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Biomedical subjects

H Bricaud

Publications and source records attributed to H Bricaud.

At least 37 records · Page 2Linked to original sources
PubMed1989

[Data of programmed ventricular stimulation in left ventricular hypertrophy of hypertensive origin].

Various studies have established the increase of sudden death in hypertensive patients with left ventricular hypertrophy (LVH). In order to specify its most important factors, an electrophysiological study consisting of Holter recording (HR) and programmed ventricular stimulation (PVS), was performed in 24 patients with hypertension: 12 with LVH and 12 without LVH, on ultrasonography. In all patients, coronary angiography was normal. The results are the following: 1) LVH increases the ventricular vulnerability, this arrhythmogenic substrate and its stability are explored by PVS; 2) HR and PVS are not correlated, therefore HR does not explore the arrhythmogenic substrate of LVH, but rather the potential triggering factors of severe rhythm disorders; 3) it has not been possible to evaluate the role of the autonomous nervous system in this study; 4) finally, a significant correlation was found between the degree of anatomical hypertrophy of the LV and the duration of the interval AH.

Adult↗
PubMed1989

[Value of trimetazidine in the long-term treatment of cardiomyopathies of ischemic origin].

The effect of a cellular anti-ischemic, trimetazidine (TMZ) in ischemic cardiomyopathies, was evaluated in a double-blind versus-placebo (P) trial, over a period of six months. 20 patients, mean age: 59.5 years, with advanced ischemic cardiomyopathy, demonstrated by left catheterization and coronary angiography, with a past history of myocardial infarction, received either 60 mg per day of TMZ (nine patients) or the placebo (eleven patients) in addition to a basic treatment of digitalis, diuretics and nitrated medications. A complete, clinical, biological and paraclinical evaluation, including chest X-ray, ultrasonography, isotopic ventriculography and 24 h-ECG, was performed upon inclusion in the study; and after three and six months of treatment. Two patients from the placebo group were not reevaluated at six months. The clinical condition, according to the NYHA classification, improved in all patients from the TMZ group, deteriorated in eight on nine patients from the placebo group (p less than 0.001). The isotopic stroke volume is preserved with TMZ, deteriorated with P. The cardiac volume decreases with TMZ, increasing with P. TMZ is beneficial clinically and functionally in advanced ischemic cardiomyopathies.

Analysis of Variance↗
PubMed1988

Accuracy of M-mode and two-dimensional echocardiography in the diagnosis of aortic dissection: an experience with 128 cases.

The accuracy of combined M-mode and two-dimensional echocardiography in the diagnosis of aortic dissection was evaluated in 673 patients with a clinical suspicion of aortic dissection, over a six-year period. In 128 cases, the diagnosis of aortic dissection was confirmed by angiographic, tomographic (CT scan), or autopsy findings, or during surgery. Two echocardiographic features were found to support a diagnosis of aortic dissection: a dilation of at least one segment of the aorta (sensitivity 95%, specificity 51%) and a typical abnormal linear intraluminal echo corresponding to the intimal flap (sensitivity 67%, specificity 100%). This pathognomonic intimal flap was observed in 86 cases, of which three types could be distinguished: (1) a long oscillating flap (n = 15), (2) a long but minimally mobile linear echo which was duplicated and parallel to one or two aortic walls (n = 64), (3) a short, double linear image with a rapid systolic motion and high frequency oscillations. These features were found to have a high sensitivity in type I aortic dissection (88%), although in types II and III the sensitivity was much lower. In some cases, a fourth type of abnormal image could be detected: a small intraluminal echo moving in parallel to the aortic wall. This feature should be interpreted with caution since its predictive value for a positive examination was low (48%). Out of 23 cases in which the diagnosis of aortic dissection was suspected on the basis of this doubtful abnormal echo, it was confirmed in only 11 patients. The results in these 128 cases of aortic dissection indicate that two-dimensional echocardiography, which is easily performed at the patient's bedside, could take priority in investigations of this condition. It is extremely sensitive in the diagnosis of ascending aortic dissection, but much less so in the diagnosis of descending aortic dissection.

