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Biomedical subjects

C Le Pailleur

Publications and source records attributed to C Le Pailleur.

At least 37 records · Page 2Linked to original sources
PubMed1985

[Hemodynamic effects of intravenous acebutolol in the acute phase of myocardial infarction].

The haemodynamic tolerance of intravenous acebutolol was evaluated during the acute phase of myocardial infarction. This is a beta-blocker with an intrinsic beta-stimulant effect. The study consisted of 14 patients (10 cases of inferior infarction and 4 cases of anterior infarction) with a mean capillary pressure of less than 20 mmHg and a cardiac index greater than 2 l X min-1 X m-2. The minimal dose of acebutolol was 0.05 mg X kg-1 X h-1 and the maximal dose was 0.125 mg X kg-1 X h-1. The intravenous infusion of acebutolol was commenced between 3 and 12 hours (average: 7.5 hours) after the infarction and was continued for 48 hours, at which time it was replaced by oral administration. The mean total intravenous dose was 409 mg (from 190 to 510 mg). Two patients were excluded from the protocol because of the development of 2nd degree atrioventricular block several minutes after the beginning of the infusion. The basal values of the cardiac index (2.7 l X min-1 X m-2 +/- 0.37), the mean capillary pressure (9.4 mmHg +/- 2.7) and the systolic index (38.3 ml/m2 +/- 6.4) did not change significantly during the infusion, in the 14 patients studied. The double product, heart rate x blood pressure, decreased from the mean basal value of 9,443 to 7,680 at 24 hours and to 7,000 at 48 hours (p less than 0.05). Acebutolol does not depress left ventricular function, provided that it is reserved for patients with class I or II disease according to Killip and Kimball's classification.(ABSTRACT TRUNCATED AT 250 WORDS)

Acebutolol↗
PubMed1985

[Evaluation of post-infarction disorders of left ventricular contraction by echocardiography and scintigraphy of the cardiac cavities].

The comparison in 36 patients of two-dimensional echocardiography and scintigraphy of the cardiac cavities in the steady state with left cineventriculography selective for the evaluation of anomalies in left ventricular contraction post infarction shows good agreement between these techniques for the detection of major segmental anomalies, a higher sensitivity being found for echocardiography in dyskinesis. The overall rejection fraction calculated by two-dimensional echocardiography is correlated with the ejection fraction calculated in left cineventriculography (r = 0.57; p less than 0.001). The same is true of the overall ejection fraction obtained by cavitary scintigraphy (r = 0.62; p less than 0.01). The indices of residual myocardium in the anterior wall (IRM ant) and the posterior wall (IRM post) calculated in apical echographic section for the two cavities and in left cineventriculography (oblique anterior right) are also well correlated (IRM ant: r = 0.70 and p less than 0.001; IRM post: r = 0.46 and p less than 0.01). The determination of these parameters as well as the percentage of shortening of the left ventricular small axis measured by echocardiography TM, to the smallest value, permits a valid assessment of ventricular function and makes it possible to avoid coronaroventriculography when this function is too impaired.

Adult↗
PubMed1984

[Enhancement of the effect of captopril in the 1st 48 hours of treating refractory heart failure. A comparison with intravenous trinitrine].

The favourable haemodynamic effects of vasodilator drugs in refractory cardiac failure sometimes alter rapidly after the initial dose. This tachyphylactic phenomenon was looked for during captopril therapy in 14 patients with chronic cardiac failure resistant to digitalo-diuretic therapy and conventional vasodilator drugs. The average age of the patients was 64,4 +/- 3,8 years. Eleven patients had signs of congestive cardiac failure while the remaining three patients had only left ventricular failure. Four patients were classified as Stage III and the other ten Stage IV of the NYHA classification. Right heart catheter studies were performed with a Swan Ganz catheter and systemic pressures were measured by femoral artery catheterisation. Right and left pressures and cardiac output were measured under basal conditions, and 1 and 5 hours after a single dose of captopril (early and late periods). Captopril was given in between meals in 3 to 6 daily doses; in 10 of the 14 cases the dose was 50 mg 6 hourly. The haemodynamic parameters were recorded again during the early and late periods after the dose of captopril 24 and 48 hours after starting therapy. Captopril is a mixed vasodilator and is effective from the first hour of administration. It preferentially lowered pulmonary capillary pressure (PCP) from 29,6 +/- 0,92 mmHg to 21,4 +/- 1,04 mmHg (delta PCP: -27,7%, p less than 0,01). Mean systemic blood pressure (MBP) fell less from 92,4 +/- 3,51 mmHg to 76,6 +/- 3,4 mmHg (delta MBP: -17%, p less than 0,01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

[Cardiac complications of radiotherapy].

