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Biomedical subjects

J Gay

Publications and source records attributed to J Gay.

At least 73 records · Page 4Linked to original sources
PubMed1985

Percutaneous brachial approach using the femoral artery sheath for left heart catheterization and selective coronary angiography.

A percutaneous method via the brachial artery for left heart catheterization and selective coronary angiography is described. The technique uses the sheath intended for the femoral artery, continuously infused and introduced following a particular technique. The procedure was performed with minimal complications over 18 months, with multipurpose "Schoonmaker" or preshaped catheters, in all the patients (37) in whom the femoral approach was contraindicated or failed. When a catheterization must be performed from the arm, this method, without cutdown and arteriotomy and allowing a good distal flow during the procedure, appears to have some advantages over the classical Sones technique or the percutaneous arterial axillary approach.

Aged↗
PubMed1985

Effect of propranolol on left ventricular relaxation in hypertrophic cardiomyopathy: an echographic study.

Many authors have shown that hypertrophic cardiomyopathy (HCM) is often associated with diastolic abnormalities. The purpose of this study was to determine the effect of propranolol on left ventricular isovolumic relaxation time (IVRT) measured by echocardiography in 20 patients with hypertrophic cardiomyopathy under basal conditions and under increasing doses of propranolol (160 mg, 320 mg, and 480 mg per day) and in two control groups, 10 patients with aortic stenosis, and 10 normal subjects. IVRT was less than 50 msec in all normal subjects, while it was always above this limit in aortic stenosis (77 msec +/- 8, p less than 0.001), and in hypertrophic cardiomyopathy (94 msec +/- 19, p less than 0.001), with also a significant difference between these two last groups (p less than 0.01). Under increasing doses of propranolol, relaxation time often shortens gradually until 50 msec or less. These results show an improvement in left ventricular relaxation dependent on the propranolol dosage and often a normalization at high dosages.

Adult↗
PubMed1985

"Mummies and babies" and friends and lovers in Lesotho.

This paper examines an institutionalized friendship among adolescent girls and young women in southern Africa. Lesotho's economy is based on migrant male labor which leaves the women dependent on male earnings or subsistence from the land, and also creates unstable marital relations. Young girls in the modern schools develop close relationships, called "mummy-baby," with slightly older girls. Sexual intimacy is an important aspect of these relationships. Mummy-baby relationships not only provide emotional support prior to marriage, but also a network of support for married and unmarried women in new towns or schools, either replacing or accompanying heterosexual bonds.

Adolescent↗
PubMed1985

[Not Available].

Explore the source record for details and available documents.

France↗
PubMed1985

[Aortic and mitral valve bioprostheses. Normal and pathological M mode echocardiographic aspects].

The M mode echocardiographic recordings of 52 normal mitral bioprostheses (NMB), 7 pathological mitral bioprostheses (PMB), 30 normal aortic bioprostheses (NAB) and 10 pathological aortic bioprostheses (PAB) were reviewed. In normal bioprostheses a significant correlation was observed between the echocardiographic and the "specified" diameters, the diastolic and systolic slopes and the amplitude of anterior motion of the support. In NMB, the end-systolic diameter of the left ventricular outflow tract depended on the "specified" diameter of the bioprosthesis. Paradoxical septal motion was observed in 78 p. 100 of cases. In PMB, the velocity of anterior leaflet opening was significantly increased (p less than 0.001). The end-diastolic internal left ventricular dimension was also increased (p less than 0.01). A significant correlation was found between left ventricular fractional shortening and maximal leaflet separation (p less than 0.05). Normal septal motion was more common (p less than 0.05). In 5 cases of prosthetic valve dysfunction with mitral regurgitation the maximal leaflet separation was greater than normal (p less than 0.001), the diastolic slope of the support was increased (p less than 0.05) and diastolic vibrations of thickened irregular leaflets were observed. Systolo-diastolic vibrations with chaotic leaflet motion were characteristic of cusp tear and/or eversion. Stratified echos behind a support with reduced leaflet excursion was observed in one case of partial thrombosis: a thickened systolic echo with reduced diastolic excursion was observed in a case of degenerative stenosis. The review of 10 PAB showed a reduced amplitude of systolic excursion of the anterior support in cases of aortic regurgitation (p less than 0.05). Systolic vibrations of the cusp were not specific and were observed in normal cases. In severe valvular regurgitation mitral and/or septal diastolic fluttering was observed. Systolic excursion of the cusps was reduced in cases of relative stenosis due to an inappropriately small sized bioprosthesis. Thickening of the diastolic cusp echos was observed in cases of degenerative stenosis. Ventricular dilatation and reduced septal and free wall motion were dysfunction.

