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Biomedical subjects

J Ponsonnaille

Publications and source records attributed to J Ponsonnaille.

At least 37 records · Page 2Linked to original sources
PubMed1991

[Silent ischemic heart diseases in patients with peripheral arterial diseases. Screening and 5-year prognosis in a population of 418 patients].

Silent ischaemic heart disease was looked for by exercise stress testing in 418 patients with chronic obliterative arterial disease of the lower limbs with no clinical or electrocardiographic signs of myocardial ischaemia. In the initial work-up, 6.2% of patients had a positive exercise test and the results were suspect in 9.2% of patients. These patients were followed up for 5 years. There were 42 deaths (10%). The cause of death was cardiovascular in 53.7% of cases (myocardial infarction 40.4%) and malignant disease in 35.7%. During the 5 year follow-up, ischaemic heart disease present as angina pectoris or myocardial infarction in 115 cases (27.5%). Patients who had a positive exercise stress test initially had a particularly high death rate (23%) and developed clinical signs of coronary insufficiency in 57.5% of cases. On the other hand, the peripheral vascular complications were relatively rare in this series: cerebrovascular accidents: 1.4%; retinal vascular accident: 1.1%; carotid surgery: 1.6%; lower limb amputation: 1.9%; lower limb vascular surgery: 17.7%. Silent ischaemic heart disease is very prevalent in patients with obliterative arterial disease of the lower limbs and is a main vital prognostic factor in these patients. These results confirm the need for a complete cardiovascular check-up in all patients with peripheral arterial disease.

Adult↗
PubMed1990

French multicenter trial of anistreplase versus heparin in acute myocardial infarction.

Eighty-four patients aged less than 71 years with less than 4-hour duration acute myocardial infarction (AMI) were randomized in a multicenter study to 30 U anistreplase or heparin (single injection of 6500 IU followed by 1000 IU/hr). Early reperfusion was assessed from ECG changes (50% of sum ST decrease 2 hours postdosing) and the CK release profile (CK peak less than 16 hours after onset of symptoms, CK slope greater than 10%/hr). Reperfusion rates in patients meeting at least two criteria of reperfusion were 62.5% on anistreplase versus 27.5% on heparin. On delayed angiogram (13.7 +/- 3.4 days), patency rates were 66% with anistreplase versus 47% (NS) with heparin in 76 patients. Global LVF was similar in both groups. With anistreplase, the mean lowest fibrinogen level was 0.43 +/- 0.55 g/l, plasminogen was 20 +/- 9%, and the highest F.D.P. was 1447 +/- 548 micrograms/ml. All values recovered by hour 48. In-hospital and 1-year follow-up mortality was 7.2% (three patients) with anistreplase versus 10.2% (four patients) with heparin. Bleeding occurred in 9.7% and 5.1% of the patients (NS), respectively. No intracranial hemorrhage occurred. Thus, with combined clinical criteria or reperfusion, anistreplase is twice as efficient as heparin, has a good tolerance, and is easy to use as a single injection.

Anistreplase↗
PubMed1990

[Carotid sinus hypersensitivity. Medium and long-term development in patients treated by ventricular pacing].

The problem of pacing patients with carotid sinus hypersensitivity (CSH) is the choice and criteria of selection of the pacing mode. The authors studied 29 patients with CSH treated by VVI pacing over a period of 10 years. The average follow-up was 34 months (range 6 to 96 months). Three of the 27 patients (11%) who were asymptomatic at the outset continued to have symptoms. The nature of the CSH was well-defined in 25 patients; 19 of the 20 cases of cardio-inhibitory CSH and 4 of the 5 cases of mixed CSH were asymptomatic. These two poor clinical results were analysed: the patient with the cardio-inhibitory CSH (one recurrence in 84 months) had a drop of 40 mmHg in systolic blood pressure which fulfilled criteria of the cardio-inhibitory form of CSH (a drop of 30 to 50 mmHg). The second case was a complete therapeutic failure with 3 recurrent syncopal episodes. The patient had a mixed form of CSH (B.P. drop of 65 mmHg) associated with a "pace maker syndrome" (drop of 50 mmHg in systolic blood pressure at the onset of VVI pacing without any sino carotid massage). The authors conclude that the cases of CSH which, during their investigation, are best corrected by dual-chamber pacing or which are associated with a significant pacemaker effect or present retrograde ventriculo-atrial conduction, should receive dual-chamber pacemakers.

Aged↗
PubMed1989

Electrophysiological effects of bepridil and its quaternary derivative CERM 11888 in closed chest anaesthetized dogs: a comparison with verapamil and diltiazem.

