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Biomedical subjects

J F Godin

Publications and source records attributed to J F Godin.

At least 19 recordsLinked to original sources
PubMed1992

[Arrhythmogenic effects of sultopride chlorhydrate: clinical and cellular electrophysiological correlation].

This study was designed following the first documented case of torsades de pointes induced by sultopride hydrochloride, a substituted benzamide neuroleptic drug. The patient, a 48 year-old woman with no known cardiovascular disease, had been treated for several years with this drug. She was admitted for severe bronchospasm requiring artificial ventilation. Twenty-one hours after her admission, she developed several episodes of torsades de pointes, which were successfully treated with magnesium sulphate. At that time, the QT interval was 500 ms for a heart rate of 108 b.min-1 (QTc of 668 ms, and theoretical QTc 370 ms). On the fourth day, QTc was 548 ms and theoretical QTc 370 ms. The sultopride was stopped on the fifth day. Two days later, QTc was 397 ms. Six months later, there was no recurrence. Several cases of TdP or sudden death have been reported in patients receiving neuroleptic drugs. The effects of sultopride hydrochloride were therefore tested on isolated ferret Purkinje fibres, using the microelectrode technique. Three concentrations of the drug (D1, D2, D3) were tested, as well as normal Tyrode solution. Maximum diastolic potentials (Vmax) were -88.37 +/- 0.89 mV (control), -89.08 +/- 1.20 mV (D1), -90.00 +/- 1.06 mV (D2), and -90.14 +/- 1.20 mV (D3). Vmax was not affected by sultopride during pacing at 1,000 ms of cycle length. The duration of the action potential increased with the drug concentration. There was no early after-depolarisation (EAD) during control, and 7 out of 9 fibers had EAD and 3 out of 9 triggered activity in D3. The solvent (benzyl alcohol) did not modify the action potential.(ABSTRACT TRUNCATED AT 250 WORDS)

Action Potentials↗
PubMed1989

[Wolff-Parkinson-White syndrome. Value of transesophageal atrial stimulation coupled with exercise test for the study of anterograde conduction in the accessory pathway].

In patients with Wolff-Parkinson-White syndrome the anterograde conduction properties of the accessory pathway determine the ventricular rate in case of atrial fibrillation (AF). Anterograde conduction in the accessory pathway was evaluated in 20 patients (mean age 31 years) by means of transoesophageal atrial pacing with increasing frequency (up to 460 per minute), first at rest, then during exercise on an ergometric bicycle and upon immediate recovery. The exploration was completed by a search for the disappearance of pre-excitation during exercise and after an intravenous injection of ajmaline 1 mg/kg. The shortest cycle (SC) of atrial pacing with 1:1 conduction by the accessory pathway regularly decreased by 80 +/- 26 ms (n = 18), i.e. 27 p. 100 of its value at rest. At immediate recovery SC increased by 40 +/- 53 ms (n = 9). Atrial fibrillation was induced at rest and/or during exercise in 12 patients. The shortest interval (SI) between two pre-excited ventricular complexes was 290 +/- 80 ms (n = 8) at rest and 244 +/- 53 ms (n = 8) during exercise. With a substantial group of values (n = 12) there was good correlation between SC and SI both at rest and during exercise. With a smaller group of values (n = 3) SI was clearly greater than SC, suggesting a concealed conduction in the accessory pathway during atrial fibrillation. Disappearance of pre-excitation during exercise was observed in 4 patients, 3 of whom had a short (less than 250 ms) SC and/or SI.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

[Cardiac transplantation at the University Hospital Center of Nantes. 2 years' experience].

