Search PubMed⌕ Search

Biomedical subjects

M Bory

Publications and source records attributed to M Bory.

At least 91 records · Page 5Linked to original sources
PubMed1988

[Prognosis of ventricular tachycardia].

The prognosis of monomorphous, sustained, non-iatrogenic ventricular tachycardia was studied in 86 patients followed up for a mean period of 42.8 months. The patients were divided into three groups as follows: group I, 46 patients with myocardial infarction beyond the acute phase; group II, 30 patients with non-ischaemic heart disease; group III, 10 patients without heart disease detectable at angiography and/or echotomography. Fifty patients died during the follow-up period. Forty (80 p. cent) of these deaths (26 in group I, 14 in group II) were due to cardiac causes: heart failure in 24 cases, sudden death in 15 cases, recurrent myocardial infarction in 1 case. The percentage of cardiac death was higher in patients with left ventricular dysfunction (66 p. 100 versus 15.2 p. 100) and when the ejection fraction was below 0.40 (52.9 p. 100 versus 11.8 p. 100). The proportion of sudden death was 66.7 p. 100 when Lown's grade IV ectopic rhythm persisted under treatment, and only 7.7 p. 100 when this was not the case (p less than 0.001). These results confirm that: ventricular tachycardia has a high mortality rate in patients with heart disease; ventricular tachycardia on a "healthy" heart is of good prognosis; left ventricular dysfunction and persistence of repetitive forms under treatment have a high predictive value for cardiac death.

Adult↗
PubMed1987

[Ergometrine test in 1200 consecutive patients presenting with normal coronary vessels].

An ergonovine test (ET) was performed in 1,200 patients-742 men, 458 women aged from 34 to 73 years (mean: 49.5 years)-either during (850 cases) or after (350 cases) coronary arteriography. Another ET made more sensitive by blocking the cardiac autonomous nervous system (CANS) with labetalol 0.04 and 2 mg/kg was performed in 291 of these patients. The ET test was positive in 10.7 p. 100 (127) of all patients and in 11.2 p. 100 (127/1125) of patients presenting with retrosternal pain. In the group where spontaneous angina could be confirmed by ECG recordings during the attack, the percentage of positive responses rose significantly to 53.7 p. 100 patients with ST depression and 56.6 p. 100 of patients with ST elevation. When the anginal nature of the retrosternal pain was not confirmed before the test, the proportion of positive responses was 6.6 p. 100. In patients who had the sensitized test the positive response rate increased in all groups and globally rose significantly from 7.9 p. 100 to 18.6 p. 100 (p less than 0.01). Thus, the usually low frequency of positive ergonovine tests differs according to the population selected and increases after CANS blockade.

Adult↗
PubMed1987

[Pure coronary spasm: autonomic disease or form of onset of atheroma? Contribution of repeat coronarography in 23 patients].

Coronary spasm has often been blamed for facilitating the development of atheroma, but some authors regard it as a separate disease. In order to form an opinion on these two theories, we performed repeat coronary arteriography at an interval of 4 years on average in 23 patients: 19 men and 4 women aged from 38 to 62 years (mean: 49,4 years). At the initial examination the coronary vessels were normal in 11 patients and showed irregular arterial walls without significant stenosis in 12 patients. Coronary spasm was demonstrated directly in 17 cases (6 spontaneous spasms during arteriography and 11 induced spasms) and indirectly in 6 cases (ECG signs of ischaemia during the anginal attack). At the second coronary arteriography we found that the spasms persisted, with positive response to a challenge test in 17 out of the 19 patients tested. The challenge test was not performed in 4 patients who had developed significant lesions. The vessels themselves were altered in 6 patients, with images of occlusion (2 cases), stenosis (2 cases), parietal irregularities (1 case) and aneurysm (1 case) appearing on spastic arteries, and images of stenosis in 2 patients with apparently non-spastic arteries. There was no difference in age, sex, risk factors, initial coronary status and time interval between arteriographies between these 6 patients and the 17 patients whose coronary arteries had remained unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

[Has the prognosis of recent myocardial infarction changed?].

