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Biomedical subjects

B Denis

Publications and source records attributed to B Denis.

At least 73 records · Page 4Linked to original sources
PubMed1990

[Anisoylated plasminogen streptokinase complex during the acute phase of myocardial infarction. Results of a multicenter double-blind study versus heparin].

Two hundred and thirty-one patients admitted to hospital within 5 hours of the onset of symptoms of a primary myocardial infarction were randomised into 2 groups: one received thrombolytic therapy [anisoylated plasminogen streptokinase activator complex (APSAC): 30 IU in 5 minutes] and the other was given conventional heparin therapy (5,000 IU). Heparin was given to both groups 4 hours later (500 IU/kg/day); the APSAC (N = 119) was identical with respect to age, location of infarct, Killip classification, delay before randomisation (188 +/- 62 minutes). Coronary angiography and ventriculography were performed after 3.4 +/- 1.2 days, and angioscintigraphy and myocardial scintigraphy after 19 +/- 2.5 days to determine the size of the infarct and the quality of left ventricular function. Coronary patency was much higher in the APSAC group (77%) than the heparin group (37%) (p less than 0.001). The angiographic ejection fraction was significantly greater in the thrombolytic group than in the heparin group (53 +/- 13% vs 47 +/- 12%, p less than 0.002), the difference being statistically significant in the anterior and inferior infarct subgroups. At the third week, the difference remained significant in the anterior infarct subgroup: a 31 per cent reduction in necrosed myocardial mass was observed in the APSAC group (33% in anterior infarcts: p less than 0.05 and 16% in inferior infarcts: NS). The limitation of infarct size explained the smaller reduction in left ventricular systolic function (r = 0.73; p less than 0.01). The hospital and one year mortality was comparable in the two groups which was not surprising given the small number of patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Anistreplase↗
PubMed1990

[Right ventricular diastolic overloading in left bundle-branch block].

The combination of left bundle-branch block with right ventricular hypertrophy is said to be exceptional. Faced with this possibility, many authors consider a diagnosis of right ventricular hypertrophy as impossible. The two cases reported were found in a total of approximately 10,000 vectorcardiograms. Starting in 1950, Laham drew attention to the special morphology of precordial left bundle-branch block when there is right ventricular hypertrophy. In 1971, Chou and Helm suggested vectorcardiographic criteria for right ventricular hypertrophy in the case of left bundle-branch block--right posterior shift of the QRS loop and clockwise rotation on the horizontal plane. These criteria are satisfied in the first case, i.e. partial atrioventricular canal, but not in the second, i.e. ostium secundum defect. In both cases, the appearance of the left bundle-branch block is very atypical.

Adult↗
PubMed1990

[A rare complication of thoracic radiotherapy: auriculoventricular block. Apropos of a case and review of the literature].

The authors report the case of a 30-year old patient who presented atrioventricular block 12 years after mediastinal radiation treatment of Hodgkin's disease. This patient had been monitored in the service for 3 years after the insertion of a pacemaker. A review of the literature, identified 15 cases of post-radiation AV block. The AV block was subnodal in the 7 cases which were subjected to endocavitary recording.

Adult↗
PubMed1990

Evaluation of ECG interpretation results obtained by computer and cardiologists.

In an international project investigators from 25 institutes are trying to establish a common reference library and evaluation methods for testing the diagnostic performance of various ECG computer programs and of cardiologists, based on ECG-independent clinical information. A first set of 500 validated ECGs was collected and analyzed by fifteen different computer programs and nine cardiologists, seven of who analysed the ECG and five the VCG. A coding scheme was used to map individual diagnostic statements onto a common set. Combined program and referee results were obtained by weighted averaging. Preliminary results indicate that the classification accuracy of several programs can still be improved. However, it was also apparent that the results of the best 12-lead ECG computer programs proved to be almost as accurate as the best of seven cardiologists in classifying seven main disease categories, i.e., normal, left, right and biventricular hypertrophy, anterior, inferior and combined myocardial infarction. Evaluation of rhythm statements and conduction disturbances was not included in the study. The data collection is still being pursued in order to reach over 1,000 cases. In this way a common diagnostic database is being established for comparative testing of diagnostic computer programs. This should lead to consumer protection and improve the accuracy and reliability of computerized electrocardiography.

Cardiovascular Diseases↗
PubMed1990

[Influence of the sclerosing of esophageal varices on portal pressure and azygos venous blood flow].

