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Biomedical subjects

J C Quiret

Publications and source records attributed to J C Quiret.

At least 37 records · Page 2Linked to original sources
PubMed1990

[EPIM. Survey of myocardial infarction in Picardie].

The aim of this prospective study carried out in picardy (Aisne, Oise and Somme Departments) between October 1st 1985 and September 30th 1986, was to determine the incidence and outcome of recent myocardial infarction (less than 1 month) hospitalised in the region, to assess the time delay before hospital admission, the mode of management, treatment in the acute phase and at discharge, and the attitudes to exercise stress testing and coronary angiography. All public and private hospitals of the 3 departments who admitted patients with acute myocardial infarction accepted to fill out the questionnaire. A total of 1260 infarcts in patients with an average age of 66.7 +/- 12.6 years were collected. Nearly 3 out of 4 patients were male, and the men generally 10 years younger (64 +/- 12.6 years) than the women (73.4 +/- 10 years). The time delay to hospital admission was very long: 16.6 +/- 47.5 hours. Two thirds of patients were transferred by non medicalised transport; 82 per cent of patients were directed to the casualty department which redirected 71 per cent to the cardiology department. Myocardial infarction was inaugural in 46.5 per cent of cases. The incidence of anterior and inferior infarction was almost identical (44 ans 45.5 per cent respectively). Treatment in the acute phase included Heparin (94 per cent), nitrate derivatives (93.7 per cent) and calcium inhibitors (78 per cent). Thrombolytic and betablocker therapy was only prescribed in 8.3 and 23.5 per cent of cases respectively. During the hospital period, average 17 +/- 9 days, the mortality rate was 22.3 per cent.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

[Demonstration by Doppler echocardiography of multiple valvular involvement in carcinoid cardiopathy].

We report a case of carcinoid heart disease which was remarkable on three scores: --the value of echocardiography which enabled us to diagnose the disease; --the usefulness of cardiac doppler examination which provided non-invasive haemodynamic evaluation of lesions of the four valves; --the presence of moderate involvement of the right heart, which is classical from the point of view of anatomopathology but is often missed clinically and was ascertained in that case by doppler-echocardiography.

Carcinoid Heart Disease↗
PubMed1989

[Infarction with angiographically normal coronary vessels. (20 cases)].

Over 8 years, 20 cases of infarction with normal coronary angiography have been reported, representing 0.9% of the patients who underwent a coronary angiography after a myocardial infarction. The main characteristics of these patients are compared with those taken from the literature. The occurrence of this disease mainly depends on the age: especially higher when the patients are younger, ranging between 1 and 4% in major series, but it may reach 25% in case of infarction occurring before the age of 30. Therefore, this entity mainly affects young patients (mean age in the literature: 34.3 years), with a large proportion of women (27%). The main risk factor is smoking, found in 3 out of 4 men an more than half of the women; on the contrary, hypercholesterolemia and arterial hypertension are only seldom found. In women, administration of estro-progestative medications in mentioned in almost every other case. Coronary heredity is mentioned in one out of 3 cases. In 68% of the cases, the infarction is the original manifestation and frequently occurs during stress: 60 p. cent of the cases. The site of the necrosis is insignificant. Mortality is low: 2 p. cent but in 5 p. cent of the cases, the course may be complicated by recurrence or heart failure. According to recent findings on coronary angiography during the acute phase, the pathogenesis could involve an arterial coronary thrombosis, perhaps developing on minimal coronary lesions, caused by a spasm and/or a platelets hyperaggregation; then this coronary thrombosis is revascularized.

Age Factors↗
PubMed1989

[Auricular flutter preceding by several years the discovery of Steinert's disease. 3 cases].

The large frequency of arrhythmias and conduction disorders in the course of Steinert's myotonic dystrophy is well known; most of the time, the muscle disease is already known when the heart disease is discovered. The authors report three cases of young subjects (2, 31 and 35 years) in whom an atrial flutter without obvious etiology preceded by several years (14, 2.5 and 2 years) the diagnosis of muscular disease. On this occasion, the characteristics of the heart involvement in Steinert's disease are reminded: large frequency of atrial and also ventricular rhythm disorders, distalic conduction disorders. Our cases emphasize the importance of diagnosing Steinert's disease by clinical examination, electromyography and neuro-muscular biopsy in front of a rhythm disorder--especially atrial flutter--or an interventricular conduction disorders occurring, without obvious etiology, in a young subject.

Adult↗
PubMed1988

[Asymptomatic and transitory electrocardiographic changes in the 24 hours following coronary transluminal angioplasty].

