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Biomedical subjects

C Dupuis

Publications and source records attributed to C Dupuis.

At least 55 records · Page 3Linked to original sources
PubMed1991

[Holter monitoring, exercise test and atropine test in isolated congenital atrioventricular block in children].

Twenty-four patients with isolated congenital heart block were investigated by 24-hour Holter monitoring at an average age of 9.3 +/- 5.5 years. Six patients were symptomatic and 18 were asymptomatic. Eight asymptomatic patients underwent exercise stress tests and an atropine test was performed in 10 asymptomatic patients to evaluate the capacity to accelerate the heart rate. The symptomatic patients were older than the asymptomatic patients. None of the parameters which analyse ventricular rate were significantly different in the two groups of patients. Significant ventricular arrhythmias (Lown Grade 2 or over) were recorded in 1 symptomatic and 3 asymptomatic patients. The incidence of these ventricular arrhythmias increased with age and degree of bradycardia. The percentage increase in ventricular rate after atropine correlated with what was observed on effort (r = 0.95, p = 0.01) but there was no relationship between the ventricular rates during these two tests and those recorded on Holter monitoring. The results of this series of children with isolated congenital heart block show the Holter parameters cannot distinguish symptomatic from asymptomatic patients. The exercise stress and atropine tests gave very similar results but their prognostic value has not yet been established.

Adolescent↗
PubMed1990

[Transcutaneous transport of trinitrin in children after application of nitroglycerin patches].

Plasma levels of nitroglycerin were measured 13 to 24 hours after the application of nitroglycerin stamps in 7 children aged from 1 month to 7 years and suffering from heart failure. The plasma levels varied considerably from one patient to another, confirming that the bioavailability of transdermal nitroglycerin is extremely variable in children. Only 3 patients had a nitraemia higher than 1 ng/ml, a figure compatible with a haemodynamic effect of the drug. No side-effect associated with the nitroglycerin stamps was observed. The dosage we use (a quarter of a stamp for 5 kg bodyweight) seems to be adequate at the beginning of treatment, to be progressively increased according to the way the drug is tolerated.

Administration, Cutaneous↗
PubMed1990

[Incidence and factors favouring ventricular arrhythmia after surgical repair of tetralogy of Fallot].

The prevalence and factors favorising postoperative ventricular arrhythmias in 62 patients undergoing surgical repair of tetralogy of Fallot between 1971 and 1982 were analysed. Nineteen patients (31 %) had significant ventricular arrhythmias (Lown greater than or equal to 2) on Holter monitoring or exercise stress testing. The arrhythmia could only be recorded after stress testing in 5 patients. The patient's age at operation, the duration of follow-up and age at evaluation were significantly greater in the group with ventricular arrhythmias. However, age at operation was closely related to the other two parameters and a discriminating analysis showed that the age at operation was not a favorising factor for the occurrence of ventricular arrhythmias (p = 0.23), in contrast to the duration of follow-up (p = 0.0015) and age at evaluation (p = 0.0007). No relationship was found between ventricular arrhythmias and the following factors: previous anastomosis, outflow patch, necessity of a ventriculotomy or reoperation, presence of residual ventricular septal defect, postoperative systolic right ventricular pressure, severity of intraventricular conduction defects, and effort tolerance. These results suggest that after surgical repair of tetralogy of Fallot, the incidence of ventricular arrhythmias increases with time. The main problem is to identify patients with a high risk of sudden death, i.e. those with high degree ventricular arrhythmias and poor haemodynamic results of repair.

Arrhythmias, Cardiac↗
PubMed1990

[Anatomic correction of simple transposition of the great vessels during the neonatal period. 5 years' experience in 235 children].

From March 1984 to August 1989, anatomic surgical correction was performed on 235 newborn infants (2 to 32 days old, mean 8.5 +/- 4) with simple transposition of the great arteries. Ninety-four percent of the patients underwent balloon atrial septostomy before the operation. The anatomy of the coronary arteries according to the Yacoub classification was as follows: type A, 160 patients (68%); type B, 5 patients (2%); type C, 11 patients (5%); type D, 41 patients (17%); and type E, 18 patients (8%). Coronary artery relocation was performed according to the Yacoub technique with some modifications, and the pulmonary artery reconstruction was done using the Lecompte manouver in association with a pericardial patch. The perioperative mortality rate was 8.9 percent for the entire series, significantly higher for the type C (46%, p less than 0.01) and significantly lower for the type D (0%, p less than 0.05). Seven patients were lost of follow-up. The follow-up ranged from 1 to 63 months (mean 21 +/- 14). Four late deaths occurred: 2 from myocardial infarction, 1 from pulmonary hypertension and one from a thrombotic occlusion of the superior Vena cava. One patient had an acute posterior myocardial infarction five months after the operation and his left ventricular contractility is normal at echocardiography three years later. Supravalvular pulmonary stenosis occurred in 17 patients but only two were operated on with no death. Mild aortic regurgitation occurred in nine patients. Ninety eight percent of the survivors have a normal life, with no cardiovascular symptoms and receive no medication.