Endoscopic sclerotherapy is widely employed for esophageal variceal hemorrhage. However it has side effects and can aggravate portal hypertension by suppression of portosystemic shunt. The purpose of the present investigation was to study the effect of variceal thrombosis on hepatic venous pressure gradient and azygos blood flow. Eight alcoholic cirrhotic patients with a first variceal hemorrhage were included. According to Child Pugh's classification, 4 patients were group A, 2 group B and 2 group C. At each session 40 to 60 ml of 1 p. 100 polidocanol were injected into the varices. A hemodynamic study was performed in each patient before and about one week after variceal obliteration (mean 3.3 procedures). Mean value of hepatic venous pressure gradient was 16.6 +/- 5.5 mm Hg and 17.0 +/- 3.8, respectively, before sclerotherapy and after eradication of varices; azygos blood flow 663 +/- 506 ml/mn before and 682 +/- 522 after; cardiac, output was 6.5 +/- 0.7 ml/min before and 6.5 +/- 0.8 after. None of these differences were significant. These results suggest that endoscopic sclerotherapy using polidocanol does not change hepatic venous pressure gradient and azygos blood flow, and does not lower blood flow through the gastroesophageal collaterals draining into the azygos vein. This is consistent with the hypothesis that thrombosis remains localized.

Adult↗
PubMed1989

Differences in tocopherol-lipid ratios in ARDS and non-ARDS patients.

Plasma tocopherol, plasma total lipid levels and tocopherol-lipid ratio were measured every 6 h during 48 h in 12 critically ill patients and compared with those of a control group. The patients were divided into two groups. Group I comprised 6 critically ill patients with ARDS and group II comprised 6 severely ill patients without ARDS. The means for all observations of plasma tocopherol, total lipid levels and tocopherol-lipid ratio in groups I and II were significantly depressed relative to a control group (p less than 0.0001). The difference in the average tocopherol-lipid ratio between the three groups (p less than 0.0001) and between the groups I and II was statistically significant (p less than 0.0001). Our results indicated: (1) a decrease of vitamin E concentrations in the critically ill patients, particularly in ARDS patients; (2) the importance of the relationship between plasma tocopherol and plasma lipids levels in evaluating the deficiency in vitamin E which was evident in ARDS patients.

Adult↗
PubMed1989

Blood genetic marker studies of a sheep-goat hybrid and its back-cross offspring.

Blood samples from a female sheep-goat hybrid and its back-cross male offspring were tested for electrophoretic variants of plasma albumin, transferrin and esterase, and of red cell carbonic anhydrase, nucleoside phosphorylase, NADH-diaphorase, 'X'-protein, superoxide dismutase, malic enzyme and haemoglobin. Red cells were also tested for blood group antigens. Both animals showed variants that could not be attributed to either sheep or goat alone, thus confirming previous chromosomal data that the female was a genuine sheep-goat hybrid.

Animals↗
PubMed1989

[Detection of parietal lesions using magnetic resonance imaging in arrhythmogenic dysplasia of the right ventricle].

Seven patients with arrhythmogenic right ventricular dysplasia were explored by magnetic resonance imaging (MRI), using the spin-echo technique (TR = the patient's own RR cycle; TE = 28 ms, 56 ms, 84 ms) with multiple, contiguous, 7 to 10 mm thick sections performed in two planes: axial plus sagittal or frontal planes. In 5 out of 7 patients, MRI showed dysplastic lesions in the right ventricular wall presenting typically as fat-like high signals contrasting with the normal myocardium. In 2 patients, no lesion was clearly visualized. The parietal lesions were located in the anterior wall of the right ventricle and conus arteriosus in 5 cases and in the lower wall of the right ventricle in one patient who had two dysplastic areas. In 3 patients the lesions extended up to the tip of the interventricular septum and of the left ventricle. In the 2 patients whose lesions were most extensive, their predominance in the subepicardial region and the concordance between the sites of abnormalities at MRI and angiography were clearly observed. Thus, despite its present technical limitations MRI seems to be one of the first techniques capable of visualizing the parietal lesions in patients with arrhythmogenic right ventricular dysplasia.

Adult↗
PubMed1988

Effect of combining electrocardiographic interpretation results on diagnostic accuracy.

In order to test the diagnostic performance of various ECG computer programs a reference library of ECGs is being established and evaluation methods are being developed in an international co-operative project. A pilot study was undertaken in which 250 validated electrocardiograms (ECG) and vectorcardiograms (VCG) comprising seven diagnostic groups i.e., normal, left, right and bi-ventricular hypertrophy, anterior, inferior and combined infarction have been analysed independently by 11 different computer programs as well as by six cardiologists. A coding scheme was applied to assign individual diagnostic statements to a common set and to obtain combined program and cardiologist interpretation results. Preliminary results indicate that the accuracy of classification by different programs varies widely. Total accuracy varied between 57.2% and 75.8% (median 69.4%). The cardiologists had a higher accuracy (median 74.3%) than the majority of programs, at least when using the standard ECG. As it is considered premature to stress individual program results, in view of the current sample size, the enhancement in diagnostic accuracy obtained by combining interpretation results is highlighted. Indeed combined cardiologist and program results demonstrated the highest accuracy i.e., respectively 78.7% and 76.1%, higher than the result of any individual reader or program. The combined result of the five most accurate programs was 78.4%, that of the six least accurate was 71.5%, which is again higher than the respective individual components. These findings demonstrate that the combination of expert knowledge of computer programs can, similar to panel review and group analysis in clinical practice, enhance diagnostic accuracy.

