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Biomedical subjects

J Carlier

Publications and source records attributed to J Carlier.

At least 37 records · Page 2Linked to original sources
PubMed1986

Incidence and significance of pericardial effusion in acute myocardial infarction as determined by two-dimensional echocardiography.

To determine the incidence and clinical significance of pericardial effusion after acute myocardial infarction, two-dimensional echocardiography was serially performed in 66 consecutive patients. Pericardial effusion was observed in 17 (26%); the effusion was small in 13 patients, moderate in 3 and large with signs of cardiac tamponade in 1. In this patient, two-dimensional echocardiography strongly suggested myocardial rupture. The observation of pericardial effusion was not associated with age, sex, previous myocardial infarction, atrial fibrillation or treatment with heparin. It was more often a complication of anterior than of inferior acute infarction. Patients with pericardial effusion had higher peak levels of creatine kinase and lactic dehydrogenase and a higher wall motion score index. More patients with pericardial effusion had congestive heart failure or ventricular arrhythmias, developed a ventricular aneurysm or died within 1 year after their infarction. In conclusion, pericardial effusion is frequently visualized by two-dimensional echocardiography after acute myocardial infarction and its presence is associated with an increased occurrence of complications and cardiac death.

Aged↗
PubMed1986

Incidence, clinical significance and prognosis of ventricular fibrillation in the early phase of myocardial infarction.

Of 1265 patients admitted to the CCU with the diagnosis of acute MI, 96 (7.6%) developed ventricular fibrillation within 72 hours following admission. Of these 96, 35 (36.5%) had secondary VF associated with left ventricular failure; they had a high in-hospital mortality of 57.1%. The remaining 61 (63.5%) had primary VF, i.e. VF occurring in the absence of significant LV failure. Fourteen of these (23%) died in hospital: 9 due to PVF (3 during the first episode, 6 during a recurrence). This mortality figure was significantly higher (P less than 0.001) than the mortality of 10% seen among patients who did not experience VF. Primary VF showed a recurrence rate of 20%. Compared with the 1061 patients who left the hospital without primary VF, the 61 subjects with this rhythm disorder were older, had larger infarcts and more frequent complications, such as pericarditis, conduction abnormalities, frequent ventricular premature contractions and signs of right ventricular failure. These findings, in contrast with a widely held view, suggest that primary VF may carry a guarded prognosis.

Adult↗
PubMed1986

[The role of plasma alpha 1-glycoprotein acid in the binding of aminopyrine].

Under certain pathological conditions the binding of various substances by serum proteins is altered. The plasma concentrations of alpha 1-acid glycoprotein, also known as orosomucoid are reported to be elevated in stressful situation and in certain disease states like acute myocardial infarction. The binding of aminopyrine to serum proteins and alpha 1-acid glycoprotein was determined using equilibrium dialysis. It appears that alpha 1-acid glycoprotein has specific binding sites for aminopyrine. Aminopyrine was also bound to other serum proteins. On addition the results indicate that an increase of alpha 1-acid glycoprotein to concentrations such as those seen in some pathological states does not really alter the percent of aminopyrine bind to serum proteins.

Aminopyrine↗
PubMed1986

Effects of age on the pharmacokinetics of mexiletine.

Mexiletine (1-methyl-2-(2, 6-xylyloxy)ethylamine hydrochloride) is an antiarrhythmic drug eliminated primarily by hepatic metabolism. The influence of age on the plasma pharmacokinetics of mexiletine was assessed in seven young and ten elderly healthy subjects. Mexiletine (50 mg) was administered orally three times daily for 10 days. The use of low doses of mexiletine was possible owing to the development of a new fluorescence high performance liquid chromatography method with a limit of sensitivity lower than 20 ng/ml. No differences in the pharmacokinetic parameters of mexiletine related to age were observed. At steady-state plasma concentrations were 0.121 +/- 0.033 microgram-ml in the young volunteers, and 0.135 +/- 0.150 microgram/ml in the older subjects. The elimination t 1/2 was 11.4 +/- 1.78 h in the young subjects and 10.48 +/- 3.06 h in the elderly. The data provide no justification for lowering the recommended dose of mexiletine for older patients.

Administration, Oral↗
PubMed1986

[The effect of sotalol on cirrhotic portal hypertension. Results of a preliminary study of cardiac and hepatic hemodynamics].

