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Biomedical subjects

B Denis

Publications and source records attributed to B Denis.

At least 91 records · Page 5Linked to original sources
PubMed1985

[Vaccination of dental surgeons against viral hepatitis B].

One hundred dental surgeons practising in western France were immunized against hepatitis B virus, using the same batch of HEVAC B vaccine from the Pasteur Institute. The vaccine was very well tolerated. Seroconversion at 10 m IU/ml was 94% after 3 injections and 98% after the booster dose. From a kinetic study of anti-HBs antibodies we were able to determine different levels of post-immunization serological response and to classify responders as very good, good and fairly good. The effectiveness of the booster dose was manifest after 10 days. In view of the efficacy and safety of this vaccine, confirmed by other studies in sanitary personnel, we do not hesitate to recommend it to dental surgeons exposed to the disease.

Dentists↗
PubMed1985

Establishment of a reference library for evaluating computer ECG measurement programs.

As a result of an international cooperative project entitled "Common Standards for Quantitative Electrocardiography" (CSE), an ECG reference data base has been established with the aim of standardizing computer-derived ECG measurements. The objective of the project is to reduce the wide variation in wave measurements currently obtained by ECG analysis programs. A library of 250 ECGs with selective ECG abnormalities was established and a comprehensive reviewing scheme was devised for the visual determination of the onsets and offsets of P, QRS, and T. This task was performed by a board of cardiologists on highly amplified, selected complexes from the library. A subset was examined in order to study beat-to-beat and intraobserver variability. By using a modified Delphi approach, individual outlying point estimates were eliminated in four successive rounds. In this way final referee estimates were obtained which proved to be highly reproducible and precise. A reference library has thereby been developed which allows testing of the performance of ECG measurement programs and is a useful instrument in establishing recommendations for more precise measurement rules and definitions.

Computers↗
PubMed1985

Assessment of the performance of electrocardiographic computer programs with the use of a reference data base.

To allow an exchange of measurements and criteria between different electrocardiographic (ECG) computer programs, an international cooperative project has been initiated aimed at standardization of computer-derived ECG measurements. To this end an ECG reference library of 250 ECGs with selected abnormalities was established and a comprehensive reviewing scheme was devised for the visual determination of the onsets and offsets of P, QRS, and T waves. This task was performed by a group of cardiologists on highly amplified, selected complexes from the library of ECGs. With use of a modified Delphi approach, individual outlying point estimates were eliminated in four successive rounds. In this way final referee estimates were obtained that proved to be highly reproducible and precise. This reference data base was used to study measurement results obtained with nine vectorcardiographic and 10 standard 12-lead ECG analysis programs. The medians of program determinations of P, QRS, and T wave onsets and offsets were close to the final referee estimates. However, an important variability could be demonstrated between measurements from individual programs and mean differences from the referee estimates amounted to 10 msec for QRS for certain programs. In addition, the variances of all programs with respect to the referee point estimates were variable. Some programs proved to be more accurate and stable when the data from high- vs low-noise recordings were analyzed. Average Q wave durations calculated from ECGs for which programs agreed on the presence of a Q or QS wave differed by more than 8 msec in several program-to-program comparisons. Such differences may have important consequences with respect to diagnostic performance. Various factors that might explain these differences have been determined. The present study demonstrates that to allow an exchange of results and diagnostic criteria between different ECG computer programs, definitions, minimum wave requirements, and measurement procedures urgently need to be standardized.

Computers↗
PubMed1985

[Topographic diagnosis of true posterior infarction. Comparison of the vectorcardiogram and myocardial scintigraphy].

