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Biomedical subjects

H Milon

Publications and source records attributed to H Milon.

At least 55 records · Page 3Linked to original sources
PubMed1996

[Left atrial free floating thrombus without mitral valve disease. Review of the literature apropos of a case].

Free ball thrombi of the left atrium are usually observed with mitral valve disease. The authors report the unusual case of this condition without mitral valve disease. A number of classical echocardiographic criteria suggested the precise nature of this left atrial mass before surgical excision. The diagnosis of a free ball thrombus of the left atrium should lead to urgent surgery because of the high risk of haemodynamic and embolic complications.

Aged↗
PubMed1996

Food intake and nutritional status during EXEMSI. Experimental Campaign for the European Manned Space Infrastructure.

Modifications of food intake by astronauts during long-duration spaceflights have been observed. Various psychological stress factors, such as isolation, confinement, constrained community and boredom, are thought to play a role in this phenomenon. For this reason it was decided to include a nutritional investigation in the EXEMSI simulation study, in which four crew members (1 female and 3 males) were isolated and confined for 60 days in a space station-like environment. The Food and Nutritional Management System, developed for this experiment, provided on-line analysis of all available foods in terms of their nutrient content (macronutrients, water, minerals, vitamins). It permitted to keep an accurate record of the daily food intake of each crew member. The system has been shown to be a powerful tool for future missions, either simulations or actual spaceflights. It permits optimal management of food and eating on board, and offers the possibility of online analysis of the nutritional status of the crew. It can provide readily usable data for future analysis of nutritional variables in relation to other physiological and metabolic parameters. It could also supply a periodic feedback to the subject for the purpose of adjusting food intake. Eating and nutrition during the experiment were not a problem, but a pleasure, and therefore played an important role in its success. Confinement and isolation apparently had no effect on either the eating habits or the nutritional status of the crew members. The good food rather helped to decrease the potentially induced stress by providing daily periods of pleasure and of social activities. Detailed analysis of food intake showed erratic eating patterns, both before and during the experiment. However, the weekly averages of macro- and micronutrient intakes were in the normal range, except for vitamins B1 and B6 that were rather low and showed the need for supplements. Food appreciation was assessed by daily questionnaires. Satisfaction with the food provided during isolation was rated very high, and there was no feeling of hunger or monotony. The satisfaction with the food was mainly due to its high palatability, the adequate selection made with direct prior involvement of the crew, the large variety, and the extra supply that allowed the crew to choose and feel free regarding food intake. Comments from the crew afterwards clearly demonstrated that food had not been considered critical during the 60 days of isolation. This is an important fact considering the importance of food in such a restricted living environment.

Adult↗
PubMed1996

[Apical hypertrophic cardiomyopathy].

Apical hypertrophic cardiomyopathy was defined initially by three electrocardiographic and angiographic criteria: the presence of giant (over 10 mm) inverted T waves in leads V4 and V5 of the resting ECG; an "ace of spades" appearance of left ventricular angiography in end diastole in the right anterior oblique projection; the electrocardiographic sum RV5 + SV1 greater than 35 mm. There after, authentic cases of apical hypertrophy have been demonstrated by imaging techniques or observed anatomically without the presence of these three criteria. The authors review the epidemiological, clinical and paraclinical features of this particular form of hypertrophic cardiomyopathy.

Adult↗
PubMed1995

A randomized comparison of the effect of four antihypertensive monotherapies on the subjective quality of life in previously untreated asymptomatic patients: field trial in general practice. The OCAPI Study Group. Optimiser le Choix d'un Anti-hypertenseur de Première Intention.

