasty was single in 93 per cent of cases. The indication was unstable angina (45%), following a myocardial infarction (44%) or, more rarely, stable angina (10%). The anterior interventricular was dilated more often than the right coronary and circumflex (56%, 31% and 22% respectively). The cardiac survival rate of 41 months was 94.3 per cent, 78 per cent of patients not having experienced any serious coronary events at the time of last available information. 65 (sixty five) per cent of patients were asymptomatic and the Thallium stress test was normal in 67 per cent of them. Angina recurred in 17 per cent of patients, twice as often in women (p < 0.02). 14 (fourteen) per cent had undergone a bypass procedure and 14 per cent had been redilated. Comparisons by the Kaplan-Meier method showed less good results after the age of 57: higher mortality (p < 0.01), more frequent recurrences of angina (p < 0.05), more frequent aorto-coronary bypasses (p < 0.001). Aorto-coronary bypasses were commoner after dilatation of the anterior interventricular (p < 0.005), after multiple dilatations (p < 0.03) or after unstable angina (p < 0.05).

Angina Pectoris↗
PubMed1992

Epidermoid cysts of testis.

A 27-year-old man presented with bilateral testicular pain and enlargement of the right testis caused by a cystic mass. Histological examination of a frozen section at exploration excluded malignancy and the final diagnosis after local excision was benign epidermoid cyst. The patient remained well three years later.

Adult↗
PubMed1992

[Intervention in PMI after mothers in difficulties with their young children: a psychomotrician in the waiting-room].

The authors report on a 3-year experience of interventions by a psychomotrician in the waiting-room of a mother-child protection (PMI) centre in order to recognize and prevent mother-infant interaction difficulties. The main mission of the psychomotrician was to help mothers to discover the competences and the desire of communication of their infants. This experience appears to be positive, allowing the improvement of some mother-infant difficulties, and a better acceptance by the mothers of a child psychiatric consultation when it appears to be necessary.

Child Behavior Disorders↗
PubMed1992

[Evaluation of cardiac output by Doppler echocardiography. Basic principles and practice].

The measurement of cardiac output by the Doppler-echocardiography method is of considerable interest since, in contrast to other available techniques, it offers the possibility of the measurement of output at each valve orifice, thus providing a quantitative approach to valve regurgitation. The 4 basic data items required are: the surface area of the valve orifice, trans-valvular Doppler velocity spectrum, duration of ejection and of filling, and heart rate. A large number of studies have analysed the various investigation techniques and have shown their excellent correlation with reference invasive methods. In the light of experience acquired in our Echocardiography Laboratory, we recommend, in accordance with data from the literature, the exclusive use of pulsed Doppler and measurement of valve orifices by two-dimensional imaging at the point of insertion of the aortic and sigmoid cusps as well as at the mitral ring. A simplified method for the measurement of mitral surface area on the basis of TM records is suggested.

Cardiac Output↗
PubMed1992

[Evaluation of cardiac output by Doppler echocardiography. Correlation of aortic, pulmonary and mitral ring flow rates. Study of 103 subjects free of valve leak].

Measurement by Doppler-echocardiography of blood flow rates has the advantage over techniques for the measurement of cardiac output of determining the latter for each valve orifice, and of opening up an approach to the quantification of aortic and mitral regurgitation. This prospective study involving 103 subjects free of any valve leak showed the absence of an significant difference between aortic, pulmonary and mitral ring flow rates in a given individual. Correlations between results obtained at the three measurement sites were: r = 0.92 between aorta and pulmonary artery, r = 0.90 between aorta and mitral ring and r = 0.90 between pulmonary artery and mitral ring. These results support the validation of this technique and would justify its use in the evaluation, quantification and monitoring of mitral and aortic valve leaks.

Adolescent↗
PubMed1992

[Measurement of mitral flow at the extremity of the valves. Validation of a simplified method based on 101 cases].

The measurement of cardiac output at the extremity of the mitral cusps, by Doppler-echocardiography, is of fundamental value, in particular for the evaluation of valve regurgitation. However, it comes up against a theoretical difficulty resulting from constant variation in the surface area of this orifice during diastole. After reviewing the main measurement methods available in the literature, a simplified method based upon the diameter of the ring and calculation of a mean diastolic intercusp distance by TM is suggested. Evaluation of this technique in 101 patients free of valve of leak showed its feasibility to be close to 100% and the correlation with aortic (r = 0.90), pulmonary (r = 0.91) and mitral ring (r = 0.88) outputs was entirely satisfactory. Our method would thus seem to be a good compromise between digitalised integration methods for the measurement of mitral surface area--optimal but complex--and the aim of simplification compatible with routine clinical use.

Adult↗
PubMed1992

[Quantification by transthoracic Doppler of tricuspid valve insufficiencies].

Various methods are available today for the quantification of regurgitation by transthoracic Doppler. The present review deals with their respective usefulness in tricuspid insufficiency (TI). Despite their contribution in the domain of mitral and aortic insufficiency, precise quantification methods remain of very limited value regarding the tricuspid orifice, and this because of practical difficulties of application. Evaluations of the severity of TI is based, essentially, on a semiquantitative approach. Cartography of the regurgitation stream, by colour Doppler, is the chief method, despite its limitations which are clearly emphasised by the effects of the contrast test. The discovery, by pulsed Doppler, of laminar systolic flow is a sign of capital importance. It is indicative of massive TI and of particular anatomical and hemodynamic conditions, but it is uncommon. Systolic reversal of flow in the inferior vena cava is a good sign of severity but lacks specificity. In contrast, measurement of maximum velocities of TI, while essential for the evaluation of pulmonary pressures, is of no value in terms of the quantification of regurgitation. Transthoracic Doppler data must be taken together with those of transthoracic echocardiography, the esophageal approach offering nothing special, being essentially useful in lesion evaluation. The quantification of TI, by transthoracic Doppler, has derived only very little benefit from the current orientation of Doppler methods.