Aortic Dissection↗
PubMed1988

Left ventricular hypertrophy and ventricular dysrhythmic risk in hypertensive patients: evaluation by programmed electrical stimulation.

Left ventricular hypertrophy in hypertensive patients is associated with an increased prevalence of ventricular arrhythmias. Twelve patients with left ventricular hypertrophy assessed by M-mode echocardiography and 12 without left ventricular hypertrophy underwent an electrophysiological study with programmed electrical stimulation. The patients with left ventricular hypertrophy had a prolonged infranodal conduction time which correlated closely with left ventricular mass (r = 0.71; P less than 0.001). Programmed electrical stimulation initiated more intraventricular re-entry and unsustained ventricular tachycardia in the group with left ventricular hypertrophy than in the control group, although sustained ventricular tachycardia was never induced. We conclude that ventricular vulnerability is increased in hypertensive patients with left ventricular hypertrophy, especially in those who show electrocardiographic evidence of left ventricular hypertrophy.

Arrhythmias, Cardiac↗
PubMed1988

Serum type III procollagen peptide levels in coronary artery disease (a marker of atherosclerosis).

The known shift in collagen synthesis from procollagen type I to type III in patients with atherosclerosis, suggested measurement of serum procollagen III peptide (PIIIP) levels in patients with coronary artery disease (CAD). Two groups of patients were studied: group I--thirty-six patients with CAD (male, mean age 56.9 +/- 7.5 years, hospitalized for coronary angiography. Risk factors included 16 patients with high blood pressure, four diabetics, 31 smokers and 15 with hypercholesterolaemia. Five patients had no significant lesions, seven had one vessel with over 50% stenosis, 10 had two vessels and 14 had three vessels. Group II--35 patients (male, mean age 39.4 +/- 13.3 years), with normal physical examination and ECG according to WHO criteria, formed the control group: the risk factors included nine patients with high blood pressure, 14 smokers and one with hypercholesterolaemia. Procollagen III peptide levels were determined by radioimmunoassay. In group I, PIIIP levels were 26.8 +/- 16 ng ml-1 vs. 10.4 +/- 3.2 for group II. Sixty-one per cent of group I had pathological levels of PIIIP with an absence of correlation with the severity of atherosclerosis or risk factors. Only 2.8% of patients in group II had pathological levels. Procollagen III peptide determination would appear to be a sensitive, specific and predictive test for atherosclerosis in patients with CAD.

Adult↗
PubMed1988

[Wolff-Parkinson-White syndrome. Outcome of patients treated with anti-arrhythmia agents from data of electrophysiological examinations].

Seventy-two consecutive patients with electrocardiographic evidence of Wolff-Parkinson-White syndrome underwent electrophysiological study (EPS). Fifty-five of these patients (76 p. 100) had episodes of tachycardia, 11 experienced palpitations or syncopes and 6 were asymptomatic. The decision to prescribe an antiarrhythmic agent was reached on the basis of the patients' symptoms and EPS data. One patient was treated by surgery before the medical treatment was tried; 17 patients were discharged without treatment, 4 were discharged with an episodic and 50 with a preventive antiarrhythmic treatment. Among these 50 patients, 46 (92 p. 100) could be followed up for a mean period of 45.7 +/- 28 months. One died of lung cancer; 43 presented with spontaneous episodes of tachycardia, 4 were able to discontinue treatment at the end of the follow-up period since they had very few symptoms and 2 were lost sight of. Among the 37 patients under antiarrhythmic treatment followed up, 29 (78 p. 100) are well controlled, while 8 (22 p. 100) still present with episodes of tachycardia. A tachycardia-reducing pacemaker was implanted in 5 of these 8 patients. It therefore appears that 78 p. 100 of patients presenting with spontaneous episodes of tachycardia associated with WPW syndrome can be controlled with an antiarrhythmic treatment. This result was obtained after trying at least two types of antiarrhythmic agents in 86 p. 100 of the cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

[Protease inhibitors and ectasia in coronary atherosclerosis].

