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Biomedical subjects

D Clement

Publications and source records attributed to D Clement.

At least 109 records · Page 6Linked to original sources
PubMed1986

Postoperative immunological response against contractile proteins after coronary bypass surgery.

The pathogenesis of post-cardiac injury syndrome was studied prospectively in 62 patients who underwent coronary bypass grafting. Preoperative and serial postoperative titres of actin and myosin antibodies were measured by an enzyme linked immunosorbent assay. Perioperative cumulative release of serum aspartate and alanine aminotransferases, lactate dehydrogenase, and creatine kinase was calculated by approximation formulas that are used to estimate infarct size. Complete post-cardiac injury syndrome developed in eight (13%) patients and an incomplete syndrome developed in 16 (26%). There was a significant correlation between frequency and intensity of the syndrome and the ratio of postoperative to preoperative titres of actin and myosin antibodies. Furthermore, there was a significant correlation between the cumulative release of lactate dehydrogenase, serum aspartate aminotransferase, and creatine kinase and the number of coronary vessels that were grafted, but no correlation was found between the incidence of post-cardiac injury syndrome and the number of coronary bypasses grafted or between the cumulative enzyme release and the postoperative immunological response against the major contractile proteins, actin and myosin. The amount of enzymes released during coronary bypass surgery seems to be a good indicator of the extent of myocardial damage during operation but it does not determine either the incidence of post-cardiac injury syndrome or the postoperative immunological response against the main contractile proteins actin and myosin.

Actins↗
PubMed1986

Glucose intolerance during diuretic therapy in elderly hypertensive patients. A second report from the European Working Party on high blood pressure in the elderly (EWPHE).

Five hundred and seven elderly hypertensive patients were followed for 1 year, 371 for 2 years and 270 for 3 years in a double-blind, randomized, controlled trial in which they received either placebo or 25-50 mg hydrochlorothiazide and 50-100 mg of triamterene daily. One third of the active treatment group also received 250 mg to 2 g methyldopa daily. After 1 year the active treatment group had an average increase in fasting blood sugar of 2.5 mg/dl compared with an average fall of 1.4 mg/dl in the placebo group (P = 0.01). The increase in blood sugar 1 hour and 2 hours after 50 g oral glucose tended to be greater in the actively treated group but these increases did not achieve statistical significance. The effects of diuretic treatment were established after one year and did not increase further over the next 2 years. Overall there was an increase in fasting blood sugar of 5 mg/dl in the active treatment group which occurred mainly in the first year. The hyperglycaemic effect of diuretics appeared to be partly or wholly related to potassium loss since, in both groups, impairment of glucose tolerance was most marked in those in whom serum potassium decreased. The measures of blood sugar were also positively related to systolic pressure before and after treatment.

Aged↗
PubMed1986

Influence of antihypertensive drug treatment on morbidity and mortality in patients over the age of 60 years. European Working Party on High blood pressure in the Elderly (EWPHE) results: sub-group analysis on entry stratification.

The European Working Party on High blood pressure in the Elderly (EWPHE) trial was a double-blind randomized placebo-controlled trial of antihypertensive treatment in patients over the age of 60 years. Entry criteria included both a sitting diastolic blood pressure on placebo treatment in the range of 90-119 mmHg and a systolic blood pressure in the range of 160-239 mmHg. Eight-hundred and forty patients were randomly assigned either to active treatment (hydrochlorothiazide + triamterene) or a matching placebo. If blood pressure remained elevated methyldopa was added to the active regimen and matching placebo to the placebo regimen. Before randomization, the patients were stratified in eight strata according to sex, age groups between 60 and 69 years or 70 years and over, and the presence or absence of cardiovascular complications of hypertension. Both the intention-to-treat and 'on randomized treatment' analyses suggested a benefit from active treatment in men and women. Formal statistical significance was achieved for male cardiovascular mortality (intention-to-treat analyses) and for cardiovascular events in females. Although the event rates were greater for patients with previous cardiovascular events and patients over the age of 70 years, the percentage reduction in cardiovascular events was similar in these groups to those without complications and in patients between 60 and 69 years of age. However, little benefit from treatment could be demonstrated in patients over the age of 80 years. The presence or absence of smoking had no influence on response to treatment in these elderly patients.

Aged↗
PubMed1985

Post-cardiac injury syndrome and an increased humoral immune response against the major contractile proteins (actin and myosin).

