[Coronary insufficiency: physiopathology and clinical classification].
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Angina Pectoris↗
Biomedical subjects
J Puel
Publications and source records attributed to J Puel.
[Coronary endoprosthesis. Short- and mid-term results].
Mechanical stenting of the coronary wall by an endoprosthesis is a method of treating and preventing the 2 major complications of balloon angioplasty: acute occlusion by dissection and secondary restenosis. Forty-four self expanding stents were implanted in 42 patients presenting with post-angioplasty restenosis (35 cases), stenosis of an aortocoronary bypass graft (4 cases) or symptomatic post-angioplasty coronary dissection (3 cases). The primary results featured a high early occlusion rate of the endoprosthesis (28.5%, 12 cases). Better patient selection to include patients with stable angina and coronary arteries with a diameter greater than 3 millimeters, and the administration of an association of platelet antiaggregant therapy with heparin and oral anticoagulants has led to an improvement in these results. The early occlusion rate in the first 23 patients implanted without these selection criteria was 43% (10 cases) whereas it was only 10.5% (2 cases) in the last 19 selected patients who were prescribed effective medical therapy. The medium term results of the 27 patients implanted without complications at 6 months showed restenosis in 5 cases and reocclusion (asymptomatic) in 1 case (22.2% at control angiography at the 6th month). Restenosis was only observed in cases in which the endoprosthesis did not completely cover the coronary lesion (3 out of 3 cases) or when the endoprosthesis was implanted in a saphenous vein graft (2 out of 4 cases) and the only case of reocclusion occurred on a stent implanted in a coronary artery responsible for previous myocardial infarction. In the 21 patients in whom the stenosis had been totally covered by the stent there were no cases of restenosis.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
AIDS virus infection in Toulouse prostitutes (France)
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Adult↗
[Complete bundle branch block during exercise test. Clinical and coronary angiographic data].
Thirty-two complete bundle branch blocks were observed during 16,500 exercise stress tests between 1973 and 1988: there were 7 right bundle branch blocks and 25 left bundle branch blocks. Exercise stress testing was indicated in 15 cases for stable angina, in 15 cases for different functional disturbances and in 2 cases as a systematic investigation. All patients underwent coronary angiography and selective left ventriculography. Right bundle branch block occurring at a heart rate of 105 +/- 25/mn were associated with typical anginal pain at the time of apparition in 5 patients. Coronary angiography showed triple vessel disease in 3 cases, double vessel disease in 2 cases and an isolated proximal lesion of the left anterior descending artery in 2 cases. Left bundle branch block occurring at a heart rate of 125 +/- 12/mn was associated with normal coronary angiography in 7 cases. Eighteen patients had pathological coronary angiogrammes with severe lesions of the left anterior descending artery. Two women suffered from chest pain when the block developed and coronary angiography was normal in one of them. During follow-up (average 62 months), 16 coronary events were observed including 2 infarcts, and 6 patients developed cardiac failure. In conclusion, complete right bundle branch block appearing during exercise stress testing was constantly associated with atherosclerotic coronary artery disease. The predictive value of complete left bundle branch block on effort was 72%. Complete left bundle branch block occurring at heart rates of less than 120/mn was frequently associated with a proximal stenosis of the left anterior descending artery.
Adult↗
[Influence of pregnancy on the development of HIV infection].
In an attempt to evaluate the effects of pregnancy on HIV infection, the authors have studied the natural course of the disease in 128 female patients. A group of 64 pregnant women who were HIV seropositive and asymptomatic at the beginning of their survival was studied during childbearing and for three years thereafter. These women were compared with a control group of 64 non pregnant women who were also seropositive and asymptomatic at the beginning of the study. No statistically significant clinical or biological difference was observed between the two groups. The authors conclude that in their study pregnancy had little influence on the progression of HIV.
Adult↗
Influence of pregnancy on human immunodeficiency virus disease.
Over a period of 3 years (mean 16, extremes 3 and 36 months), we compared clinical and laboratory parameters of 128 female, human immunodeficiency virus (HIV)-infected patients, all in clinical stage II or III (CDC classification). 34 patients were pregnant and delivered a viable infant after at least 28 weeks of amenorrhea (group I), 29 patients were pregnant and had a spontaneous or induced abortion during the first or second trimester (group II), and 64 were non-pregnant female control patients (group III). The changes in the clinical stages over time were not statistically significant between the groups. The only laboratory parameters that were significantly higher in group I at the time of the delivery were: leucocyte count (p less than 0.001), lymphocyte count (p less than 0.05), and sedimentation rate (p less than 0.001). These changes are known to be related to pregnancy and not to HIV disease. All other laboratory parameters showed no significant differences within and between the groups. We conclude, that pregnancy--carried to term or interrupted--does not aggravate the natural evolution of HIV infection in clinical stage II and III patients.
Adolescent↗
[Concentric left ventricular hypertrophy in patients with hypertension. When should ventricular hyperexcitability be searched for?].
