Biomedical subjects

J Allal

Publications and source records attributed to J Allal.

82 records · Page 5Linked to original sources

PubMed1984

Rheumatological manifestations of infective endocarditis.

A retrospective study showed musculoskeletal manifestations in 32 of 108 patients treated for infective endocarditis in several departments at the Poitiers CHU. Such manifestations included articular pain or aseptic arthritis, typically involving the major joints, as well as vertebral osteomyelitis, low back pain (inflammatory or non-inflammatory), and myalgia. Patients showing such signs were generally younger than those without musculoskeletal involvement, diagnosis was made later, and prognosis was worse; streptococcus D was more often involved, and microscopic haematuria was more common. With the exception of vertebral osteomyelitis, the pathogenesis was not clear.

Antigen-Antibody Complex↗

PubMed1984

[Treatment of atrial fibrillation with fenoxedil hydrochloride. Apropos of 112 cases].

One hundred and twelve patients with atrial fibrillation of different causes were treated with fenoxedil chlorhydrate. Sinus rhythm was restored in 81 cases (72.3 p. 100). The best results were obtained in the following conditions: hypertensive heart disease (77.6 p. 100), ischemic heart disease (75 p. 100), idiopathic atrial fibrillation (76.4 p. 100), senile lone fibrillation (78.2 p. 100). The results were average in valvular heart disease (57.1 p. 100) and in hyperthyroidism (40%). Age did not appear to be a deciding factor, the overall results being comparable in patients under 70 years of age (70.8 p. 100) and over 70 years of age (73.4 p. 100). Although recent atrial fibrillation was reduced more easily (83.3 p. 100), the results were satisfactory in chronic arrhythmias (over 3 years) (77.7 p. 100). The success rate was 76.3 p. 100 when the cardiothoracic index was over 0.60, and 66.6 p. 100 when less than 0.60. The antiarrhythmic effect of fenoxedil chlorhydrate is related to its electrophysiological properties as it depresses sinus node activity and atrioventricular conduction. No arrhythmic or conduction complications were observed during a short period (maximum 5 days) of close monitoring. However, lengthening of the QT and PR intervals was a common phenomenon. The advantages of fenoxedil chlorhydrate over electrical cardioversion (atraumatic, possibility of associating digitalis) and the results obtained whilst respecting the prescribing advice, justify its adoption as a method of converting atrial fibrillation.

Adult↗

PubMed1984

[Determination of the optimal dose of captopril in the treatment of severe cardiac failure by hourly hemodynamic monitoring].

The optimal dose of Captopril was evaluated by hourly haemodynamic monitoring in 10 patients with chronic congestive cardiac failure (Stage IV of the NYHA Classification) after administration of 25 mg, 50 mg, and 100 mg of Captopril. A similar improvement was observed in all the parameters considered with all three dosages. At its peak effect (90 minutes) 25 mg of Captopril caused a fall in pulmonary capillary, and mean pulmonary artery pressures, and a fall in systemic resistance of 40%, 20% and 30% respectively; with 50 mg of Captopril, the effect was a fall of 36%, 24% and 35% respectively. The cardiac index rose by 17% with 25 mg of Captopril, 28% with 50 mg and 12% with 100 mg of Captopril. Although the fall in pulmonary capillary pressure remained significant up to the 6th hour, the improvement in cardiac index was not significant after the 3rd hour. After 8 days' treatment, plasma renin activity increased from 7.01 +/- 4.68 to 23.6 +/- 18.3 ng/ml/hour (p less than 0.02) and serum aldosterone fell from 1.175 +/- 386 p. moles/l to 497 +/- 277 p. moles/l (p less than 0.001). There was no correlation between basal plasma renin activity and pre- or post-therapeutic systemic resistances. The clinical and haemodynamic improvement was sustained after 2 months' treatment in 5 of these patients without side effects. Increasing the dosage of Captopril does not reinforce or prolong its action; moderate doses (25 mg) are as effective as high doses (100 mg). Captopril, which acts by inhibiting the renin- angiotensin-aldosterone system is the current treatment of choice in severe refractory cardiac failure.

Aged↗

PubMed1984

[Acute hemodynamic and coronary effects of captopril in chronic cardiac failure].

