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Biomedical subjects

J Gouffault

Publications and source records attributed to J Gouffault.

At least 37 records · Page 2Linked to original sources
PubMed1982

[Torsade de pointes. Apropos of 54 cases].

A retrospective study of 54 torsades de pointe cases in a cardiology department enabled us to specify the main characteristics of this serious arrythmia often observed in intensive care units: --the diagnostic criteria: more than the pattern of tachycardia attack, late ventricular premature beats and particularly QT prolongation are necessary for proper diagnosis. These two criteria allow us to differentiate between torsades de pointe and multiform ventricular tachycardia with similar morphology especially in acute myocardial ischaemia; --their clinical repercussion: the shortness of circulatory arrest related to the spontaneous end of the arrythmia explains that the torsades de pointe often result in short faintings. Nevertheless, they may degenerate into ventricular fibrillation (17 p. 100) which, in cases of recurrence, induced four deaths in this study; --there are many possible aetiologies often associated (30 p. 100) in the same patient. Their research must be exhaustive in each case. The chronic bradycardias especially the atrioventricular blocks of two or three degree whether continuous or not are often responsible (57 p. 100). Then, the metabolic disorders, essentially hypokalaemia and constant drug administration (antiarrythmic agents belonging to group I of Vaughan William's classification, some antianginal drugs, vasodilatator drugs) are often chief causative agents. Other aetiologies are rare. In 9 p. 100 of cases, no aetiological factor is found; --the best treatment is to suppress aetiological factors, to stop the administration of antiarrhythmic drugs; torsades de pointe must be controlled by increasing the heart rate; pace maker stimulation is the best way of making QT shorter and thus of synchronizing ventricular depolarization.

Adolescent↗
PubMed1982

[Hemodynamic and biological effects of bromocriptine in essential hypertension].

Central dopaminergic dysfunction has been suggested as the cause of essential hypertension. Agonist dopaminergic substances (AD) possess documented anti-hypertensive properties. We studied the cardiovascular effects of a single oral dose of 10 mg of Bromocriptine (Br) in untreated subjects with essential hypertension. A number of hemodynamic and biological parameters (direct blood pressure, pulmonary arterial and capillary pressures, cardiac index, heart rate, right ventricular and left ventricular work indices, systemic arterial and pulmonary vascular resistance, plasma renin activity, prolactin, and circulating Br levels) were measured before and after ingestion of the drug (at I, 1,5, 2, 3, 4, 5, 6, 8, 10 and 12 hours). Despite great individual variability, under the experimental conditions, Br displayed a strong anti-hypertensive action. The fall in blood pressure was early (Ist our) progressive, stabilising between the 3rd and 6th hour and prolonged (12 hour). This response was independent of the basal blood pressure with basal plasma renin activity (R = 0.64; p less than 0.05) but not with the prolactin level. The left ventricular work index underwent a similar change. Systemic arterial resistance fell, but this occurred after the fall in blood pressure. There was an independent and significant fall in pulmonary arterial pressure and pulmonary vascular resistance. The prolactin level fell very quickly and remained low throughout the 12 hours. There was an excellent correlation between the direct blood pressure and prolactin level (r = 0.97; p less than 0.01). Plasma renin activity rose after the third hour to reach a maximum at the 8th hour. There was a weak correlation between the blood pressure and plasma renin activity (r = 0.65, p less than 0.05). The serum Br level varied from patient to patient but reached a maximum at 1 hour, remaining stable until the 6th hour before decreasing. There was a correlation between the plasma renin activity and prolactin levels at each dosage (r = 0.66; p less than 0.005). The hemodynamic effects of Br are similar to those of central anti-hypertensive agents. The changes in plasma renin activity are comparable to those observed in central dopaminergic dysfunction. The excellent chronological correlation between the change in blood pressure and prolactin level is compatible with the hypothesis of this type of dysfunction in essential hypertension, if the inhibition of prolactin is accepted as a central dopaminergic effect of bromocriptine.

Adult↗
PubMed1981

[Value of serum myoglobin in acute myocardial infarction. Kinetic study].