Adolescent↗
PubMed1985

[Outcome of hypertrophic and obstructive myocardiopathies treated with high doses of propranolol].

Twenty-five patients with hypertrophic obstructive cardiomyopathy confirmed by clinical, echocardiographic and haemodynamic investigations were treated with high dose propranolol (320 to 800 mg/day, average 420 mg/day) and assessed after an average follow-up period of 25 months. The effects of treatment were assessed by interrogation in all patients and by exercise testing before and after propranolol in 19 cases. Comparative echocardiographic (21 patients) Holter (20 patients) and catheter studies (14 patients) were also performed. The cardiovascular mortality rate during the study period was nil. All patients were symptomatic before treatment; 9 became asymptomatic and 13 patients were improved, the average functional score decreasing from 5.16 +/- 2.15 to 2.28 +/- 1.49 (p less than 0.001). The persistence of severe symptoms led to withdrawal of the beta-blocker in 2 cases. There was a parallel improvement in maximal work capacity during exercise stress testing (96 +/- 27 watts vs 117 +/- 30 watts, p less than 0.01). A resting intraventricular pressure gradient was recorded in 12 of the 14 patients undergoing repeat catheter study which decreased after propranolol from an average of 66.75 +/- 32.72 mmHg to 42.75 +/- 37.6 mmHg (p less than 0.05). Left ventricular end diastolic pressures remained unchanged. The change in pressure gradient did not correlate with the symptomatology and there were no associated echocardiographic changes. The Holter monitoring did not show any improvement of ventricular hyperexcitability under propranolol: the number of patients with complex ventricular arrhythmias remained unchanged (7 patients).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

[Significance of repetitive ventricular extrasystoles in the acute phase of myocardial infarction].

Ventricular extrasystoles were analysed by a computerised monitor in 144 patients during the first three days of myocardial infarction. The patients had been hospitalised within 6 hours (77% of cases) and within 12 hours (92% of cases) of onset of symptoms. The patients were divided into 4 groups: Group A (46 cases) without repetitive ventricular extrasystoles; Group B (37 cases) with repetitive ventricular extrasystoles but without frequent isolated extrasystoles; Group C (25 patients) with repetitive ventricular extrasystoles and frequent isolated extrasystoles but without polymorphism or R on T phenomenon; and Group D (36 patients) with repetitive extrasystoles, frequent isolated polymorphic extrasystoles and/or R on T phenomenon. The size of infarction, as judged by peak CPK values, was smaller in Group A than in the other groups but was not significantly different in Groups B, C and D. The incidence of cardiac failure was comparable in Groups A and B and in Groups C and D, and was higher in the latter two groups than in A and B. The cardiothoracic ratio on admission was increased more often in Group D than in the other groups. Therefore, repetitive ventricular extrasystoles are the result of large infarcts. Their association with frequent isolated ventricular extrasystoles is a sign of insufficiency of the remaining myocardium. Patients with pre-existing poor myocardial function develop polymorphism and R on T phenomenon, signs which are associated with a particularly poor prognosis (hospital mortality: 42%). On the other hand, patients in Group B appeared to have satisfactory myocardial function despite the size of their infarcts, and the mortality, nil in this group, was less than in patients without arrhythmias.

Adult↗
PubMed1984

[Coexistence of left branch block and ectopic rhythm simulating alternating block].

