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Biomedical subjects

G Grollier

Publications and source records attributed to G Grollier.

At least 199 records · Page 11Linked to original sources
PubMedDate not supplied

[Infectious endocarditis on native valves. Report of a series of 142 surgically treated cases].

The results obtained in a series of 142 patients operated upon, between December 1978 and December 1987, for infective endocarditis on native valve are reported. 61 patients (group 1) had acute progressive endocarditis and 81 patients (group 2) had subacute old-standing endocarditis. In group 1 patients, hospital mortality (i.e. occurring during the first 30 post-operative days) was 11.5 p. 100. During a mean follow-up period of 37.6 months (1.5 to 104.5 months), the survival rates were 52 p. 100 at 72 months and 37.4 p. 100 at 104.5 months. Mechanical desinsertion without persistence or relapse of the infective process, and recurrent endocarditis accounted for 27.8 p. 100 of deaths of known cause. Prognosis was better in group 2 patients. Hospital mortality was 4.9 p. 100, and during a mean follow-up period of 58 months (2 to 124 months) the survival rates were 84 p. 100 at 72 months and 73.4 p. 100 at 124 months. 60 p. 100 of late deaths of known cause were due to heart failure. In native valve infective endocarditis the post-operative diagnosis depends upon the pre-operative haemodynamic status, and the assessment of this status (notably with echocardiography) is a crucial element in the decision to operate.

Adolescent↗
PubMedDate not supplied

TNK-tissue plasminogen activator compared with front-loaded alteplase in acute myocardial infarction: results of the TIMI 10B trial. Thrombolysis in Myocardial Infarction (TIMI) 10B Investigators.

BACKGROUND: Bolus thrombolytic therapy is a simplified means of administering thrombolysis that facilitates rapid time to treatment. TNK-tissue plasminogen activator (TNK-tPA) is a highly fibrin-specific single-bolus thrombolytic agent. METHODS AND RESULTS: In TIMI 10B, 886 patients with acute ST-elevation myocardial infarction presenting within 12 hours were randomized to receive either a single bolus of 30 or 50 mg TNK-tPA or front-loaded tPA and underwent immediate coronary angiography. The 50-mg dose was discontinued early because of increased intracranial hemorrhage and was replaced by a 40-mg dose, and heparin doses were decreased. TNK-tPA 40 mg and tPA produced similar rates of TIMI grade 3 flow at 90 minutes (62.8% versus 62.7%, respectively, P=NS); the rate for the 30-mg dose was significantly lower (54.3%, P=0.035) and was 65. 8% for the 50-mg dose (P=NS). A prespecified analysis of weight-based TNK-tPA dosing using median TIMI frame count demonstrated a dose response (P=0.001). Similar dose responses were observed for serious bleeding and intracranial hemorrhage, but significantly lower rates were observed for both TNK-tPA and tPA after the heparin doses were lowered and titration of the heparin was started at 6 hours. CONCLUSIONS: TNK-tPA, given as a single 40-mg bolus, achieved rates of TIMI grade 3 flow similar to those of the 90-minute bolus and infusion of tPA. Weight-adjusting TNK-tPA appears to be important in achieving optimal reperfusion; reduced heparin dosing appears to improve safety for both agents. Together with the safety results from the parallel Assessment of the Safety of a New Thrombolytic: TNK-tPA (ASSENT I) trial, an appropriate dose of this single-bolus thrombolytic agent has been identified for phase III testing.

Aged↗
PubMedDate not supplied

[Treatment of acute phase of myocardial infarction with injectable bisoprolol with oral versus].

The early treatment of acute myocardial infarction with beta-blockers represents a major advance in the management of this condition which was proved in a large serie of international studies including a total of about 30,000 patients, and in recent overviews. As a whole such treatment reduces total mortality by 13 to 14% during the first week (p less than .02) in the treated group compared with the controls. The mortality reduction appears most marked in the first two days, about 25%, after early intravenous infusion. Data on non fatal reinfarction in hospital suggest that early treatment reduces this risk by about 19% (p less than .01). Furthermore data on all patients suffering deaths, non fatal arrest and non fatal reinfarction indicate a 16% reduction in the risk of suffering one of these major events (p less than .001) and provide strong evidence of the beneficial effect of this class. Bisoprolol (Detensiel) is a high beta 1-selective beta-adrenoceptor blocking agent without intrinsic sympathomimetric activity and local anaesthetic activity. Its pharmacokinetic profile appears extremely favourable with a plasma elimination half-life of about 10 h and a balanced clearance: bisoprolol is inactivated by liver metabolism (about 50%) and excreted unchanged in the urine (about 50%). Two pilot open studies were performed up to now with IV bisoprolol in acute myocardial infarction (MI). The first trial (n = 37) confirms the clinical and ECG safety of the administered dose regimen: repeated IV infusion of 1 mg up to a cumulative maximum dose of 5 mg and subsequent oral treatment with 10 mg once daily (o.d.).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMedDate not supplied

[Rilmenidine, a new antihypertensive agent in the first line treatment of essential arterial hypertension. Multicenter double-blind study versus atenolol].