1. The electrophysiological effects of bepridil, its quaternary derivative, CERM 11888 (methylpyrrolidinium bromide) (both 2.5 mg kg-1 i.v.) and those of verapamil and diltiazem (0.2 mg kg-1 i.v.) were studied in closed chest anaesthetized dogs at doses used in clinical studies. 2. The four drugs caused a bradycardia with the following order of potency: bepridil greater than CERM 11888 greater than diltiazem greater than verapamil. 3. All the compounds slowed conduction in the AV node, increased the refractory period (RP) and decreased Wenckebach rates with the following order: verapamil much greater than diltiazem greater than bepridil greater than CERM 11888. 4. Verapamil and diltiazem did not affect conduction or the RP in atria while bepridil weakly slowed the former and markedly increased the latter. CERM 11888 caused a lengthening of RP but this was a delayed effect. 5. In the ventricle, bepridil and CERM 11888 caused a small increase in the QRS and a more pronounced increase in the RP. Both compounds increased QTc but did not modify HV. Verapamil and diltiazem had no significant effects at the ventricular level. 6. Our results confirm that the main sites of action of calcium antagonists are the SA and AV nodes. Bepridil has a broader spectrum of activity and also acts at the atrial and ventricular levels. A comparison of the effects of bepridil with those of its quaternary derivative suggests the involvement of an intracellular action in the electrophysiological effects of bepridil.

Anesthesia↗
PubMed1989

[Detection of coronary restenosis using myocardial tomoscintigraphy with thallium 201. A series of 85 cases].

UNLABELLED: After a successful coronary angioplasty (less than 50 p. 100 residual stenosis and no complication), can restenosis be detected by a non-invasive method? We tested the value of stress thallium 201 myocardial scintigraphy by comparing this method with clinical angina and the conventional exercise-induced angina test. The study was prospective and involved 85 patients (74 men, 11 women; mean age 54.7 years, range 33-78 years). Sixty patients were suffering from angina, 13 had post-infarction angina and 12 had mild necrosis. Angioplasty had been performed on a single vessel (LAD in 57 cases, right in 18 cases and CX in 10 cases). After 6.4 +/- 1.8 months, all patients were re-evaluated under treatment, undergoing successively an exercise test, a stress and recovery myocardial scintigraphy and a coronary angiography. Restenosis was defined as a more than 50 p. 100 reduction of diameter on two orthogonal planes and was observed in 22 cases (26 p. 100). 19 patients were suffering from angina, 12 had restenosis, 10 were asymptomatic but had restenosis. Eighteen exercise tests were pathological; 10 corresponded to restenosis and 12 were normal in spite of restenosis. Myocardial scintigraphy was regarded as positive when, outside a necrotic territory, a lack of uptake at stress was reversible or became worse at redistribution. 27 tests were positive, 18 corresponded to restenosis, 4 were normal in spite of restenosis. The diagnostic values of the three methods were compared: (Table: see text). CONCLUSIONS: (1) stress myocardial scintigraphy has the best sensitivity and specificity; (2) if it is negative, restenosis is very unlikely; (3) coronary angiography may be performed only in case of symptoms and/or of positive stress scintigraphy.

Adult↗
PubMed1988

[Electrophysiological study of pro-arrhythmogenic effects of erythromycin].

Three cases of torsades de pointe induced by erythromycin have recently been reported. After observing a new case, the authors tried to demonstrate the possible mechanism of the arrhythmogenic action of this molecule. Twenty-two patients undergoing electrophysiological studies in the catheter laboratory to determine the cause of syncope were given an intravenous injection of 10 mg/Kg of erythromycin lactobionate. The drug was injected in 1 minute (bolus) in 11 patients (Group A). The other 11 patients (Group B) received the drug by slow intravenous infusion (20 minutes). Electrophysiological parameters were measured before and after erythromycin. A significant prolongation of the atrial refractory periods (+39 ms), ventricular refractory periods (+20 ms), QT (+20 ms) and QTC intervals (+42 ms) was observed in Group A. These electrophysiological effects could explain an arrhythmogenic action similar to that of antiarrhythmic drugs in Group I of Vaughan-Williams' classification. The slow intravenous infusion of erythromycin in Group B considerably reduced these undesirable secondary effects. This difference was directly related to serum concentrations of the molecule.

Adult↗
PubMed1987

[Study of electrophysiological effects of betaxolol].

Betaxolol is a new cardioselective beta-blocker without any intrinsic sympathomimetic activity. A study of the cardiac electrophysiological effects of this molecule used intravenously was carried out in 20 patients. Betaxolol prolongs the sinus cycle (+ 25%, p 0.001), prolongs the sino-atrial conduction time (+ 20.1%) and atrio-hissian conduction time (+ 10.8%, p 0.001), and prolongs the refractory periods at all levels: atrial (+ 8%), nodal (+ 20.8%), right ventricular (+ 4.3%). These findings confirm the electrophysiological characteristic effects of the beta-blockers series; however, the moderate but significant increase of the refractory ventricular period, seems to provide this molecule with a certain degree of originality in this therapeutic class.