The rise in serum myoglobin (MGB), total CPK (CKT) and its MB isoenzyme (CK - MB) was studied and compared over the first three days of acute myocardial infarction (AMI) and correlations were sought between the peak values of these three parameters and haemodynamic and biological indices of left ventricular function. Blood was taken from MGB (radio immunological technique), CKT and CK - MB (spectrophotometry) estimation every 2 hours for 24 hours and then every 6 hours up to the 72nd hour in 36 patients with AMI less than 12 hours old. On admission, this protocol was completed by a haemodynamic study (right heart pressures, systemic blood pressure, cardiac output measurement by thermodilution), arterial gases and ECG recordings. The average delays before the pathological rise, the maximal peak value and the return to normal were significantly shorter (p less than 0.001) for MGB (2, 6 and 25 hours) than for CK - MB (5,16 and 34 hours) or CKT (5,21 and 57 hours). The sensitivity of the diagnosis of myocardial infarction was not significantly higher with MGB than CKT or CK - MB either in the whole group (sensitivity of 91.6 p. 100 for MGB and 86.1 p. 100 for CKT and CK - MB) or in a subgroup of ten patients without transmural infarction (70 p. 100 for MGB compared with 60 p. 100 for CKT and CK - MB). A significant correlation was found between the peak values of MGB (p less than 0.02) and CK- MB (p less than 0.02) and the indices of left ventricular function (PCP, PAO2 and LVSWI). This was not observed with CKT. In conclusion, apart form technical problems which remain unresolved time-consuming investigation), serum MGB gives a much earlier and as sensitive a biochemical diagnosis of AMI as CKT and CK - MB. MGB and CK - MB are much better prognostic indicators than CKT as judged by the indices of left ventricular function. Finally, MGB estimation should be of particular value in the diagnosis of secondary extension of infarction.

Acute Disease↗
PubMed1980

[Study on myoglobinemia and its development during myocardial infarction (author's transl)].

Thirty six patients suffering from myocardial infarction were investigated by assay of their serum myoglobin, total creatine kinase and creatine kinase isoenzyme MB activities. Determination of serum myoblobin presents, with regard to creatine kinase MG, two major advantages: a very early increase after the onset of the pain (about three hours later) and a very quick clearance, allowing the diagnosis of a second episode of necrosis after about one day.

Creatine Kinase↗
PubMed1979

[Traumatic myocardial infarct].

Two cases of traumatic, closed chest, myocardial infarction in two young patients, aged 18 and 19 years respectively, are reported. They illustrate the two possible physiopathological mechanisms of this affection: in the first case, myocardial contusion after thoraco-abdominal trauma by crushing, probably complicated by a subendocardial tear of the inferior wall of the left ventricle, with a spontaneous favourable outcome; in the second case, a transmural myocardial infarction was observed secondary to a coronary lesion (? tearing of the adventitia of the left anterior descending artery) complicated by the early development of a large antero-apical aneurysm. Haemodynamic and arrhythmic complications necessitated infarctectomy and aorto coronary bypass surgery on the 35th day. The pathological lesions and their outcome are examined with respect to these two cases. The diagnostic, therapeutic and medieolegal problems associated with this condition are also discussed.

Adolescent↗
PubMed1978

[Myocardiopathies during pregnancy. Possible role of beta-mimetics].

The authors report two cases of severe non-obstructive cardiomyopathy presenting at the end of pregnancy in young women treated for long periods and at high dosage with beta 2-adrenoceptor stimulants, prescribed for threatened abortion or premature labour. The circumstances of the presentation, the clinical prescribed for threatened abortion or premature labour. The circumstances of the presentation, the clinical picture and the course towards complete recovery suggest that this might be a pathological process different from "cardiomyopathy of pregnancy" and be an "adrenergic myocarditis" induced or made worse by these drugs. The authors deduce some simple preventive measures.

Adrenergic beta-Agonists↗
PubMed1978

[The cardiomyopathy of idiopathic hemochromatosis].

A retrospective study of the case histories of 216 patients with idiopathic haemochromatosis has highlighted the frequency of cardiac involvement in this condition (53%). Two forms can be distinguished: a latent one (65%), in which the changes are predominantly electrocardiographic, and a clinical form (35%) with the features of congestive cardiomyopathy, notable for the rapidity of onset after right heart failure, the degree of cardiomegaly, the constant finding of abnormalities of ventricular repolarisation, the relative frequency of latent disorders of supra-His atrio-ventricular conduction, and the finding of elongation of the isovolumic contraction time on the phonomechanocardiogram. A haemodynamic profile is the same as for non-obstructive hypotonic cardiomyopathies, and is usually associated with a slow rise in left ventricular pressure. The cardiomyopathy, which is the most frequent cause of death, determines the prognosis in this condition. It may be found in association with diabetes and gonad failure. The finding of cardiomyopathy indicates basic treatment by veresection, which may be the only means of establishing a favourable outcome.

