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Biomedical subjects

M Dallocchio

Publications and source records attributed to M Dallocchio.

At least 55 records · Page 3Linked to original sources
PubMed1990

[Value and limitations of transthoracic Doppler echocardiography in the diagnosis of thromboses of mechanical valve prosthesis. Report of 19 cases].

The diagnosis of thrombosis of a valvular prosthesis is difficult especially in cases of partial thrombosis. The authors report 19 cases of partial thrombosis of mainly (16 cases) mechanical valve prostheses confirmed by radioscopy and treated either by reoperation or fibrinolysis. Mitral Valve Prostheses: 14 cases (6 Björk, 7 SJM, 1 Carbomedics). All but one case showed significant prolongation of the pressure half time compared with the postoperative reference value. In one case, however, the functional parameters of the prosthesis were normal; the diagnosis was made from the finding of a mobile thrombus on the ventricular surface of the prosthesis. Aortic Valve Prostheses: 5 cases (3 Björk, 1 SJM, 1 Duromedics). Continuous wave Doppler showed significant increases in the velocity of transprosthetic blood flow with respect to the postoperative reference values. Accurate analysis of the mobile elements of the prostheses was usually impossible. These results show that transthoracic Doppler echocardiography remains an excellent method of study and surveillance of mechanical valve prostheses but the limitations of the technique should be familiar to all operators.

Aged↗
PubMed1990

[Two-dimensional echocardiography in the diagnosis of intracardiac metastases].

The authors describe the echocardiographic features of 19 cases of intracardiac metastatic tumours diagnosed over a 5-year period. The cardiac appearances were very varied: pericardial effusion alone or associated with an intrapericardial tumour (9 cases), myocardial infiltration (9 cases), immobile or mobile intracavitary tumour sometimes simulating a myxoma (15 cases). In 18 out of the 19 cases, the tumour mass was hyperechogenic which made it easy to diagnose. However, in one case of right atrial tumour, the mass was hypoechogenic and the diagnosis could only be made by contrast echocardiography. This study illustrates the important role that two-dimensional echocardiography plays in the non-invasive diagnosis of intracardiac metastatic tumours but physicians should be aware of the potential pitfalls and limitations of the technique.

Aged↗
PubMed1990

[Value of Doppler color echocardiography in the diagnosis of diastolic mitral insufficiency in severe aortic insufficiency. Report of 2 cases].

The authors report the value of Doppler color flow mapping in the diagnosis of late diastolic mitral regurgitation in two patients with severe post-endocarditis aortic regurgitation requiring rapid surgical intervention. Doppler color flow mapping played an essential part in the management of these cases by helping in the diagnosis of late diastolic mitral regurgitation which is known to carry a very poor prognosis in this context.

Aortic Valve↗
PubMed1990

[Incidence and severity of cardiac involvement in Streptococcus bovis septicemia. Report of 10 cases].

Endocarditis due to the streptococcus Bovis is an affection which is more and more often recognized and whose link with the colic tumor pathology has been well established those last few years and confirmed in this study with a frequency of 60 p. cent. However, few studies have stated the gravity of the heart affection in streptococcus Bovis septicaemias. In this series of 10 streptococcus Bovis septicaemias, the valvular affection is frequent and serious. The vegetations are found in 9 cases out of 10. The aortic affection is slightly more frequent (8 times out of 10), against 7 times out of 10 for the mitral affection (double mitroaortic affection, 6 times). A valve replacement due to sub-acute or chronic cardiac failure was necessary in 6 cases out of 9, that is 66 p. cent. The mortality was nil.

Aged↗
PubMed1990

[Value and limitations of the measurement of the jet diameter in aortic insufficiency using Doppler color. Report of 68 patients].

The aim of this study is to specify the feasibility and value of the diameter measurement of the jet of aortic insufficiency (AI) in colour Doppler. 68 consecutive patients had a supra-sigmoid angiography and a colour echo-Doppler. An aortic insufficiency was revealed 58 times by the angiography and Doppler. In all the cases except four, it has been possible to measure the jet diameter at the origin in para-sternal incidence in colour TM by confronting the images in great and small axis section. The Doppler results have been compared to the angiographic score in 4 grades according to Sellers classification. The jet diameter at the origin in colour TM is significantly different in groups I, II, III-IV. In the group III-IV, it is always higher or equal to 13 mm. The failures of quantification of the AI jet in colour Doppler are linked with the very eccentric nature of the jet or to the poor quality of the echo-Doppler imaging. On the whole, the jet diameter measurement proves to be a very useful element in the assessment of the gravity of an AI, particularly when it is a central and circular jet.