After 4 weeks on placebo, 90 hypertensive patients (37 men, 53 women, mean age 55 years) with systolic (SBP) and diastolic (DBP) blood pressures of 162/99 and 165/100 mmHg respectively received double-blind treatment with either rilmenidine 1 mg/day or atenolol 50 mg/day. This treatment was given alone for 8 weeks, with possible DBP greater than or equal to 90 mmHg, hydrochlorothiazide 25 mg/day was added between the 9th and 12th weeks of treatment. At week 13 all treatments were replaced by placebo. Both groups were similar at randomisation, and both treatments were similarly effective: after 8 weeks of monotherapy with rilmenidine or atenolol, the SBP/DBP had decreased by -18/-13 mmHg and by -21/-15 mmHg respectively, and the proportion of patients with normalised blood pressure (SBP/DBP less than or equal to 160/90 mmHg) was 66 percent and 65 percent. Effectiveness was maintained at 12 weeks, when less than 20 percent of the patients had taken hydrochlorothiazide. Both drugs were well tolerated clinically and electrocardiographically. There was a significantly greater decrease in heart rate on atenolol than on rilmenidine. Eleven patients (5 on rilmenidine, 6 on atenolol) dropped out of the trial, 2 and 3 patients in the respective groups on account of side-effects. Laboratory tests showed that the HDL-cholesterol level significantly decreased on atenolol and remained stable on rilmenidine (P less than 0.01), whereas the LDL-cholesterol level was stable on atenolol and decreased on rilmenidine (P less than 0.05). No rebound in blood pressure was observed on discontinuation of both treatments. This study shows that rilmenidine administered as first-line treatment is as effective as atenolol in lowering blood pressure, and it confirms that this drug is clinically and biochemically well tolerated.

Adult↗
PubMedDate not supplied

[A randomized double-blind therapeutic trial of enalapril versus timed-release nifedipine in mild to moderate essential hypertension].

In a multicentre, randomized, double-blind, double-placebo therapeutic trial, the effectiveness and safety of enalapril and slow-release nifedipine were studied in two groups of ambulatory patients with mild to moderate essential hypertension. Following a 2-week placebo period, 136 patients were allocated at random to either enalapril 20 mg/day in one evening dose (group 1, n = 68) or to nifedipine 40 mg/day in two doses, one a.m. the other p.m. (group II). Each treatment was administered for 12 weeks. Patients in both groups whose diastolic arterial pressure remained above 90 mmHg were given hydrochlorothiazide 25 mg/day from the 4th week onward. When blood pressure did not return to normal, the dose of hydrochlorothiazide was increased to 50 mg/day in the 8th week. After 4 weeks of treatment, no significant difference in reduction of supine diastolic arterial pressure was observed between the two groups (- 12.1 +/- 9.9 mmHg in groups I vs - 10.3 +/- 9.0 mmHg in group II). At the end of the 12-week treatment the decrease of diastolic blood pressure was more pronounced in patients on enalapril than in those on nifedipine (- 16.3 +/- 8.0 mmHg vs - 13.9 +/- 7.1 mmHg), although the difference was not statistically significant (P = 0.06). The number of patients with undesirable side-effects was greater in the nifedipine group (33 patients; 48.5 per cent) than in the enalapril group (18 patients; 26.5 per cent). Treatment was discontinued on account of side-effects in 3 patients of the enalapril group and 10 patients of the nifedipine group.

Aged↗
PubMedDate not supplied

[Treatment of deep venous thrombosis. Comparative study of a low molecular weight heparin fragment (Fragmin) by the subcutaneous route and standard heparin by the continuous intravenous route. A multicenter study].