The aims of this comparative study by vectorcardiography and myocardial scintigraphy in the topographical analysis of primary inferior and/or posterior wall infarction, were: to obtain data confirming the value of identifying true posterior wall infarction; to confirm the diagnostic value of vectorcardiography in this condition. The patients in this retrospective study were admitted to hospital for primary inferior and/or posterior wall infarction and underwent vectorcardiography and myocardial scintigraphy either with Thallium 201 (137 patients) or 99m Technetium (88 patients) in the acute phase. The scintigraphies of all patients included showed hypofixation compatible with inferior and/or posterior infarction as this was used as the topographical reference. The results of vectorcardiography and myocardial scintigraphy were concordant in 164 of the 225 patients (72.8%), 18 with true posterior infarction [%), 110 with inferior wall infarction (48.8%) and 36 with postero-inferior wall infarction (16%). The results were discordant in 61 patients (27.1%); infarcts of the inferior or posterior walls according to one technique, were observed on the posterior or inferior walls with the other. The majority of these cases had postero-inferior wall changes on vectorcardiography and inferior wall infarction alone on scintigraphy (35 patients: 15.5%). The specificity of the vectorcardiographic signs of true posterior wall infarction remained satisfactory.(ABSTRACT TRUNCATED AT 250 WORDS)

Diphosphates↗
PubMed1985

[Prospective study of the value of echocardiography and myocardial scintigraphy with Tc 99m pyrophosphate during the acute stage of right ventricular infarction].

The aim of this study was to compare the clinical values of 99mTc pyrophosphate scintigraphy and M mode and 2D echography in the diagnosis of right ventricular infarction and in the predicting of some of its complications. Fifty-two patients were prospectively studied by echocardiography and scintigraphy at the acute stage of inferior wall infarction. Scintigraphy was performed in the antero-posterior and 45 degrees left anterior oblique incidences during the first 3 days of infarction. Right ventricular infarction was diagnosed if the right ventricular fixation was separated from the left ventricle by fixation at the base of the septum. Echocardiography was performed at an early stage by the usual 3 incidence. Dilatation of the right ventricle on the parasternal and submitral incidences; abnormal right ventricular contraction was searched for in all the incidences. The following results were obtained: scintigraphy showed a localised fixation allowing a topographic study in 40/52 patients (77%); satisfactory echocardiographic studies were obtained in 46/52 patients (88.5%). Signs of right ventricular infarction: scintigraphy showed signs of necrosis of the right ventricle in 12/40 patients (30%) who had a localised fixation; echocardiography showed dilatation (greater than 25 mm) of the superior part of the right ventricle with a right/left ventricle ratio greater than 0.5 in 16/46 patients (37%) with interpretable studies and obvious abnormalities of right ventricular wall motion in 7 patients (15.2%), less obvious in 10 other patients (22%).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1985

[Cost/efficacy ratio in the diagnosis of coronary disease. Bayes' analysis by computer: respective role of the exercise test, isotopic methods and coronarography].

UNLABELLED: Between January 1983 and May 1984, 104 patients with no known cardiac pathology were referred by their cardiologist for diagnosis of chest pain. They all underwent coronary angiography which was used as the reference investigation and the following sequential Bayes' analysis was performed. The percentage probability of coronary artery disease was estimated from clinical date (age, sex, characteristics of the chest pain subdivided into 3 groups); an exercise ECG was performed in all cases (classified as positive, negative or non diagnostic); if the probability of coronary artery disease was greater than 95% (or less than 5%) after exercise stress testing the patients was diagnosed as having (or not having) coronary artery disease. If the probability was between 6 and 94% the patient underwent Thallium myocardial scintigraphy (Thallium dipyridamole; analysis on a colour television screen); the coronary risk probability before Thallium was that calculated after exercise stress testing. If after myocardial scintigraphy the coronary risk remained between 6 and 94%, an exercise angioscintigraphy was performed and interpreted in the same way. The clinical and complementary date was analysed on a mini-computer, the values of the sensitivity and specificity of the tests used for the calculation of the probability of coronary artery disease were those previously published by our group. RESULTS: 31/88 (35%) of patients were classified in the 5% risk groups after exercise stress testing (24 coronary artery disease; 7 normals: no errors of classification). Fifty six out of the 88 patients (65%) were classified in the 5% risk group after myocardial scintigraphy (42 patients with coronary artery disease with 41 abnormal coronary angiographies and 14 normal patients, all of whom had normal coronary angiographies; this represents a 1.8% divergence of classification compared with coronary angiography). Angioscintigraphy only classified 3 of the remaining patients, one wrongly, and did not seem to be useful diagnostically as a third-line investigation after Thallium scintigraphy or as a second-line investigation instead of Thallium scintigraphy. This strategy is less costly than carrying out coronary angiography systematically in these patients: if diagnostic coronary angiography is performed alone in patients with a risk of 6 to 94% the cost is 4 800 FF vs 10 400 FF per patient; if coronary angiography is performed in all patients in whom coronary artery disease is possible or certain (all patients with a risk of over 5%), the cost is 8 400 FF vs 10 400 FF per patient, a saving of 20%.(ABSTRACT TRUNCATED AT 400 WORDS)