Adult↗
PubMed1990

[Treatment of post-reno-contusive arterial hypertension by upper polar nephrectomy. Results after 10 years].

The authors report the observation of arterial hypertension occurring six years after renal trauma, secondary to the upper polar infarction of the left kidney accompanied by a hypersecretion of bilateral renin and whose cure was obtained by partial nephrectomy. According to a literature review, it seems that post-reno-contusive arterial hypertension is not rare and can be due to various lesions whose common denominator is renal ischaemia. At present, no clinical or paraclinical element enables the prediction with certainty of the reversibility of the hypertension after the surgical intervention. However, the earlier the intervention, the better the chances of recovery, thus showing the importance of the systematic screening of renal lesions after lumbo-abdominal trauma.

Child↗
PubMed1989

Left ventricular mass changes with nicardipine therapy in essential hypertension.

Eighteen hypertensive patients (13 males, 5 females; age 48 +/- 13; diastolic blood pressure greater than 95 mmHg), either previously untreated or who had been off treatment for more than 3 months, underwent M-mode echocardiography before (DO) and after (D90) 3 months of nicardipine therapy (60-90 mg/day). All echocardiograms were read blind, and left ventricular mass (LVM) was calculated (Devereaux's formula). Blood pressure was significantly reduced after 3 months from 167 +/- 15/102 +/- 8 mmHg on DO to 152 +/- 16/92 +/- mmHg on D90 (p less than 0.001). The reduction in LVM was not significant: 266 +/- 95 g on DO, 247 +/- 78 g on D90. There was a trend to a higher (although nonsignificant) LVM reduction in patients with left ventricular hypertrophy at entry (-11%, n = 11) than in patients without left ventricular hypertrophy (-2%), n = 7).

Adult↗
PubMed1989

Left ventricular mass in normotensive subjects. Importance of blood pressure response to activity.

Recent works have shown the importance of blood pressure (BP) response to exercise or to daily activity as determinants of hypertensive cardiac hypertrophy. We have tested the relationship between BP and left ventricular (LV) mass in 23 normotensive young adults (mean age 25 +/- 5) with normotensive parents. Blood pressure was measured at rest, at the end of maximal exercise test, and during 24-hour ambulatory monitoring during daily routine. Left ventricular mass was assessed with M-mode echocardiography. We found a closer relationship between LV mass with BP when measuring during activity (average day time BP and end exercise BP) than with rest BP (rest BP and average nighttime BP). Multiple regression analysis indicates an independent association of LV mass with both average day time and end exercise systolic blood pressure. Thus, we conclude that these two ways of assessing "activity" BP may be more complementary than opposing. Ambulatory BP monitoring appreciates the reactions to daily stresses and the exercise test measures the response to physical activity.

Adult↗
PubMed1989

Captopril test in the detection of renovascular hypertension in a population with low prevalence of the disease. A prospective study.

The value of the captopril test as a screening test for identifying renovascular hypertension has been outlined by several studies performed in populations with a high prevalence of renovascular disease (20% to 50%). We prospectively assessed the value of the test in 103 hypertensive patients referred to our center for evaluation of their hypertension. They had taken no diuretics and no converting-enzyme inhibitors for more than four days. The interpretation of the results of the test was done according to the criteria defined by Muller et al. All patients underwent a digital venous angiography and when positive or doubtful, a conventional angiography. Eleven patients (10%) had unilateral or bilateral artery stenosis greater than 70%. The sensitivity of the test was 73% with a specificity of 84% and a positive predictive value of 35%. The three patients with a false negative test underwent a surgical treatment or a transluminal angioplasty of the stenosis but remained hypertensive. Thus, the captopril test is a useful screening test for identifying patients with renovascular disease, even in a population with a low prevalence of the disease.

Captopril↗
PubMed1989

Relationship between left ventricular mass and noninvasive monitoring of blood pressure.

