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Biomedical subjects

F Prigent

Publications and source records attributed to F Prigent.

At least 37 records · Page 2Linked to original sources
PubMed1993

Prevalence and functional significance of transient ST-segment depression during daily life activity: comparisons of ambulatory ECG with stress redistribution thallium 201 single-photon emission computed tomographic imaging.

To assess the prevalence and functional significance of ischemic ambulatory ECG responses, we prospectively performed ambulatory ECG monitoring in 244 patients (mean age 61 +/- 10 years) referred for stress redistribution thallium 201 myocardial perfusion scintigraphy. The prevalence of ST-segment depression during ambulatory ECG was 33% among patients with a positive exercise ECG, but prevalence varied in selected patient subgroups. Among three groups with coronary artery disease (CAD), the group with ambulatory ECG ischemia (group 1) had a greater frequency of ischemic thallium responses (p = 0.07), a greater median number of reversible thallium defects (p < 0.05), and a greater summed thallium "reversibility" score (p < 0.05) than did the group with a positive exercise ECG but negative ambulatory ECG response (group 2) or that with negative exercise and ambulatory ECG responses (group 3). Exercise ST depression in group 1 versus group 2 was significantly greater (p = 0.002), occurred at a lower heart rate threshold (p = 0.002), and lasted longer after exercise (p = 0.001). Notably, one third of group 1 patients also manifested evidence of transient ischemic dilation of the left ventricle after exercise (p < 0.01 vs groups 2 and 3), a sign of severe ischemia. However, although functionally less "sick" than group 1 patients, 66% of group 2 patients and 50% of group 3 patients still had an ischemic thallium response, which was sometimes severe. Thus transient ischemia during ambulatory ECG monitoring identifies a functionally sicker cohort of patients with CAD and occurs in approximately one third of CAD patients with positive results of exercise tests. A negative ambulatory ECG response, however, does not exclude functionally significant disease among CAD patients. These results imply that caution should be applied in the interpretation of a negative ambulatory ECG response for the purpose of patient risk stratification.

Activities of Daily Living↗
PubMed1993

Controlled trial of azathioprine and plasma exchange in addition to prednisolone in the treatment of bullous pemphigoid.

BACKGROUND AND DESIGN: Bullous pemphigoid is usually treated with systemic corticosteroids. Side effects are common in elderly patients, justifying the search for adjuvant therapy. This randomized, multicentric unblind study was designed to assess the efficacy of azathioprine or plasma exchange when added to conventional doses of prednisolone. One hundred patients with active disease entered the study. They were randomly allocated to receive 28 days of treatment with oral prednisolone sodium metasulfobenzoate (1 mg/kg per day) either alone or in combination with oral azathioprine (100 to 150 mg/d) or four large-volume plasma exchanges. After 28 days, the prednisolone doses were progressively decreased according to the same strict regimen in the three groups (in combination with oral azathioprine in group 2). RESULTS: The clinical results were evaluable in 98 of the 100 patients included in the study. There was no appreciable difference in the percentages of complete remission of the disease in the three therapeutic groups at 28 days (71%, 80%, and 71%, respectively) or at 6 months (42%, 39%, and 29%, respectively). Severe complications were more often observed among patients receiving azathioprine. At 6 months, 14 of 98 patients had died, without any differences noted among the three study groups. CONCLUSIONS: We conclude that neither azathioprine nor plasma exchange is effective enough to be used routinely as an adjuvant to corticosteroids in the management of bullous pemphigoid.

Aged↗
PubMed1992

Quantitative stress-redistribution thallium-201 SPECT using prone imaging: methodologic development and validation.

Prone 201Tl myocardial perfusion SPECT has been shown to improve left ventricular inferior wall counts compared to supine imaging, thus minimizing diaphragmatic attenuation. Prone SPECT quantitative normal limits were developed and prospectively applied to 36 patients who had coronary angiography. The prone imaging table used had a cut-out under cardiac area which increased the average myocardial counts by 10.7% compared to prone SPECT through the standard table. Overall specificity and sensitivity were 80% and 93%, respectively. For the right, left circumflex and left anterior descending coronary arteries, the specificities were 94%, 71%, and 94%; and sensitivities were 88%, 89% and 78%, respectively. The normalcy rate in 55 normal patients was 89%. Incidence and the severity of patients motion in 200 prone SPECT studies were compared to 200 supine SPECT studies. Mild and severe motion occurred in 12% and 4% of the supine studies and in only 3.5% and none of the prone studies, respectively. When compared to supine SPECT, prone SPECT had higher (p less than 0.01) regional counts/pixel in the inferior wall and septum, but required an average increase of 2.9 +/- 1.0 cm in camera to chest wall distance and resulted in a reduction of total myocardial counts. Prone SPECT provides an alternative approach for patients who cannot tolerate supine imaging. It should be considered when inferior wall defects on supine imaging pose a diagnostic dilemma and when motion on supine imaging necessitates repeat acquisition.