Animals↗
PubMed1992

[Measurement by Doppler echocardiography of the ratio of pulmonary/systemic flow rates in atrial septal defects. Apropos of 15 cases].

Fifteen patients with an ostium secundum type atrial septal defect, aged between 5 and 68 (mean = 31) underwent Doppler-echocardiographic evaluation of the ratio of pulmonary and systemic flow rates. Systemic flow was evaluated at the aortic orifice, as well as at the mitral ring and at the extremities of the mitral cusps, based upon the measurement of valve diameters by 2D or TM echocardiography, pulsed Doppler velocity curve and hear rate. Pulmonary flow was measured by the same technique at the site of insertion of the pulmonary cusps. The values obtained were compared with cardiac catheterisation findings, the reference method being an oxymetric measurement of the shunt ratio. Feasibility of the Doppler investigation was 100 per cent. Correlation between the two techniques was r = 0.85 when the Doppler measurement was at the aorta, r = 0.81 for the mitral ring and r = 0.71 at the extremity of the mitral cusps. Doppler-echocardiography thus appears to be a reliable and reproducible method for the evaluation of left-right shunts, confirming data from the literature.

Adolescent↗
PubMed1992

[Clinical evaluation after myocardial infarction. Its role, date and methods].

Although global mortality in the year following myocardial infarction is about 10%, this figure varies from less than 1% to more than 50% in some very high risk cases. The principal objective of clinical evaluation during the acute phase is to establish a prognosis and propose a rational strategy for myocardial revascularisation (by bypass grafting or angioplasty) in patients with a poor prognosis. An essential feature of this evaluation is to reduce health care costs and hospital stay to a minimum. Coronary angiography is the only investigation which allows assessment of the coronary circulation and is probably the best method of evaluating global and regional left ventricular function, two essential prognostic factors: on the other hand, it does not provide information about the presence of residual ischaemia or persistent myocardial viability in the infarcted territory. Some very high risk patients should undergo systematic coronary angiography to determine the possibilities for myocardial revascularisation: early post-infarction angina, left ventricular failure, chronic angina, elderly but valid patients... The indications of coronary angiography should also extend to patients with non-Q wave infarction, to young patients with myocardial infarction on thrombolysed infarcts: results of coronary angiography should then be compared with those of standard exercise stress testing. It is only in other situations, concerning a minority of patients, in which two attitudes may be considered: the first, to perform coronary angiography very early (within 24-48 hours of admission) allowing early discharge from hospital of many cases, completed later by standard exercise stress testing: any revascularisation procedure is considered at that time and requires a second hospital admission. The second attitude consists in performing coronary angiography between the 7th and 10th day only if some paraclinical changes are present: exercise stress testing then has an essential role; to improve its negative predictive value for absence of long-term coronary events it should be associated with radionuclide investigation of myocardial perfusion (thallium, MIBI) or with an evaluation or residual myocardial viability (labelled fatty acids, cyclotron). This attitude also allows early identification of "good candidates" for myocardial revascularisation.

Coronary Angiography↗
PubMed1991

The diagnostic performance of computer programs for the interpretation of electrocardiograms.

BACKGROUND: Computer programs for the interpretation of electrocardiograms (ECGs) are now widely used. However, a systematic assessment of various computer programs for the interpretation of ECGs has not been performed. METHODS: We undertook a large international study to compare the performance of nine electrocardiographic computer programs with that of eight cardiologists in interpreting ECGs in 1220 clinically validated cases of various cardiac disorders. ECGs from the following groups were included in the sample: control patients (n = 382); patients with left ventricular hypertrophy (n = 183), right ventricular hypertrophy (n = 55), or biventricular hypertrophy (n = 53); patients with anterior myocardial infarction (n = 170), inferior myocardial infarction (n = 273), or combined myocardial infarction (n = 73); and patients with combined infarction and hypertrophy (n = 31). The interpretations of the computer programs and the cardiologists were compared with the clinical diagnoses made independently of the ECGs, and the computer interpretations were compared with those of the cardiologists. RESULTS: The percentage of ECGs correctly classified by the computer programs (median, 91.3 percent) was lower than that of the cardiologists (median, 96.0 percent; P less than 0.01). The median sensitivity of the computer programs was also significantly lower than that of the cardiologists in diagnosing left ventricular hypertrophy (56.6 percent vs. 63.9 percent, P less than 0.02), right ventricular hypertrophy (31.8 percent vs. 46.6 percent, P less than 0.01), anterior myocardial infarction (77.1 percent vs. 84.9 percent, P less than 0.001), and inferior myocardial infarction (58.8 percent vs. 71.7 percent, P less than 0.0001). The median total accuracy level (the percentage of correct classifications) was 6.6 percent lower for the computer programs (69.7 percent) than for the cardiologists (76.3 percent; P less than 0.001). However, the performance of the best programs nearly matched that of the most accurate cardiologists. CONCLUSIONS: Our study shows that some but not all computer programs for the interpretation of ECGs perform almost as well as cardiologists in identifying seven major cardiac disorders.

Cardiology↗