Search PubMed⌕ Search

Biomedical subjects

M Bory

Publications and source records attributed to M Bory.

At least 73 records · Page 4Linked to original sources
PubMed1990

[Contribution of Doppler echocardiography to the evaluation and monitoring of normal and pathologic mitral valve prostheses].

Doppler echocardiographic examinations were performed in 146 patients with normal and 42 patients with pathological (31 regurgitations and 11 obstructions) mitral valve prostheses confirmed by catheterisation and/or surgery. The maximum and mean transprosthetic gradients and pressure half times (PHT) were calculated from continuous wave Doppler recordings and regurgitant signals were searched for by continuous and pulsed wave Doppler. In the group of normal mitral valve prostheses, the mean gradients and PHT were very variable even within the subgroups of the same type and size of prosthesis. The best haemodynamic profile was observed with the St Jude prosthesis (mean gradient = 5 +/- 2 mmHg, PHT = 90 +/- 22 ms, p less than 0.05 vs other prostheses). Minimal mitral regurgitation was detected in 12 per cent of bioprostheses and 20 per cent of mechanical prostheses. No correlations were found between the mean pressure gradient or PHT and the size of the prostheses. Regular Doppler echocardiographic follow-up over 2.4 years was obtained in 25 patients and showed a remarkable stability of the Doppler parameters in 17 patients whereas prosthetic valve dysfunction was diagnosed in the other 8 cases. In the group of pathological mitral valve prostheses, regurgitation (N = 31) was associated with a high early diastolic pressure gradient (20.2 +/- 8 mmHg) and a normal or shortened PHT (84 +/- 28 ms). Obstructed prostheses (N = 11) had high mean pressure gradients (17 +/- 5 mmHg) and increased PHT (195 +/- 53 ms). All cases of obstruction were correctly identified by the Doppler but 4 prosthetic valve regurgitations were missed or underestimated (4 mechanical prostheses).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

[Contribution of Doppler echocardiography in the evaluation of normal and pathologic aortic valve prosthesis].

Doppler echocardiography was performed in 112 patients with normal aortic valve prostheses and 13 patients with dysfunction (3 obstructions, 10 regurgitations) confirmed at catheterisation and/or surgery. The maximum and mean transprosthetic pressure gradients were measured in all patients by continuous wave Doppler. The prosthetic valve surface area was calculated by applying the continuity equation in the last 67 patients and compared with the effective surface area deduced from hemodynamic studies in the literature: --There was a great variability in the values of mean pressure gradient and prosthetic valve area within each group and with each size of prosthesis in patients with normal valves. No significant difference was observed between the gradients of different prostheses. However, for a given size, the St Jude Medical prosthesis had larger calculated surface areas than the other prostheses. The Doppler valve surface area did not differ significantly from the area measured invasively for the different categories of prostheses, and it increased with the size of the prosthesis. Mild aortic regurgitation was observed in 16 per cent of bioprostheses and 30 per cent of mechanical prostheses. The three cases of obstruction were characterised by a high mean pressure gradient (59 +/- 16 mmHg, p less than 0.01 vs normal prostheses) and a reduced Doppler surface area (0.7 +/- 0.2 cm2, p less than 0.005 vs normal prostheses) and were correctly diagnosed by Doppler echocardiography. Eight of the ten prosthetic regurgitations were correctly quantified by Doppler. Cardiac Doppler coupled with echocardiography is a very valuable method of non-invasive assessment of aortic valve prostheses.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

[Immediate delayed coronary angioplasty after intravenous thrombolysis in myocardial infarction. Prospective study].

A prospective randomized study was undertaken in 50 patients treated with intravenous thrombolysis (streptokinase, tissue plasminogen activator, association of the two thrombolytics) for acute myocardial infarction to determine the best time to perform percutaneous transluminal coronary angioplasty (PTCA). Coronary angiography was carried out 24 to 72 hours after thrombolysis. This investigation allowed identification of the patients in whom PTCA was technically feasible. These patients were then divided into two groups: Group A: early PTCA (24-72 hours) and Group B: delayed PTCA (8-10 days). During the hospital period, the patients were prescribed heparin therapy and aspirin. Recurrent ischemia (RI) was investigated and treated by PTCA. The criteria of success of strategies A and B were a primary success of PTCA and no RI during the hospital period. Coronary angiography was performed in 108 successive patients of whom 50 were included for the comparative trial, 25 in Group A and 25 in Group B. In group A, PTCA was successful in 24 cases and there were 2 incidents of RI (6 hours and 12 days). In Group B, 4 episodes of RI were observed in the 24 hours following coronary angiography: after 10 days, 15 of the 20 patients with uncomplicated courses underwent PTCA; 1 patient refused consent, 2 regressions of stenosis and 3 asymptomatic reocclusions were observed. A primary success of PTCA was obtained in 13 of the 15 patients. There was no statistically significant difference between the results of the strategies adopted in Groups A and B. A therapeutic success was obtained in 22 of the 25 patients in Group A, and 19 of the 25 patients in Group B.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