Between March, 1985 and April, 1987, 25 orthotopic heart transplantations were performed in 20 men and 5 women aged from 17 to 58 years (mean 42 years) on account of cardiomyopathy (n = 15), ischaemic heart disease (n = 6) or miscellaneous lesions (n = 4). The immunosuppressive treatment consisted of antilymphocyte serum and corticosteroids during 10 days; cyclosporine was introduced on the 7th day and continued thereafter in association with low-dose corticosteroid therapy. Endomyocardial biopsies were performed. Acute rejection, responsible for 2 deaths (one on the 10th day, the other in the 10th week), usually occurred within the first 3 months. Infections were frequent and often serious, resulting in one death in the 7th week. One out of patients had to be treated for arterial hypertension, and 3 patients presented with renal impairment (blood creatinine over 200 mumoles/l). The actuarial survival rate at 2 years is 84 p. 100. More than one-half of the patients have resumed social and occupational activities.

Actuarial Analysis↗
PubMed1988

[Which pacemaker for which patient?].

Since the early 1980's, in parallel to development of "physiological" cardiac stimulation, modalities and objectives for cardiac stimulation have been modified radically. Among the many methods of stimulation available, in practice the physician may choose from four main types: (1) single-chamber ventricular stimulation; (2) single-chamber atrial stimulation; (3) two-chamber stimulation; (4) variable rate stimulation. Three main elements determine choice of the method of stimulation: the patient's physical condition, his heart condition (nature and type of cardiopathy and hemodynamic profile) and of course, electrophysiological data and cardiac rhythm encountered. The object of this paper is to schematically describe this choice.

Arrhythmias, Cardiac↗
PubMed1984

[Beneficial effects of coronary transluminal angioplasty on resting left ventricular systolic function].

Resting left ventricular systolic function was studied by cardiac catheterisation before and 6 months after effective transluminal coronary angioplasty (TCA) to evaluate the myocardial effects of this procedure. The global left ventricular systolic function was assessed by measuring ventricular volumes, the ejection fraction, the mean velocity of circumferential fibre shortening (m VCF) and mean normalised systolic ejection rate (MNSER). The regional function was studied by dividing the left ventricle into 8 regions using the Stanford radial model and measuring the percentage shortening and velocity of circumferential fibre shortening (VCF). These parameters were obtained from selective left ventriculography filmed at 100 frames/second in the RAD plane. Left ventricular function was analysed from the whole of systolic ejection and then sequentially during each third of systole (early-mid-and end systole). The 10 patients studied had an average age of 45 years. Coronary angiography was performed for unstable angina (6 cases), stable angina (3 cases) and post-infarction angina (1 case). Except for 1 patient with associated LAD and right coronary disease they all had single vessel disease. TCA was performed on the LAD artery in 8 cases, on a dominant left circumflex artery in 1 case and on a right coronary artery in 1 case. The efficacy was demonstrated by angiographic reduction of the degree of stenosis (85 to 25 p. 100 immediately after TCA, and 30 p. 100 at control angiography at 6 months), and by a reduction of more than 40 p. 100 in the average transstenotic pressure gradient.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

[Aortic sigmoid cusp anomaly: rare cause of myocardial infarction in children].

A three and a half year old child with no previous medical history died, 20 hours after extensive anterior myocardial infarction. Post-mortem examination showed an abnormal aortic valve: the cusps were thick, indurated and white in colour. The free edge of the left antero-lateral cusp was higher than that of the other two cusps and presented a discrete thickening which overlapped the superior border of the left coronary ostium, obstructing the orifice at its thickest part. The other two cusps were tipped by fibrous spurs, one of which partially obstructed the right coronary ostium which was slightly narrowed at its origin. A review of the literature on aortic pathology causing coronary obstruction revealed rare cases of malignant disease and, more commonly, malformations usually associated with supravalvular aortic stenosis. This case might illustrate a partial and atypical form of supravalvular aortic stenosis.

Aortic Valve↗
PubMed1984

[Cardiac stimulation in children. A multicenter study of 241 patients].