Using two balloon-tipped flotation catheters introduced through the jugular vein, systemic and hepatic hemodynamic measurements were made in nine cirrhotic patients before and 15, 30, 45 and 60 minutes after intravenous injection of 1.5 mg/kg of sotalol. At 30 minutes, the occluded sus-hepatic pressure fell from 23.6 +/- 6.4 mm Hg to 16.7 +/- 5.7 mm Hg (P less than 0.025); the sus-hepatic pressure gradient decreased from 16.2 +/- 3.8 mm Hg to 8.1 +/- 2.7 mm Hg (P less than 0.0005) whereas cardiac output failed to show any significant change (6.8 +/- 2.4 l/minute prior to drug versus 5.7 +/- 2.1 l/minute). These results suggest that sotalol, a non selective beta-adrenoceptor blocking drug with weaker negative inotropic effects than propranolol is effective in lowering portal pressure. The decrease of the sus-hepatic pressure gradient induced by the dose we used (50.2 +/- 20.0%) is statistically greater than that observed by Westaby et al. with intravenous propranolol (31.0 +/- 8.2%). The absence of hepatic metabolism of the drug which is excreted untransformed by the kidney should facilitate the selection of the optimal oral dose. The rather long half-life should also allow administration of one single daily dose which improves patients' compliance. The long term oral efficacy remains to be demonstrated in further studies, but in view of the advantages that sotalol possesses over propranolol, these studies are deemed justified.

Adult↗
PubMed1985

Hemodynamic effects of nifedipine on secondary pulmonary hypertension in man.

We evaluated the hemodynamic effects of the calcium antagonist nifedipine in 13 consecutive patients admitted to the intensive care unit with secondary pulmonary hypertension. Etiology of secondary pulmonary hypertension was: chronic obstructive pulmonary disease (n = 9), pulmonary emboli (n = 2), pulmonary fibrosis (n = 2). We obtained the resting hemodynamic parameters before, and 60, 120, 180 minutes after the sublingual administration of nifedipine 20 mg. All patients had normal pulmonary artery wedge pressure before nifedipine. After 60 minutes, systolic pulmonary artery pressure fell from 72.3 +/- 7 to 57.3 +/- 5.4 mm Hg (p less than 0.005) and mean pulmonary artery pressure from 44.6 +/- 4.0 to 33.6 +/- 3.2 mm Hg (p less than 0.001). Cardiac output rose from 6.36 +/- 0.56 to 7.65 +/- 0.64 l/min (p less than 0.005). The pulmonary vascular resistance fell from 431 +/- 58 to 238 +/- 36 dynes. sec. cm-5 (p less than 0.001). Heart rate, mean systemic arterial pressure, pulmonary artery wedge pressure, total systemic vascular resistance and arterial partial pressure of O2 (PaO2) remained unchanged. In this heterogenous population we were unable to reproduce the results of other authors, showing a correlation between PaO2 and fall of pulmonary vascular resistance. These findings confirm the pulmonary vasodilating effect of nifedipine in patients with secondary pulmonary hypertension.

Blood Pressure↗
PubMed1984

Old and new inotropic drugs.

An ideal cardiotonic agent should improve cardiac contractility and increase the oxygen supply to various tissues without inducing tachycardia, arrhythmias, decrease in coronary blood flow or increment in oxygen requirements of the myocardium. It should also be safe and orally active and have a persistent action. The aim of this paper is to describe various positive inotropic drugs at our disposal. The hemodynamic effects and the indications of adrenaline, noradrenaline, isoprenaline, dopamine, dobutamine and cardiac glycosides are presented first. Then several new promising orally active compounds are discussed.

Adrenergic beta-Agonists↗
PubMed1984

Atherosclerosis and cerebral ischemic attacks: intakes of cerebrography with xenon133 inhaled and platelet tests in the diagnosis, clinical and therapeutic monitoring; the preventive role of dipyridamole.

A study of patients to develop the significance of the role of the blood platelets in the recurrence of transient cerebral ischemic attacks in patients with cerebral atheromatous, develop the effectiveness of dipyridamole in the prophylactic therapeutic regimen. In the group treated with dipyridamole, a 76.3% clinical improvement was recorded (mean increases of 11.2 ml/min. and 11.4 ml/min. of the cerebral hemispheric flows), 15.8% of cases stabilized (mean increases of 1.7 ml/min. and 1.2 ml/min.) and 7.9% failures (mean decreases of 10.4 ml/min. and 14.3 ml/min.) of these same flows. The cerebrography with xenon133 inhaled as well as the platelet tests used, constitute unfailing means of diagnosing and monitoring the clinical development.

Adult↗
PubMed1984

Two-dimensional echocardiographic guiding of endomyocardial biopsy.

Two-dimensional echocardiography provides adequate spatial orientation and anatomic definition. Eighteen consecutive patients undergoing myocardial biopsy had concomitant two-dimensional echocardiography during 22 biopsies of five to six samples each. The transducer was placed at the apex and in the subcostal area and four-chamber views were used. The bioptome was seen entering the right atrium and crossing the tricuspid valve to the right ventricle. The catheter was then manipulated under two-dimensional echocardiography and the tip's position was strictly adapted, using two different classic views before sampling. The success rate in visualizing the forceps and in defining the site of sampling was 100 percent, and no complication was noted. Radiation exposure was largely reduced. Two-dimensional echocardiography to guide endomyocardial biopsy may reduce the risk of perforation by a better anatomic definition of the sampling site. It permits sampling from different ventricular sites or from the same site during serial procedures for monitoring evolution or treatment.