The acute effects of captopril on haemodynamics, coronary flow and myocardial metabolism were studied in 12 patients with chronic severe cardiac failure (primary cardiomyopathy: 10 cases; ischaemic: 2 cases) in functional Classes III or IV of the NYHA. All patients were male and their average age was 51.3 +/- 14.1 years (range 27 to 68 years). Measurements were carried out under basal conditions and 90 minutes after a single dose of 50 mg (5 cases) or 100 mg (7 cases) of captopril. Captopril administration leads to an increase in cardiac index from 2.05 +/- 0.32 to 2.34 +/- 0.35 l/min/m2 (p less than 0.05) and a greater increase in systolic index from 23.9 +/- 6.7 to 29.8 +/- 6.9 ml/syst/m2 (p less than 0.01), because the heart rate decreased slightly (p less than 0.05). These changes were the result of a decrease in afterload: mean aortic pressure fell from 85 +/- 11.8 to 68 +/- 19.6 mmHg (p less than 0.01) and systemic arterial resistance fell from 2 886 +/- 745 to 2 010 +/- 610 dynes/cm-5/sec/m-2 (p less than 0.01). Captopril also led to a fall in venous tone, i.e. pre-load: left ventricular end diastolic pressure fell from 26.9 +/- 6.1 to 20.8 +/- 6.6 mmHg: p less than 0.01. There was no change in contractility as shown by the absence of variation of the V.max (0.92 +/- 0.18 under basal conditions, and 0.90 +/- 0.15 after 90 minutes).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1984

[2 new cases of myocardial infarction after injection of vincristine].

The authors report two cases of myocardial infarction following the injection of vincristine. The vincristine is held responsible for several reasons: absence of past history or risk factors of coronary artery disease, no past history of mediastinal radiotherapy, the development of coronary manifestations several hours after the injection of vincristine. Both cases followed a fatal course. The pathophysiology of this iatrogenic complications is unclear. Any patient receiving such treatment should be carefully monitored clinically and electrocardiographically.

Aged↗

PubMedDate not supplied

[Value of echocardiography in the diagnosis of a complicated form of Kawasaki's disease].

Kawasaki disease affects children under 4 years of age and is characterized by fever, mucocutaneous rash and cervical lymph node enlargement. It is often complicated by coronary vasculitis and/or pericarditis, myocarditis and endocarditis. Echocardiography is indispensable to diagnose and follow up these complications. A study of the literature and of 4 personal patients showed that it is also useful for the early detection of coronary aneurysm and simple dilatation of the coronary arteries. The sensitivity and specificity of echocardiography in recognizing these complications are such that coronary angiography is exceptionally required. In the search for a cause of prolonged fever in children, the sensitivity of echocardiography makes it possible to diagnose an atypical form of Kawasaki disease.

Child, Preschool↗

PubMedDate not supplied

[Atypical echocardiographic aspects of cardiac amylosis].

Echographic abnormalities of cardiac amylosis are now well known and quite useful to the diagnosis. Forms that are morphologically atypical are rare. From three observations (2 hypertrophic, asymmetrical and obstructive forms, and 1 hypertrophic and dilated form) and a review from the literature, we study the nosological, diagnostic and therapeutic problems presented by these atypical echographic of cardiac amylosis.

Aged↗

PubMedDate not supplied

[Brief losses of consciousness of unknown origin. The contribution of echocardiography and of Holter monitoring].

67 patients presented with a syncope of unknown origin following the usual exploration and were the subject of a more elaborated study: echocardiography (echo 2D) and Holter. 3.5 per cent of the Holter recordings enabled to ascribe to the heart the cause of the syncope. More than half of the Holters disclosed abnormalities of the cardiac rhythm leading to an anti-arrhythmic therapy in some cases, even when the cardiac origin of the loss of consciousness (LC) could not be confirmed. Echocardiograms could not lead to the diagnosis and less than one fourth of them disclosed abnormalities. In a developing study (14.8 +/- 8.7 months) that was carried out, 3 out of 4 patients did not present with any more LC; 3 died (6%) and 9 (18%) had LC again. On the other hand, in 5 patients (10%) a diagnosis could be evoked at the end of this follow-up. This study confirms the difficulties of diagnosis of this group of syncope of unknown etiology, as evidenced by the low results of intense and costly explorations and the little information obtained, even after a follow-up of more than 1 year.

Adult↗

PubMedDate not supplied

[Thrombopenia induced by heparin].

The authors report three cases of heparin-induced thrombocytopenia. Two cases were associated with deep venous thrombosis and pulmonary embolism and the other case was associated with arterial embolism. The clinical course was serious, with one death and one amputation of a limb. The thrombocytopenia developed suddenly, 10 to 15 days after the start of treatment; the platelet count was always below 100 000/mm3. The platelet aggregation test is an important diagnostic element, together with the rapid return to normal of the platelet count once the heparin is stopped. An anti-platelet antibody was detected in two patients, suggesting an immuno-allergic mechanism for this new complication of heparin treatment. The treatment consist of immediately stopping the heparin and replacing it with an anti-vitamin K drug or low-molecular weight heparin. The platelet count should be monitored systematically in all patients receiving heparin treatment for more than 8 days.

Female↗

PubMedDate not supplied

[Candida albicans myocarditis or endocarditis? Echocardiographic aspects].

The authors report the case of a patient presenting with atypical features of Candida albicans cardiac infection, with unusual infectious destructive lesions. While the initial hypothesis was that of aortic endocarditis, the clinical course and operative findings showed echocardiographic features of septal micro-abscesses adjacent to the aortic orifice, which was devoid of any infectious lesions.

Adult↗