This study analyses the results of cardiac pacing in 241 children operated between 1965 and March 1982 in 9 french cardiac centres. The ages at primary implantation were: less than 5 years, 32.8 p. 100, 6 to 10 years, 33.6 p. 100 and 11 to 16.5 years, 33.6 p. 100. Atrioventricular block was congenital in 40.7 p. 100 of cases (98 children) and postoperative in 56.4 p. 100 (136 children) with 67 cases, after repair of isolated ventricular septal defect and 18 after repair of an endocardial cushion defect. The symptoms preceding pacing were syncope (67 cases), bradycardia (92 cases) and cardiac failure (33 cases). The electrocardiographic indications were third degree block in 66.8 p. 100 of cases. The pulse generators were usually implanted in the abdominal wall (71.8 p. 100). The power sources in service (August 1982) were lithium (74 p. 100) and isotopic batteries (26 p. 100). Myocardial electrodes were used in 93.4 p. 100 of cases; 82.2 p. 100 were made by Medtronic. Early problems included: infection (10 cases), displacement of endocavitary electrodes (3 cases), elevated thresholds (2 cases). The late problems encountered were due to fracture of the pacing electrodes (19 cases) and elevated thresholds (50 cases). Two hundred and seven children are alive and well. A total of 341 pulse generators were implanted, 90 p. 100 being VVI mode. In August 1982, 56.6 p. 100 were programmable or multiprogrammable. Despite the technical problems involved, the myocardial approach is still used with good results, especially in young children and babies. The endocavitary approach is an alternative after 5 years of age.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1983

[Strategy of the medical treatment of angina pectoris].

The first objective is to correct any existing coronary risk factors but this must be achieved with discrimination. Smoking should be strictly forbidden, hypertension reduced and a more active life style encouraged. However, a more nuanced approach should be adopted towards dietetic problems, obesity and disorders of lipid metabolism. It is also very important to teach the patient to use glyceryl trinitrate correctly in the double objective of relieving pain as quickly as possible and of preventing pain by using it in certain critical situations. Clinical practice shows that patients often use glyceryl trinitrate too sparingly. When these general measures have been settled, treatment must be adapted to each particular situation. The patient's age, the frequency of attacks, trigger factors, the repercussions of the disease on the patient's life all have to be considered before deciding on the individual's treatment. In younger patients, a controlled exercise ECG is essential for selecting patients for surgery. The drugs of choice for stable angina are the betablockers which have been shown to be effective and well tolerated. When this group of drugs cannot be used or is ineffective, other major anti-anginal drugs may be chosen according to the individual terrain and their known secondary effects.

Adrenergic beta-Antagonists↗
PubMed1983

[Aortic stenosis in adults: contribution of catheterization to the study of associated lesions. Apropos of 137 cases].

The results of cardiac catheterisation in 137 cases of pure adult aortic stenosis considered to be isolated after non-invasive investigation (clinical examination, carotid pulse tracing, echocardiogramme) are reported. The authors analyse the reliability and risks of this examination to which they attribute a triple objective; evaluation of the severity of the AS, evaluation of LV and/or mitral valve dysfunction and the assessment of the coronary circulation in patients with angina or in all patients over 54 years of age or with coronary calcifications. The aortic valve was crossed in 89,8 p. 100 of patients. Coronary angiography was attempted in 128 cases (93,4 p. 100) and was successful in 110 cases (85,9 p. 100). The investigation was complicated by one death (0,73 p. 100) and one femoral artery thrombosis, and was complete in only 74 p. 100 of cases. The results showed the aortic stenosis to be isolated in only 84 cases (61,3 p. 100). In the other 53 cases (38,7 p. 100) there was unrecognised associated pathology: mitral valve disease was diagnosed in 14 cases (12,3 p. 100); significant coronary artery disease (greater than 50 p. 100 narrowing) was observed in 34 of the 110 patients in whom coronary angiography was successful (30,9 p. 100). In the last 5 cases, catheterisation showed: two ASDs, one partial abnormal pulmonary venous drainage, one fusiform aneurysm of the aortic isthmus, one abnormal origin of the left anterior descending artery in the right coronary sinus with a pre-pulmonary trajectory. The authors discuss the value of the various methods of preoperative assessment of AS. The relative reliability of the different non-invasive techniques is compared.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