To better understand the pathogenesis of the post-cardiac injury syndrome (PCIS) 2 models of cardiac injury were studied. One hundred twenty-nine patients who underwent cardiac surgery and 80 patients with acute myocardial infarction (AMI) were prospectively followed and the levels of anti-heart antibodies (AHA), anti-actin antibodies (AAA) and anti-myosin antibodies (AMA) were determined. In the surgical group, PCIS developed in 27 patients (21%) and incomplete PCIS in 36 (28%). In the AMI group, PCIS did not develop in any patient, but incomplete PCIS developed in 11 patients (14%) (p less than 0.001). The surgical group showed a significantly higher humoral immune response than the AMI group when analyzed for AHA and anti-contractile protein antibodies. After cardiac surgery, AHA developed in 59 patients (46%), AAA developed in 33 (26%) and AMA developed in 49 (38%); in the AMI group, significant levels of AHA, AAA and AMA developed in 16 (20%), 7 (9%) and 13 patients (16%), respectively. These studies show a significant correlation between the PCIS clinical classification and auto-antibodies raised against heart contractile proteins.

Actins↗
PubMed1985

Mortality and morbidity results from the European Working Party on High Blood Pressure in the Elderly trial.

A double-blind randomised placebo-controlled trial of antihypertensive treatment was conducted in patients over the age of 60. Entry criteria included both a sitting diastolic blood pressure on placebo treatment in the range 90-119 mm Hg and a systolic pressure in the range 160-239 mm Hg. 840 patients were randomised either to active treatment (hydrochlorothiazide + triamterene) or to matching placebo. If the blood pressure remained raised, methyldopa was added to the active regimen and matching placebo in the placebo group. An overall intention-to-treat analysis, combining the double-blind part of the trial and all subsequent follow-up, revealed a non-significant change in total mortality rate (-9%, p = 0.41) but a significant reduction in cardiovascular mortality rate (-27%, p = 0.037). The latter was due to a reduction in cardiac mortality (-38%, p = 0.036) and a non-significant decrease in cerebrovascular mortality (-32%, p = 0.16). In the double-blind part of the trial, total mortality rate was not significantly reduced (-26%, p = 0.077). Cardiovascular mortality was reduced in the actively treated group (-38%, p = 0.023), owing to a reduction in cardiac deaths (-47%, p = 0.048) and a non-significant decrease in cerebrovascular mortality (-43%, p = 0.15). Deaths from myocardial infarction were reduced (-60%, p = 0.043). Study-terminating morbid cardiovascular events were significantly reduced by active treatment (-60%, p = 0.0064). Non-terminating cerebrovascular events were reduced (-52%, p = 0.026), but the non-terminating cardiac events were not (+3%, p = 0.98). In the patients randomised to active treatment there were 29 fewer cardiovascular events and 14 fewer cardiovascular deaths per 1000 patient years during the double-blind part of the trial.

Actuarial Analysis↗
PubMed1985

Association between post-pericardiotomy syndrome and coronary occlusion after aortic valve replacement.

Fever, leucocytosis, and pericardial and pleural effusions developed after the first postoperative week in a 56 year old man who had undergone aortic valve replacement. Four months later, coronary angiography showed bilateral proximal stenosis of the coronary arteries. In this patient post-pericardiotomy syndrome and subsequent coronary artery stenosis were thought to be associated and an immunological mechanism was suspected.

Aortic Valve↗
PubMed1985

Peripheral vascular responses during stimulation of the low pressure receptors in man.

Several studies have been devoted to the cardiovascular responses to stimulation of low pressure receptors in animals. Yet, in man, the vascular participation in this reflex response is not fully documented. In the present work, the response of forearm and finger blood vessels was studied in a group of healthy subjects during stimulation of the low pressure receptors, using lower body negative pressure (LBNP) at -10, -20 and -40 mmHg. Blood flow was measured simultaneously at the forearm and the finger with an electrocardiogram (ECG)-triggered venous occlusion plethysmograph. Blood pressure remained unchanged at LBNP -10 and -20 mmHg, while there was a significant decrease of systolic and mean arterial blood pressure at LBNP -40 mmHg. Heart rate significantly increased at LBNP -20 and -40 mmHg, while no change in heart rate was seen at LBNP -10 mmHg. There was a significant decrease of blood flow at the forearm and a significant increase of the vascular resistance at LBNP -10, -20 and -40 mmHg. There were no changes in finger circulation. Thus, peripheral circulation is only partially involved in the cardiovascular response to stimulation of the low pressure receptors in men. There is a significant vasoconstriction of forearm blood vessels, occurring before any change in blood pressure and heart rate, while finger blood vessels do not participate in this reflex.

Blood Pressure↗
PubMed1985

Influence of hypotensive drug treatment in elderly hypertensives: study terminating events in the trial of the European Working Party on High Blood Pressure in the Elderly.