Adult↗
PubMed1977

[Infarction of the right ventricle. 1. Hemodynamic diagnosis; pathologic correlations].

70 patients with acute myocardial infarction were submitted to a full haemodynamic assessment at the onset of the condition. In 28 of them there was a disproportionate rise in the right ventricular end-diastolic pressure which could not be explained on the basis of a primary rise in left ventricular filling pressures; these were divisable into two subgroups: -- 19 infarcts without septal rupture, almost all with an inferiorly or posteriorly placed lesion (17); in these cases, an analysis of the curves shows, among other features, a syndrome of adiastole whose three forms (minor, moderate or severe) correlate well with the clinical features. Six cases died, and in four of those it was possible to study the correlation with the post-mortem findings: there were major lesions of the free wall of the right ventricle in 3 cases, but constrictive pericardial changes, the main differential diagnosis of right ventricular infarction, in the fourth. -- 9 cases of necrosis of the septum with rupture, of which only 3 had a syndrome of adiastole; three of these necroses were posterior, and post-mortem examination in two of them confirmed that there were indeed major lesions in the posterior wall of the right ventricle. It therefore seems that the diagnosis of infarction of the right ventricle is a haemodynamic one, and rests especially on the discovery of a syndrome of adiastole. Findings such as these are confined almost exclusively to posteriorly placed infarctions.

Cardiac Output↗
PubMed1977

[Infarction of the right ventricle. 2. Prognostic and therapeutic aspects].

Infarctions of the right ventricle have a reputation for being innocuous which appears to be unjustified; in a group of 21 patients in whom the diagnosis has been based on the haemodynamic principles put forward in the previous paper, we have had 7 deaths. The prognosis appears to be determined by two types of complication: ruptures of the posterior septum (4 cases), which are very distinctive in their clinical and topographical picture; and haemodynamic complications (10 cases of decompensation) which are related fairly rarely with the lesion of the right ventricle (2 cases), but more often with an associated complication, especially hypovolaemia, in which state the involvement of the right ventricle seems to play a particularly major role in increasing the slowing of the circulation. The proposed treatment plan is aimed at the permanent establishment of an effective circulating volume in the uncomplicated cases; in cases with complications, the aims are twofold--filling of the vascular bed and vasodilators, either separately or simultaneously.

Aged↗
PubMed1977

[Familial long QT-syncope syndrome. 2 cases of Romano-Ward syndrome].

Two families with the Romano-Ward syndrome were studied; in family A there were 19 members from three generations, 11 of whom had the abnormality of a long QT interval, 2 of whom had fainting attacks, and 2 of whom died suddenly. In family B, comprising 5 members of two generations, 3 had the anomaly, one of these having fainting attacks, and also having an atrio-ventricular block. The bicycle ergometer test has an important part to play in decisions about treatment of the asymptomatic forms of the condition.

Adolescent↗
PubMed1976

[Coronary insufficiency in pheochromocytoma].

The authors report the case of a 42 year old female with a phaeochromocytoma who, in the course of a hypertensive episode, had ECG changes typical of a myocardial infarction. These changes regressed within a few days. A normal coronary arteriogram confirmed the purely functional nature of this episode of acute myocardial ischaemia. In addition to the case report, the authors discuss the physio-pathological and electrocardiographic features of the coronary insufficiency of phaeochromocytoma, and also the problem of the rapide regression of the changes of infarction on the ECG.

Adrenal Gland Neoplasms↗
PubMed1976

[Mitral stenosis and partial abnormal pulmonary venous return. 3 case reports].

The association of mitral stenosis with an abnormal pulmonary venous return in the absence of an atrial septal defect, is a rare occurrence, and three cases are reported here. If this diagnosis is suggested by the chest Xray, it is confirmed by haemodynamic investigation, which defines the abnormal pulmonary drainage, guages the size of the left-right shunt, and demonstrates the degree of mitral steonsis. If the defect is poorly tolerated, surgical treatment is required.

Aged↗
PubMed1976

[Abnormal pulmonary venous return from the right lung into the inferior vena cava or scimitar syndrome. 2 cases: hemodynamic study and surgical correction].

Two cases of abnormal venous return from the right lung into the inferior vena cava, or the scimitar syndrome, have been studied. The essential features of this condition are given, emphasis being laid on the haemodynamic findings. Surgical correction of the abnormal pulmonary venous return seems to be a logical solution when the left-right shunt is of significant size.

Adult↗