Biomedical subjects
Publications and source records attributed to M de Marneffe.
A case is described of severe Nocardia farcinica infection which mimicked a pulmonary neoplasm with pneumonia, superior vena cava syndrome, pericarditis, and hypertrophic osteoarthropathy. Treatment with trimethoprim-sulphamethoxazole and surgery resulted in complete recovery.
A 17-year-old boy presented with fever, bilateral conjunctival infection, angina and extensive cervical adenopathy. Amoxycillin was started. Ten days later he was admitted to hospital because of persistent high fever, cervical adenopathy, erythema of the pharynx and tongue and lip fissuration. The most important interventions of his first hospitalization were endotracheal intubation because of increasing dyspnoea due to adult respiratory distress syndrome and haemodialysis for renal insufficiency. His admission to our hospital was marked by the echocardiographic discovery of giant coronary aneurysms in the first few centimeters of both right and left coronary arteries. Coronary angiography confirmed giant aneurysm formation of the right and left coronary arteries. Similarly, medium sized arteries (cerebral, hepatic, mesenteric, iliac) presented abnormalities and laboratory findings. This is the first description of adult-onset Kawasaki disease with giant coronary aneurysm formation and more generalized arterial involvement. The severity of the clinical symptoms and the severity of the coronary disease indicates that Kawasaki disease of the adult does not always have a benign course.
To determine the evolution with age, of extrinsic and intrinsic sinus node electrophysiological parameters and to assess the role of each component of the autonomic nervous system relative to age in patients with and without sick sinus syndrome, electrophysiological studies of sinus node function were performed in 227 patients subdivided into four groups according to the results of their electrophysiological testings: group I included patients with normal extrinsic and intrinsic sinus node function, group II patients with exclusive extrinsic sinus dysfunction, group III patients with exclusive intrinsic sinus dysfunction and group IV patients with extrinsic and intrinsic sinus node dysfunction. The electrophysiological study was performed 4 times: at basal state, after sympathetic, autonomic and parasympathetic blockades. Whatever the sinus node function (normal or abnormal) the extrinsic sinus node electrophysiological variables did not correlate with age; inversely all the electrophysiological measurements of the intrinsic sinus node (normal or abnormal) lengthened progressively with age, suggesting an ageing phenomenon of the intrinsic sinus node throughout life. Moreover, the study of the percentage of chronotropy of the sinus node electrophysiological variables shows a predominance of vagal tone in young subjects, whereas sympathetic activity is most prominent in elderly patients with and without sick sinus syndrome. Besides, sympathetic activity increases and vagal tone decreases with increasing age in normals whereas the age-related modifications of each component of the autonomic nervous system in sick sinus patients vary according to the type of sinus node dysfunction. The sinus node (normal or pathological) represents an equilibrated system: the age-related modification of the autonomic nervous system counterbalances the senescence of the intrinsic sinus node in such a way that the basal electrophysiological characteristics remain stable throughout life.
To determine the evolution with age, of extrinsic and intrinsic sinus node electrophysiological parameters and to assess the role of each component of the autonomic nervous system relative to age in patients with and without sick sinus syndrome, electrophysiological studies of sinus node function were performed in 223 patients subdivided into four groups according to the results of their electrophysiological testings: group I included patients with normal extrinsic and intrinsic sinus node function, group II patients with exclusive extrinsic sinus dysfunction, group III patients with exclusive intrinsic sinus dysfunction and group IV patients with extrinsic and intrinsic sinus node dysfunction. The electrophysiological study was performed twice: at basal state and after autonomic blockade. Whatever the sinus node function (normal or abnormal) the extrinsic sinus node electrophysiological variables did not correlate with age; inversely all the electrophysiological measurements of the intrinsic sinus node (normal or abnormal) lengthened progressively with age, suggesting an ageing phenomenon of the intrinsic sinus node throughout life. Moreover, the study of the percentage of chronotropy of the sinus node electrophysiological variables shows a predominance of vagal tone in young subjects, whereas sympathetic activity is most prominent in elderly patients with and without sick sinus syndrome. The sinus node (normal or pathological) represents an equilibrated system: the age-related modification of the autonomic nervous system counterbalances the senescence of the intrinsic sinus node in such a way that the basal electrophysiological characteristics remain stable throughout life.