During the acute phase of diaphragmatic myocardial infarction with septal extension, the ECG of a patient with a chronic left bundle branch block changed in a period of seconds from complete left bundle branch block to incomplete right bundle branch block then to narrow QRS complexes followed by incomplete and then complete left bundle branch block: the same QRS changes then occurred in reverse order; the atrial rhythm was absolutely stable during the recording. These appearances are explained by fusion of sinus and of an ectopic rhythm arising distal to the zone of block, the rate of which (sometimes faster and sometimes slower than the sinus rhythm) could have been influenced by an electrotonic effect after retrograde activation of the right bundle and concealed conduction in the left bundle. Appearances of bundle branch block may be recorded when the ventricle is partially activated from the point of breakthrough of the blocked branch.

Aged↗
PubMed1984

[Wolff-Parkinson-White syndrome and cardiopathies].

Forty-nine cases of Wolff-Parkinson-White syndrome (WPW) were diagnosed out of 10 750 patients with cardiac disease (0.45 p. 100), 24 cases out of 3 761 congenital malformations and 25 cases in the 6 989 patients with acquired heart disease. Right ventricular pre-excitation was recorded in 31 cases; 13 in the lateral zone, 12 in the posterior paraseptal zone and 6 in the anterior paraseptal zone. Left ventricular pre-excitation was recorded in 18 cases: 8 in the lateral zone, 5 in the anterior paraseptal and 5 in the posterior paraseptal zones. WPW and congenital heart disease: Out of 20 cases of Ebstein's anomaly, 5 cases of WPW were observed: 4 right posterior and 1 right lateral pre-excitations. Out of 218 cases of hypertrophic obstructive cardiomyopathy, 7 cases of WPW were observed, 4 of which were congenital. Three cases of WPW were recorded in 699 patients with ventricular septal defects. Out of 1 348 cases of atrial septal defect, 5 cases of pre-excitation were recorded, including 3 right posterior pre-excitations associated with an ostium primum defect. Pre-excitation was also observed in isolated cases of corrected transposition of the great arteries, supravalvular aortic stenosis, aortic incompetence and patent ductus arteriosus. Pre-excitation and acquired heart disease: Five cases of pre-excitation were recorded out of 305 cases of dilated cardiomyopathy (1.62 p. 100). Eleven cases of pre-excitation were recorded in a total of 3 471 cases of valvular heart disease (0.31 p. 100): 9 in rheumatic valve disease and 2 in mitral valve prolapse. Nine cases of pre-excitation were observed in 2 850 cases of coronary artery disease. Intermittent Wolff-Parkinson-White syndrome: Ventricular pre-excitation masks the ECG changes of complete right bundle branch block in Ebstein's anomaly, complete left bundle branch block in aortic incompetence and dilated cardiomyopathy, and the in-complete right bundle branch block often seen in mitral valve prolapse. The characteristic appearances of WPW depend on the zone of pre-excitation. Right ventricular hypertrophy observed in ventricular septal defect with pulmonary stenosis and mitral stenosis may be masked by right lateral pre-excitation. Changes of inferior wall myocardial infarction may be masked by left anterior wall pre-excitation. On the other hand, the effects of WPW on left ventricular hypertrophy are variable, high amplitudes of the resultant forces seeming to depend on late and isolated activation of one of the left ventricular walls.

Adolescent↗
PubMed1984

[Myocardial infarction in young subjects].

The annual incidence of myocardial infarction (MI) before 40 years of age is 10 times less frequent than that in patients of all ages, and 10 times less frequent in women than men. The severity and extensiveness of lesions demonstrated by coronary arteriography are significantly less in a young patient with an infarction than an elderly patient. Significant isolated coronary artery stenosis is encountered 10 times more frequently before age 35 than after age 50; 15 percent of young patients have no significant stenosis and 8 to 14 percent have entirely normal coronary artery circulation, depending on the study. There appears, then, to be two pathogenetically distinct varieties of MI in the young patient: approximately one-half of cases exhibit multiple sclerosis seen with typical coronary artery atherosclerotic disease; the remainder, which are almost specific for young patients, represent a single obstruction due most often to the rapid development of a thrombosis on an otherwise normal vascular tree. Coronary artery spasm resulting in complete arterial occlusion is certainly involved, nevertheless its frequency must be further defined.