Bayes Theorem↗
PubMed1985

[Pleomorphic cell sarcoma responsible for a picture of retroperitoneal fibrosis].

A 68 years-old patient was followed-up during five years for idiopathic retroperitoneal fibrosis. The diagnosis was based on repeated examinations with two laparotomies as well as numerous biopsies. At autopsy a primary retroperitoneal sarcoma was found. This case points out the difficulty to differentiate idiopathic from malignant retroperitoneal fibrosis. Only one similar case was published in the literature.

Aged↗
PubMed1984

[Bilateral coronaro-pulmonary fistula. Apropos of a new case with review of the literature].

Two coronary pulmonary fistulae were demonstrated between the right coronary and left anterior descending arteries and the main pulmonary artery at coronary angiography, in a 66 year old woman with a continuous murmur in the third left intercostal space. This double malformation, though uncommon is not rare (18 previously published cases). It is usually diagnosed late (17 to 76 years) and the presentation is limited in half the cases to a localised continuous murmur, the localisation of which may simulate a patent ductus arteriosus. The hypothesis of a supernumerary coronary artery arising from the main pulmonary artery is suggested by the constancy of the anatomical characteristics of the reported cases. Eight patients presented typical attacks of angina which were due to severe coronary atherosclerosis, affecting two or three main vessels except in one case. Therefore, it is unlikely that these fistulae cause coronary insufficiency by a coronary steal syndrome. However, this mechanism may aggravate symptoms in patients with coronary artery disease and necessitate surgical cure of the fistulae at the same time as coronary bypass surgery. On the other hand, surgery does not seem to be indicated in asymptomatic patients.

Aged↗
PubMed1984

[Role of left ventricle angioscintigraphy during exercise in the diagnosis of coronary disease. Comparison of static and dynamic exercise].

The aim of this study was to compare the diagnostic value of exercise stress testing, Thallium 201 myocardial scintigraphy or after administration of dipyridamole and left ventricular angioscintigraphy performed either during a static (handgrip) or dynamic exercise (bicycle ergometry) for the positive diagnosis of stenosing coronary artery disease. The exercise angioscintigraphy was performed at equilibrium with 99m Tc red blood cell labelling. The global ejection fraction and that of seven radial segments of the left ventricle were measured, the data being recorded within a period of 2 minutes. The handgrip consisted in compressing a dynamometric ball at 1/3 maximal force for 3 minutes, with both hands; the ergometric exercise was increased by 30 Watt 2 minute increments until a positive ECG or 85% of the theoretical maximal heart rate for age was obtained. Normal subjects (n = 29) increased their global (+ 8%) and regional ejection fractions in each of the seven segments (p less than 0.05) during ergometric exercise: there was no significant change of global (-3% NS) or segmental ejection fractions during the handgrip exercise. In the coronary group (at least one greater than 70% stenosis) (n = 61) the fall in global ejection fraction was the same (-14%) with both forms of exercise; a similar fall in the segmental ejection fraction in the territory distal to the stenosis was observed with the handgrip (-22%) and bicycle ergometry (-28% NS). Dynamic exercise testing seemed superior to handgrip exercise. Therefore, the finding of an abnormal global ejection fraction on exercise (i.e. either a global ejection fraction less than the lower limit of normal on exercise, or lower than the global ejection fraction at rest), or of an abnormal regional ejection fraction (i.e. either a regional ejection fraction less than the lower limit of normal over at least 3 segments, or a regional ejection fraction on exercise lower than the regional ejection fraction at rest over at least 3 segments) detected coronary artery disease with a sensitivity of 94% and a specificity of 72%. Dynamic exercise angiography seemed to be more sensitive than maximal ECG stress testing (94% compared to 64%) more rapidly positive (p less than 0.05), as sensitive (94% compared to 83% NS) than Thallium myocardial scintigraphy, but less specific (72% compared to 90%, p less than 0.05), and as unspecific as ECG stress testing.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1984

[Hyperaldosteronism in the acute phase of myocardial infarction. Effects of its treatment on the prevention of ventricular fibrillation].