Fifty patients underwent a 24-hour Holter system recording immediately after successful coronary angioplasty. Only those patients who had been "successfully" dilated and who, during the following 2 days, had remained totally symptomless and without changes in standard ECG were selected. Arrhythmias occurred in 18 patients: 12 had supraventricular arrhythmia, including 3 prolonged attacks of tachyarrhythmia due to atrial fibrillation; 6 had ventricular arrhythmia, with numerous extrasystoles in 5 cases and bursts of ventricular tachycardia in 1 case. Changes in ventricular repolarization were recorded as: (1) isolated T-wave modification (11 patients), and (2) ST-segment depression (11 patients) reaching or exceeding 2 mn in 5 cases and lasting from 4 to 33 minutes. These silent and transient electrical abnormalities were observed mostly during the 12 hours which followed transluminal angioplasty, and particularly after dilatation of the right coronary artery. The physiopathological mechanisms of these changes are uncertain, but their occurrence has no influence on mid-term results, i.e. the follow-up coronary arteriography at 6 months.

Adult↗
PubMed1988

[Echocardiographic aspects of pericardial metastases. Apropos of 7 cases].

Modern two-dimensional imaging is of such quality that echocardiography is now capable of detecting intrapericardial formations. Three morphological types of abnormal intrapericardial echoes have been described: round masses, mattresses and linear echoes. These have been observed in effusions of various origin and seem to be lacking in aetiological specificity. In order to determine more precisely the echocardiographic signs of pericardial metastases, the authors have analyzed 7 cases of intrapericardial masses visualized in a series of 10 patients with metastatic pericardial effusion and examined in two-dimensional mode. These were echogenic and dense masses implanted on the pericardium and subject to cyclic movements linked with those of that membrane. Morphologically, they fell into two categories: round and sessile masses (6 cases) 8 to 23 mm high and 22 to 48 mm wide at their implantation; they were found mostly opposite the cardiac apex (4 cases) and/or in the lateral wall of the right ventricle (3 cases), oval formations (2 cases) which were 70 mm long and 17 mm wide in one case and 50 mm long and 15 mm wide in the other. One patient had two masses of different shapes. A review of the literature showed that these two echocardiographic images corresponded to two macroscopic types of pericardial invasion: either tumoral nodules or infiltration plaques betraying a diffuse invasion of the pericardium. All masses observed by the authors were located on the visceral leaflet of the pericardium. This predominantly epicardial location might be due to the visceral leaflet being selectively invaded by retrograde lymphatic embolization from the mediastinal lymph nodes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

[Asymptomatic recurrence of a left auricular myxoma. Apropos of a case].

A case of asymptomatic recurrence, in a 23-year old female patient, of a left atrial myxoma surgically removed 7 years previously is reported. The initial tumour, revealed by lipothymias and progressive heart failure, had been diagnosed by TM-mode echocardiography. The myxoma had been entirely removed, together with part of the atrial septum around its pedicle. The recurrent tumour was discovered by chance during routine control echocardiography. Post-surgical recurrent cardiac myxomas are uncommon (5% of the cases), and they predominate in the left atrium, like the initial tumours. They develop more rapidly and may recur several times in succession, becoming increasingly aggressive and multiple, though most of them remain benign. They are thought to result from the proliferation of myxomatous cells in clusters disseminated within the cardiac walls. Echocardiography is the key to the diagnosis; it is also used for post-surgical follow-up.

Adolescent↗
PubMed1987

[Metastatic pericardial effusions. Apropos of 12 cases. Review of the literature].

The authors report 12 cases of metastatic pericardial effusions with clinical manifestations. Primary bronchial cancer is the most frequent with 7 cases; in 3 of these patients, the original manifestation is a tamponade. The contributions of sonocardiography to the diagnosis are analyzed: evaluation of hemodynamic tolerance and visualization within the effusion, in 4 out of 7 patients undergoing bidimensional sonocardiography, of dense masses, implanted on the visceral layer of the pericardium; the frequent epicardic location of these metastases may be explained by preferential invasion of the visceral layer by retrograde lymphatic route. The advantage of pericardial cytology is discussed. From the therapeutic standpoint, a pleuro-pericardial window or tetracycline instillation tend to prevent a recurrence of the effusion and the risk of tamponade; the neoplastic process is controlled with local and/or general chemotherapy and radiotherapy; therapeutic strategy depends on the sensitivity of the primary tumor. The prognosis remains very dim with a mean survival of 3.7 months in our series.

Adult↗
PubMed1987

[Streptobacillus moniliformis endocarditis. Apropos of 2 cases].