We studied the relationship between left ventricular mass index (LVMI) and blood pressure (BP) monitored during 24 hours in 35 normotensive and 58 hypertensive patients with no treatment for more than three months. We found a close correlation between LVMI and the average daytime systolic BP (r = 0.68). Other parameters derived from BP monitoring were also correlated with LVMI: daytime diastolic BP (0.54), nighttime systolic and diastolic BP (0.61 and 0.54), pulse pressure (0.58), the average of the five highest systolic and diastolic BP (0.57 both), and the percentage of systolic BP above 140 mm Hg (r = 0.64). However, in a stepwise multiple regression analysis only daytime systolic BP was independently correlated to LVMI. The standard deviation of systolic BP was not significantly correlated to LVMI. The same positive correlation between daytime systolic BP and LVMI was found in normotensive and hypertensive patients, males and females, and patients with and without left ventricular hypertrophy. So, at least regarding the prediction of the degree of left ventricular hypertrophy, the average systolic BP during daytime seems to be the only valuable parameter to look at in ambulatory BP monitorings of untreated hypertensive patients.

Adult↗
PubMed1989

[Association of sacciform aneurysm of the renal artery and hypertension. Cause or coincidence? Apropos of a case].

Aneurysms of the renal artery are seldom encountered. They present as different aetiopathological types. We report the case of a female patient who had both severe arterial hypertension and an apparently dysplastic aneurysm of the right prepyelic artery. Resection of the aneurysm failed to have the effect we expected on arterial hypertension. The relationship between arterial hypertension and aneurysm of the renal artery is discussed.

Adult↗
PubMed1989

[Prognostic value of arterial pressure during exertion in hypertensive subjects].

UNLABELLED: We reviewed the course of 240 patients with uncomplicated essential hypertension whose condition has been initially evaluated between january 1976 and february 1979 with both exercise (bicycle) and casual BP. Their outcome was evaluated in the first months of 1988. Thirty-eight patients were lost to follow up. The remaining 202 patients (67 p. 100 males, mean age at entry 43 +/- 13 years, mean casual BP at entry 161 +/- 25/98 +/- 15) had a mean follow-up of 9.5 +/- 2 years. Events retained for the analysis were myocardial infarction (n = 12), angina pectoris with positive coronarography (n = 8), stroke (n = 8), cardiac failure (n = 2) and sudden death (n = 3). We performed a stepwise discriminant analysis first with only casual and end exercise systolic and diastolic BP, then after introducing age, overweight (Lorentz's formula), duration of hypertension, Sokoloff index and cholesterolemia. RESULTS: the analysis with only BP shown that end exercise BP was the best predictor of outcome with 64 p. 100 of the subjects correctly classified (CC). After introducing the other risk factors, the significantly discriminant variables were 1) overweight (65 p. 100 CC) 2) age, 3) end exercise systolic BP, 4) cholesterolemia. These 4 variables adequately classified 70 p. 100 of the subjects. Another analysis was performed in patients with maximal exercise test and gave the following results: 1) overweight, 2) cholesterolemia, 3) end exercise systolic BP with 77 p. 100 patients CC. In women, the pronostic value of exercise BP seems less important than in men.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

[Data of programmed ventricular stimulation in left ventricular hypertrophy of hypertensive origin].

Various studies have established the increase of sudden death in hypertensive patients with left ventricular hypertrophy (LVH). In order to specify its most important factors, an electrophysiological study consisting of Holter recording (HR) and programmed ventricular stimulation (PVS), was performed in 24 patients with hypertension: 12 with LVH and 12 without LVH, on ultrasonography. In all patients, coronary angiography was normal. The results are the following: 1) LVH increases the ventricular vulnerability, this arrhythmogenic substrate and its stability are explored by PVS; 2) HR and PVS are not correlated, therefore HR does not explore the arrhythmogenic substrate of LVH, but rather the potential triggering factors of severe rhythm disorders; 3) it has not been possible to evaluate the role of the autonomous nervous system in this study; 4) finally, a significant correlation was found between the degree of anatomical hypertrophy of the LV and the duration of the interval AH.

Adult↗
PubMed1989

ACE inhibitors in mild to moderate hypertension: comparison of lisinopril and captopril administered once daily. French Cooperative Study Group.