Actuarial Analysis↗
PubMed1989

Evaluation of vein of Galen arteriovenous malformation in newborns by two dimensional ultrasound, pulsed and colour Doppler method.

Two babies with severe cardiac failure caused by a large arteriovenous malformation of the vein of Galen were evaluated with 2-dimensional ultrasound, pulsed and colour Doppler techniques. In both cases similar findings were recorded: dilated right cardiac chambers with high cardiac output in superior vena cava and ascending aorta; retrograde diastolic flow in descending aorta and continuous forward flow in arch arteries reflecting low resistance to flow in cerebral arteries; recirculation of microbubbles through the superior vena cava after passage unchanged through the cerebral malformation following contrast injection of saline into a peripheral vein or an arterial umbilical line. In addition, colour Doppler study of the brain clearly showed the malformation and the dilated straight sinus. Arteriovenous malformation of the vein of Galen can be noninvasively and easily detected by ultrasound studies of the heart and the brain.

Cerebral Veins↗
PubMed1989

Effects of oral cimetidine and ranitidine on gastric pH and residual volume in children.

The effect of orally administered cimetidine 7.5 mg/kg (group 1), ranitidine 1.5 mg/kg (group 2), ranitidine 2.0 mg/kg (group 3), or a placebo (group 4) on gastric pH and gastric residual volume of 60 healthy children 2-6 yr of age admitted for elective surgery was evaluated. Both cimetidine and ranitidine administered 1-2 h prior to induction of anesthesia effectively increased the gastric pH:5,47 - 1.85 ml/kg (group 1), 4.92 +/- 2.1 ml/kg (group 2), 5.30 +/- 1.82 ml/kg (group 3) compared with 1.75 +/- 0.58 ml/kg (group 4) (P less than 0.001). A single dose of ranitidine 1.5 mg/kg was an effective as ranitidine 2.0 mg/kg and cimetidine 7.5 mg/kg. Neither drug decreased the gastric residual volume: 0.32 +/- 0.33 ml/kg (group 1), 0.31 +/- 0.06 ml/kg (group 2), 0.23 +/- 0.05 ml/kg (group 3), and 0.33 +/- 0.05 ml/kg (group 4). The combination of a volume greater than 0.4 ml/kg and a pH less than 2.5 was found in 33% (five of 15) of patients in the placebo group (group 4). In contrast, there were no patients with this combination in groups 1, 2, or 3 (P less than 0.001).

Administration, Oral↗
PubMed1989

Heart rate and blood pressure reactivity during active coping with a mental task in healthy 18- to 73-year-old subjects.

Alterations with aging in the responses of heart rate (HR) and blood pressure (BP) reactivity were investigated during mild mental stress induced by undergoing a psychometric test, in 52 women and men aged 18-73 years, with no history of cardiovascular, renal or neurological deficits. HR and BP responses were measured before, during and after the test. Resting HR and diastolic BP (DBP) were not age-related while resting systolic BP (SBP) was. HR and SBP were increased during test performance. HR reactivity, measured during task execution as well as during recovery, was significantly decreased in older subjects. DBP recovery variation was lowered with age. These results indicate that age is an important determinant of the magnitude of cardiovascular adjustment during minor mental stress in women and men.

Adolescent↗
PubMed1989

[Treatment with urokinase of systemic arterial thrombosis in the newborn infant].

The records of 5 neonates with systemic arterial thrombosis (aortic in one case, peripheral in four cases) were reviewed. Fibrinolysis was performed with urokinase administered by infusion (1,000 to 4,000 U/kg/h). This treatment was combined with heparin therapy in 4 cases. Thrombosis was due to various causes: umbilical arterial catheter (1 case), disorders of supraventricular rhythm in utero (1 case), aneurysm of the ductus arteriosus with dysplastic aortic arch vessels (2 cases); one of these patients also had myocardiopathy. No cause could be found in a premature child weighing 1,300 g. The presenting symptoms of systemic arterial thrombosis are ischaemia of the extremities and suppression of peripheral pulses; heart failure with arterial hypertension is frequent. In our series the diagnosis was confirmed by doppler-ultrasonography in one case and by angiography in three cases (angiography in the left ventricule with foramen ovale, or umbilical aortography). Treatment with urokinase lasted 1.5 to 7 days. In 2 children the initial dosage had to be increased as there was no clinical improvement. Four children were completely cured; the fifth child, who had left renal thrombosis, shows slight functional impairment of the left kidney. There were no haemorrhagic complications. The fibrinolytic treatment with urokinase of systemic arterial thrombosis in the newborn is effective and has few drawbacks.

