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Biomedical subjects

G Ducloux

Publications and source records attributed to G Ducloux.

At least 109 records · Page 6Linked to original sources

[Value of esophageal manometry with the methylergometrin maleate test in angina with normal coronarography. The concept of esophageal angina].

22 patients presenting an "angina with normal coronarography" and 5 control subjects were subjected to a manometric exploration of the oesophagus in the basal state and under methylergometrine maleate (MEM) treatment. The MEM test is shown to be a good one for the induction of painful oesophageal dyskinesias, particularly in patients who had suffered in an inexplicable manner when that substance was administered for coronarography.

Adult↗

[Congenital agenesis of the inferior vena cava. Apropos of a case presenting as an ilio-femoral phlebitis. Contribution of echography and x-ray computed tomography].

The authors report the case of a young patient, 24 years old, hospitalized for a phlebitis of the right inferior member. The cause determined by venous angiography, echography and computed tomography, was a congenital agenesis of the inferior vena cava. This case allows to remember the embryology of the congenital anomalous inferior vena cava, which are rare and often unknown.

Adult↗

[Cardiovascular complications due to naftidrofuryl].

The authors report the case of a serious cardiovascular complication due to naftidrofuryl overdosage following its intravenous administration. Other similar complications have already been reported in the literature and in experimental animal studies (particularly involving the conduction system of the heart). Since naftidrofuryl belongs to the class of local anesthetics and is pharmacologically related to procainamide, certain precautions must be closely followed if it is administered intravenously: avoidance of rapid injection directly into the vein, limiting the infusion to 200 to 400 mg given over a 3 hour period using preferably a constant infusion syringe pump or an infusion pump, and using caution when associated with other medications, particularly antiarrhythmic agents which could affect atrioventricular or intraventricular conduction.

Adolescent↗

[Evaluation of the severity of coronary disease by thallium 201 myocardial scintigraphy and technetium 99m isotope ventriculography. Comparison of the 2 methods apropos of 30 cases].

The evaluation of the severity of coronary artery disease by non-invasive methods may involve the use of isotope techniques. The authors compared the results of technetium 99m cardiac functional angioscintigraphy and thallium 201 myocardial scintigraphy, performed at rest and on effort, in a group of 30 patients. The 30 patients consisted of 6 normal patients (control group) and 24 patients with coronary artery disease (8 cases of angina; 16 infarcts, including 12 inferior infarcts). Coronary angiography revealed 13 cases of one vessel disease, 8 cases of two vessel disease and 3 cases of three vessel disease. The results of angioscintigraphy revealed that the technique was reliable in terms of the evaluation of the abnormalities of contraction (sensitivity: 96%, compared with the results of haemodynamics) and that the study of the ejection fractions at rest and on effort was particularly valuable. The ejection fractions calculated by the isotope method were not statistically different from the ejection fractions calculated by the haemodynamic method. The patients with one vessel disease and the normal subjects increased their ejection fraction on effort by about 12% (p = 0.03), in contrast with the patients with multiple vessel disease, who increased their ejection fraction on effort by 2% (p greater than 0.05). In contrast, the results of myocardial scintigraphy at rest and on effort were disappointing. The method was specific (100%), but in our series, its sensitivity was only 72% for the group of patients with coronary artery disease. In cases with infarction and multiple vessel disease, the zone of the infarction was always detected, but no other abnormalities were observed in the other territories.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

[Diastolic restriction caused by an encysted hemopericardium a year after coronary bypass].

The case of a 54 year old patient presenting with congestive cardiac failure one year after single aorto-coronary bypass surgery is reported. Paraclinical investigations showed a pericardial effusion compressing the inferior wall of the heart. Echocardiography was essential for diagnosis. This localised compression was responsible for the haemodynamic changes of adiastole. Pericardial drainage confirmed the diagnosis of an encysted hemopericardium containing about 300 ccs of liquid. Right and left cardiac catheter studies before and after surgery, and 8 months postoperatively, showed progressive normalisation of the intracardiac pressures. A volume expansion stress test excluded possible associated pericardial constriction. Therefore, the finding of diastolic restriction with a residual effusion after cardiac surgery should orientate management towards pericardial drainage before considering pericardectomy.

Coronary Artery Bypass↗

[Atrioventricular discordance without ventriculo-arterial discordance. Apropos of 3 cases].

Three cases of atrioventricular without ventriculo-arterial discordance are reported. The first case was a young woman with situs solitus, atrioventricular discordance and ventriculo-arterial concordance, large atrial and small ventricular septal defects. The functional tolerance was relatively good. The second case was an infant girl with dextrocardia by dextroversion and abdominal situs solitus. The child had atrioventricular discordance with ventriculo-arterial concordance and an ostium primum atrial septal defect. Cyanosis was mild and, in addition, complete heart block was diagnosed on the fourth day of life. The functional tolerance was good in this case too and growth was normal. The third case was a young girl with levocardia, atrial situs inversus, and abdominal situs inversus. A double outlet right ventricle was diagnosed at catheterisation with atrioventricular discordance, ventricular septal defect, and severe valvular and infundibular pulmonary stenosis. The first palliative procedure was performed at eight months: a left Blalock-Taussig anastomosis. As cyanosis has recurred a second procedure is being considered, the child now being 5 years old. Different forms of atrioventricular discordance without ventriculo-arterial discordance have been described: atrioventricular discordance with ventriculo-arterial concordance; atrioventricular discordance with double outlet right ventricle; atrioventricular discordance with double outlet left ventricle; atrioventricular discordance with a single vessel issuing from the right or left ventricle. With reference to their personal cases and those described in the literature, the authors describe the anatomy, physiopathology and the clinical consequences of the different forms encountered in their cases. The different surgical techniques for each anatomical form of this condition are discussed.