Since a decade, new treatments have been developed in the field of Cardiology as thrombolysis in acute myocardial infarction, use of angiotension converting enzyme inhibitors in cardiac insufficiency, heart transplantation... Percutaneous transluminal coronary angioplasty has been developed since 1977. The aim of this new technology is to treat myocardial ischemia and appears complementary to coronary artery bypass graft.
The electrophysiologic effects of xamoterol were studied in ten patients with electrophysiologic evidence of sinus node dysfunction. A significant shortening of mean sinus cycle length, maximal corrected sinus-node recovery time, and the mean of the three longest corrected sinus-node recovery times was observed after intravenous administration of 0.1 mg/kg of xamoterol. The atrioventricular (AV) conduction time and the effective and functional refractory periods of the AV node were shortened as the effective refractory period of the atrium. These effects suggest that xamoterol could be tried safely for the treatment of patients with moderate symptoms due to sinus-node disease.
The authors report the case of a 63 year old woman who developed refractory arterial hypoxemia due to a right-to-left interatrial shunt through a patent foramen ovale during the acute phase of right ventricular infarction. The precarious haemodynamic condition of the patient contra-indicated surgical intervention and so the effects of the shunt were reduced by obstructing the atrial septal defect with the balloon of a Swan-Ganz catheter. The management of this type of shunt is discussed based on the degree of hypoxemia and the patient's haemodynamic status with reference to this particular case and a review of the literature.
Clinical variables and those obtained by non-invasive techniques were recorded in a series of 306 patients discharged from hospital after an acute myocardial infarction. We studied the prognostic value at 2 and 12 months of these variables (alive/dead). The results of simple clinical data were as discriminant as those from more elaborated techniques. When the prognostic value of the same data at 12 months was studied in those surviving for two months, most of the predictive variables lost their discriminant power. The study shows that the predictive value of many of the predischarge variables usually taken into account in the assessment of long term risk, does not extend beyond the first two months.
Clinical variables and those obtained by non-invasive techniques were studied prospectively in a series of 306 patients discharged from hospital after an acute myocardial infarction. The predictive value of the data at two and 12 months was assessed by univariate and multivariate analyses. The best correlation was found for age, hypertension, bundle branch block, early and late heart failure, x ray cardiothoracic ratio, digoxin use, the number of metabolic equivalents reached during the stress test, echocardiographic wall motion score index, left ventricular end diastolic diameter, left ventricular ejection fraction, and the presence of an aneurysm. The prognostic value of the same data at 12 months was studied in those surviving for two months. There was a noticeable decline in the relative risk of all but two of the factors (number of metabolic equivalents, ventricular arrhythmias). All of the predictive variables except the x ray cardiothoracic ratio, number of metabolic equivalents, and the presence of an aneurysm lost their discriminant power. The explanation for this is the strength of statistical relations of these variables with the outcome at two months. They continued to influence the score at 12 months even when the entire patient series was considered. In conclusion, the study shows that the predictive value of most of the predischarge variables usually taken into account in the assessment of risk in patients one year after infarction does not extend beyond the first two months.
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.