Adult↗
PubMed1984

Combined haemodynamic effects of low doses of dopamine and dobutamine in patients with acute infarction and cardiac failure.

The haemodynamic effects of an optimal dose of dobutamine (DUo) (6.7 +/- 4.2 micrograms kg-1 min-1) and the combination of this optimal dose minus 2.5 micrograms kg-1 min-1 of dobutamine (DU) plus dopamine 2.5 micrograms kg-1 min-1 (DA) were studied in a first group of 12 consecutive patients with acute myocardial infarction (AMI) and cardiac failure (CF). DUo decreased pulmonary wedge pressure from 23.5 to 16 mm Hg (P less than 0.01), systemic vascular resistance from 1 774 to 1 417 dynes s cm-5 (P less than 0.01). DUo increased cardiac output from 3.21 to 4.55 litres/min (P less than 0.01) and urinary flow (UF) from 20 to 68 ml/h (P less than 0.01). Heart rate and blood pressure did not change significantly. DUo - DU + DA significantly increased UF from 68 to 107 ml/h (P less than 0.05) while the other parameters remained unchanged with respect to DUo. The positive effect of DA on UF was confirmed in a second group of 12 consecutive patients by comparing the successive effects of DA + DUo and DUo + DU : all previously described parameters remained unchanged except UF which decreased from 107 to 65 (P less than 0.01). We conclude that in patients with CF and AMI, association of DA and DUo is useful in obtaining both inotropic and diuretic effects.

Acute Disease↗
PubMed1984

The new inotropic phosphodiesterase inhibitors.

Compounds with phosphodiesterase inhibitory activity stimulate myocardial contractility by increasing the intracellular cyclic AMP concentrations. They can also increase Ca2+ entry and inhibit Ca2+ sequestration by the sarcoplasmic reticulum. Xanthines produce bronchodilation with associated venous and arteriolar dilation. However, their use is limited by their positive chronotropic effect and other side effects at high plasma levels. New phosphodiesterase inhibitors have been perfected: they are more specific with little chronotropic effect. Increasing the sensitivity of the myofilaments to Ca2+, and other unclear mechanisms may be involved in the inotropic action of these drugs. These new promising active compounds are described and discussed. They augment cardiac performance and improve regional distribution of blood flow and symptoms. However, their influence on the long-term outcome of severe heart failure has yet to be determined.

Aminopyridines↗
PubMed1984

[Development of urea, creatinine and creatinine clearance as a function of age and sex].

Serum urea and creatinine concentrations were determined in 150 healthy subjects. The formula of Cockcroft and Gault was used in order to calculate creatinine clearance. Such estimation of creatinine clearance is widely used as a parameter for individualization of dosage of drugs secreted primary via the kidneys. The effects of age and sex were then assessed on serum urea, serum creatinine and on creatinine clearance.

Adult↗
PubMed1984

Acute clinical benefits of a new inotropic agent AR-L 115 BS after i.v. and oral administration.

AR-L 115 BS is a new active noncatecholamine, non glycoside phenyl-imidazo-pyridine derivative inotropic agent. It has a strong inotropic effect in experimental animals. Its effectiveness and associated adverse effects were tested in 23 patients with severe heart failure (NYHA class III to IV). Intravenous administration of AR-L 115 BS at 1.4 mg/min for 6 hours in 11 patients increased cardiac index from 2.07 +/- 0.13 to 2.99 +/- 0.203 l/min/m2 (p less than 0.005) while pulmonary wedge pressure decreased from 23 +/- 2 to 13 +/- 2 mm Hg (p less than 0.005). Systemic vascular resistance fell from 1759 +/- 137 to 1263 +/- 71 dynes.sec. cm-5 (p less than 0.005). Heart rate and blood pressure remained unchanged. Following oral administration (450 mg) in 12 other patients, cardiac performance was similarly improved. Hemodynamic changes were apparent as early as 60 min after administration, and the duration of action ranged from 5 to 7 hours. No serious arrhythmias or side effects occurred. It could therefore be useful in the management of congestive heart failure.

Administration, Oral↗
PubMed1983

Correlation between the demethylation rate of 14C-aminopyrine (breath-test) and haemodynamic parameters in congestive heart failure.

In 18 patients with congestive heart failure, the 14C-aminopyrine demethylation rate was studied by the breath-test, 24 hours after the measurement of haemodynamic parameters. In the 12 patients with a cardiac index higher than 2.2 l/m2/min, the half life of 14CO2 specific activity in breath was found to be significantly correlated (p less than 0.001, r = 0,82) with the telediastolic pressure of the right ventricle. On the other hand, in the 6 patients with a cardiac index below 2.2 l/m2/min the 14C-aminopyrine half life was higher than the value predicted by this correlation. Congestive heart failure probably reduces hepatic demethylation of aminopyrine through altered hepatic microsomal function associated with congestion and possibly hypoxia.

Aged↗