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Biomedical subjects

P Bernadet

Publications and source records attributed to P Bernadet.

At least 19 recordsLinked to original sources
PubMed1995

Benefits of physical activity in the prevention of cardiovascular diseases.

Today it is undisputed that physical exercise and sports activity have beneficial effects in the prevention of cardiovascular diseases. Heberden, who in 1772 brilliantly described the clinical manifestations of angina pectoris, anticipated the benefits of physical exercise when he asked whether "chopping wood for 30 min every day would not be a remedy." These beneficial effects have been demonstrated in primary and in secondary prevention after a heart attack or coronary event. Physical rehabilitation enables patients to recuperate quickly, and provides optimal conditions for their reintegration into professional, social, and family life after a temporary incapacity. Since the days of Heberden, physical exercise and rehabilitation of the cardiac patient have acquired great importance in the fight against the risk factors for atherosclerosis, owing to their practical importance and to the many research problems they provoke. The European Society of Cardiology, the French Society of Cardiology, the European Federations, and the French Federation of Cardiology have unanimously recognized the theoretical and practical importance of this issue, and each of these organizations has formed a working group, undertaken clinical research, or assisted cardiac patients with counseling. The Fifth World Congress, held at Bordeaux in 1992, has confirmed the importance of the topics in cardiology that are discussed here. The aim of this general review is to analyze the benefits obtained from physical activity on cardiovascular function, and, in the light of the most recent and important studies, to discuss the effects of physical exercise in the primary and secondary prevention of cardiovascular diseases, particularly of coronary atherosclerosis.

Carbohydrate Metabolism↗
PubMed1994

Renal artery stent placement: long-term results with the Wallstent endoprosthesis.

PURPOSE: To evaluate clinical success and long-term patency of a Wallstent in the renal artery. MATERIALS AND METHODS: Twenty-five Wallstents were placed in 21 patients to treat delayed restenosis after previous balloon angioplasty (n = 13) or inadequate immediate postangioplasty response (n = 8). Indications for angioplasty were hypertension in all patients and renal preservation in seven. Stenosis was atheromatous in 15 patients, involving ostium in seven. RESULTS: Stent placement was successful in all patients. At follow-up angiography (range, 12-60 months), four patients (20%) had stent restenosis. Of these, three had undergone treatment for restenosis after angioplasty and three had ostial lesions. Cumulative primary patency rate was 95%, 85%, and 77% at 7, 9, and 15 months, respectively. Hypertension was cured in three patients and improved in 18. CONCLUSION: Arterial stent placement has good clinical results and high long-term patency rates after conventional renal angiography or delayed restenosis, especially in ostial lesions.

Adult↗
PubMed1994

Relationships between angiotensin I converting enzyme gene polymorphism, plasma levels, and diabetic retinal and renal complications.

Insulin-dependent diabetes mellitus (IDDM), cardiovascular morbidity, and vital prognosis are linked to diabetic nephropathy, which is probably determined by renal hemodynamic abnormalities and by a genetic predisposition. Angiotensin I converting enzyme (ACE) regulates systemic and renal circulations through angiotensin II formation and kinins metabolism. Plasma and cellular ACE levels are genetically determined; an insertion/deletion polymorphism of the ACE gene is strongly associated with ACE levels, subjects homozygote for insertion (genotype II) having the lowest plasma values. We studied the relationship between the ACE gene polymorphism or plasma levels and microcirculatory disorders of IDDM through two independent studies: one involved 57 subjects with or without diabetic retinopathy, and the other compared 62 IDDM subjects with diabetic nephropathy to 62 diabetic control subjects with the same characteristics (including retinopathy severity) but with normal kidney function. The ACE genotype distribution was not different in diabetic subjects with or without retinopathy and in a healthy population. Conversely, an imbalance of ACE genotype distribution, with a low proportion of II subjects, was observed in IDDM subjects with diabetic nephropathy compared with their control subjects (P = 0.006). Plasma ACE levels were mildly elevated in all diabetic groups, independently of retinopathy, but they were higher in subjects with nephropathy than in those without nephropathy (P = 0.0022). The II genotype of ACE gene is a marker for reduced risk for diabetic nephropathy.