The main objective is to determine when concentric left ventricular hypertrophy (LVH) increased ventricular ectopic activity in essential hypertension. Twenty-four hours Holter monitoring was recorded in 56 patients with essential hypertension: 20 without LVH and 36 with concentric LVH determined by echocardiography (left ventricular mass greater than 215 g). According the degree of septal thickness (ST), patients were classed in 4 groups: (formula; see text) This study allows to conclude that mean and severe concentric LVH (ST greater than or equal to 12) detected by echo are associated with a greater PVC and a higher Lown's class ventricular ectopy. The degree of ST was strong correlated with the Lown's classification (r = 0.6, p less than .0001).
Arrhythmias, Cardiac↗
[Early reocclusion after in situ coronary desobstruction either with streptokinase or angioplasty during the acute phase of myocardial infarction].
The aim of this study was to assess the incidence of early reocclusion after therapeutic reperfusion of coronary arteries in acute myocardial infarction. Seventy four patients underwent intracoronary thrombolysis and 133 patients had immediate coronary angioplasty. The success rates were 70 per cent and 86 per cent respectively (p less than 0.01) and the degree of residual stenosis was 77 +/- 13 percent and 25 +/- 15 per cent respectively (p less than 0.001). The patients in whom coronary reperfusion was successful, 52 after in situ thrombolysis, 48 after angioplasty alone, and 66 after combined angioplasty and intravenous thrombolysis, underwent coronary arteriography 24 to 36 hours later. Reocclusion was asymptomatic in 46 per cent of cases (13/28) and its prevalence was 16.9 per cent: 25.5 per cent for the right coronary compared with 12.8 per cent for the left anterior descending (p less than 0.05) and 11.7 per cent for the left circumflex artery; reocclusion occurred in 8.6 per cent of patients treated before the 3rd hour compared with 22.9 per cent of patients receiving treatment after the 3rd hour (p less than 0.05). The incidence of reocclusion was 17.3 per cent after intracoronary thrombolysis and 16.7 per cent after angioplasty (angioplasty alone 18.7 per cent; associated with thrombolysis 15.2%). The degree of residual stenosis was nil after intracoronary thrombolysis and 16.3 per cent after angioplasty when the stenosis was insignificant, and 20.5 per cent and 18.8 per cent respectively with stenotic lesions greater than 50 per cent.
Adult↗
[Enoximone/dobutamine comparison in chronic congestive cardiac insufficiency with low cardiac output].
In severe chronic congestive cardiac failure the physician has the choice of two families of positive inotropic agents, the direct sympathomimetics and the phosphodiesterase inhibitors. The aim of the study was to compare the efficacy and tolerance of enoximone and dobutamine in this indication. Twenty patients with severe chronic cardiac failure with a cardiac index of less than 2.2 l/min/m2 and pulmonary capillary pressure of over 20 mmHg were randomised into two groups in an open trial. One group received enoximone 50 micrograms/kg/min for 30 minutes then 10 micrograms/kg/min and the other received dobutamine 10 micrograms/kg/min. The two groups were comparable. Results were analysed 12 hours after starting therapy, well after the loading dose of enoximone and before the appearance of tolerance to dobutamine. Neither drug caused a significant change in heart rate or mean blood pressure. The pressure-rate product did not increase significantly with enoximone (+9.2% NS) in contrast with the dobutamine group in which a significant elevation was observed (+23.5%, p less than 0.05). The cardiac index increased with enoximone (+61.0%, p less than 0.01) and with dobutamine (+32.1%, p less than 0.02). This resulted mainly from an increase in the systolic index (+45.5%, p less than 0.05 with enoximone and +30.1%, p less than 0.05 with dobutamine). Pulmonary capillary pressure and total systemic resistance decreased with enoximone (-29.1%, p less than 0.001 and -36.7%, p less than 0.05 respectively) and with dobutamine (-23.4%, p less than 0.001 and -20.7%, p less than 0.05 respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Prospective study of HIV infection in a group of 30 young hemophiliacs].
In order to investigate the progression to AIDS, we studied 39 patients with hemophilia ranging presently in age from 8 to 20 years, who had been positive for HIV antibodies for a mean of 36 months. Every 3 to 6 months a clinical and laboratory examination was performed. The number of patients with AIDS increased from 2 to 6 and 2 patients died from opportunistic infections. The percentage of patients with less than 500 T4 cells increased from 28% to 41%. Increase in serum IgA concentrations above 2.5 gl/l ranged from 23% to 38% of patients. Seven subjects were found to be positive for HIV antigen and 11 of 15 had a loss of p24 antibody. Patients' distribution into two groups according to the results of T4 cells count at the beginning of the study have shown a significant difference on the basis of clinical and biological progression. The present investigation confirms the progression in this population and the importance of some markers.
Acquired Immunodeficiency Syndrome↗
[Transluminal coronary angioplasty. The 2d generation].
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Angioplasty, Balloon↗
Risk factors in multiple sclerosis: a population-based case-control study in Hautes-Pyrénées, France.