OBJECTIVE: To assess the equivalence of four antihypertensive treatments in patients with mild-to- moderate hypertension, and to compare the effects of those drugs on the subjective quality of life and clinical safety. DESIGN, SETTING AND PATIENTS: 653 patients aged > or = 18 years with untreated hypertension were randomly allocated to receive a combination of two diuretics (altizide and spironolactone), a beta-blocker (bisoprolol), a calcium antagonist (verapamil), or an angiotensin converting enzyme (ACE) inhibitor (enalapril). Follow-up lasted for 1 year. MAIN OUTCOME MEASURES: A composite outcome of the following measures was used to define success: attendance at the 12-month visit; at least nine supine DBP measurements during the study; and median supine DBP < 90 mmHg and a reduction of at least 10 mmHg compared with the baseline value. Failure was defined as one or more of those criteria not being fulfilled. Equivalence was concluded if the 95% confidence interval for the success rates differed between two groups by less than +/- 10%. Clinical safety and subjective quality of life were also assessed. RESULTS: No statistically significant differences in the change in DBP or systolic blood pressure were observed between the groups. The success rates were 43.9, 42.0, 32.5 and 43.9% in diuretic, beta-blocker, calcium antagonist and ACE inhibitor groups, respectively. Equivalence between the treatments could not be concluded, although analysis with a larger equivalence interval showed that some comparisons indicated equivalence. Significant improvement in satisfaction was observed for certain items for subjective quality of life at 1 month in the calcium antagonist treatment group, and significant differences in the responses to the clinical safety questionnaire were observed after 1-month follow-up in calcium antagonist and beta-blocker groups. Differences were no longer significant after 9 months. CONCLUSIONS: These results do not provide evidence on the basis of efficacy of blood pressure lowering or ability to increase short-term (1-year) safety and quality of life favouring any particular treatment among the studied drugs for newly diagnosed patients with mild-to-moderate hypertension.

Adolescent↗
PubMed1995

[Management of myocardial infarction in the Rhone-Alps area. Are there many variations in practice?].

The aim of this study was to determine the diagnostic and therapeutic strategies after myocardial infarction and to examine variations in medical and surgical practice with respect to the severity of disease, status of the hospital and patients' characteristics. The method used was a prospective study with follow-up at 30 days and 18 months. The subjects came from an exhaustive cohort of all patients admitted to hospital for myocardial infarction during the month of April 1991 in 57 public and private hospitals in the Rhone-Alps region (n = 311). The patients were identified after admission by consulting physicians of the Department of Social Security. The study included all patients with acute myocardial infarction with at least two of the three usual diagnostic criteria (prolonged, constrictive chest pain, enzyme increases and electrocardiographic changes). The study excluded patients who were dead before arrival at hospital. The parameters analysed included the clinical management, use of echocardiography, exercise stress testing, myocardial scintigraphy, coronary angiography, thrombolysis, angioplasty and coronary bypass surgery in the first 30 days after admission. The severity of infarction was assessed by seven clinical, enzymatic and electrocardiographic criteria by physicians from the Department of Social Security (pain, syncope, shock, left ventricular dysfunction, elevation of CPK > 1000 IU, anterior or extensive necrosis, arrhythmias). The mortality rate of this cohort was calculated from hospital statistics and then by enquiring in the town halls of the region. The demographic features of the cohort were marked by a predominance of men (69.5%) and a relatively high mean age (69 years; 23% over 80 years). Complementary investigations were used with the following frequencies: echocardiography, 61.1%; coronary angiography, 26.4%; exercise stress testing 22.8%; myocardial scintigraphy, 5.5%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Compliance to dietary advice directed towards increasing the carbohydrate to fat ratio of the everyday diet.