An electrophysiological study of sinus node function, including measurements of resting heart rate, maximal corrected sinus node recovery time and sinoatrial conduction time, was performed in 30 patients, 12-79 years of age, without any clinical, electrocardiographic or electrophysiological evidence of sinus node disease. To analyse autonomic influences, variables were measured before and after sympathetic and parasympathetic blockade. No significant correlations were observed between age and electrophysiological measurements of sinus node function at the control study or after sympathetic blockade. In contrast, the electrophysiological parameters of intrinsic sinus node activity were correlated with age and showed a progressive lengthening of mean sinus cycle length, of maximal corrected sinus node recovery time and of sinoatrial conduction time. In addition, measurements after vagolysis suggest a progressive decrease of parasympathetic activity with increasing age. These data also indicate that the respective role of the two components of the autonomic nervous system vary with increasing age: parasympathetic activity predominates in younger subjects; sympathetic and parasympathetic tones are equilibrated in older subjects. The normal sinus node function represents an equilibrated system: in parallel with ageing of the intrinsic properties of the sinus node, parasympathetic activity decreases so that basal properties remain stable throughout life.
In a group of 50 patients we investigated the daily reproducibility of the resting heart rate (RHR), the maximal corrected sinus node recovery time (CSNRTM), the pacing rate at which the CSNRTM occurred (OP), and the sinoatrial conduction time (SACT) during basal state. The study population was divided into two groups according to the presence or absence (as evidenced during the initial electrophysiologic study) of sinus node disease: group I included 35 patients with normal sinus node function, and group II included 15 patients with sick sinus syndrome. The electrophysiologic study was repeated approximately at the same hour and under similar conditions after an interval of at least two days (mean: 3.2 days for group I and 4.7 days for group II). The results showed good reproducibility with the exception of RHR in group I which slightly but significantly decreased in the second electrophysiologic study. The daily variations of the sinus node parameters appeared to be of similar levels in the two groups except for the CSNRTM; this parameter showed wide variations in single values in both groups, more marked in group II than in group I. Furthermore, if the CSNRTM and/or SACT were normal, it was likely that they would remain normal whatever the electrophysiologic status of the patient. Inversely, the change of status from abnormal to normal CSNRTM or SACT was not uncommon in patients with electrophysiologic signs of sinus node disease.
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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.
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Marcellomycin is a new anthracycline that was proposed for clinical trials on the basis of experimental data suggesting reduced potential for hematologic and cardiac toxicity as compared to conventional anthracyclines. This phase I trial was designed to determine the maximum tolerated dose of marcellomycin at a single-dose schedule. The drug was given as a 15-to 30-min i.v. injection. Eighteen patients with a variety of solid tumors received a median of 2 courses (range: 1-5) at doses of 5-60 mg/m2. Myelosuppression was dose-limiting and somewhat unpredictable. It was characterized by early thrombocytopenia and late leukopenia. It occurred at doses greater than or equal to 40 mg/m2 and resulted in a few cases of infection and hemorrhage. Nausea, vomiting and stomatitis were frequent and occasionally severe. Other common non-hematological toxic effects consisted of local phlebitis and fatigue. Electrocardiographic changes were also encountered. Hair loss was rare and negligible. No antitumor activity could be detected. It appears that phase II trials should be preferably restricted to ambulatory patients and that a dose schedule of 50 mg/m2 repeated every 3 weeks may be proposed for this favorable patient population.
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Physical activity during leisure time and on the job have been measured with standardized interview techniques in 1,513 normal men, aged 40-55 years, who were regularly employed in different industries. Physical fitness was simultaneously estimated by measuring the work load at which a heart rate of 150 bpm was reached on a standardized exercise test. The median energy expenditure from leisure time activities above the basal metabolic rate was 195 kcal/day; 19% of these activities were classified as heavy, 37% as moderate and 43% as light intensity. The median energy expenditure from job physical activity was 1,676 kcal/day including basal metabolic rate. The median physical fitness level was 125 W. The leisure time activity score was significantly related to physical fitness through the light and the heavy intensity subscores. Independently, job physical activity was also significantly related to physical fitness. However, both activity scores accounted for only 2% of the variance in physical fitness. The data illustrate an overall low energy expenditure profile of middle-aged normal men and a low order relationship between physical activity pattern and physical fitness.