The possibility of elastase contributing to degradation of the arterial wall in atherosclerosis and to the formation of ectasia has prompted us to assay the main protease inhibitors, alpha 1-antitrypsin and alpha 2-macroglobulin, in patients with angiographic coronary disease with and without coronary ectasia. Serum concentrations of these two proteins were measured by immunonephelometry in 203 patients admitted for coronary arteriography. The results obtained were analyzed according to the presence of atheromatous lesions and their severity and to the presence or absence of ectasia. There was no correlation between the values observed and the presence or severity of coronary atherosclerosis, but the concentration of alpha 1-antitrypsin was significantly higher in patients with coronary ectasia (247.2 +/- 40.5 mg/ml) than in patients without ectasia (213.5 +/- 36.6 mg/100 ml; p less than 0.001). This study shows that coronary ectasia is associated with disturbances in the protease-antiprotease system, which may be consecutive to initial changes in elastase activity. Our results support the theory that elastase and protease inhibitors play a specific role in some atheromatous processes.

Adult↗
PubMed1988

[Ablation of atrio-ventricular conduction by fulguration of the His bundle. Proposal for a simplified technic. Apropos of 70 cases].

Between 1982 and 1987, 70 patients (32 men, 38 women, aged from 45 to 93 years) underwent catheter ablation of His bundle and were followed up for more than 3 months. The disorders treated were atrial fibrillation, flutter of tachycardia (62 cases), junctional tachycardia (7 cases) and refractory atrial extrasystoles (1 case). The overall results were: early failure in 1 case, late death in 3 cases, persistent high degree AV block in 53 cases (75 p. 100), 1st degree AV block in 9 cases (12 p. 100) and failure in 8 cases (13 p. 100). Two techniques were used. In the first 30 patients ablation was performed by tri- or quadripolar catheters with electrodes 10 mm apart (USCI 2943/2854) and localization by an unipolar electrode connected to the negative pole of the defibrillator. The mid-term results in this series were: complete AV block in 20 cases (66 p. 100), partial AV block in 5 cases (17 p. 100) and failure in 17 cases (17 p. 100). In the last 40 patients localization was bipolar and ablation was obtained with simultaneous bipolar leads taken from a Josephson catheter with electrodes 5 mm apart (USCI 8567); the two electrodes recording the highest His bundle potential were connected to the negative pole of the defibrillator. The results in these series were: complete AV block in 33 cases (82 p. 100), partial AV block in 4 cases (11 p. 100) and failure in 3 cases (7 p. 100). Although the two series were not exactly similar, it seems permissible to recommend the second, more convenient technique.

Aged↗
PubMed1987

Megakaryopoiesis disturbances in atherosclerotic rabbits.

Rabbits given a hypercholesterolemic diet (500 mg/day) for 6 months and then maintained for another 6 months on a normal diet were found to have developed fibrous lipidic lesions in the aorta. Although circulating platelet levels in these animals were normal there was a reduction in mean megakaryocyte ploidy. The high concentrations of megakaryoblasts in all the sedimentation fractions collected by the 'STAPUT' system suggested an increase in megakaryocyte turnover with activation of committed stem cells. In addition, other defects in maturation of megakaryocytes were observed, such as abnormalities in the demarcation membrane system and granule number. These data reveal that defects in megakaryocyte maturation and turnover may occur during the process of reparative fibrosis of the arterial tree following a period of moderate hypercholesterolemic diet in the rabbit.

Animals↗
PubMed1987

[Cardiac complications of dermatopolymyositis. Apropos of 56 cases].