Adrenergic beta-Antagonists↗
PubMed1986

[Acute myocarditis in Lyme's syndrome. Value of myocardial scintigraphy with gallium 67].

The authors report the case of a 35 year old man with no known previous cardiac disease. One month after a tic bite causing diffuse abdominal erythema, he was admitted to hospital with fever, breathlessness and bradycardia. The electrocardiogramme showed first degree atrioventricular block with a sinoatrial block (SA = 200 ms, AH = 240 ms). Echocardiography eliminated the diagnosis of pericardial effusion. Thallium 201 myocardial scintigraphy was pathological and showed irregular global uptake suggesting cardiomyopathy. Gallium 67 scintigraphy showed increased uptake in the left ventricle. The evolution was uncomplicated with normalisation of clinical, ECG and radiological changes. Cardiac catheterisation and angiography eliminated ischaemic and primary cardiomyopathy. Control radionuclide investigations were normal at one month: there was no persistent abnormal Gallium uptake. The diagnosis of Lyme's syndrome was confirmed by positive serology with successive titres of 1/1024 and 1/2048 (significant at titres over 1/256). This unusual case illustrates: the risk of myocardial disease in Lyme's syndrome; the diagnostic value of Gallium 67 scintigraphy in acute myocarditis: Gallium seems to fix specifically on inflamed tissues, so distinguishing myocarditis from primary cardiomyopathies.

Acute Disease↗
PubMed1985

[Possible role of a cardiac factor in limiting the walking perimeter in the treadmill test in the arteritis patient].

Electrocardiographic modifications appearing during a treadmill test undergone by 145 patients with arterio-sclerosis obliterans at stage II without coronary antecedents and with normal resting electrocardiograms were studied. Twenty per cent of the patients had to discontinue the test (slope 12%, 3,8 km/h). A repolarization anomaly of ischemia type appeared in 13% of the cases (19 patients) and a rhythm disorder in 1%. Hence systematic monitoring of the electrocardiogram during walking test can enable subjects with high coronary risk to be singled out.

Arteritis↗
PubMed1984

[Early diagnosis of postinfarction ventricular aneurysm. Value of contrast scintigraphy].

Early diagnosis of a ventricular aneurysm after myocardial infarction may provide a valuable means of preventing certain complications. We studied 55 patients with acute myocardial infarction on the 8th day by Technetium 99 angioscintigraphy with study of wall motion and ejection fraction at equilibrium. The results were compared with left ventriculography performed three months after infarction. Angioscintigraphy demonstrated 17 cases of dyskinesia, 16 cases of hypokinesia, and 22 cases of akinesia, divided into two subgroups depending on whether the ejection fraction was lower (n = 11) or higher than 40% (n = 11). Contrast angiography at 3 months confirmed the presence of 27 aneurysms, 17 akinetic plaques and 11 cases of hypokinesia. Comparison between the two series of investigations showed excellent correlations: in the group of dyskinesia (17 cases) an aneurysm was confirmed in 15 cases; in the group of hypokinesia (16 cases) only one aneurysm was demonstrated by the reference angiography. The results were less uniform in the group with akinesia. In the subgroup with a low ejection fraction, 9 out of 11 cases progressed to aneurysm and, in retrospect, should be considered as likely aneurysms. There were only 2 aneurysms (2/11) in the subgroup with localised akinesia and a high ejection fraction. The overall results suggest that angioscintigraphy at the 8th day of myocardial infarction is a reliable means of detecting left ventricular aneurysm; in cases of dyskinesia or widespread akinesia with an ejection fraction of less than 40% the presence of an aneurysm was confirmed in 24 out of 28 patients (86%).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1982

[The electrophysiologic effects of intravenously administered bepridil].

The electrophysiological effects of intravenous bepridil were studied at doses of 2 mg/kg and 3 mg/kg. The drug was tested on 25 patients of both sexes who were undergoing electrophysiological investigation for other reasons (11 normal ECGs, 11 pathological ECGs, 3 WPW syndromes). Electrophysiological parameters before and after bepridil were compared. The following changes were noted: - the refractory period was significantly prolonged at all conducting levels; - the sinus cycle was significantly lengthened in a practically constant fashion (+9,2 p. 100); - conduction in the sinoatrial and atrioventricular nodes was significantly prolonged (+15 p. 100 and + 11 p. 100); - the Luciani-Wenckebach point was significantly decreased in the anterograde, and even more so in the retrograde, directions (-20 and -23 p. 100 respectively); - however, infrahisian conduction was not affected either in patients with normal or pathological ECGs. The drug was effective in blocking the accessory pathway in two of the three patients with the WPW syndrome. A study of drug plasma levels did not show a dose-effect relationship. The plasma levels were extremely variable from one subject to another, suggesting tissue fixation of the active part of the molecule. These results demonstrate the valuable electrophysiological effects of bepridil which, by its mode of action, is very similar to amiodarone.

Adult↗