[Late potentials in patients with hypertension].

UNLABELLED: The presence of late potentials (LP) is considered as the evidence of an anatomical and electrophysiological condition which can give rise to life threatening ventricular arrhythmias. The aim of this work has been to study the incidence of LP in the setting of hypertension and to study their relation to ventricular hypertrophy on one hand and to ventricular arrhythmias on the other. Our study was conducted in 45 hypertensive patients (mean age +/- SD = 53 +/- 12). None of them had clinical evidences of a coronaropathy and only 5 had never been treated. For every patient we carried out a signal averaged electrocardiogram to detect LP, an echocardiogram to determine the myocardial mass index and 48 hours Holter monitoring to record ventricular arrhythmias filed according to the Lown classification. RESULTS: LP have been found in 13 patients. The following table summaries relations between LP, ventricular arrhythmias and myocardial hypertrophy: [table: see text] CONCLUSION: LP are frequently found in hypertensive patients (29%); their incidence is not higher in patients with left ventricular hypertrophy although they more frequently have serious ventricular arrhythmias; the severity of ventricular arrhythmias is not correlated with the presence of LP.

Adult↗
PubMed1990

[Minimal lipid anomalies in a group of men with early coronary disease compared to a control group].

A group of 27 men with early coronary disease (mean age: 52 years) with cholesterol levels below 6.45 mmol/l and triglycerides levels below 2.3 mmol/l, who underwent a coronary angiography, is compared with a control group of 18 men (CG) with normal angiography. The only significant differences between the two groups are: a triglycerides levels slightly higher in the CM group (1.55 + 0.4 mmol/l) vs 1.18 +/- 0.37 mmol/l, p 0.001), a HDL-cholesterol level slightly lower in the CM group (1.08 +/- 0.19 mmol/l vs 1.26 +/- 0.21 mmol/l, p 0.01) and an Apo AI/Apo B ratio slightly lower in the CM group (1.02 +/- 0.24 vs 1.18 +/- 0.17, p 0.005). In the CM group, 21 patients in 27 present a lipid abnormality requiring, according to the European consensus recommendations, the prescription of hygieno-dietetic measures. In the CM group, 10 patients in 18 present a minimal lipid abnormality, also requiring hygieno-dietetic measures. These results are compared with the recommendations of the European consensus.

Coronary Disease↗
PubMed1989

[Angina-like chest pain of esophageal origin].

Chest pain of oesophageal origin closely resembles chest pain of coronary origin, and the distinction between these two sources of pain is crucial to give the patients a precise prognosis and to use the appropriate therapeutic approach. Once the coronary origin has formally been excluded, the oesophageal origin can be confirmed by several examinations of varying sensitivity and specificity. To date, prolonged oesophageal manometric and pH recordings give highly reliable results as they establish a cause-effect relationship between pain and the phenomena recorded. Besides, these methods have refined the therapeutic approach since they also inform on the mechanisms of oesophageal pain.

Catheterization↗
PubMed1989

[Is home thrombolysis of myocardial infarct realistic?].

Based on a 19-month experience of intravenous thrombolysis performed at home during the acute phase of myocardial infarction, we feel it is a realistic procedure, since it did not result in too many unnecessary calls: in 648 calls which seemed attributable to a coronary emergency by the Emergency Medical Services, this diagnosis was ruled out in 119 instances (18.4%) and confirmed in 529 instances (81.6%); diagnostic errors were not too frequent: 3.8 p. cent of false positive and 5.8 p. cent of false negative; it was not very hazardous: one death only from cardiogenic shock; it permitted to save time by decreasing by 30 minutes the start of the treatment; it avoided excessive costs by using already established structures.