OBJECTIVE: To assess the effects, on food intake, body weight and body composition, of compliance to advice aiming at increasing the carbohydrate to fat ratio of the everyday diet without imposing voluntary restriction on the amount of food consumed. DESIGN: Eight moderately overweight women (body mass index > 27 kg/m2, relative body fat mass > 30%) received dietary advice during a 2 month period. Additionally, each evening the subjects had to consume a meal artificially enriched with 13C-glucose in order to assess their compliance from the 13CO2 enrichment in expired air. MEASUREMENTS: Dietary intakes, body weight, body composition and individual compliance. RESULTS: The energy derived from fat decreased from 44 +/- 1% to 31 +/- 1% and the proportion of carbohydrate increased from 38 +/- 2% to 50 +/- 1%, whereas the absolute carbohydrate intake remained constant (182 +/- 18 g/d). Energy intake decreased by 1569 +/- 520 kJ/d. There was a net loss of fat mass (1.7 +/- 0.7 kg, P = 0.016) with fat free mass maintenance. Dietary compliance ranged from 20 to 93% (mean: 60 +/- 8%) and was positively correlated to the loss of body fat mass. CONCLUSION: Advice aiming at increasing diet's carbohydrate to fat ratio induces a loss of fat mass with fat-free mass maintenance.

Adult↗
PubMed1994

[Prognosis of non-revascularized triple coronary vessel disease. Apropos of 87 cases].

Between 1982 and 1988, 87 patients (74 men, 13 women), with an average age of 59.6 +/- 10.1 years, had triple coronary artery disease and did not undergo any medical or surgical revascularisation, mainly because of the severity of the coronary disease or left ventricular dysfunction. Sixty-four patients had previous myocardial infarction, 33 unstable angina and 37 left ventricular failure. At coronary angiography, 31 patients had Class III or IV (NYHA) angina. The cardiothoracic ratio was 0.50 +/- 0.06; the left ventricular ejection fraction was 0.47 +/- 0.20. During follow-up of 3.9 +/- 2.6 years (2 patients lost to follow-up), 35 patients died (26 of cardiac and 9 of non-cardiac causes), giving a 5 year actuarial survival of 63%. In univariate analysis, the factors predictive of increased cardiac mortality were: absence of alcohol consumption (p = 0.013); class 3 or 4 angina (p = 0.017); resting angina (p = 0.030); cardiac failure (p = 0.0006); chest X ray showing interstitial or alveolar oedema (p = 0.002); increased cardiothoracic ratio (p = 0.003). A decreased left ventricular ejection fraction was only at the limit of statistical significance (p = 0.054). In multivariate analysis (Cox model), only 4 variables were correlated with increased cardiovascular mortality: resting angina (relative risk, RR = 2.56), cardiac failure (RR = 2.55), increased cardiothoracic ratio (RR = 2.14), absence of alcohol consumption (RR = 4.43). These results confirm the poor prognosis of patients with triple vessel disease not revascularised. They show the value of clinical appreciation to determine the prognosis of these patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Phlebitis of the right upper limb and thromboembolic pulmonary hypertension. Apropos of a case of heart-lung transplantation].

The authors report the case of a 25 year old man with unexplained pulmonary hypertension during his first hospital admission. However, a past medical history suggesting right arm vein thrombosis was obtained. Venography showed signs of thoraco-brachial compression. After heart-lung transplantation, pathological studies of the explanted organs showed changes of thrombo-embolic pulmonary hypertension. A spontaneous right arm venous thrombosis occurred during convalescence. The possibility of post-embolic pulmonary hypertension caused by venous thrombosis of the upper limbs is discussed.

Adult↗
PubMed1993

Arteriographically documented coronary artery disease and alcohol consumption in French men. The CORALI Study.

The relationship between alcohol consumption and angiographically documented coronary artery disease was examined among 484 men who underwent coronary arteriography. Severity of coronary artery disease was assessed by the number of arteries, or the number of segments, with at least one in which the luminal diameter is reduced by > or = 50%. Alcohol and tobacco consumption were assessed by a technician according to a standardized questionnaire, and an estimate of the average consumption level prior to the onset of the clinical symptoms was used for analysis. A decrease in the average coronary artery disease scores was observed with increasing alcohol consumption until a mean consumption of about 100 ml.day-1. After adjustment for age, town, clinical group and tobacco consumption, the same pattern of association was obtained. Similar trends were also present with alcohol consumption restricted to wine, beer and other alcoholic beverages. Taking into account classical risk factors of the disease and blood lipid levels at the time of angiography, did not modify these trends but less significant differences were observed. These findings provide additional evidence that the reduction of the clinical coronary risk observed in moderate alcohol consumers might be secondary, at least partly, to an anatomically less extensive disease. This, however, does not justify the recommendation of alcohol for prevention purposes.