Many metabolic and hormonal changes are observed during the acute phase of myocardial infarction (glucose metabolism, lipoproteins...). Mineralocorticoid function may also be disturbed but there have been few studies of this problem. The aim of this study was to confirm the elevation of serum aldosterone during the acute phase of myocardial infarction and to determine the effects of antialdosterone treatment in these patients. Hyperaldosteronism was confirmed in 74% of 72 consecutive patients admitted for acute myocardial infarction, in 85% if patients previously treated by an antialdosterone drug or admitted after the acute phase are excluded, and in 96% if patients with cardiac failure are included. One thousand consecutive patients admitted for myocardial infarction were given an antialdosterone agent systematically (intravenous potassium canrenoate , 600 mg daily for 5 days). The serum and red blood cell potassium concentrations rose, the number of ventricular extrasystoles and the administration of anti-arrhythmic drugs fell, and, above all, the prevalence of ventricular fibrillation decreased significantly: 0,8% (p less than 0,001), compared with comparable previously reported series.

Acute Disease↗
PubMed1984

[Treatment of cardiac failure with refractory edema using extracorporeal ultrafiltration].

Thirteen patients with chronic congestive cardiac failure and refractory oedema were treated by haemodialysis. All patients had severe cardiac failure (Class IV NYHA) due to primary myocardial disease (5 cases), ischaemic heart disease (4 cases) or valvular heart disease (4 cases). Haemodialysis was performed via a Shaldon Y-shaped catheter in the internal jugular vein, with input and output through the same catheter using an alternating clamp. Filtration was carried out through a highly permeable membrane by a simple hydrostatic pressure gradient without a dialysis bath. The sessions were monitored haemodynamically by measuring the pulmonary artery pressures. The mean weight loss was 4.9 +/- 0.4 kg obtained after 3 three hour dialysis sessions with 24 hour intervals between each session (mean filtration flow = 12 ml/min). Hypotension was observed in one patient with low initial pulmonary artery pressures; two patients with severe valvular stenosis (1 mitral stenosis; 1 aortic stenosis) failed to lose weight. In the 10 remaining cases, there was a clearcut symptomatic improvement (5 patients Class III; 5 patients Class II NYHA) with total regression of oedema. There was a significant fall in pulmonary artery (mean PAP 40.5 +/- 6.5 mmHg to 34.6 +/- 6.5 mmHg; p less than 0.001) and pulmonary capillary pressure (27.6 +/- 6.9 mmHg to 22.5 +/- 5.8 mmHg; p less than 0.05) in these 10 cases. Cardiac output did not change significantly (cardiac index 2.2 +/- 0.5 l/m2/min compared to 2.3 +/- 0.4 l/m2/min after dialysis).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1983

[Comparative study of quinidine and disopyramide in the treatment of stable ventricular extrasystole].

The antiarrhythmic efficiency of quinidine arabogalactan-sulphate (QAGS) and disopyramide were determined in 38 patients showing chronic, stable frequency premature ventricular beats (PVB). The study which was carried out in 4 medical Centers, used a longitudinal cross-over design. After a baseline evaluation which consisted of two 24 hours electrocardiograms, the patients were randomised to one of the two drugs during a period of 6 or 7 days. The drug sequence were followed by a placebo sequence. A 24 hours electrocardiogram was performed at the end of each sequence. The daily doses were equivalent to 660 mg of quinidine base for QAGS and 600 mg for disopyramide. Among the 38 patients who entered in the study, 32 went through each sequence of the test. The average number of PVB was significantly reduced by QAGS and disopyramide (p less than 0.0001). With QAGS 18 patients had more than 65 p. 100 reduction of PVB and 12 of them more than 80 p. 100. With disopyramide, 14 patients had more than 65 p. 100 reduction of PVB and 12 of them more than 80 p. 100. There was no statistical difference in the overall efficiency of the two drugs. Three patients died, one from myocardial reinfarction, one from ventricular fibrillation; in one other case, the cause of the death remained undetermined. QAGS was better tolerated than disopyramide; adverse effects occurred in 6 patients with QAGS and in 10 with disopyramide. The responsibility of disopyramide in the occurrence of two severe ventricular arrhythmia may be questioned.