Adult↗
PubMed1989

[Diagnostic value of exercise tomoscintigraphy with thallium 201 in patients with complete left branch block].

Eighteen patients with rate-dependent (n = 5) or chronic (n = 13) left bundle branch block underwent thallium 201 exercise SPECT and selective coronary arteriography. 15 patients showed significant septal or anteroseptal perfusion defects on the exercise scintigrams, but in only 4 of them did the coronary disease involve the left anterior descending artery (LAD) (n = 3) or the left main coronary artery (n = 1). Among patients with normal scintigrams, one had right coronary artery stenosis. Test performance in detecting individual coronary artery stenosis greater than 70 p. 100 was: sensitivity 80 p. 100 (4/5) and specificity 15 p. 100. In patients with left bundle branch block, T1 201 SPECT was indeterminate for LAD disease due to reversible septal perfusion defect. We conclude that the usefulness of stress thallium 201 SPECT in patients with left bundle branch block is very limited.

Aged↗
PubMed1989

[A combination of nifedipine and diltiazem in the treatment of refractory spastic angina].

Both diltiazem (D) and nifedipine (N) have been shown to be effective in the treatment of spastic angina, but they sometimes prove inadequate, even in high doses. These two drugs have been given in combination on the grounds of a possible synergistic action, but the results obtained were limited by side-effects. We decided to administer the combined treatment in half doses to patients with spastic angina and normal coronary vessels in order to assess its effectiveness and acceptance. The trial was conducted on 13 patients: 11 men and 2 women aged from 37 to 71 years (mean 53 years) with normal or subnormal coronary arteriography. In the absence of any treatment, these patients responded to the ergonovine test by a coronary spasm which we were subsequently unable to prevent with either D or N. Each patient underwent, at the same hours, 4 ergonovine tests, the product being injected intravenously every 3 minutes in incremental doses of 1, 2, 3 and 6 micrograms/kg. These tests were performed without treatment, after 3 days of treatments with D alone (360 mg/kg), after 3 days of treatment with N alone (60 mg/kg) and after 3 days of treatment with D (180 mg/kg) plus N (30 mg/kg). Without treatment, ergonovine triggered the coronary spasm in all 13 patients at a mean threshold dose of 2.7 micrograms/kg. Under treatment with D or N given separately, no test became negative, but the threshold doses of ergonovine rose to 4.5 and 4.6 micrograms/kg respectively (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Double mitral valve orifice. Apropos of a case discovered by echocardiography].

The authors report a case of isolated double orifice mitral valve in a 20-year old pregnant woman. This exceptional and seldom isolated anomaly is usually discovered at autopsy or surgery. In this particular case it was diagnosed by pulsed doppler ultrasound combined with echocardiography. Data from the literature are reviewed on that occasion, and the echocardiographic images of the malformation are described. Despite its rarity, double orifice mitral valve deserves to be known and its presence should be looked for by echocardiography, notably in patients with complete or partial atrioventricular canal.

Adult↗
PubMed1989

[Detection of acute rejection by Doppler echocardiography in orthotopic cardiac transplantation. Prospective comparative study with endomyocardial biopsy].

In a prospective study of 23 patients who had undergone orthotopic heart transplantation we tried to assess the value of doppler-echocardiography in the detection of acute graft rejection. For this purpose, 220 echocardiographic records were compared with the results of endomyocardial biopsies performed at an interval of less than 12 hours. The parameters investigated by TM and two-dimensional echocardiography were: morphological parameters (including septal echodensity), left ventricular mass and systolic function parameters. Diastolic parameters (isovolumetric relaxation time [IVR], transmitral gradient half-decrease time [T 1/2] and proto-end-diastolic mitral velocity ratio [E/A] were measured by TM echocardiography and pulsed doppler velocimetry. The best doppler-echocardiographic criteria for graft rejection were a more than 15 ms reduction of IVR, a more than 15 p. 100 increase of myocardial mass, and a more than 30 p. 100 increase of teh E/A ratio, the corresponding sensitivities for histological rejection being 82, 76 and 74 p. 100 respectively. In contrast, T 1/2 and systolic function studies seemed to be disappointing. Finally, the increase of septal echodensity enabled rejection to be diagnosed with an excellent (92 p. 100) specificity but an insufficient sensitivity. Thus, none of the parameters measured were sensitive enough, taken separetely, to replace endomyocardial biopsy. However, the combined use of the most sensitive of them should make it possible to reduce the frequency of systematic biopsies.

