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Biomedical subjects

M Riachi

Publications and source records attributed to M Riachi.

15 recordsLinked to original sources
PubMed1998

Diameters of acute proximal and distal deep venous thrombosis of the lower limbs.

BACKGROUND: Duplex ultrasonography of the veins in the diagnosis of deep venous thrombosis (DVT) can be interpreted in a semi-quantitative mode by measuring the antero-posterior (AP) diameter of the thrombus. We report the values of the diameters of thrombi and the factors influencing these values. Therefore we propose a quantitative definition for DVT in duplex ultrasonography. METHODS: 1,017 patients (3,767 thrombosed venous segments), referred to the Emergency Angiology Unit from January 1994 to September 1996. Characteristics: 55% F, 45% M; mean age 68+/-18 years; 624 proximal DVT (61%) and 393 distal DVT (39%). Measurement by venous echography of the antero-posterior diameters of thrombi at 25 predetermined sites in the area of the vena cava. RESULTS: (In mm, median, 10th and 90th percentiles after regrouping of contiguous anatomical sites not statistically different): thrombus in the common iliac veins and the inferior vena cava (12 mm, 7-17); external iliac and common femoral veins (9 mm, 5-14); superficial femoral, deep femoral and popliteal veins (6 mm, 4-10); calf veins (5 mm, 4-8). The age of the patients, their sex, body mass index (BMI), whether they were in- or outpatients or the laterality of the thrombus never significantly influenced its diameter. CONCLUSIONS: It is very unusual to observe a diameter of under 5 mm in cases of DVT. For clinical research therefore, we propose 5 mm as the minimum threshold value for this diagnosis. This value could be used in the venous echographic definition of DVT, as a criterion for inclusion in a therapeutic trial, for example, or in an epidemiological study.

Aged↗
PubMed1997

[Value and limitations of pulmonary scintigraphy/venous duplex Doppler echography in the management of pulmonary embolism].

PURPOSE: To assess the accuracy of diagnostic strategy of pulmonary embolism (PE) based on clinical examination, lung scan and venous duplex US findings. METHODS: 1,819 patients have been included in a prospective study (mean age: 66, range: 6-102, F 54% H 46%) over a 13 month period. RESULTS: To decide the opportunity of anticoagulant therapy, lung scan alone is decisive in 30.6% of the cases. When taking into account clinical examination, lung scan and venous duplex US findings in a combined diagnostic strategy, a therapeutic decision can be made for 74.2% of the patients. The decisive characteristics of this strategy were influenced by two factor: age (therapeutic decision can be reached for 83% of the patients aged 30 to 50 vs 65% when they are over 85, p < 0.01); history of heart or pulmonary disease (therapeutic decision reached in 62% of the cases with history vs 78% without, p < 0.01). CONCLUSION: Pulmonary angiography seems theoretically necessary in less than 26% of the patients with suspected PE when they have undergone lung scan and venous duplex US. In this case, and when these strategies are not very decisive, it would be important to assess the diagnostic value of spiral CT scanning.

Adolescent↗
PubMed1997

Pulmonary embolus as a complication of femoral venous catheter removal.

The case of a 31 year old woman who developed asymptomatic pulmonary emboli after removal of a femoral venous catheter is reported. A deep venous thrombus had previously been shown to be associated with the catheter. Therefore it is argued that care should be taken when removing femoral lines especially in patients at high risk of thrombosis and that femoral venous duplex scan may be warranted prior to line removal in these high risk patients.

Adult↗
PubMed1996

[Short-term change in sural venous thrombosis in patients in surgical intensive care when anticoagulants are contraindicated].

Venous thrombo-embolic disease in neurosurgical and surgical intensive care units is a frequent disorder (between 4.3 and 43 per cent of patients according to studies). The treatment is often difficult. We carried out a retrospective study from January 1994 to September 1995 of 57 patients in neurosurgical and surgical intensive care who developed thrombosis of a sural vein and in whom anticoagulant at therapeutic doses was contraindicated. After a median follow up 14 days echography showed proximal extension of the thrombosis in 4 patients and distal extension in 3 others. Five cases of pulmonary embolism occurred during the follow up period, one of which led to death. No complications (pulmonary embolism or proximal extension of venous thrombosis) occurred in those patients receiving heparin at prophylactic doses (0/11 versus 8/46 in the non-heparin group; p = 0.13). No case of pulmonary embolus occurred in those patients with partial or complete regression of the thrombosis (0/21 versus 5/36 in the group with stable or extending thrombi, p = 0,05). Echographic monitoring enabled therapeutic modification in 5 cases. These results indicate that sural venous thrombosis in the context of neurosurgical and surgical intensive care is a potentially grave situation and that the prescription of anticoagulant therapy even at preventive dose should always be considered. Further, we propose regular echographic monitoring until the patient is mobile.