A retrospective study was conducted on 58 patients hospitalized for dermato- or polymyositis between 1967 and 1986, with the view of determining the cardiovascular complications specific to these diseases. The patients' mean age was 51 years, less than 6 months had elapsed between first symptoms and diagnosis, and 31 p. 100 of the patients had died. The electrocardiogram was considered normal in 46 patients, none of whom presented with the slighted clinical evidence of cardiovascular involvement. ECG abnormalities were present in 10 cases, including 5 with disorders of conduction. Five cases of cardiovascular pathology with clinical manifestations were discovered. A 36-year old woman had severe myocardial pathology with marked rhabdomyolysis (CPK greater than 100,000) and complete atrio-ventricular block requiring emergency pacemaker implantation. Three years after the onset of the disease, and whilst the clinical signs of polymyositis had regressed, this patient still had complete AVB and moderately dilated congestive cardiomyopathy. This study shows that cardiac complications of dermato-polymyositis are rare and predominantly consist of disorders of conduction which may become permanent and associated with alterations of left ventricular kinetics. The authors suggest that a high-risk category for patients with disorders of conduction and cardiomyopathy can be identified by echocardiography, but this examination needs mainly be performed in cases when ECG abnormalities are present, since no clinical cardiac pathology was observed in patients of this series with normal electrocardiogram.

Adult↗
PubMed1987

[Effectiveness of double fibrinolytic treatments in subacute deep vein thrombosis of the lower limbs].

The purpose of this study was to evaluate the effectiveness and desirability of a double fibrinolytic treatment in subacute venous thrombosis of the lower limbs. Thirty-four patients (mean age 55.2 +/- 15.4 years) hospitalized for thrombosis of deep lower limb veins were treated with two different fibrinolytic drugs administered successively: 23 patients received streptokinase first followed urokinase, and 11 patients received urokinase first followed by streptokinase. The overall results that improvement of the phlebographic score (Ph.s) was significantly greater in double fibrinolytic treatment (delta Ph.s. = 4.41 +/- 6.45, p less than 0.001) than after a single fibrinolytic treatment (delta Ph.s. = 3.14 +/- 4.76, p less than 0.001). Individual analysis of the results showed that 28% of the patients were improved by a second fibrinolytic treatment. It would appear that two fibrinolytic treatments are truly effective, albeit inconstantly and in most cases partially. We were unable in this study to determine the characteristics of patients likely to benefit from a double treatment.

Adult↗
PubMed1987

[Metabolism of collagen in coronary patients].

The alterations observed in connective tissue of the arterial wall and dermis in atherosclerosis incited us to investigate collagen metabolism in patients with coronary disease. We first studied collagen metabolism in fibroblast cultures, then measured serum levels of type III procollagen aminoterminal peptide. Fibroblast collagen metabolism was investigated in 12 consecutive patients of less than 45 years of age presenting with coronary disease and coronary atherosclerosis was found to be preserved in patients with atherosclerosis, but less type III type I procollagen was synthesized (14.6 +/- 6.6% versus 22.3 +/- 4.3%). This abnormality, found in 83% of our coronary patients, seemed to be unrelated to risk factors or to the severity of atherosclerosis. Serum type III procollagen aminoterminal peptide was assayed comparatively in 36 patients with coronary atherosclerosis confirmed at coronary-ventriculography and in 35 patients free from coronary disease as defined by the W.H.O. criteria. Serum levels of this peptide were significantly higher in patients with coronary atherosclerosis (26.76 +/- 16 ng/ml) than in controls (10.43 +/- 3.18 ng/ml). 61% of coronary patients had a peptide level higher than the normal value (17 ng/ml). No correlation was found between this rise in type III procollagen aminoterminal peptide and the severity of coronary lesions or the importance of risk factors. Thus, collagen metabolism is altered in coronary patients, and this alteration can be detected by a peripheral marker. However, the use of this marker to diagnose the presence or evaluate the course of atherosclerosis requires clarification.