Angiocardiography↗

[Right ventricular dysplasia: Uhl's disease. Echocardiography and tomodensitometry study. Apropos of a case in an adult].

The author discusses Uhl's disease in a 60 year old patient as indicated by right ventricular insuficiency without troubles of the ventricular rhythm. Echocardiography revealed the distinctive symptoms of this illness (dilation of the right cavities, diastolic opening of the pulmonary valve, delayed closing of the tricuspid valve) emphasizing its diagnostic value. The contribution of tomodensitometry is considered.

Echocardiography↗

[Circulating anticoagulant, recurrent abortions and venous thrombosis: a new entity or a pre-lupus syndrome? 2 cases].

The authors report the presence of a circulating anticoagulant in two patients who had suffered multiple abortions. The circulating anticoagulant was discovered during evaluation of repeated phlebothromboses in the first case and of a chronic inflammatory syndrome in the second. While the apparently paradoxical relationship between the circulating anticoagulant and venous thrombosis is relatively well-known, that between the circulating anticoagulant and repetitive abortions is more difficult to establish. The rarely reported association of these three events leads us to a discussion of the nosologic place of this pathology and of the common ground it shares with S. L. E., as the circulating anticoagulant is of the antiprothrombinase variety, the antibody commonly called the lupus anticoagulant.

Abortion, Habitual↗

[Treatment of a severe coronary artery spasm, refractory to complete denervation of the heart (autotransplantation)].

The case reported is that of a 49 year old man with very severe Prinzmetal angina due to spasm of the left circumflex artery. Despite intensive medical treatment he continued to suffer frequent attacks with atrioventricular block. As plexectomy was not possible in this case, complete cardiac denervation was performed. After surgery, he had no further attacks and continuous ECG monitoring showed no ischemic phenomena. Nevertheless, a stress test was still able to induce spasm of the same artery which was painless but associated with ECG changes. Eighteen months postoperatively, resting angina recurred with positive stress tests giving painful attacks. Four hypotheses are discussed: 1) the local factor was very important, with a zone of hyperactivity on the left circumflex artery, 2) one of the mechanisms of coronary artery spasm could be the nervous stimulation of this zone, 3) this zone was insensitive to nervous stimulation after autotransplantation but remained sensitive to methylergometrine, 4) the recurrence of resting angina and painful symptoms on stress testing suggests the possibility of reinnervation of the heart, as has been shown after cardiac transplantation, the autonomic nervous system does not play the role generally attributed to it in the genesis of spasm.

Aged↗

[False aneurysms extending from true aneurysms of the left ventricle].

Over a 10 year period, four cases of post myocardial infarction pseudo-left ventricular aneurysm were observed, two directly arising from the infarct (postero diaphragmatic patients had pseudo-aneurysms which arose inferiorly from true anteroapical aneurysms and underwent surgical resection. Apart from the histological features, a certain number of diagnostic signs merit review: --A clinical course marked by a number of phases (myocardial infarction--pericardial syndrome--true aneurysm complicated or not by arrhythmias--period of stabilisation followed by deterioration due to rapid progression of cardiac failure). -- "Angiographic-like" ultrasonic and isotopic methods complement left ventriculography which confirms the parietal aneurysm and may show three very suggestive signs of pseudo-aneurysm: a narrow communication with the true aneurysm; delayed and prolonged filling of the bulge; inferior extension with localization by pericardial adhesions. Surgery is imperative, the main problem being the extent of resection of the true aneurysm. This is related to the rigid or calcific character of the neck of the pseudo-aneurysm.

Diagnosis, Differential↗

Atrial flutter.

Explore the source record for details and available documents.

Atrial Fibrillation↗

Complete denervation of the heart (autotransplantation) for treatment of severe, refractory coronary spasm.

A 49 year old man had severe refractory Prinzmetal's variant angina and angiographically documented coronary arterial spasm of a dominant circumflex artery. The spasm was provoked by methergine (an ergot alkaloid) and seemed resistant to various forms of medical therapy including administration of nitrates, nifedipine, verapamil, diltiazem and amiodarone. The attacks of angina at rest persisted at the rate of 7 to 15/day and were frequently associated with atrioventricular (A-V) block. After unsuccessful plexectomy performed in another institution, the patient underwent complete cardiac denervation (produced by autotransplantation). The follow-up data have interesting implications in relation to treatment of refractory variant angina, as well as possible mechanisms of coronary arterial spasm.

Angina Pectoris↗