Adult↗
PubMed1995

[Partial interruption of the inferior vena cava using a Greenfield titanium percutaneous filter. Present indications and evaluation].

We report a prospective study of 39 patients who presented thromboembolic disease (TED) treated by partial interruption of inferior vena cava (PIIVC) with Greenfield Titanium filter. We observed 2 recurrent pulmonary embolisms, 1 symptomatic deep venous thrombosis and 2 asymptomatic filter thrombosis. With 1 year follow up, the survival probability is of 85%. Concerning the 12 last years evolution in our hospital, we note that the approach of TED diagnosis and treatment by a central, specialised team within the hospital care structure has lead to a reduction in the number of severe cases of TED, and consequently of PIIVC. So the use of percutaneous filters has not lead to an increase in the real rate of PIIVC performed but to a decrease (21% of patients with TED in 1982 vs 8% in 1993).

Adult↗
PubMed1993

[Baroreflex regulation and blood pressure variability during rest in the hypertensive patient].

The object of this study was to compare the variability of blood pressure measured non-invasively with the Finapres under resting conditions in hypertensive patients with non-hypertensive subjects matched for age, and to evaluate the relationship between resting blood pressure, i.e. without any stimulation, and the sensitivity of the baroreflex evaluated by crossed spectral analysis (SA). Thirty-four hypertensives (WHO criteria) untreated for three weeks, with a mean age of 50 +/- 7 years, were compared with 60 control subjects with a mean age of 50 +/- 9 years. The blood pressure and heart rate were measured continuously in the dorsal decubitus and standing positions. The direct and crossed SA was undertaken by a specific programme using the fast Fourier method. The average blood pressure of controls differed significantly from that of the hypertensive population (118 +/- 15/65 +/- 10 mmHg vs 157 +/- 20/86 +/- 11 mmHg). The mean heart rate of the hypertensives was faster: 76 +/- 11 vs 67 +/- 10 beats/min (p < 0.001). Under basal conditions, there was greater absolute variability in the hypertensive subjects but the relative variability and heart rate were the same as those of the controls. Direct SA provided additional data by showing that this variability was due to LF oscillations. Crossed SA showed a change in the sensitivity of the slope of regulation of the baroreflex in hypertensives, 7.35 vs 8.68 ms/mmHg (p < 0.05). These results show that, under basal conditions, it is possible to demonstrate an increase in the absolute variability in blood pressure in hypertensive patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Evaluation of the aging change in cardiac autonomic nervous system by automated clinical measurement].

The object of this study was to establish normal values for age of clinical tests of autonomic nervous system activity based on an automatic measuring system. Ninety-seven subjects (50 M/47 F) aged 20 to 85 years (average 45 +/- 13 years) with a normal clinical examination and no medication were included in the study. The blood pressure (BP) and heart rate (HR) were measured continuously with the Finapres system. After a resting period, the BP and HR were measured continuously in 5 different situations: dorsal decubitus position for 7 minutes; on getting up actively in less than 3 seconds and for 9 minutes in the upright positions, during deep breathing at 6c/min and Valsalva manoeuvre during a handgrip test at 30% of maximal voluntary strength for 3 minutes. A specific programme (ISN-CNRS) initiated the calculations of the test and performed direct and crossed spectral analysis in the lying and standing positions. The average BP was 120 +/- 18/66 +/- 11 mmHg and HR was 67 +/- 9 b/min. A negative linear correlation was observed with age with respect to the 3 tests investigating vagal activity: 30/15 ratio, spontaneous variations of respiration and HR, ratio of HR at the end of Valsalva with r = -0.43, r = -0.60, r = -0.34 (p < 0.001). The other two tests: variation of systolic BP 1 min 30 after standing and variation of diastolic BP during the handgrip did not change with age.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Segmental arterial compliance of the radial artery: physiological role of age, hypertension and type I insulin-dependent-diabetes].

OBJECTIVE: To study the structural modifications of a muscular and medium-size radial artery as regards age, in normal subjects (NT) and HT and DTI. MATERIAL AND METHODS: Transverse study with 39 NT aged 48 +/- 16 years, were compared to 22 HT, aged 50 +/- 11 years, and to 22 DT aged 37 +/- 12 years. An echo-tracking system (NIUS 01, Asulabs, Neuchatel, Switzerland) were used to measure the systolic (Ds) and diastolic diameter (Dd) and derive three indices of compliance and storage capacity: systolo-diastolic variation of cross sectional area VSCA = tau [(Ds2/4)-(Dd2/4)] mm2, operative arterial compliance CA = tau Dd (Ds-Dd)/2 (PAS-PAD) in mm2/mmHg. RESULTS: 1. In NT, Ds and Dd increased significantly with age (p < 0.01), likewise the VSCA, and CA (p < 0.002). 2. In HT and DTI, when age was taken into account, the Ds and Dd were significantly greater than in control but VCSA and CA were higher in HT and lower in DT. CONCLUSION: Similar to ageing changes in NT, HT lead to increase in medium-size radial artery the diameter and storage capacity, while to decrease in DT. This suggests that opposite cardiovascular load induce opposite modifications in arterial wall structure leading to reduce the wall stress.