A population-based study of the prevalence and risk factors of multiple sclerosis (MS) was conducted in the Hautes-Pyrénées, the southwestern region of France. The prevalence rate per 100,000 was equal to 40. Data on the past medical history of 63 MS patients and matched controls were collected. The frequency and age at occurrence of common childhood infections were similar for both the MS cases and controls. There was no difference between the frequency of vaccination for MS patients and for controls. However, the age at which MS patients were immunized against poliomyelitis was significantly higher than the corresponding age for controls (15.8 years versus 8.9 years, P less than 0.01). Antibody titers for various viruses were measured. The mumps antibody titer was significantly higher in the MS patients than in the controls. Also, MS patients tended to have higher titers for measles antibodies.
Adult↗
[Assessment of immediate geometric changes in coronary stenosis after implantation of stents by quantitative angiographic analysis].
In order to assess the immediate geometric changes in coronary stenosis that occur after implantation of intra-coronary stents, a quantitative angiographic analysis (automatic delineation of contours) was performed in 18 patients. Following angioplasty, the implantation of a stent significantly increases the diameter and area of the stenotic segment in absolute values. This improvement is attended by a significant decrease in resistance and in the theoretical trans-stenotic pressure gradient. Beside its role as mechanical support of the dilated arterial wall, the stent possesses an intrinsic force of dilatation confirmed by the results of quantitative angiographic analysis.
Adult↗
[Interventional radiology and vascular pathology].
Percutaneous transluminal angioplasty (PTA) has been an important step in the therapy of arterial diseases. Nowadays, it opens the way to new techniques which main goals are to improve the PTA results and to enlarge the indications. This article review these new techniques. The principles, the therapeutic possibilities, the advantages and the inconvenience of each are evaluated, based upon the personal experience of the authors, the bibliography of current literature and the proceedings of a meeting organized on this topic (Toulouse, February 1988). All these procedures are encouraging and let foresee new possible therapy in vascular pathology.
Angioplasty, Balloon↗
[The timing of angioplasty in acute myocardial infarction].
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Coronary Vessels↗
Additional improvement of stenosis geometry in human coronary arteries by stenting after balloon dilatation.
The purpose of this study was to assess the early changes in stenosis geometry after insertion of intravascular stents in human coronary arteries. Morphologic changes were evaluated by quantitative coronary angiography (using automated edge detection) and by calculation of the theoretical pressure decrease across the dilated and stented stenosis from the Poiseuille and turbulent resistances assuming a coronary blood flow of either 1 or 3 ml/s. Twenty-six patients were studied before and after angioplasty, as well as immediately after stent implantation. The stented coronary artery was the left anterior descending artery in 19 cases, the circumflex artery in 2 cases, the right coronary artery in 2 cases and a coronary artery bypass vein graft in 3 cases. After stent implantation, an additional increase in minimal luminal cross-sectional area of the dilated vessel was observed, suggesting that the self-expanding stainless steel endoprosthesis used in this study has a dilating function in addition to its stenting role.
Angiography↗
Early and late assessment of stenosis geometry after coronary arterial stenting.
Early and late modifications of stenosis geometry after stenting of coronary arteries were assessed. Morphologic changes were evaluated by quantitative coronary angiography (automated edge-detection) and theoretical pressure drop across the dilated and stented stenosis was calculated from the Poiseuille formula, with turbulent resistances assuming a coronary blood flow of 1 or 3 ml/s. Eleven patients (ages 41 to 69 years, mean 55) were studied before and after angioplasty, and immediately after stent implantation. The stented coronary artery was the left anterior descending artery in 9 patients and the left circumflex in 2. Following stent implantation, an additional increase in minimal luminal cross-sectional area of the dilated vessel was observed, suggesting that the self-expanding stainless-steel endoprosthesis used had a dilating function in addition to its stenting role. Repeat angiography in 6 patients 3 months after stent implantation showed a decrease in the minimal luminal cross-sectional area without a significant change in theoretic pressure decrease. This slight reduction in vessel caliber had no hemodynamically significant repercussions. Thus, stenting of coronary arteries following dilatation is a potentially valuable technique for preventing both abrupt closure and late reduction in lumen diameter.
Adult↗
Diagnosis of endocarditis in acute Q-fever by immunofluorescence serology.
The authors compared two groups of 20 patients suffering from Q fever using microimmunofluorescence (micro IF) serology. One group had endocarditis and the other conventional symptoms of acute Q fever but no endocarditis. Determination of the levels of antibodies against the two phases of rickettsiae in each of the three immunoglobulin classes (IgG, IgM and IgA), allowed to determine the type of infection using a single serum sample. Patients having IgA class antiphase I antibodies at a level equal to/or higher than 1:25 as well as those whose antibody levels fulfilled the conditions for the equation (IgG anti-phase I greater than or equal to IgG anti-phase II) + (IgA anti-phase I greater than or equal to IgA anti-phase II) were suffering from endocarditis. The positive predictive value of these tests was 100% and 94.1%, respectively.
Adolescent↗