Adolescent↗
PubMed1994

[A year follow-up of 328 patients with myocardial infarction].

Three hundred and twenty eight patients (238 men, 90 women) with an average age of 63.5 +/- 18 years admitted consecutively for acute myocardial infarction over a 24 month period (March 1989-March 1991) were followed up at one year by out-patient appointment, questionnaire or telephonic enquiry. The average delay before hospital admission was 6.7 +/- 44 hours (1 h-48 h). The infarct was transmural in 82% of cases, anterior in 45.3%, inferior in 46.3% and lateral in 8.4% of cases. Forty eight per cent had one or several complications during the hospital period with a 10.4% hospital mortality rate. Thirty eight per cent of patients underwent primary thrombolysis and 9% had primary angioplasty. Seventy four per cent of patients had coronary angiography; 41% underwent deferred angioplasty and 6% surgical revascularisation. The global 1 year survival rate was 81.4%. At follow-up, 52.6% of patients were asymptomatic, 31% had signs of cardiac failure and 18% had residual angina. Sixty five per cent were treated with 2 or 3 drugs; 6% underwent secondary angioplasty and 2.8% secondary coronary bypass surgery. Of the 34% of active subjects, 61.4% declared having returned to full-time professional activity. Therefore, in 1992, a continuous reduction of infarct-related mortality and morbidity was observed.

Actuarial Analysis↗
PubMed1994

[Stenosis of the renal artery of the transplant: comparison between interventional and medical treatment].

In a retrospective analysis of 542 renal transplantations performed over a 10 years period, we diagnosed 25 cases of renal allograft artery stenosis that is a prevalence of 4.6%. The reason for angiography was persistent hypertension and/or renal insufficiency. An interventional procedure was performed in 16 patients (group 1): surgery in 5 and transluminal angioplasty (PTA) in 11. Nine other patients were medically treated (group 2). PTA or surgery was undertaken when a significant stenosis (> 70%) was found and when hypertension was severe (mean PAM = 123 +/- 11 mmHg). PTA was primarily performed when the anatomical situation of the stenosis was judged suitable. Medical treatment was chosen because the stenosis was assesses as not being severe enough or because was considered unsuitable for correction. Interventional treatment was successful in 77%. Long term results are shown in the table: in both 2 groups blood pressure decreased significantly at mean follow-up; the number of antihypertensive drugs decreased non significantly but are still necessary in the group 1. Mean serum creatinine is not significantly modified after treatment, there is no degradation of renal function in group 2 and no amelioration in group 1.

Adult↗
PubMed1994

[Production of oxygen free radicals in myocardial infarction treated by thrombolysis. Analysis of glutathione peroxidase, superoxide dismutase and malondialdehyde].

Many enzyme systems such as glutathione peroxidase (GPx) or superoxide dismutase (SOD) neutralise the oxygen derived free radicals produced during myocardial reperfusion by thrombolysis. Erythrocytic SOD, plasma and erythrocytic GPx and their cofactor selenium, substances reacting with thiobarbituric acid (TBARS) were analysed by repeated sampling between T0 and 48 hours in 24 patients treated by thrombolysis for acute myocardial infarction. Angiographic control was undertaken systematically between 60 and 180 minutes after initiating thrombolytic therapy: 18 patients had a patent vessel and 6 patients had an occluded vessel recanalised in 5 cases by angioplasty. Biological analysis was performed in the 23 patients successfully revascularised by thrombolysis, eventually completed by angioplasty. The plasma GPx decreased non-significantly between T0 and 2 hours from 246.8 +/- 53.3 to 233 +/- 39 U/ml with a significant increase between 2 and 48 hours from 233 +/- 39.2 to 294 +/- 76 U/ml, whereas the erythrocytic GPx rose significantly and constantly between T0 and 48 hours from 34.8 +/- 7.1 to 37.6 +/- 7.5 U/gHb with significant consumption of selenium between T0 and 4 hours from 81.2 +/- 14 to 68.5 +/- 12.6 micrograms/l. The erythrocytic SOD increased significantly between T0 and 48 hours from 318.9 +/- 40.8 to 337 +/- 59 U/gHb. Finally, the analysis of plasma TBARS showed a non-significant rise between T0 and 30 minutes from 1.59 +/- 0.30 to 1.71 +/- 1.43 mm/l with a return to the basic line values after about 2 hours. These results show a significant increase in the activity of enzymes protecting against the liberation of oxygen free radicals, such as erythrocyte or plasma GPx and erythrocyte SOD between T0 and 48 hours with consumption of selenium, cofactor of GPx, and an increase in circulating lipid peroxydes in acute myocardial infarction treated by thrombolysis. They also illustrate the oxidative stress which occurs in this situation.