The authors report two cases of endocarditis secondary to Streptobacillus moniliformis. A 41 year-old man, bitten by a rat, is hospitalized 5 weeks later for an endocarditis demonstrated by echocardiography, with massive aortic escape and hemodynamic failure requiring emergency valve replacement: after a favorable course, the patient dies suddenly 4 months later. A 63 year-old woman is admitted for a septicemic syndrome with sterno-clavicular arthritis which occurred 10 days after a rat bite; followed by a transient ischemic cerebral vascular accident; echocardiogram shows a clubshaped bulge of the distal end of the large mitral valve; the course is uneventful under antibiotherapy. In both cases, blood cultures isolate a Streptobacillus moniliformis. Infections secondary to Streptobacillus moniliformis are rare; this Gram negative bacillus, saprophyte of the rat's rhinopharynx, is transmitted to man, most of the time, by bite, and this causes a septicemia, the evolution of which is usually favorable. Complications, especially endocarditis, are exceptionally rare: only 12 cases are found in the world's literature. The evolution is always fatal in the absence of treatment which must include the association penicillin-aminoside. Prophylaxis of this disease is provided by penicillin antibiotherapy which should be systematic after a rodent's bite.

Adult↗
PubMed1987

[Significance of an upward shift of the ST segment during an exercise test].

The objective of this study is to investigate the significance of the occurrence of an upward shift of the ST segment curing a stress test in patients with no previous history of myocardial infarction. Over 10 years, totalling 9,500 stress tests, we have collected 10 cases. They always concern men including one with angina on exertion, one with spontaneous angina, one with spontaneous angina occurring at the end of an intense stress, and 7 with mixed angina. None of them had a previous history of myocardial infarction or documented spastic angina. The upward shift of the ST segment occurred 9 times during stress and once during recovery. 9 patients had a coronary arteriogram with in 8 cases severe fixed coronary lesions. The patient with the upward shift of ST during the recovery period had a normal coronary arteriogram with a positive methylergometrin test. There is a good correlation between the appearance of an upward shift of ST during stress in the anterior derivations and a significant involvement of the anterior interventricular artery. In our series, there were no complications, especially myocardial infarction, in the immediate period following the stress test. 7 patients underwent an aorto-coronary by-pass. The 10 patients are presently asymptomatic after a 47 months follow-up. The occurrence of an upward shift of ST during stress, in the absence of a previous history of myocardial infarction, represents in more than 80 p. cent of the cases the existence of severe coronary lesions leading to hospitalization and the immediate performance of a coronary arteriogram.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

[Long-term prevention of the recurrence of auricular fibrillation using cibenzoline. Multicenter study apropos of 89 case reports].

The aim of this study was to evaluate the long-term efficacy of cibenzoline in preventing recurrence of atrial fibrillation compared to a reference drug: quinidine arabo-galactane sulfate (QAGS). The two products were administered orally in a double blind multicentre trial to two different groups of patients (96 patients in all) in whom atrial fibrillation had been previously converted to sinus rhythm after having been present for at least 15 days and less than 18 months. The patients were either given four 65 mg gelules of cibenzoline (group I) or four 206 mg gelules of Longacor (group II) and were reviewed systematically after 3 days of treatment, in order to retain only those who had not relapsed during the first 72 hours (89 patients: 42 in group I; 47 in group II). As Holter monitoring was not available in all centres, follow-up was assessed by conventional ECG during clinical examination after 2 weeks, 6 weeks, 3 months and 6 months. The results seem to indicate that cibenzoline was more effective at the 6th month (20% recurrence rate in group I compared to 43.2% in group II). This difference was significant especially at the end of the 2nd week of treatment (p less than 0.04); the number of recurrences did not differ significantly between the two groups thereafter. In general the clinical tolerance was good. Biochemical tests showed a greater increase in serum transaminases (SGOT) in the cibenzoline than in the QAGS group but this difference did not attain statistical significance. We conclude that at 6 months cibenzoline is more effective than QAGS in preventing recurrent atrial fibrillation.

Adult↗
PubMed1985

[Torsades de pointe. Apropos of 60 cases].