In this retrospective study changes in the prognosis of recent myocardial infarction were evaluated by comparing 731 patients hospitalized in the 1970-1974 period (group I) with 755 patients hospitalized in the 1984-1986 period (group II). The possible factors responsible for the changes observed were investigated. A 34 percent decrease in hospital mortality was recorded (19.2% in group I versus 12.6% in group II; P less than 0.001). The decrease was present irrespective of the patients' sexes and ages; it was more pronounced in patients under 65 (-42%) and in elderly women (-43%). Compared with group I patients, group II patients showed a significant decrease in cardiogenic shock (P less than 0.02), atrial fibrillation (P less than 0.05) and, chiefly, atrioventricular block (P less than 0.001). The improvement in prognosis cannot be ascribed to a change of population since both groups were matched in male to female ratio, age distribution and presence of the main risk factors. Three factors may have contributed to a better prognosis: (1) more rapid admission to hospital; the proportion of patients admitted within 6 hours of the initial symptoms rose from 37.5% in group I to 49.8% in group II (P less than 0.001); (2) modification of the conventional treatment, with a reduced prescription of digitalis and a less frequent recourse to temporary electrical pacing; (3) introduction of new treatments aimed at limiting the size of the necrotic area; these include thrombolytic agents which were administered in 19.2% of patients under 65 and may well have played the principal role in the improvement of outcome.

Adult↗
PubMed1986

[Treatment of unstable angina. A randomized double-blind study of propranolol, diltiazem and molsidomine].

A randomized, multicentric, double blind study attempted to compare in 41 patients hospitalized for unstable angina, the efficacy of diltiazem (D) 240 mg/day, propranolol (P) 160 mg/day and molsidomine (M) 8 mg/day. The patients included in the study presented one or several spontaneous angina episodes accompanied by a transient and significant lowering of ST and/or an inverted T wave without necrosis. The evaluation criteria were the occurrence of new angina pain and electrical alterations on a continuous Holter for 5 days. 11 patients received diltiazem, 13 patients received propranolol and 15 patients received molsidomine (including an early death). Clinically, the number of painful episodes per day and per patient goes, in an average, from 1.2 to 0.23 diltiazem, from 2.2 to 0.44 for propranolol and from 2.2 to 0.45 for molsidomine. Pain disappeared on the 5th day in 54.5 per cent of patients under diltiazem, 58.8 per cent of patients under propranolol and 53.5 per cent of patients under molsidomine. Electrically, the number of ischemic accidents per day and per patient was 0.45 under diltiazem, 2.12 under propranolol (0.53 in excluding one patient with latent angina) and 0.81 under molsidomine. The number of patients without any ischemic accident was 63.6 per cent under diltiazem, 53.8 per cent under propranolol and 40 per cent under molsidomine. In conclusion, diltiazem, propranolol, and molsidomine have a comparable efficacy in unstable angina. The association of these medications could have a synergistic effect.

Angina Pectoris↗
PubMed1986

[Hypertrophic myocardiopathy. Course and prognosis. 60 cases].

The evolution of 60 cases of hypertrophic cardiomyopathy over a mean period of 6.3 years is described. The cases were separated according to echo-cardiographic findings into 4 categories: obstructive cardiomyopathy (29 cases), asymmetrical septal hypertrophy (22 cases), diffuse cardiomyopathy (6 cases) and apical cardiomyopathy (3 cases). A number of complications occurred during the follow-up, consisting of cardiac failure (20 cases), embolic accident (9 cases), aortic endocarditis (1 case) and arrhythmia (32 cases including 12 cases of supraventricular arrhythmia and 20 cases of ventricular arrhythmia). Five patients died suddenly. These data are compared with those obtained from the literature in an attempt to determine the main prognostic factors in hypertrophic cardiomyopathy.