Adult↗
PubMed1994

[Isoforms of creatine kinase and myoglobin in myocardial infarct treated by thrombolysis].

The isoforms of creatinine kinase (CK) and myoglobin were analysed by serial samplings in 45 patients admitted consecutively for myocardial infarction treated by thrombolysis according to the usual indications. Angiographic controls were carried out systematically in the first 24 hours, including 20 cases at the end of thrombolysis. The patients were divided into two groups according to the patency of the infarct related artery: Group I (n = 35) with a patent vessel and Group II (n = 10) with an occluded vessel; 4 patients in Group II were successfully revascularised by angioplasty. The total CK had a higher peak value in Group II (2,393 +/- 1,991 UI/l at 547 +/- 247 min versus 2,888 +/- 2,189 IU/l at 584 +/- 395 min) but the difference was not statistically significant. The analysis of CK isoforms showed the MM3/MM1 ratio to be higher at the 2nd hour in Group I (3.74 +/- 2.37 versus 3.09 +/- 1.43) with a faster increase, without attaining statistical significance. A fourth CK MM fraction was observed at the 2nd hour in 71% of patients in Group I compared with only 20% of patients in Group II. Analysis of myoglobin showed a significantly earlier peak value in Group I (1,218 +/- 1,117 micrograms/l at 133 +/- 62 min versus 1,309 +/- 1,549 micrograms/l at 210 +/- 84 min). The sensitivity and specificity of these different markers were respectively 40%, 86%, 77%, and 60%, 70% and 67% for the CK (peak before 8 hours), the MM3/MM1 ratio (increase of over 35% in the first hour) and myoglobin (peak before 2 hours).(ABSTRACT TRUNCATED AT 250 WORDS)

Angiocardiography↗
PubMed1994

[Continuous monitoring of cardiac output by analysis of the pulse contour].

One method of continuous cardiac output monitoring by analysis of the radial pulse contour (Qcp) relates left ventricular stroke volume and systolic blood pressure by calculating the impedence characteristic of the aorta (Zao). It was assessed during haemodynamic monitoring by comparing it with the thermodilation method in the pulmonary artery (Qtd) in 20 patients with cardiac failure due to dilated cardiomyopathy (6 cases) and ischaemic cardiomyopathy (14 cases) treated by inotropic agents or vasodilators. Over an average monitoring period of 35 hours 159 measurements of cardiac output were performed by the two methods. There was an excellent correlation between the two methods (r = 0.90; p < 0.001; Qcp = 0.97 Qtd). The systematic error (bias) between the two methods was about 2.5%. The accuracy of Qcp compared with Qtd was 12.5%. During infusion with a vasoactive agent (Piroximone), the method based on pulse contour analysis did not reflect sudden variations in cardiac output. The systematic error between the two methods rose to 19% of the value measured, reflecting the lack of adaptation of parameters of correction in this situation and which necessitated recalibration of Zao at least once after injection of the drug.

Cardiac Output↗
PubMed1994

[Infarction in patients aged over 70. Apropos of 194 patients].