This open, randomised multicenter trial compares the efficacy and safety of Fragmin administered subcutaneously twice daily with standard heparin administered by continuous infusion in the treatment of deep vein thrombosis (DVT). The initial dose of Fragmin is 100 U anti-Xa/kg/12 h and the further doses are adjusted according to the anti-Xa activity between 0.5 and 0.8 U/ml, 3 hours after the morning injection. The initial dose of standard heparin is 240 UI/kg/12 h. The dose adjustments are based on the daily results of APTT (1.5 - 3 times the control). Treatments efficacy are appreciated when comparing the venography performed before and after 10 days of treatment. The safety is evaluated on clinical parameters and iterative biological tests. Sixty-six patients have been included in this study. Efficacy of the two treatments is equivalent with a phlebographic improvement in respectively 79.3 p. 100 (Heparin Group) and 71.0 p. 100 (Fragmin Group) of the cases and an aggravation in 3.4 p. 100 and 6.4 p. 100 (NS) respectively. The frequency of dosage adjustments is lower and the stability of biological tests is better in the Fragmin group. In conclusion, the administration of Fragmin twice daily by subcutaneous route seems to be equivalent at least to standard heparin continuous infusion in the treatment of recent DVT. The better convenience and safety of Fragmin have to be verified on a larger panel of patients.

Adult↗
PubMedDate not supplied

[Thromboses of the right cardiac cavities: echocardiographic diagnosis and therapeutic indications apropos of 2 cases and review of the literature].

Two cases of pulmonary emboli are reported: a thrombus was detected by echocardiography in the right atrium in the first case and in the right ventricle in the second. Following a review of the 28 cases published to date, criteria are given for distinguishing between those thrombi embolizing from the peripheral veins and those arising in the right cavities of the heart. Therapeutic recommendations are also given.

Adult↗
PubMedDate not supplied

[Value of echocardiography in the diagnosis of arrhythmias].

Identification of auricular activity is important for the diagnosis of arrhythmias. P waves however are often difficult to recognize. Using M-mode and 2-D echocardiographic techniques, it is often possible to recognize atrial contraction at the level of the atrial septum or of the free wall of the right atrium. Diagnosis can be made in cases of sinus tachycardia, supra ventricular tachycardia with and without aberrancy and ventricular tachycardia with dissociation. Ventricular tachycardia with one to one retrograde conduction or with atrial fibrillation cannot be recognized by this method.

Arrhythmias, Cardiac↗
PubMedDate not supplied

[Ectasia of coronary arteries. Review of the literature. Apropos of 5 cases].

The authors present 5 cases of coronary artery ectasia discovered on coronary angiography and review the literature on the subject. The aetiology of these coronary aneurysms is discussed: coronary atherosclerosis seems to be the most common cause of this condition which some authors consider to be a variant of coronary atheroma. The therapeutic management is controversial. The indications for surgery are rare and should be carefully considered. Long term anticoagulant therapy, however, appears to be essential.

Aneurysm↗
PubMedDate not supplied

[Angiosarcoma localized in the right cardiac cavities. Apropos of a case].

The authors report the case of a young 26 years old man admitted for abundant fluid pericarditis which was rapidly recurrent, requiring two perocardial punctures and a surgical drainage. The two dimensional echocardiogram demonstrated a large right atrio-ventricular tumour with infiltration of the right ventricular wall, suggesting its malignant nature. After confirmation by right angiography and in view of the rapid cardiovascular deterioration, it was decided to operate. The surgery was only exploratory; not even palliative surgery was possible for this tumour mass invading the right atrium, the right ventricle and the pericardium. Histology revealed it to be an angiosarcoma.

Adult↗
PubMedDate not supplied

[Pulmonary arterial hypertension and generalized scleroderma. A propos of 10 cases].

Whereas pulmonary fibrosis is a very frequent manifestation of scleroderma, pulmonary hypertension of the precapillary type is a much rarer occurrence in this affection. Two cases of scleroderma with subsequent development of a pulmonary hypertension are reported. Various hypotheses have been advanced to explain the origin of this disorder during the course of scleroderma. Rather than a direct consequence of the sclerodermic pulmonary fibrosis it probably arises secondary to the specific, diffuse, primary pulmonary vascular lesions.

Aged↗
PubMedDate not supplied

[Multiple coronary-left ventricular fistulae. Apropos of a case].

The authors report the case of a 57 years old man who was admitted for angina unresponsive to medical treatment. Coronary angiography revealed significant atherosclerotic lesions in the right coronary artery and also revealed multiple left coronaro-ventricular fistulae, hence the interest of this case. The fistulae were filiform and originated in the circumflex and posterior interventricular arteries. Coronaro-cardiac fistulae are rare, but this type of left-sided coronaro-ventricular fistula is exceptional. The patient was asymptomatic following surgical correction of the atheromatous lesions of the right coronary artery.

Coronary Angiography↗