Adolescent↗
PubMed1985

Randomised trial of intravenous recombinant tissue-type plasminogen activator versus intravenous streptokinase in acute myocardial infarction. Report from 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 differences 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↗
PubMed1985

[Immediate coronary angioplasty in the acute phase of myocardial infarction. French multicenter study: December 1983].

Following the introduction of intracoronary thrombolysis in the acute phase of myocardial infarction (AMI), transcutaneous coronary angioplasty (TCA) was originally conceived as a logical complementary procedure to treat residual stenosis and so prevent the frequent post-thrombolysis reocclusion (20-30 p. 100 of cases). With increasing experience TCA of first intent appeared rational, more rapid and effective, ensuring coronary recanalisation (CR), suppression of residual stenosis and the prevention of reocclusion in the same procedure with with the objective of reducing the number of coronary bypass grafts (CBG) in patients with single vessel disease. A French multicentre study of 22 cases was organised by 9 centres. The average period between onset of symptoms and intervention was 2 hours 10 mins (range 30 mins-5 hours 30 mins). The average duration of the procedure was only 30 mins. 16 patients had anterior and 6 patients inferior AMI. Coronary angiography showed 12 occlusions (54.5 p. 100) and 10 sub-occlusions with 6 cases of delayed opacification. All patients had successful initial TCA with no major complications. The arterial occlusions decreased from 100 p. 100 to 31 p. 100 and the subocclusions from 94 to 12 p. 100. 2 patients died in the hospital period, one at the 48th hour of controlateral AMI and the other one at the 5th day of reocclusion. Three patients developed reocclusion at the site of the original TCA. Complete regression of ECG changes was observed in 31.8 p. 100 of cases. Complete recovery of normal left ventricular function was observed in 8 of the 17 patients who underwent follow-up investigations (47 p. 100 of cases).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

[Long-term effects of transluminal coronary angioplasty. French multicenter study].

Although transluminal coronary angioplasty is now acknowledged as an effective treatment for coronary artery disease, the long-term outcome of patients treated by this method is still under evaluation. A french multicenter trial was set up and the long-term efficacy of transluminal coronary angioplasty was assessed in 546 patients undergoing the procedure before the 31/3/83. 380 initial successes (69 p. 100) were followed up for a period ranging from 6 to 48 months (average 19.9 +/- 10.4 months). A control coronary angiography was carried out in 88 p. 100 of cases. Restenosis (loss of over 50 p. 100 of initial angiographic improvement) was observed in 27 p. 100 of cases. Including the repeat procedures, the patency rate of the dilated vessels was 82 p. 100. Progression of atherosclerosis on another coronary artery was observed in 1.3 p. 100 of cases. After transluminal coronary angioplasty, 72 p. 100 of patients remained improved, 11 p. 100 underwent repeat angioplasty, 8 p. 100 underwent coronary bypass surgery, 1.3 p. 100 suffered myocardial infarction and 1.3 p. 100 died. Restenosis was associated with recurrence of angina pectoris in 90 p. 100 of cases (within 3.3 +/- 1.6 months) and a positive exercise stress test in 87 p. 100 of cases. Recurrence of angina due to progression of disease on the dilated vessel was observed in 24.2 p. 100 of cases; repeat transluminal coronary angioplasty was carried out for this indication in 38 p. 100 of cases, coronary bypass in 34.8 p. 100 and medical treatment was continued in 27.2 p. 100 of cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗
PubMed1985

[Repeated coronarographies in 122 medically treated patients].

