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Biomedical subjects

M Ewalenko

Publications and source records attributed to M Ewalenko.

5 recordsLinked to original sources
PubMed2002

[Scuba diving: practical aspects].

Keeping in mind some fundamental physic's laws permits to better understand the risks of scuba diving. Essentially, it concerns Boyle's-Mariotte's law (pressure/volume relationship), Dalton's and Henry's laws on the gases partial pressures. Contra-indications of scuba diving depend on the possibility of accidents due to preexisting diseases. The most frequent accidents occur in the O.R.L. and pulmonary systems with the risk of barotraumas, and also in the cardiovascular system with the risk of fainting, uncontrolled ascent to the surface and even drowning. The aptitude test is essential to evaluate and minimize these risks with judicious advices. Generally, complementary tests are performed. In some cases, diving must be limited to "recreational diving", and sporting deep diving, where the conditions are more tiring and hard, must be discouraged. A list is added to the paper, to assist those with any medical problem related with scuba diving, to find informations and advices.

Accident Prevention↗
PubMed1999

[Fenfluramines and cardiac valvular lesions].

We report cardiac valvulopathy occurring after prolonged intake of anorectic drugs containing fenfluramine (Fen) and/or dexfenfluramine (D-Fen) in 14 patients whose evolution was followed by Doppler echocardiography. A relation between these drugs and valvular regurgitation was first suspected after 4 cases reported in 1991-1992 and confirmed after 3 more patients in 1993-94-95, who were taken D-Fen or Fen alone. All were women, aged 42 to 73 years. Patient 1 to 7 had been taking Fen and/or D-Fen for 14 to 52 months. Patients 8 to 14 had been taking a mixture of Fen and/or D-Fen, diethylpropion and chinese-herbs for 3 to 69 months. These last 7 patients developed renal failure requiring hemodialysis or peritoneal dialysis in 5 and subsequent renal transplantation in 4. All presented with cardiac murmur(s) and some with dyspnea or palpitations. An initial echocardiography was performed at the time of diagnosis, and was repeated annually for a follow-up period extending to 8 years. We conclude that a relation between Fen and/or D-Fen and the outbreak of valvular heart disease is identified in our patients, confirming previous findings. The nephrotoxicity observed in 7 patients is due to the "chinese-herbs". When Fen and/or D-Fen are stopped and proper therapy initiated, the cardiac symptoms may stabilize or even subside, though slowly. Hemodynamic unstability and/or infection appear to be an aggravating factor. These patient's follow up must be prolonged for several years and is readily achieved with echocardiography. Systematic screening of all patients having taken Fen and/or D-Fen must be performed, as renal and urinary screening for all patients having taken chinese-herbs. Endocardial prophylaxis must always be prescribed.

Adult↗
PubMed1986

Predictors of early death after acute myocardial infarction: two months follow-up.

Clinical variables and the results of non-invasive tests (exercise test, echocardiogram, gated equilibrium radionuclide ventriculography and 24 h ECG) were recorded in a series of 202 patients who left the hospital alive after an acute myocardial infarction. The short term (two months) predictive value of all these data was prospectively assessed by uni- and multi-variate analysis. The best correlation with early death was observed with the variables related to the extent of infarction and left ventricular dysfunction, namely: early clinical signs of heart failure, high peak CK-MB level, complete bundle branch block, increased cardiothoracic ratio on chest X-Ray, number of Mets reached during the stress test, echocardiographic dyskinesia index, and decreased left ventricular ejection fraction as measured by radionuclide ventriculography. Using multi-variate stepwise discriminant analysis, the following independent prognostic factors appeared by order of entry: early clinical signs of heart failure, peak CK-MB level and cardiothoracic ratio on chest X-Ray. These results highlight the short-term predictive value of the data related to left ventricular dysfunction and especially of simple clinical data for patients surviving an acute myocardial infarction.

Acute Disease↗
PubMed1985

High-dose intravenous thrombolytic therapy in acute myocardial infarction: efficiency, tolerance, complications and influence on left ventricular performance.

Ten patients with acute myocardial infarction (AMI) underwent coronarographic studies before, immediately after and ten days after an intravenous infusion of 1 500 000 I.U. streptokinase (STK). Mean time between onset of symptoms to initiation of STK infusion was 03 hours 34 minutes. Occlusion of the infarct-related vessel was present in all of them and successful thrombolysis was obtained in 8 of the patients. Systemic fibrinolytic activity was present in 9 patients, one of whom required a transfusion of blood because of severe bleeding. At ventriculography, the global left ventricular ejection fraction and the regional ventricular ejection fraction, whatever the area involved, showed no significant improvement 10 days after the procedure. This suggests that high-dose intravenous STK in AMI, although causing an effective thrombolysis, does not seem to improve early myocardial function.

Adult↗