The European Working Party on High Blood Pressure in the Elderly (EWPHE) trial was a double-blind randomized placebo-controlled trial of antihypertensive treatment in patients over the age of 60 years. Entry criteria included both a sitting diastolic blood pressure on placebo treatment in the range 90-119 mmHg and a systolic blood pressure in the range of 160-239 mmHg. The patients (n = 840) were randomized either to active treatment (hydrochlorothiazide + triamterene) or matching placebo. If the blood pressure remained elevated, methyldopa was added to the active regimen and matching placebo in the placebo group. An overall intention-to-treat analysis, combining the double-blind part of the trial and all subsequent follow-up, revealed a non-significant change in total mortality rate (-9%, P = 0.41) but a significant reduction of cardiovascular mortality rate (-27%, P = 0.037). The latter was due to a reduction of cardiac mortality (-38%, P = 0.036) and to a non-significant decrease of cerebrovascular mortality (-32%, P = 0.16). In the double-blind part of the trial, total mortality rate was not significantly reduced (-26%, P = 0.077). Cardiovascular mortality was reduced in the actively treated group (-38%, P = 0.023), due to a reduction of cardiac deaths (-47%, P = 0.048) and to a non-significant decrease of cerebrovascular mortality (-43%, P = 0.15). Deaths from myocardial infarction were reduced (-60%, P = 0.043). Study-terminating morbid cardiovascular events were significantly reduced by active treatment (-60%, P = 0.0064). In the patients randomized to active treatment there were 14 fewer cardiovascular deaths per 1000 patient-years during the double-blind part of the trial. Version 3.

Aged↗
PubMed1985

Detection of anti-contractile antibodies after cardiac surgery using ELISA assay.

Sera from 196 patients were collected before and after cardiac surgery to measure antibodies against heart tissue and against actin and myosin. In the post-operative period antibodies were found in 87 patients (44%) producing a cross-striated fluorescence pattern in heart tissue. Antibodies against the major contractile proteins were found in 91 patients (46%), anti-actin antibodies in 49 patients (25%) and anti-myosin antibodies in 65 patients (33%). We found a significant correlation (P less than 0.0001) between the antibodies producing a cross-striated fluorescence pattern and antibodies recognizing contractile proteins. These results suggest that contractile proteins evoke an immune response after cardiac surgery and that this response may compromise cardiac function.

Actins↗
PubMed1984

Association of anti-heart antibodies and circulating immune complexes in the post-pericardiotomy syndrome.

The post-pericardiotomy syndrome (PPS) is a common complication of cardiac surgery. In order to better understand the pathogenesis of this complication we undertook a prospective, triple blind study of consecutive long term survivors of cardiac surgery. We followed 82 patients and determined anti-heart antibodies (AHA), circulating immune complexes (CIC) and anti-viral antibodies (AVA) on sera pre-operatively and serially post-operatively. According to the clinical features of pericarditis, fever and leucocytosis, patients were divided into three groups: (1) complete PPS with all three symptoms, (2) incomplete PPS with two symptoms and (3) no PPS with one or no symptoms. Clinical PPS was found in 16 patients (19.6%). All of these patients had positive AHA, 12 patients (75%) had increased CIC and five patients (31%) had a four-fold or greater rise in titre to viruses studied. Twenty-four patients (29.2%) had an incomplete PPS. It was accompanied by positive AHA in 17 patients (70.8%), increased CIC in 14 patients (58.3%) and a four-fold rise or greater in virus titre in seven patients (29.2%). No PPS was found in forty-two patients (51.2%). It was accompanied by positive AHA in eight patients (19%), increased CIC in 10 patients (24%) and a four-fold or greater rise in virus titre in 12 patients (28.6%). There was a good correlation between the presence of PPS, AHA, CIC and the type of operation. Heart valve replacement surgery was more frequently complicated by PPS. Development of post-operative AHA and increased CIC were also more frequently found. We found a good correlation between PPS, positive AHA and increased CIC. No correlation was found between PPS and virus serology.

Adult↗
PubMed1984

Single ventricle in pregnancy: case report and review of the literature.

A pregnancy complicated by cyanotic heart disease due to single ventricle was recently managed at the authors's institution. Review of the literature showed only five previous case reports. The management of this uncommon disorder is presented along with a review of the literature. The presence of pulmonary hypertension appears to be a major determinant in assessing maternal risk.

Adult↗
PubMed1983

The progress of patients in the European Working Party on Hypertension in the Elderly trial.