Angiocardiography↗
PubMed1989

[Value of percutaneous trinitrin to facilitate access to the peripheral venous system in infants].

In order to establish the value of a small dose of trinitrine (0.4 mg less than 1 yr and 0.8 mg greater than 1 yr of age) to facilitate access to peripheral veins in the pediatric age group, 150 children were divided in 3 equal groups. In group 1, trinitrine was used whereas in group 2 vaseline was applied to the puncture site. In group 3, trinitrine was applied at a distance from the zone of puncture. The degree of difficulty of gaining access to the venous system was assessed through the use of scoring from 1 to 5. A score of 1 indicated easy access, 5 was indicative of failure. In order to determine the eventual hemodynamic effects of such a dose of trinitrine, 8 children were studied during a cardiac catheterization. Application of trinitrine on the zone of puncture made easier the peripheral venous approach in children under 1 year of age (p less than 0.02). No patient presented with headache or vertigo and no hemodynamic changes were observed during cardiac catheterization. The application of a small percutaneous dose of trinitrine on the zone of puncture seems to be a simple, efficacious and innocuous method to facilitate access to peripheral veins in infants.

Administration, Cutaneous↗
PubMed1988

Asymptomatic form of left pulmonary artery sling.

Eight patients with left pulmonary artery sling, which were asymptomatic at the time of the last consultation, are described: 2 adults and 1 child with no history of symptoms, 3 children with mild forms of airways obstruction and 2 patients with typical severe symptoms of airways obstruction in infancy. The mean follow-up of these 8 patients was 10 years (range 4 to 23), and in 1986, all were in good health and free of respiratory symptoms. The long-term prognosis is usually good.

Airway Obstruction↗
PubMed1988

Pharmacokinetics and clinical efficacy of intrarectal solution of acetaminophen.

Acetaminophen is frequently administered orally to children for its analgesic properties, although its potency has never been clearly evaluated in this population. In certain situations (patients vomiting or unconscious), acetaminophen has to be given rectally. However, the rectal absorption of suppositories is frequently erratic. We undertook this study first, to measure the absorption of an aqueous solution of acetaminophen administered rectally. Secondly, we evaluated acetaminophen's postoperative analgesic effects in children aged 1 to 8 years old undergoing adenoidectomy and/or tonsillectomy and compared its efficacy to meperidine. Twenty children received 20 mg.kg-1 of acetaminophen at the time of induction of anaesthesia while 20 others received 1 mg.kg-1 of meperidine intramuscularly. Thirty-two patients required meperidine in the Recovery Room. There was no statistical difference between the patients who received acetaminophen (18), and those who received meperidine (14). The absorption of acetaminophen was incomplete (peak serum concentration: 70.8 mumol.L-1) and delayed. We conclude that the rectal administration of acetaminophen at the induction of anesthesia results in incomplete and delayed absorption and does not prevent the occurrence of immediate postoperative pain in children undergoing adeno-tonsillectomy.

Acetaminophen↗
PubMed1988

Percutaneous transluminal balloon valvuloplasty of congenital pulmonary valve stenosis, with a special report on infants and neonates.

Fifty-six percutaneous transluminal balloon valvuloplasty procedures were performed in 51 patients suffering from congenital pulmonary valve stenosis. The patients ranged in age from 1 day to 60 years (mean 6.9 years); 21 were infants less than 1 year of age, including 8 neonates. The peak systolic pressure gradient was greater than 50 mm Hg (mean 81.5) in 47 cases, and less than 50 mm Hg (mean 34.6) in 9. Valvuloplasty enabled a reduction in the mean right ventricular peak systolic pressure from 93.1 to 51.6 mm Hg (p less than 0.001), the mean transvalvular gradient from 73.4 to 27.0 mm Hg (p less than 0.001) and the mean right ventricular pressure expressed as a percent of systemic pressure from 99.5 to 52.0% (p less than 0.001). In infants and neonates, the mean right ventricular pressure expressed as a percent of systemic pressure decreased from 117.3 to 64.4% (p less than 0.001). In 23 patients, follow-up cardiac catheterization at 1 to 17 months revealed a significant change in the right ventricular systolic pressure, which decreased from 54.0 to 46.7 mm Hg (p less than 0.05), and in the peak systolic pressure gradient, which decreased from 27.3 to 22.6 mm Hg (p less than 0.05). Valvuloplasty is an effective procedure in relieving pulmonary stenosis in patients of all ages, including neonates.

Adolescent↗