Adult↗
PubMed1983

[Measurement of the right ventricular ejection fraction during the acute phase of myocardial infarction using 81m krypton infusion. Comparison with the left ejection fraction].

The right ventricular ejection fraction is rarely measured, as conventional diagnostic methods (radiology, echocardiography) are confronted with the problem of representing the right ventricle as a simple tridimensional geometrical model. This is not necessary with the radio-isotopic techniques. However, all those used for the measurement of right ventricular ejection fraction lead to important methodological problems. We have therefore developed a technique of measuring this parameter with an infusion of 81 m Kr. This radioactive gas is pure gamma-ray emitter with a 13 second period. Dissolved and infused intravenously, it is eliminated during the first passage through the lung. The continuous separation of the generator of 81 m Kr is performed with isotonic dextrose solution which is then infused for a period of 7 minutes. During this time, the activity detected by the scintillation camera inclined in the 30 degrees RAO projection is stored, together with the electrocardiogram in a computer. The precordial radioactivity of the retrocardiac lung tissue is subtracted after injection of 74 MBq of 99 mTc microspheres. A graph of right ventricular activity can then be reconstructed and the right ventricular ejection fraction calculated. The left ventricular ejection fraction is then measured with 99 mTc--labelled RBCs. This method allows the right ventricular ejection fraction to be measured in the RAO projection, the best incidence for the separation of the right atrial from the right ventricular activity without interference from left ventricular activity because of the pulmonary elimination of the Krypton radioactivity. The measurement performed on a large number of cardiac cycles allows a continuous study of the right ventricular ejection fraction. At the end of the infusion there is no circulating radioactivity so that the measurement can be repeated. This technique was used in 17 patients with acute myocardial infarction. In the 7 patients with anterior infarcts reduction of the left ventricular ejection fraction was the predominant finding (21,6 +/- 6,8%). The right ventricular ejection fraction was 34,2 +/- 6,4%. On the other hand, patients with a postero-inferior infarction had little change in left ventricular ejection fraction (59,2 +/- 12%) but those with right ventricular extension of their infarcts had very reduced right ventricular ejection fractions (less than 23%). The measurement of right ventricular ejection fraction with 81 m Kr is a reliable atraumatic method for diagnosing right ventricular infarction by the quantification of its functional impairment.

Adult↗
PubMed1983

[Aortic and tricuspid valve involvement caused by myxoid degeneration associated with a severe mitral prolapse. Apropos of 2 patients undergoing a double valve replacement].

Idiopathic mitral valve prolapse due to severe myxoid degeneration may be associated with aortic and/or tricuspid valve disease of the same aetiology. These localisations, which usually give rise few symptoms, can be detected by echocardiography. Sometimes, however, they may give rise to serious valvular regurgitation requiring surgical correction at each diseased valve. The authors report two cases of "floppy" mitral valve prolapse, the first requiring mitral and tricuspid, and the second, mitral and aortic, valve replacement. These cases underline the value of especially by echocardiography, in view of their serious complications.

Adult↗
PubMed1982

[Value of isosorbide dinitrate injection in the acute phase of myocardial infarction. Clinical and haemodynamic study (author's transl)].

Left ventricular failure is one of the most common complications of acute myocardial infarction and may have very serious haemodynamic consequences. Isosorbide dinitrate administered by intravenous infusion in doses of 3 to 7 mg/hour had highly beneficial effects on pre-load and frequently improved cardiac output. The results obtained in this series of 10 consecutive patients demonstrate that the drug has very favourable effects on the immediate prognosis of myocardial infarction.

Adult↗