Diagnosis, Computer-Assisted↗
PubMed1987

A reference data base for multilead electrocardiographic computer measurement programs.

In an effort to standardize and evaluate the performance of electrocardiographic computer measurement programs, a 15 lead reference library has been developed based on simultaneously recorded standard 12 lead and orthogonal XYZ lead data. A set of 250 electrocardiograms (ECGs) with selected abnormalities was analyzed by a group of five referee cardiologists and 11 different 12 lead and 6 XYZ computer programs. Attention was focused on the exact determination of the onsets and offsets of P, QRS and T waves. The referees performed their task on highly amplified, selected complexes from the library in a two round process. Median results of the referees coincided best with the median derived from all programs. An analysis of stability proved that the combined program median was a robust reference. However, some individual program results were widely divergent. Paired t tests demonstrated earlier onset for P and QRS (p less than 0.001), as well as later offset for P and T waves in the median 12 lead than in the XYZ results. Significant differences also existed among results obtained by programs analyzing all standard ECG leads at one time, the so-called multilead programs, and those obtained by the conventional standard three lead analysis programs. As a consequence, the derived P, PR, QRS and QT interval measurements varied quite widely among the various programs. Significant differences were also observed among measurements of Q, R and S duration. Some programs showed Q waves that were on the average 6 ms (p less than 0.001) longer than those of others. This may significantly influence diagnostic performance.(ABSTRACT TRUNCATED AT 250 WORDS)

Electrocardiography↗
PubMed1987

[Restrictive ostium secundum: a new fetal malformation syndrome].

Echocardiographic examination of a 23 weeks' hydropic fetus disclosed abnormal kinetics of the valve of the foramen ovale. This valve was constantly bulging out, dome-like, into the left atrium, and on TM-mode tracings in transatrial projection the alpha and beta peaks which occur respectively during the opening and closure of the atrioventricular valves throughout fetal life were missing. This anomaly suggested that the ostium secundum was restrictive; the foramen ovale itself was not restrictive. Such abnormal kinetics have not been encountered among 16 other cases of hydrops fetalis of cardiac or other origin, or in a control series of 81 normal fetuses, which clearly shows that the restriction was primitive. At birth, the child presented with aneurysm of the foramen ovale, probably due to the restrictive ostium secundum.

Echocardiography↗
PubMed1987

[Magnetic resonance imaging in dissection of the aorta].

In order to evaluate the usefulness of this new exploratory method in dissection of the aorta, 13 patients (10 men and 3 women, mean age 58 +/- 14 years) were examined by means of an 0.5 Tesla Magniscan 5000 nuclear magnetic resonance machine. Fifteen examinations were performed: 5 in patients with actual aortic dissection (type A 4 including one acute, type B1), 5 in patients previously operated upon for type A dissection and 5 for suspected acute aortic dissection unconfirmed by other examinations. Magnetic resonance imaging (MRI), synchronized with electrocardiography, was carried out using spin-echo techniques with 1 to 3 echoes and multiple contiguous sections along several planes. In the 5 patients with actual dissection the 2 channels separating the membrane could be demonstrated, thus providing a firm diagnosis (MRI proved superior to angiography in 2/5 patients). All 5 patients could be classified as either type A or type B. Extension to the cervical vessels was observed in 3 cases and the portal of entry was seen in one case, but the origin of the coronary arteries was never visualized. In the 5 patients previously operated upon MRI provided detailed analysis of the prosthesis of the supra-coronary ascending aorta implanted in all cases, of the aorta proximal and distal to that segment and of the periaortic mediastinum. By studying the signal from the false channel distal to the prosthesis information was obtained as to the presence in it (2 patients) or absence of circulating blood.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

[Value of magnetic resonance imaging in a lipoma of the left ventricle].

A patient with benign left ventricular lipoma was explored pre- and post-operatively with echocardiography, computerized tomography (CT) and magnetic resonance imaging (MRI). With MRI spin-echo sequences the lipoma emitted a bright signal similar to that of normal fatty tissue on the two echoes of the sequence (28 ms and 65 ms). MRI was not better than CT to demonstrate that the tumour was a lipoma, but it proved to be the best technique to obtain information on tumoral spread to the myocardium and pericardium, and it showed the intracavitary extension without the need for contrast medium injection. After surgery, MRI displayed the remains of a septal lipomatous lesion. This case underlines the usefulness of MRI for the evaluation of cardiac tumours, and particularly lipomas.

Echocardiography↗
PubMed1987

Testing the performance of ECG computer programs: the CSE diagnostic pilot study.

In an international project investigators from 21 institutes are trying to establish a common reference library and evaluation methods for testing the diagnostic performance of various ECG computer programs using ECG independent clinical information. Preliminary results indicate that the classification accuracy of different programs varies widely.

Electrocardiography↗