A double-blind, parallel-group, multicentre study was carried out to compare the effects of once-daily treatment with lisinopril 20 mg and captopril 50 mg in 304 patients with mild to moderate hypertension. Following a 2-week placebo run-in period, patients with a lying DBP between 95 and 115 mmHg were randomised to either active treatment for 10 weeks. BP measurements were made approximately 24 h after the previous dose of either drug. After 6 weeks, hydrochlorothiazide 25 mg once daily was added for patients with a lying DBP greater than or equal to 95 mmHg and a final assessment was made in all patients after a further 4 weeks of treatment. After 6 weeks of monotherapy, lisinopril had reduced lying and standing BP by an average of 18/14 mmHg and 19/12 mmHg, respectively, compared with 15/12 mmHg and 14/11 mmHg respectively for captopril. The larger fall in SBP with lisinopril was statistically significant (lying SBP, P = 0.01; standing SBP, P = 0.0001). In addition, a significantly larger proportion of patients achieved BP control (DBP less than 95 mmHg) with lisinopril than with captopril (79% versus 67%; P = 0.02). Neither drug significantly altered heart rate. The addition of hydrochlorothiazide in some patients produced a further, small reduction in mean BP in both groups although, 10 weeks after randomisation, the proportion of patients in whom BP control had been achieved with lisinopril was still significantly greater than that achieved with captopril (90% versus 79%; P = 0.02). Both drugs were well tolerated and no serious adverse events occurred during the study.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

[Role of beta-blockers in the treatment of arterial hypertension].

The introduction, more than twenty years ago, of beta-blockers in the treatment of arterial hypertension, represented a significant advance. With these medications, many hypertensive patients are effectively under control and malignant hypertension is practically inexistent. Today, the treatment of hypertension is markedly improved with the development of new, active medications, while the beta-blockers family has markedly evolved. The role of beta-blockers in the treatment of hypertension, must therefore be re-evaluated according to their properties as compared to those of other classes of antihypertensive medications. Indeed, there are standard contraindications to he use of beta-blockers, sometimes resulting in adverse reactions, either clinical (fatigue, sexual disorders, vasomotor syndromes)--much less frequent with the new molecules--or biological (especially serum lipid levels), the consequences of which remains ill-defined--some beta-blockers appear practically without any harmful effect. Actually, despite these drawbacks, usually minimal, there are numerous and strong arguments in favor of the use of beta-blockers in the treatment of hypertension: 1) their significant follow-up in the treatment of hypertension; this is a well-known argument; 2) their effectiveness in hypertension, as a single drug and single daily dose; 3) their cost, which is lower than that of new anti-hypertensive medications; 4) their cardio-protective role, demonstrated by experimental data (myocardial protection and anti-arrhythmic effect in experimental ischemia), and clinical data (improvement of left ventricular hypertrophy, control of blood pressure increase during exertion and stress, secondary prevention after myocardial infarction).(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗
PubMed1989

[Persistent arterial hypertension].

Antihypertensive therapy has markedly improved, in the last few years, but, in some patients, the blood pressure remains high despite an association of several medications. We are proposing to consider as persistent or refractory, any essential hypertension remaining higher than or equal to 165/95 despite a well administered triple therapy, initiated since at least one month. With such patients, the first step consists in verifying the various terms of the definition: measurement of the blood pressure under standard condition and, at best, over a long period of time, in ambulatory conditions; re-evaluation of the drug combination (synergistic action); observance of the treatment by the patient; re-investigation of the etiology; determination of the resistance factors to the treatment. The treatment should then be patiently and methodically reviewed, based on the most potentialized combinations, taking into consideration the first signs of occurrence of the hypertension, without neglecting hygieno-dietetic measures. Sometimes, it will be necessary to resort to more potent treatments, which are more delicate to handle.

Drug Resistance↗
PubMed1989

[Low blood pressure].

When facing a chronic hypotension, underlying chronic diseases must be ruled out. In most cases, it concerns a "constitutional" benign, low blood pressure, however ill-tolerated and associated with neurovegetative dystonia. In so far as it is not a disease, there is no specific treatment. The long-term prognosis is excellent since symptoms usually improve with years and a low blood pressure is a sign of longevity.

Humans↗