Adult↗
PubMed1993

[Placenta percreta and uterine rupture. Apropos of 2 cases].

The authors present two cases of uterine rupture by placenta percreta at 27 and 36 weeks of gestation. Conservative treatment was used in the first case, and radical in the second. Concerning placenta percreta, an overview is presented. The pathophysiology is unclear, but a perturbation in the equilibrium between the trophoblast and the caduque is accepted. Many factors, maternal uterine and placental, contributes to this situation. Clinical presentations are hemorrhage, uterine inversion or rupture. The disappearance of the retroplacental anechogenic zone is the recent ultrasound's contribution to the early diagnosis. The treatment is either radical which is the treatment of choice or conservative and the methotrexate could be an interested option.

Adult↗
PubMed1992

Relationship between low-frequency oscillations of blood pressure and changes in arterial diameter.

AIM: To study spontaneous variations in radial artery compliance. METHODS: Compliance was evaluated non-invasively by an echo-tracking system, and variations in sympathovagal tone were analysed by a spectral analysis of continuous blood pressure recordings using a Fast Fourier algorithm. We studied 23 healthy volunteers, aged 25 +/- 4 years (mean +/- SD), at rest, on two occasions at least one day apart (5 +/- 3 days). RESULTS: There were no significant differences between the means of the arterial compliance measurements and those of the corresponding spectral analysis. However, the magnitude of change in the low-frequency periods (4-66 mHz) was significantly related (P less than 0.01) to a significant and inverse change in compliance for the same level of blood pressure. CONCLUSIONS: While it is possible to use spectral analysis to measure the effect of autonomic nervous regulation on radial artery properties, low-frequency periods cannot be safely ascribed to sympathetic effects alone. Other effects must also be taken into account in measurements of radial artery distensibility.

Adult↗
PubMed1992

[Methods of computerized approach of dysautonomia from a non-invasive pressure signal].

OBJECTIVE: examination of an automated exploration of autonomic neuropathy using the Ewing score and evaluation of sympatho-vagal tone. MATERIAL: continuous non-invasive collection of blood pressure (BP) data by means of Finapress fingerprobe. The signal was analysed after digitization at 500Hz, sampled and computerised. Values of systolic BP (SBP), diastolic BP (DBP) and heart rate (HR) are analysed by Anapres (Notochord). PROTOCOL: the pressure monitor is placed on the finger and the reading calibrated to the BP value recorded by auscultatory method on the contralateral arm to give a gap of less than 10 mmHg. BP and HR response to five different manoeuvres are recorded, namely: at rest over 7 minutes, after lying decubitus for 15 minutes; on rising suddenly over 3 seconds, and then over 9 minutes standing still; during 2 respiratory manoeuvres (a) deep breathing over 6 cycles per minute, (b) Valsalva pressure at 40 mmHg sustained over 20 seconds; isometric exercise with sustained handgrip at 30% maximal force sustained over 3 minutes. ANALYSIS: a dedicated computer programme displays in graphic form BP and HR over each manoeuvre and allows the operator to locate the exact cut-off of normality for each test of the Ewing score and also measure the balance of sympatho-vagal tone by Fourier transformation of the interval data of HR or BP peaks. APPLICATION: this approach allows evaluation of autonomic function and sympatho-vagal tone by means of 40 minutes of clinical testing and two minutes of automated analysis. This approach seems useful in the assessment of the autonomic nervous system in diabetes.

Autonomic Nervous System Diseases↗
PubMedDate not supplied

[Lung cancer in Lebanon. Experience at the l'Hôtel-Dieu de France in Beirut].

All lung cancer cases admitted in our hospital from the 1st of January 1979 to the 31st of December 1995 were reviewed to allow for the study of the "behaviour" of the disease in Lebanon. A total of 386 cases included 87.5% males and 12.5% females. Mean age was 60 years. 87.3% were smokers. Squamous cell carcinoma was the most frequent histologic type (37.3%) and predominant in men. Adenocarcinoma was more frequent in women (50% v/s 29.9%). Patients often consulted their physician after delays of several months. Diagnosis is commonly confirmed by bronchoscopy. Transthoracic needle aspiration has become, since 1990, a very useful procedure for diagnosis of peripheral lesions with a sensitivity of 90.6%. Metastases are recorded in 30.9% of cases. Histological type distribution and advanced cancer stages found in our study are similar to that encountered in extensive international studies over the last few decades.

Adenocarcinoma↗