Acute Disease↗
PubMed1989

[Treatment of coronary restenosis by repeated coronary transluminal angioplasty. Immediate and medium-term results].

To assess the immediate and medium term efficacy of percutaneous transluminal coronary angioplasty (PTCA) for restenosis, we retrospectively studied 102 patients undergoing a second PTCA between August 1983 and October 1987. The patients were 89 males and 13 females, mean age 61 +/- 7 years. Before the second PTCA, 13 patients were asymptomatic, 31 had effort angina and 58 resting angina. Exercise stress test performed in 50 patients was positive in 40 cases, negative in 9 and uninterpretable in 1. The coronary lesions were: 59 one vessel disease (58 p. 100) and 43 multivessel disease in which PTCA was performed on 1 lesion in 40 and on 2 lesions in 3. Primary success of PTCA was obtained in 100 patients (98 p. 100); 2 patients underwent coronary artery bypass graft (CABG), 1 as an emergency. At 6 months 45 patients had recurrent chest pain (46 p. 100) and 52 were asymptomatic. Control coronary angiogram performed in 70 patients (72 p. 100) after a mean delay of 7.4 +/- 6 months showed a second restenosis in 34, symptomatic in 31. Medium term follow-up was obtained for 96 patients (96 p. 100) with a mean follow-up period of 22.3 +/- 13.2 months. There were 5 cardiac deaths (5.2 p. 100) and 4 non fatal myocardial infarctions (4.2 p. 100). A new revascularization procedure after the second PTCA was performed in 33 patients (34.4 p. 100). Twenty-five patients underwent a third PTCA (26 p. 100), 5 patients a fourth PTCA (5.2 p. 100) and 11 patients underwent a CABG (11.4 p. 100).(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon, Coronary↗
PubMed1988

Methergin testing with angiographically normal coronary arteries.

To evaluate the incidence of spasm in patients with angiographically normal coronary arteries or with stenosis less than or equal to 50%, methergin testing was done consecutively in 1,200 patients (742 men and 458 women). The methergin test was performed 850 times during coronary angiography and 350 times after it. The test was globally positive in 11% (127 of 1,200 patients), positive in 7% among 921 patients presenting with atypical chest pain, 13% of 31 patients with effort angina, 54% of 54 with angina at rest, 57% of 53 with Prinzmetal's angina, 3% of 59 with acute myocardial infarction and 1% of 82 miscellaneous patients without chest pain. Another test was done in 291 patients after blockade of the cardiac autonomous nervous system with 0.04 mg/kg of atropine and 2 mg/kg of labetolol. The frequency of positive results in the methergin test increased after blockade from 8 to 19% (p less than 0.01). The increase of positive results was especially obvious among patients with atypical chest pain (from 6 to 14%). Thus, frequency of spasm in these patients with normal coronary arteries or without significative lesions was 11%. This incidence was influenced by the composition of the patient population and increased with blockade of the cardiac autonomous nervous system.

Adult↗
PubMed1988

[What strategy for treating the acute phase of myocardial infarction?].

Therapeutic strategy of treatment of the acute phase of myocardial infarction has been considerably modified the last few years by the administration of drugs which protect the ischemic myocardium (beta-blockers, calcium-channel inhibitors, notably), or in preventing development of necrosis by reperfusing it either by coronary bypass procedures, or by intracoronary thrombolysis or coronary angioplasty. But these methods are difficult to institute rapidly. Thus, we prefer to perform intravenous thrombolysis, which now may even be given in the patient's home. Clinical experience obtained by the SAMU medical emergency unit in Marseille, France shows the feasibility of such an approach. Initial results are satisfactory. The question of coronary angioplasty as a supplementary procedure may then be discussed: which patients are candidates for this method and when should it be performed?

Angioplasty, Balloon↗
PubMed1988

[Comparative randomized study of the effectiveness of intravenous recombinant tissue-type plasminogen activator and intravenous streptokinase in patients with acute myocardial infarct. Report of the European Cooperative Study Group for Recombinant Tissue-Type Plasminogen Activator].