Aged↗
PubMed1991

[Cutaneous lesions during the 1st week of life in 306 consecutive newborn infants].

The authors report the results of a systematic study of the skin conducted during three months in 306 neonates born in a hospital maternity unit in the Hauts-de-Seine departement, France. Two hundred and ninety-nine infants could be examined: 91 (30.5 p. 100) developed erythema toxicum neonatorum; 102 (34 p. 100) had port wine naevus; 42 (14 p. 100) mongolian spot, and 10 (3.5 p. 100) pigmented epidermal naevus. Various other abnormalities were found. These findings are compared with those of previous French (5, 14) and foreign (1, 3, 7-11, 13, 16, 17-19) studies.

Erythema↗
PubMed1990

Myocardial perfusion imaging with technetium-99m sestamibi SPECT in the evaluation of coronary artery disease.

Technetium-99m (Tc-99m) sestamibi is a new myocardial perfusion imaging agent that offers significant advantages over thallium-201 (Tl-201) for myocardial perfusion imaging. The results of the current clinical trials using acquisition and processing parameters similar to those for Tl-201 and a separate (2-day) injection protocol suggest that Tc-99m sestamibi and Tl-201 single photon emission computed tomography (SPECT) provide similar information with respect to detection of myocardial perfusion defects, assessment of the pattern of defect reversibility, overall detection of coronary artery disease (CAD) and detection of disease in individual coronary arteries. Tc-99m sestamibi SPECT appears to be superior to Tc-99m sestamibi planar imaging because the former provides a higher defect contrast and is more accurate for detection of disease in individual coronary arteries. Research is currently under way addressing optimization of acquisition and processing of Tc-99m sestamibi studies and development of quantitative algorithms for detection and localization of CAD and sizing of transmural and nontransmural myocardial perfusion defects. It is expected that with the implementation of the final results of these new developments, further significant improvement in image quality will be attained, which in turn will further increase the confidence in image interpretation. Development of algorithms for analysis of end-diastolic myocardial images may allow better evaluation of small and nontransmural myocardial defects. Furthermore, gated studies may provide valuable information with respect to regional myocardial wall motion and wall thickening. With the implementation of algorithms for attenuation and scatter correction, the overall specificity of Tc-99m sestamibi SPECT should improve significantly because of a substantial decrease in the occurrence of attenuation-related image artifacts.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Disease↗
PubMed1990

Quantitative exercise thallium-201 rotational tomography for evaluation of patients with prior myocardial infarction.

The utility of stress-redistribution thallium-201 myocardial perfusion single-photon emission computed tomography (SPECT) in patients with a prior single myocardial infarction was studied in 66 patients who were tested by both SPECT and coronary angiography. SPECT was quantified by comparing the patients' circumferential count profiles to a previously established normal data base and by plotting the results onto a polar coordinate map that localized defects to the 3 major coronary artery territories. The pattern of reversibility of the quantitatively detected defects was assessed by consensus visual analysis. SPECT thallium-201 detected myocardial infarction in 62 of 66 patients (sensitivity = 94%). Sixty-five percent of the infarct zones showed some reversibility at 4-hour imaging which corresponded with angiographic evidence of flow to the infarct zones in 95.5% of cases. Late (18 to 24 hours) imaging, done in 26 patients, showed complete or partial reversibility of 29% of infarct zone segments which were nonreversible on 4-hour images. To improve specificity for detection of disease in coronary arteries supplying the non-infarct territories, new quantitative criteria were developed that took into consideration contiguity of defects with the infarct zone. Accuracy for detection of patients with multivessel coronary disease by quantitative thallium-201 SPECT was 86%, which was significantly higher than those of the clinical response to exercise (48%), the exercise electrocardiographic response (56%) or their combination (65%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Quantitative analysis of tomographic stress thallium-201 myocardial scintigrams: a multicenter trial.

The accuracy of the previously developed and validated Cedars-Sinai Medical Center (CSMC) computer program for quantitative analysis of thallium-201 (201TI) stress myocardial tomograms was assessed in a multicenter trial consisting of 242 patients with coronary angiography and 76 with a low likelihood (LL) of coronary artery disease (CAD) involving various cameras, computers, and operators. The program utilized gender-matched normal limits developed from 35 LL patients at CSMC. The multicenter results as compared to those of 168 patients from CSMC were not significantly different with respect to the overall sensitivities (94% versus 95%) and specificities (44% versus 56%) for identification of CAD and normalcy rates which were determined in LL patients (82% for both) and with respect to identification of individual diseased arteries. The results indicate that our method for quantifying tomographic 201TI stress scintigrams utilizing standard normal limits can be applied at other institutions by different operators, using a variety of cameras and computers, with similar accuracy to that currently obtained at our institution.

Coronary Disease↗