The authors report a personal series of 60 cases of "torsade de pointe" (the largest series published to date) seen in the Cardiology department of Amiens Hospital over a period of 11 years. They review the essential features of this arrhythmia, which was well described by F. Dessertenne in 1966, but which is still sometimes confused with certain forms of ventricular tachycardia. "Torsade de pointe" is still a topical issue, as 25% of the cases in this series were seen over the last two years. These cases were classified into three groups according to their aetiology: severe bradycardia (21 cases), potassium depletion (16 cases), drug causes (23 cases). This arrhythmia was essentially associated with iatrogenic factors, in particular potassium depletion (41.6% of cases). The classical notion of predisposed patients was confirmed: elderly patients (mean age of 68 years), with cardiovascular disease in 70% of cases (i.e. heart failure or coronary insufficiency, hypertension) and with a marked female predominance (70% women). The ECG between episodes of "torsade de pointe" always revealed a prolonged QT interval which, in relation to the heart rate, was more marked in the patients with potassium depletion. During an attack, the average ventricular rate was 210/min (range: 170 to 290/min). 20% of cases subsequently developed ventricular fibrillation. The overall mortality was 16.6% (10 out of 60 cases), but there have been no deaths since 1977 due to the better understanding of this arrhythmia.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1984

[Diagnostic and prognostic value of ST segment depression greater than or equal to 3 mm during exercise testing].

This study was undertaken to assess the diagnostic and prognostic value of ST depression equal to or more than 3 mm during exercise stress testing (EST). Out of 4050 EST performed over an 8 year period, 128 patients (3,2%) had this degree of ST depression. These changes were observed in leads V4 V6 in 92% of cases. Coronary angiography was performed in 56 patients: all had significant coronary artery disease (greater than 50% stenoses) with 50% three vessel, 30% two vessel and only 20% single vessel disease; all patients had at least one severe stenosis (greater than 75%) of a main coronary artery. The predictive value of EST was therefore 100% in the 56 patients undergoing coronary angiography. Angina or ventricular extrasystoles during EST or greater than 5 mm ST depression were predictive of multiple vessel disease. The following correlations were observed between EST and the extent of coronary artery disease: maximal heart rate and systolic pressure were lower, ischemic changes appeared sooner (less than 2 min) and lasted longer during the recovery phase (greater than 7 min) in patients with multiple vessel disease. The 5 year prognosis was studied in 58 patients; it was poor (death or infarction) in 31 cases (53%). The following factors were associated with a poor prognosis: low maximal heart rate and systolic blood pressure, early ischemic changes and frequent ventricular extrasystoles on EST; on the other hand, the development of anginal pain during EST was not of significant prognostic value in this series. ST depression greater than 3 mm on EST is rare.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Aortoseptal approach for optimal resection of diffuse subvalvular aortic stenosis.

The results of conventional operative resection of diffuse subaortic stenosis (tunnel subaortic stenosis and diffuse idiopathic hypertrophic subaortic stenosis) have been less than satisfactory. A new approach using the concept of aortoventriculoplasty was designed to allow adequate surgical resection of a diffuse subvalvular aortic stenosis. The aorta, the right ventricle, and the septum are incised in the same way as during aortoventriculoplasty , with the aortic anulus being divided carefully across the commissure between the left and right aortic cusps. The septotomy is extended beyond the limits of the stenosis, and fibrous and/or muscular tissue is removed from each edge of the septal incision. After adequate widening of the subvalvular area, the various incisions are closed and the aortic valve is reconstructed. This aortoseptal approach was studied experimentally in the dog and then carried out on two patients, both of whom had excellent hemodynamic and functional results. The aortoseptal approach may be the procedure of choice in the treatment of diffuse stenoses limited to the subvalvular area, whereas other procedures ( aortoventriculoplasty , and apico-aortic valved conduit) should be used when the valvular and/or supravalvular levels are involved.

Adolescent↗
PubMed1983

[Propranolol-nifedipine combination in the treatment of exercise-induced asthma].

The therapeutic effects of the association of propranolol (P) and nifedipine (N) were compared with those of propranolol alone in the treatment of effort angina. Ten patients under 65 years of age with stable effort angina confirmed by stress testing and coronary arteriography were studied. The criterion of selection was inadequate improvement of symptoms with the betablocker alone, prescribed in first intention. The patients were divided into two groups (A and B) at random: --Phase I (2 weeks) : group A : P 80 mg/day + N 30 mg/day, group B : P 80 mg/day + Placebo 3 tablets/day; --Phase II (2 weeks) : group A : P 80 mg/day + Placebo 3 tablets/day, group B : P 80/day. The results of this cross-over trial were assessed blind. The association N + P compared to P alone led to a clinical improvement in 7 out of 10 patients, a clear cut increase in maximal exercise capacity (44%), a reduction in ST depression of 0.8 mm and to the disappearance of effort angina in half the patients. The haemodynamic tolerance of this drug association was good. These statistically significant differences between the P + N and P + placebo treatment periods demonstrate that this drug association is beneficial in patients with effort angina who are inadequately relieved by betablocker therapy alone.

Asthma↗