In a single-blind randomised trial in patients with acute myocardial infarction of less than 6 h duration, the frequency of coronary patency was found to be higher after intravenous administration of recombinant human tissue-type plasminogen activator (rt-PA) than after intravenous streptokinase. 64 patients were allocated to 0.75 mg rt-PA/kg over 90 min, and the infarct-related coronary artery was patent in 70% of 61 assessable coronary angiograms taken 75-90 min after the start of infusion; 65 patients were allocated to 1,500,000 IU streptokinase over 60 min, and the infarct-related vessel was patent in 55% of 62 assessable angiograms. The 95% confidence interval of the difference ranges from +30 to -2% (p = 0.054). Bleeding episodes and other complications were less common in the rt-PA patients than in the streptokinase group. Hospital mortality was identical in the 2 treatment groups. At the end of the rt-PA infusion the circulating fibrinogen level was 61 +/- 35% of the starting value, as measured by a coagulation-rate assay, and 69 +/- 25% as measured by sodium sulphite precipitation. After streptokinase infusion, corresponding fibrinogen levels were 12 +/- 18% and 20 +/- 11%. In the rt-PA group only 4.5% of the fibrinogen was measured as incoagulable fibrinogen degradation products, compared with 30% in the streptokinase group. Activation of the systemic fibrinolytic system was far less pronounced with rt-PA than with streptokinase.

Adult↗
PubMed1988

[Thrombolysis in the pre-hospitalization phase of myocardial infarction].

In myocardial infarction (MI), the sooner thrombolysis is performed, the greater the chances of it being effective. We report a 19-month experience (July 1, 1986 to December 31, 1987) of thrombolysis performed at home prior to hospitalization by an organization called SOS Myocardial Infarction (SOS MI). Method. Throughout 24 hours, any patient may call by telephone a doctor attached to SAMU 13. If the doctor suspects a coronary emergency, he sends to the patient's home the SOS MI team (1 doctor and 1 nurse) in a medically-equipped ambulance. The diagnosis of MI is made on the finding of a nitroglycerin-resistant chest pain of more than 30 minutes duration associated with a more than 2 mm elevation of the ST segment on at least two electrocardiographic leads. Patients aged under 70 and in whom thrombolytic drugs are not contra-indicated are then treated intravenously with either streptokinase (1.5 million units over 30 min) or the tissue plasmogen activator (10 mg followed by a 90 mg infusion over 90 min). Results. During the 19-month period, 648 coronary emergencies were suspected from data given by telephone. The diagnosis made by the SOS MI doctor was non-coronary chest pain in 119 cases (18.4 p. 100), angina pectoris in 211 cases (32.6 p. 100).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1988

[Intravenous thrombolysis in myocardial infarction. Influence of the quality of the anticoagulation on the early recurrence rate of angina or infarction].

In this retrospective study the data of 70 patients treated with streptokinase in the acute phase of myocardial infarction were reviewed in search of a possible relation between recurrent ischaemic events and degree of anticoagulation. All patients had received a 30 mn infusion of streptokinase 1.500.000 units within a mean 175 mn period from the initial symptoms. They were followed up clinically (signs of angina or infarction), angiographically (coronary arteriography within 5.5 days on average) and biochemically (daily measurements of TCA values and blood fibrinogen concentrations). Fifteen recurrent ischaemic events (21.4 p. 100), including 6 attacks of angina and 9 myocardial infarctions, were observed. Angiography showed that the artery responsible for the initial infarction was occluded in 23.6 p. 100 (13/55) of patients without recurrent ischaemic accident. This figure rose to 46.6 p. 100 in patients who suffered a new anginal attack (7/15; NS) and up to 77 p. 100 in those who developed a new myocardial infarction (7/9; p less than 0.01). Biochemical data showed that 13 recurrent ischaemic accidents occurred when the APTT values were lower than 1.5 (176 measurements), as against 2 when these values were higher than 1.5 (359 measurements) (p less than 0.01). These two recurrent ischaemic accidents took place when fibrinogen concentrations abruptly rose above 1 g/litre. These results demonstrate that poor quality anticoagulation is responsible for the occurrence of recurrent ischaemic events within days of thrombolysis for acute myocardial infarction. They prompt the authors to recommend anticoagulation with heparin started at an early stage and carefully adjusted by means of repeated biochemical essays.

Adult↗