Adult↗
PubMed1987

[Indications for the long-term electrocardiogram and echocardiogram after a cerebral ischemia complication].

Ninety patients admitted to a neurology unit for cerebral ischaemic accident without evidence of embolism from the heart were examined by ambulatory electrocardiographic monitoring (AEM) and by echocardiography assessable in 76 cases. On the basis of a standard cardiac evaluation (SCE) including physical examination, chest radiography and electrocardiography, the patients were divided into 3 groups: 42 with normal SCE (group I), 19 with isolated arterial hypertension (group II) and 36 with patent cardiac disease (group III). Significant abnormalities were detected by AEM in 10.5% of group I patients, 18.5% of group II patients and 33% of group III patients. A structural cardiopathy was discovered at echocardiography in 33%, 62% and 91% respectively of patients in these 3 groups. The greatest number of mitral valve prolapses (7/9 cases) was found in group I. The main echocardiographic abnormality detected in group II was dilatation of the left cardiac cavities: atrium more than 38 mm in 8 cases, ventricle more than 50 mm in 3 cases. Comparisons between the two explorations showed that arrhythmias were often associated with dilatation of the left cardiac cavities (39%) and much less frequently with mitral valve prolapse (11%) and myocardial hypertrophy (16%). Our results suggest that when examinations cannot be routinely performed in hospital patients with a cerebral ischaemic accident echocardiography should be reserved to patients with heart disease or hypertension, and AEM to those with heart disease or hypertension and with dilatation of the left cardiac cavities.

Adult↗
PubMed1987

[Fate of angina in women with healthy coronary vessels. Retrospective study of 68 patients with a 42-month follow-up].

The discovery of normal coronaries on angiography in patients known and treated for many years for true angina, if reassuring for the physician, raises other problems about the evolution of the patient. Among the 235 patients seen with this diagnosis between january 1980 and may 1986, 68 had healthy coronaries without any associated disease (mean age = 57.4 years). The objective is to determine the evolution of this group with a mean follow-up of 42 months and the advantages of coronary angiography. No infarction or sudden death occurred. 91 p. cent have an unlimited housekeeping activity, 10 p. cent have stopped working for a cardiac reason, 55 p. cent continue to work, 13 p. cent were rehospitalized for the same reason and 25 p. cent developed extra cardiac symptoms (2 neoplasms). But only 35 p. cent do not experience chest pain. On the contrary, failure is obvious concerning the anti-angina treatment since only 10 p. cent are not any longer on medication and the total consumption did not vary. The fact that 84 p. cent of the patients have little or no pain under calcium-blockers, taken alone or in association with other drugs, raises the question of their true efficacy, without any placebo effect, since the beta-blockers consumption decreases slightly.

Angina Pectoris↗
PubMed1987

[Familial protein C deficiency and venous thrombosis].

Constitutional deficiency in C-protein appears to be a very often underestimated or unrecognized cause of thromboembolic disease. C-protein deficiency in a family (father, son and daughter) was associated with clinical manifestations of thrombosis (post-embolic cor pulmonale, fatal pulmonary embolism, post-partum phlebitis), all appearing before 35 years of age. These three cases confirm the absolute need for routine exploration of physiologic inhibitors of coagulation in all young patients with venous thrombosis.

Adult↗
PubMed1986

[Myocardial infarction, an unrecognized complication of Behçet's disease?].

It the vascular complications of Behcet's disease, especially thrombophlebitis, are well known, coronary involvement in seldom described (less than ten cases in the literature). The two cases reported here, of patients under 45, having presented both a myocardial infarction confirmed by coronary arteriography, lead to bring up first the problem of the causal relationship between disease and necrosis (inflammatory syndrome, thrombogenic tendency, vasospastic aspect), to reach a preventive attitude with, firstly, and extended use of anticoagulants in patients severely affected, in evolutive outbreaks, and then with the easier indication of anti-spastic treatments, mostly calcium blockers.

Adult↗