Radiotherapy is an effective tool in the treatment of thoracic cancers. However, radiotherapy also carries a risk of severe cardiac complications. The cancers most commonly concerned are Hodgkin's and non-Hodgkin's lymphomas (90 per cent of cases), breast cancers, especially on the left side (4 per cent) and bronchogenic cancers (2 per cent). Ionizing radiation can damage the three layers of the heart and the coronary arteries. Pericardial involvement is the most frequent, occurring in 10 to 12 per cent of cases. It generally occurs 6 to 18 months after the radiotherapy and may present either acutely (35 per cent of cases) or chronically (65 per cent of cases). It is often latent, only detected on X-rays or on ultrasound. Constrictive forms can occur, which require pericardiectomy. Myocardial fibrosis, which is anatomically common, may present as disturbances of repolarization, arrhythmia or disturbances of conduction, or even cardiac failure. Rarely, radiation damage of the coronary arteries can cause angina or myocardial infarction. These cases can benefit from coronary artery by-pass grafts. All of these lesions have a common anatomical denominator:fibrosis, which develops progressively following the radiotherapy. It has now been demonstrated that the incidence of cardiac radiation lesions can be reduced by homogeneous distribution of the dose of radiation administered to the mediastinum, by treating each side alternately, by fractionating the radiation and staggering the sessions and by reducing the cardiac mass which is irradiated.

Adult↗
PubMed1981

[Cardiomyopathy in uremia: hemodynamic and metabolic aspects (author's transl)].

Precise determination of myocardial function in chronic renal failure is difficult because of the fluctuation of parameters especially in those patients undergoing intermittent hemodialysis. Reliable methods of investigation should be used to correctly evaluate possible functional abnormalities. Results of our study and of several other publications prove that some hemodialysis patients have a congestive cardiomyopathy (non obstructive) which is likely to be in relation with uremia. Several factors have been suggested in the literature to explain the etiology and pathogenesis of uremic cardiomyopathy. Disturbed metabolism of phosphate and calcium associated with the hyperparathyroidism of renal failure has been observed both in laboratory animals and patients with uremia. Altered metabolism of lipids associated with carnitine deficiency might also play a role. More thorough methods of investigation and additional experimental studies, both in vitro and in vivo are called for in order to define myocardial dysfunction in chronic renal failure. This should provide a basis for improved prevention and treatment of uremic cardiomyopathy.

Calcium↗
PubMed1980

Effect of parathyroidectomy on left-ventricular function in haemodialysis patients.

The effect of parathyroidectomy on left-ventricular function was evaluated in chronic-haemodialysis patients with advanced hyperparathyroidism. Radionuclide angiocardiography (22 patients) and ultrasound echography (8 patients) revealed a significant increase in left-ventricular ejection fraction 1--2 weeks after parathyroidectomy. This improvement was associated with an augmented cardiac index (radionuclide method) and with an increase in mean velocity of circumferential myocardial fibre shortening (echocardiography). Circulating blood volume and erythrocyte space, as well as arterial blood-pressure, had changed little after parathyroidectomy, whereas plasma calcium, phosphate, and immunoreactive parathyroid hormone were significantly lower after surgery. Thus, correction of severe hyperparathyroidism led to a significant improvement in cardiac performance.

Adult↗
PubMed1979

[Intravenous trinitroglycerin during acute myocardial infarction with cardiac failure. Cooperative study of 68 patients (author's transl)].

Intravenous trinitroglycerine was administered in 68 patients in cardiac failure during the acute phase of myocardial infarction. With a mean hourly dose of 1.58 mg, trinitroglycerine was effective against signs of left and right heart failure after about ten minutes for almost all the teams involved, its tolerance being excellent. Mean capillary pressure fell by 33% (from 22.4 +/- 0.71 mmHg to 15.5 +/- 0.60 mmHg; n = 68; p < 10(-9), as did mean pulmonary artery pressure. Mean right atrial pressure fell by 25% (from 9.96 +/- 0.53 mmHg to 7.48 +/- 0.58 mmHg; n = 68; p < 10(-9). Cardiac output increased by 10.7% (from 2.48 +/- 0.07 l/mn/m2 to 2.74 l/mn/m2; n = 68; p < 10(-7). Since cardiac output was unaltered, systolic index was improved, as was cardiac index, by 11.5% (from 28.4 +/- 1.08 cm3/syst/m2 to 31.7 +/- 1.15 cm3/syst/cm2; n = 68; p < 10(-5). Mean arterial blood pressure was slightly decreased (-9.3%; p < 10(-9), as were systemic resistance (-13%; p < 10(-6) and pulmonary resistance (-27%; p < 10(-6). Systolic work index was significantly improved by 8.37% (from 31.3 +/- 1.73 g-m/m2 to 33.7 +/- 1.74 g-m/m2); n = 68; p < 0.01), which reflects, in view of the decrease in the total work supplied by the heart, a redistribution in favour of more useful work. Treatment must be adapted for each patient, in order to determine the optimum hourly dose of TNT,. which ensures the best cardiac index whilst adequately reducing capillary pressure to levels of the order of 14 to 18 mmHg. Treatment must be closely observed and altered several times a day in relation to values of cardiac output and pulmonary capillary pressure.

Acute Disease↗
PubMed1979

Angiocardiographic and haemodynamic studies in chronic haemodialysis patients with cardiomegaly.

Twenty-one chronic haemodialysis patients with cardiomegaly and repeated episodes of heart failure were selected for left ventricular cineangiography and haemodynamic studies. Left ventricular end-diastolic (LVED) volume was augmented in eleven, LVED pressure increased in fourteen, and ejection fraction decreased in nine patients. A decrease of maximum velocity of myocardial fibre shortening was observed in fifteen, and of normalised ventricular rigidity index in eleven. Many patients had diminished cardiac performance in the absence of demonstrable coronary heart disease, hypertension, or chronic volume overload. The diagnosis of congestive cardiomyopathy of unknown aetiology, possibly related to uraemia, was reached in ten patients.

Adolescent↗