792 hypertensive patients above the age of 60 have entered the double-blind multicentre trial of the European Working Party on High blood pressure in the Elderly (EWPHE). Half were treated with hydrochlorothiazide and triamterene and half were given placebo and a second capsule was given and if necessary up to 2 g of methyldopa/day. The measurements in a sample of 157 patients suggested 80-86% compliance rate. A significant blood pressure difference of 25/10 mm Hg was obtained between the groups and maintained during five years of follow-up. The increase in serum creatinine found in the actively treated group was related to the decrease in sitting systolic blood pressure. Changes in serum uric acid correlated with changes in serum creatinine both in the placebo and in the actively treated group. Fasting blood glucose changed significantly in the active treatment group. The balance between this decreased risk on the basis of the blood pressure reduction and the increase produced by the rise in blood glucose and the other treatment effects remains to be determined. The trial continues and more patients are being admitted.

Aged↗
PubMed1982

Antihypertensive therapy in patients above age 60 with systolic hypertension. A progress report of the European Working Party on High Blood Pressure in the Elderly (EWPHE).

1. Although systolic blood pressure elevation is responsible for increased incidence of cardiovascular accidents in old people, the preventive benefit of lowering systolic hypertension in elderly has not been confirmed. 2. A double blind study comparing the effects of a placebo and of an active regimen (hydrochlorothiazide-triamterene with or without methyldopa) in people over 60 years with isolated systolic hypertension has been undertaken by the European Working Party on High blood pressure in the Elderly (EWPHE). 3. The actively treated group shows a lowered sitting blood pressure (-15/6 mm Hg), a mild increase of serum creatine, serum uric acid and blood glucose and a mild decrease of serum potassium after two years of treatment when compared to the spontaneous changes observed in the placebo treated group. 4. The study is continuing to evaluate if the blood pressure reduction prevents or reduces the incidence of cardiovascular accidents, although some biochemical changes were provoked by the treatment.

Aged↗
PubMed1982

Influence of anti-hypertensive therapy on serum cholesterol in elderly hypertensive patients. Results of trial by the European Working Party on High blood pressure in the Elderly (EWPHE).

In the European Working Party trial on High blood pressure in the Elderly, patients over 60 are randomly allocated either to receive diuretic capsules containing 25 mg hydrochlorothiazide and 50 mg triamterene or matching placebos. If the blood pressure remains high those receiving active diuretic treatment also receive methyldopa. Those receiving a placebo diuretic area given placebo methyldopa tablets. The study is double blind, started in 1974 and is still in progress. Three hundred and thirty-one patients have now been followed for 1 year and of these 190 have been followed for 2 and 90 for 3 years. After 1 year the serum cholesterol in the placebo group fell by an average of 10.4 mg/100 ml; over 2 years the fall was 16.0 mg/100 ml and over 3 years 20.8 mg/100 ml (6.7%). The corresponding results for the actively treated group were falls of 3.1 mg/100 ml; 20.3 mg/100 ml and 17.3 mg/100 ml (6.6%). Over a period of up to 3 years the average fall in cholesterol was 5.9 mg/100 ml/year in the placebo group and 5.0 mg/100 ml/year in the actively treated group. Thus the changes in serum cholesterol were similar whether the patients received active or placebo medication. In particular there was no evidence for an increase in cholesterol nor for a smaller decrease during diuretic therapy. In the actively treated group the fall in blood pressure in the more hypertensive patients was accompanied by a fall both in haematocrit and serum cholesterol. In patients with less severe hypertension, active treatment was not accompanied by a fall in either hematocrit or cholesterol. These different responses of serum cholesterol in the more and less severe hypertensives in the present study could explain some of the previous conflicting reports on the influence of diuretic treatment on serum cholesterol.

Aged↗
PubMed1981

Comparison of abdominal circumference measurements by real-time and B-scan techniques.

In an effort to evaluate the efficacy of measuring abdominal circumference with real-time ultrasound, 53 patients were scanned with both contact scanning and linear array real time. Image measurements were made blindly from both types of equipment. Abdominal circumference measurements with real time compared favorably with those obtained from contact images (r = +0.984).

Abdomen↗
PubMed1980

Near haploid cell line in lymphoid blast crisis of Ph1-positive chronic myeloid leukemia.

This report describes a case of lymphoid blast crisis of a chronic myelocytic leukemia with the occurrence of a double chromosomal population carrying a Philadelphia chromosome. Fifty-five % of the cells have 28 chromosomes, and 36% show the exact duplicate of the near haploid chromosome complement. The similarities between this near haploid cell line and those previously reported, as well as the presence of such clones in acute lymphoblastic leukemia, are discussed. In the leukemic lymphoblasts, the association of the Philadelphia chromosomes with a near haploid karyotype described so far in acute lymphoblastic leukemia provides further support for the concept of a pluripotent Philadelphia chromosome-positive stem cell common to both lymphoid and myeloid lines.

Chromosome Aberrations↗