Adult↗
PubMed1984

[Myocardial infarction in the young subject: a medium-term clinical and coronary angiographic study in 40 patients under 36 years of age. Comparison with coronary angiographic data of myocardial infarction in patients after 50 years of age].

A series of 40 myocardial infarctions, occurring in patients under 36 years of age was studied retrospectively (Group I: mean age 31.3 years). The medium term results of coronary angiography in this group were compared with those of 60 myocardial infarctions after 50 years of age (Group II: mean age 56.6 years). Group I had a clear male predominance (92.5%), a high incidence of smoking (69%), hypercholesterolaemia (69%); myocardial infarction was the first manifestation of their disease in 54% and it was often extensive (42%). A comparative angiographic study between the two groups showed: 1) Less widespread lesions in Group I, as assessed by the number of main arteries stenosed (p less than 0.001), the coronary index (p less than 0.01) and the mean coronary score using Friesinger's method (p less than 0.01). 2) A higher incidence of subnormal coronary angiogrammes in Group I (absence of 50% stenosis) (15%) and of single vessel disease (40%): compared with Group II in which multivessel disease was observed in 86.5% of cases. 3) Collateral circulation was less common in Group I (p less than 0.01). On the other hand, a comparative study of regional and global left ventricular function showed no difference between the two groups. Two subgroups were distinguished in Group I: in one subgroup, multiple lesions similar to those found in Group II, suggestive of premature coronary atherosclerosis (52.5%); the other group (47.5%) presented unilocular lesions i.e. focal mono-arterial lesions compatible with other causes of infarction (thrombosis and/or spasm). These patients were younger (p less than 0.05) and had significantly fewer cardiovascular risk factors (p less than 0.01). Despite the fact that the coronary lesions were limited, the myocardial damage was comparable with the other groups as the collateral circulation was much less developed (p less than 0.02). These appearances were only observed in 3.5% of patients in Group II. The study of the angiographic outcomes of these two types of lesions should show a difference and could contribute to the understanding of their mechanisms.

Adult↗
PubMed1984

[Rare complication of extracorporeal circulation: diffuse coronary fibrosis; giant cell myocarditis].

A 38 year old woman developed severe coronary stenosis several months after double valve replacement. Aorto-coronary bypass surgery was performed but the patient died of a peroperative myocardial infarction. Histological studies showed not only fibrous thickening of the intima of the whole coronary arterial tree, but also variable medial changes with inflammatory infiltration. In addition, inflammatory granulomata with giant cells were found in the myocardium. These coronary lesions and their association with a giant cell myocarditis cannot be satisfactorily explained by known pathological conditions. The usual mechanisms of coronary disease were not operative in this case. There remains the hypothesis of a primary change of the coronary wall related to either cannulation, anoxic arrest or perfusion fluid, or a combination of these factors. The coronary lesions could have developed by an immunological process which would also explain the giant cell myocarditis.

Adult↗
PubMed1984

[Sustained ventricular tachycardia 7 years after complete correction of tetralogy of Fallot].

The authors report a case of sustained ventricular tachycardia which occurred seven years after complete surgical correction of Fallot's tetralogy in a 13 year old girl. This arrhythmia was well tolerated haemodynamically, showed right-sided delay and was associated with mitral valve prolapse. After reviewing the literature, several physiopathological mechanisms are discussed: --the role of residual intraventricular conduction defects in sustaining the tachycardia; --the role of the ventriculotomy scar or of other associated lesions (mitral valve prolapse in this case) in the genesis of ventricular extrasystoles; --the postoperative haemodynamic status in the tolerance of the arrhythmias. This is a rare complication with an incidence of less than 2% of survivors followed-up over long periods. There is a risk of sudden death in 38% of these patients with ventricular arrhythmias which justifies Holter monitoring and ECG stress testing for their detection.

Adolescent↗
PubMed1984

[Time of occurrence of primary ventricular tachycardia in the acute phase of myocardial infarction].