Adult↗
PubMed1993

[Obstructive hypertrophic cardiomyopathy: medical or surgical treatment?].

This retrospective study assesses the results of medical and surgical treatment on survival and functional capacity of patients with hypertrophic obstructive cardiomyopathy (HOCM). Between 1981 and 1991, 73 patients were referred for treatment of HOCM: 24 were operated (Group 1) and 49 were treated medically (Group 2). Patients in Group 1 had more severe forms of HOCM than those in Group 2: 83% were in > or = NYHA Class III compared with only 20% in Group 2 (p = 0.003); 42% had previous cardiac failure compared with 16% in Group 2 (p = 0.02); 29% had atrial fibrillation compared with only 8% in Group 2 (p = 0.004); the average intraventricular pressure gradient was 78 mmHg compared with 42 mmHg in Group 2 (p = 0.001); mean pulmonary arterial pressures were 24 mmHg compared with 15 mmHg in Group 2 (p < 0.001); the cardiac index was 2.2 l/min/m2 compared with 2.7 l/min/m2 in Group 2 (p = 0.001); Sellers > or = grade 3 mitral regurgitation was present in 48% compared with 12% in Group 2 (p = 0.002). However, a family history of HOCM or of sudden death was commoner in Group 2 (28% vs 4% in Group 1: p = 0.03). Surgery consisted of myomectomy alone (5 patients) or associated with mitral valve replacement (MVR) (17 patients) or MVR alone (2 patients). Two patients in Group 1 died (1 perioperative death, 1 late death due to dissection of the aorta), giving over a 3.4 +/- 3.0 year follow-up period without any losses to follow-up, an abnormal mortality of 2.4%.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1993

[Pre- and postoperative right cardiac insufficiency in patients with mitral or mitral-aortic valve diseases].

The prognosis of right ventricular failure in patients with mitral valve disease would seem to depend on its chronicity and progression according to the results of a study of 382 cases of mitral valve disease: 231 women, 151 men: average age 55 +/- 13 years, operated between January 1983 and December 1986, most (321) for mitral valve replacement, one third (108) with associated aortic valve replacement. Right ventricular failure was or had been present before surgery in 161 patients: the peri-operative mortality was 11.2% and the secondary mortality 21.7% in these cases, significantly higher than in patients without RVF (respectively 5.0%, p = 0.02, and 8.1%, p < 0.0005). The RVF was present in the immediate post-operative phase in 43 patients, 8 of whom had no signs of this complication beforehand. The cause of this "de novo" early RVF is multifactorial. Ten other patients developed secondary RVF without any obvious cause in 3 cases. The prognosis of "de novo" RVF is very poor (28% survivors at 75 months). At the end of 60.4 +/- 13.6 months 20 patients were lost to follow-up, RVF was present in 60/286 patients followed up. The mortality was high in the patients with residual RVF (38.3% vs 4.0% in patients without: p < 0.0001). This study confirms the poor prognosis of RVF in patients with mitral valve disease whatever the timing with respect to surgery. Right ventricular failure occurring for the first time after surgery is rare (4.7% of cases), of uncertain cause, and carries a particularly poor prognosis.

Actuarial Analysis↗
PubMed1992

[Diverticulum of the right atrium. A case report and review of the literature].

Congenital atrial diverticula are rare, especially those involving the right atrium. This condition was observed in a 52 year old man who presented with palpitations. The diagnosis was made by two-dimensional echocardiography and confirmed by CT scan, magnetic resonance imaging and angiography. In the absence of significant invalidity, no treatment was recommended. Only three other cases of this condition have been previously reported, all of which were referred for surgery for thrombotic complications, arrhythmias and cardiac failure. Anatomo-pathological analysis showed different appearances: fibrous tissue and lipomatous degeneration. In the absence of associated heart disease, these aneurysms are probably congenital.