122 patients treated medically 115 men and 7 women aged 51.9 +/- 8.51 years (range 32 to 79 years) underwent repeat coronary angiography 34 +/- 26 months (1 month-11 years) after the initial investigation Patients with normal coronary arteries were excluded. The repeat investigation was performed for aggravation and persistance of symptoms in 74 cases, myocardial infarction in 14 cases, with a view to aortocoronary bypass in 23 cases, for cardiac failure in 8 cases and for ventricular arrhythmias in 3 cases. Three groups of patients could be distinguished: Group I: the coronary angiography was unchanged (41 patients, 33.6 p. 100). The interval between the two investigations was 30.7 +/- 24.8 months. Group II: the coronary lesions had regressed in 12 patients (9.8 p. 100). The interval between the two investigations was 29.4 +/- 23 months. The degree of stenosis was reduced in 6 cases; recanalisation of an occluded artery was demonstrated in 3 cases; coronary spasm was diagnosed in 3 cases. Paradoxically, 4 patients had developed lesions on other coronary segments. Group III: the coronary lesions had progressed in 69 patients (56.6 p. 100). The interval between the two investigations was 36.8 +/- 26.9 months. The progression was observed on a pre-existing stenosis in 51 cases and on an initially normal segment in 34 cases. Left ventricular function had worsened in 21.7 p. 100 of patients compared to only 5.6 p. 100 of patients in groups I and II (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

[Chemical blockade of the cardiac autonomic nervous system. Effects on the coronary arterial vasomotor activity].

The results of cardiac plexectomy in spastic angina are controversial. This study was undertaken to evaluate the effects of blocking the cardiac autonomic nervous system (CANS) in this syndrome in 61 patients presenting with chest pain and angiographically normal coronary arteries. All patients underwent a methyl-ergometrine provocation test with a sequential protocol. They were then divided into two groups: Group 1 (13 patients): positive response to ergometrine. Group 2 (48 patients): negative response to ergometrine. Three sub-groups were identified: 2: 1: 9 patients with coronary spasm demonstrated by another method: 2: 2: 6 patients with myocardial infarction: 2: 3: 33 patients with chest pain alone. The results of these tests were compared with those obtained after blocking the CANS by intravenous injection over 3 minutes of an alpha and beta-blocker (labetalol 2 mg/kg) and a parasympathetic blocker (Atropine. 0.04 mg/kg). The CANS blockade was confirmed by two facts: the basal heart rate of 66.38 +/- 9.91 rose to ots intrinsic rate of 89.76 +/- 10.5 (p less than 0.01) and remained at that rate after ergometrine and trinitrate administration and myocardial ischaemia; changes in blood pressure were greater after CANS blockade: + 30.62 +/- 16.13 mmHg instead of + 8.62 +/- 0.33 mmHg after ergometrine (p less than 0.01) and -43.16 +/- 16.32 mmHg instead of -25.16 +/- 3.64 mmHg after trinitrate (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

[Simultaneous appearance of precordial pain and effort-induced left bundle branch block. A study of 6 patients with normal coronary angiography].

6 patients, 4 men and 2 women, aged 38 to 60 years, were hospitalised for chest pain on effort, labelled as angina. The resting electrocardiogram was normal, except in 2 cases with incomplete left bundle branch block. Exercise stress testing induced simultaneous chest pain and complete left bundle branch block (LBBB) (at a rate of 15 to 160 beats/min, mean 115). The pain lasted as long as the LBBB was present and eased as it disappeared. All patients had normal coronary angiography and negative provocative tests of coronary spasm with atrial stimulation (4 cases), isoprenaline test (2 cases), atropine injection (2 cases) and nitroglycerin (1 case). A 2D echocardiogram performed in all the patients, showed no signs of myocardial disease. Myocardial perfusion on effort was studied by Thallium 201 scintigraphy in all 6 patients. There were no perfusion defects. An exercise stress test was performed after beta-blocker treatment in 3 patients. LBBB appeared each time and the pain was always present. The induction of bradycardia with propranolol (5 cases) or verapamil (3 cases) did not reduce the frequency of chest pain. No serious complications were observed during follow-up (myocardial infarction, death). The syndrome of painful LBBB is not related exclusively to tachycardia. Myocardial ischaemia does not seem to be the underlying mechanism judged by the negative thallium studies.

Adult↗
PubMed1984

[Relation between personality and spastic angina].