The hour of day of primary ventricular tachycardia (VT) in the acute phase of myocardial infarction was studied in 63 consecutive patients without cardiac failure or antiarrhythmic therapy, admitted to hospital less than 6 hours after the onset of chest pain. There were 19 women and 44 men, with an average age of 63 years. The site of infarction was anterior in 23 cases, posterior in 34 cases and circumferential in 6 cases. The cardiac rhythm was analysed from the 6th hour following the onset of chest pain for 4 days, using a HP 98220 A computerised analyser CPK levels were measured daily. Ventricular tachycardia occurred in 73% of cases with no significant difference between daytime (18 patients) and night time (28 patients). The patients developing VT did not differ from the remainder with respect to age, sex, or site of ECG changes, but peak CPK levels were significantly higher than in patients without VT. The risk of VT decreased slowly as the interval from the onset of chest pain increased and fell practically to zero after the 40th hour. Diurnal and nocturnal VT were independent of age, sex or site of infarct. However, nocturnal VT correlated independently of the time of onset of chest pain to high values of CPK. There was no difference with respect to age, sex, location of infarct or incidence of ventricular tachycardia between infarcts with pain starting during the day, and infarcts with pain starting at night. However, when the pain started during the day, the peak CPK was significantly higher and there were significantly more attacks of nocturnal ventricular tachycardia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

[Ventricular arrhythmias in obstructive hypertrophic cardiomyopathy. Continuous electrocardiographic study].

Ventricular arrhythmias are thought to be responsible for the high incidence of sudden death among patients with hypertrophic obstructive cardiomyopathy (HOC). 24-h ECG recording was applied to 27 HOC patients before any treatment and repeated under beta-blockade with propranolol in doses not lower than 320 mg/day (mean dose : 354 mg/day). ECG tracings showed that 26/27 patients (96%) had ventricular arrhythmia; the arrhythmia was repetitive in 15 patients (55%), 3 of whom (11%) had bouts of ventricular tachycardia. These figures are very different from those found in normal subjects, i.e. : 40-50% ventricular arrhythmia and less than 5% repetitive arrhythmia. The most severe forms of ventricular arrhythmia (categories IVA and IVB in the Ryan, Lown and Horn classification) were exclusively seen in patients who had one or several syncopes. Statistically, the only positive correlations of arrhythmias were with age and left ventricular end-diastolic pressure on the one hand, and age and left ventricular systolic pressure gradient on the other hand. Propranolol had no effect on arrhythmia, which seems to contradict studies suggesting that high doses of propranolol play a substantial role in the prevention of sudden death among patients with HOC. Beta-blockers might act by preventing the transformation of arrhythmia into ventricular fibrillation.

Adult↗
PubMed1983

[Effects of diltiazem on cardiac and coronary circulation, at rest and during rapid auricular electric stimulation].

The effects on cardiac performance and systemic and coronary blood flow of rapid atrial pacing alone and associated with an intravenous infusion of a slow calcium channel inhibitor, diltiazem, at a dose of 20 mg/kg were studied in 20 patients with chronic coronary artery disease. Atrial pacing increased coronary flow and myocardial oxygen consumption: it decreased coronary arterial resistance and the coronary arteriovenous difference in lactates. Left ventricular end diastolic pressure rose significantly compared to the basal state in the period following pacing. The administration of diltiazem was associated with a significant fall of femoral arterial pressure, of coronary arteriovenous difference and myocardial consumption of oxygen, and an increase in the coronary arteriovenous difference in lactate. Left ventricular end diastolic pressure did not differ significantly from the basal values recorded after terminating atrial pacing. Left ventricular end diastolic volume decreased. Diltiazem opposed or cancelled the undesirable effects of rapid atrial pacing with respect to coronary arteriovenous difference in lactate content. The beneficial action of diltiazem does not seem to be closely related to its hemodynamic effects. It could be related to a reduction in myocardial oxygen demands due to a decrease in systolic ventricular strain and the specific metabolic effects of the drug, and also to an increase in myocardial oxygen supply due to the reduction in left ventricular end diastolic stress and the coronary vasodilation caused by the drug.

Adult↗