Angiocardiography↗
PubMed1991

[Alcohol and salt consumption. Two closely related variables].

In a transverse epidemiological study, 3,329 male firm-employees were questioned on their daily alcohol consumption and on their use of salt during meals, which divided them into four categories: those who virtually never added salt to their food; those who salted their food according to its taste; those who salted systematically, and those who added salt to a salt-free family cooking necessitated by the health of another member of that family. This questioning showed that as the alcohol consumption increased the proportion of subjects who salted their food without tasting or because of salt-free familial meals was greater (P = 0.0018) and, conversely, the proportion of subjects who virtually never added salt to their food decreased (P = 0.0001). There is, therefore, a highly significant correlation between the alcohol consumption level and the type of salt consumption. Whether there is a relationship between the amount of salt consumed and the level of alcohol consumption remains, for the time being, an open question.

Adult↗
PubMed1991

Effect of low intake of n-3 fatty acids during development on brain phospholipid fatty acid composition and exploratory behavior in rats.

The effect of dietary restriction of n-3 fatty acids during development on brain phospholipid fatty acid composition and exploratory behavior has been studied in male Sprague Dawley rats. Female rats were fed semipurified diets containing either 5.5% safflower oil or 6% soybean oil for 6 wk prior to mating and throughout gestation and lactation. Control rats were maintained on laboratory chow. The male pups were weaned to the diets of the dams except for one group which was switched from safflower to soybean oil at weaning. Behavioral studies and brain phospholipid analyses were conducted at 16-18 wk of age. Rats fed safflower oil showed significantly lower levels of 22:6n-3 in phospholipids of synaptic membranes and myelin than rats fed soybean oil or chow. The decrease in 22:6n-3 was compensated for by an increase in 22:5n-6, the total content of polyunsaturated fatty acids remaining approximately constant. The brain phospholipid fatty acid composition of rats switched from safflower to soybean oil at weaning was similar to that of rats fed soybean oil throughout the experiment. There was no difference in spontaneous locomotor activity among the different dietary groups. However, rats raised on safflower oil displayed a significantly lower exploratory activity (horizontal movements and rearings) in a novel environment than rats fed soybean oil or chow. In contrast to the brain phospholipid fatty acid composition, there was no recovery of exploratory behavior in rats raised on safflower oil and switched to soybean oil at weaning suggesting a specific requirement of n-3 fatty acids during development.

Animals↗
PubMed1991

Natural history of severe mitral regurgitation.

The aim of this retrospective study was to review the outcome of 216 patients (pts), investigated for severe mitral regurgitation (MR) between January 1980 and December 1987. Definition of 'severe' was mainly clinical: MR sufficiently advanced for the cardiologist to investigate whether surgery should be imminent. One hundred and sixty two pts (group 1) were operated on; 54 (group 2) did not undergo surgery. Baseline characteristics were similar in the two groups, except for aetiology (less dystrophic and more ischaemic MR in group 2), functional class (88.3% class III or IV in group 1 vs 48.1% in group 2; P = 0.001), pulmonary pressures (lower in group 2) and left ventricular ejection fraction (group 1: 0.66 +/- 0.13; group 2: 0.56 +/- 0.17; P = 0.001). Mean follow-up after hospital admission or surgery was comparable in the two groups (group 1: 3.9 +/- 2.5 years; group 2: 3.5 +/- 2.7 years). Three pts (group 2) were lost to follow-up. Sixty-three pts died; 35 of the 162 operated on; 28 of the 54 non-operated on. Actuarial survival rate at 8 years was 74.0 +/- 4.3% in group 1 vs 33.2 +/- 9.2% in group 2 (P = 0.001). These results confirm that the prognosis of severe MR is poor if it is not operated on, whereas the postoperative course of severe MR, when operated on in time, is good.

Aged↗