The personalities of 60 patients suffering from episodes of retrosternal pain were evaluated by means of psychological tests ( Cattel 's questionnaire and Eysenck's personality inventory) and semi-directive interviews. The patients fell into three groups: group I patients (n = 21) had atheromatous lesions of the coronary arteries detected at angiography; group II patients (n = 19) had normal or subnormal coronary arteries, but angiography demonstrated arterial spasm; group III patients (n = 20) had angiographically normal coronary arteries without spasm. A statistically significant difference (p less than 0.05) was noted between groups I and II, but not between groups II and III. Eleven of the 21 patients in group I presented with an obsessional personality which was not found in groups II and III where 13/19 and 16/20 patients respectively had a hysterical personality.

Adult↗
PubMed1984

Evidence for isosorbide dinitrate (ISDN) promoting effect on prostacyclin release by the lung and prostacyclin implication in ISDN-induced inhibition of platelet aggregation in humans.

We investigated thromboxane B2 (TxB2), 6-keto-PGF1 alpha (6KPGF1 alpha reflecting prostacyclin), PGE2 and PGF2 alpha plasma levels; TxB2, PGE2 and PGF2 alpha platelet production and platelet aggregation response in ascending aorta (reflecting trans-pulmonary difference) and in venous coronary sinus (reflecting transcardiac difference) simultaneously in patients with ischemic heart disease, before and after right-atrial administration of 3 mg ISDN bolus. Transcardiac differences were scarce before as well as after ISDN administration. In aortic blood, ISDN administration into the right atria resulted in a significant increase in prostacyclin and PGF2 alpha plasma levels (472% and 242%, respectively), a decrease of both PGE2 plasma level (-173%) and PGE2 platelet production (-485%) and a marked lowering of platelet aggregation response to ADP, concomittantly. In contrast, TxB2-related features were poorly affected by ISDN. In coronary sinus blood, the aortic increase in 6KPGF1 alpha and PGF2 alpha plasma levels was detected to a lower extent whereas the characteristics of platelet aggregation had returned to control levels. By contrast, PGE2 plasma level (-191%) and PGE2 platelet production (-133%) were lower than prior ISDN administration. The results we report here, strongly support the view that ISDN promotes release of prostacyclin and PGF2 alpha from the lung and inhibit PGE2 production. These prostanoids may be responsible for the concomittant platelet reactivity lowering, thus providing a basis for understanding how ISDN might relieve myocardial ischemia favoring prostanoid mediated vasodilation and inhibition of platelet reactivity.

6-Ketoprostaglandin F1 alpha↗
PubMed1984

[Genesis of myocardial infarction].

The causes of myocardial infarction (MI) are complex and multiple and may eventually be associated. Two main types of mechanism are thought to be implicated: Functional mechanisms: these are operative in prolonged angina: the difference between MI and angina pectoris is related to the duration of these phenomena and to the resistance of the myocardial cells to anoxia: unsatisfied increase in myocardial oxygen demand, as for example in exercise-induced myocardial infarction; sudden reduction in oxygen supply due to an excessive fall in coronary flow, inadequate vasodilatation, platelet aggregation or coronary spasm. Priviledged cases are presented to demonstrate the reality of these phenomena. These mechanisms can sometimes cause MI by themselves, even when the coronary arteries are normal (5% of cases), and nearly always complicate and aggravate obstruction due to an atheromatous plaque. Organic obstructive lesions: coronary obstruction observed in about 2/3 of cases, sometimes caused by rupture of an atheromatous plaque, is usually the result of coronary thrombosis. The predominance of this mechanism is an argument in favour of it being the principal cause of MI. However, other workers believe that thrombosis is a secondary phenomenon induced by stasis, functional mechanisms or severe stenosis. The clot itself would then cause obstruction even if the primary cause were to regress. Irrespective of the roles of each of these factors it would appear logical to treat the functional mechanisms assumed to be responsible and the coronary thrombosis before the myocardial cells are destroyed by the anoxia.

Coronary Circulation↗