Among 498 patients hospitalised for myocardial infarction during a three year period, 194 (39%) were aged over 70 (mean age: 78.6 +/- 6), including 99 women and 95 men. Comparison of this group of patients with those aged under 70 showed a significantly higher hospital mortality (17.5% v. 6.5%) (p < 0.01) and a higher acute complication rate (60.8% v. 23.7% (p < 0.01), in particular after the age of 75. Twenty-eight patients were treated by thrombolysis (14.4% v. 50.6%) (p < 0.05), with a 79.2% patency rate in follow-up angiography at 48 h, and only one non-fatal hemorrhagic complication. Eighty-six patients were investigated by coronary arteriography (44.9% v. 87.2% (p < 0.05) without any complication. Mean ejection fraction was 57.3 +/- 13.5%. Fifty patients were treated by angioplasty (24.6% v. 57%) (p < 0.01) including 15 during the acute phase, with primary success in 40 of them (80%). Ten patients underwent coronary bypass following their infarction (5.1% v. 6.25%) (NS) with two per- or postoperative deaths (20%). Follow-up study revealed high secondary mortality with an overall survival rate at one year of 59.6% v. 81% in patients aged under 70 (p < 0.01). In total, infarction in the elderly is characterised by high mortality and morbidity as compared with infarctions in patients aged under 70, and requires active management during the acute phase, assessed according to the physiological status and age of the patient.

Aged↗
PubMed1993

[Value of continuous measurement of mixed venous oxygen saturation (SVO2) during coronary angioplasty].

Mixed venous oxygen saturation (SVO2) is an haemodynamic parameter of cardiovascular function. The object of this study was to measure SVO2 during percutaneous transluminal coronary angioplasty (PTCA) with prolonged balloon inflation in order to evaluate haemodynamic tolerance more precisely in two groups of patients. Twenty-six patients undergoing PTCA were divided into two groups: Group I, N = 15, with single vessel disease and good left ventricular function (EF: 61.63 +/- 10.1%); Group II, N = 11, with triple vessel disease and poor left ventricular function (EF: 48.05 +/- 14%; p < 0.05). Continuous monitoring of SVO2 with an oximetrix fiber optic catheter was performed in all patients during PTCA. Irrespective of the duration of balloon inflation, a significant correlation was observed between the changes in cardiac output and VSO2. Given that arterial oxygen pressure, global oxygen consumption and haemoglobin concentrations remained constant during balloon inflation, SVO2 was an indicator of cardiac output.

Adult↗
PubMed1993

[Simultaneous thrombosis of the left anterior interventricular and right coronary arteries in a 27 year-old patient with protein S deficiency].

The authors report a case of myocardial infarction in a 27 year old patient by simultaneous thrombosis of the left anterior descending and right coronary arteries in an angiographically normal coronary circulation. The young age of the patient, the absence of the usual risk factors and a normal angiographic network after arterial recanalisation by angioplasty led to the search for a risk factor of thrombosis. This showed a qualitative deficiency of protein S and the absence of any other abnormality of coagulation or fibrinolysis. This case raises the question of a causal relationship between a hereditary protein S deficiency and thrombotic arterial occlusion.

Adult↗
PubMed1993

[Renal hemosiderosis caused by chronic hemolysis in a patient with a Saint-Jude mitral valve prosthesis].

The authors report a case of renal hemosiderosis in a 33 year old patient with mitral valve replacement with a Saint Jude Medical prosthesis. Chronic, well-tolerated hemolysis developed after surgery and a peri-prosthetic leak was demonstrated. Alteration of renal function and abnormalities on urinalysis led to renal biopsy which showed massive localised hemosiderosis, mainly in the interstitial tissues. Repeat mitral valve replacement led to a regression of the hemolysis. Significant hemolysis in patients with mechanical cardiac valves prostheses should lead to investigation of prosthetic valve function and, if dysfunction is demonstrated, the patient should be considered for reoperation because of the potential severity of renal complications.

Anemia, Hemolytic↗
PubMed1993

[Acute severe coxsackie virus B myocarditis of pseudonecrotic form. Apropos of 2 cases].

This study reports two cases of acute severe Coxsackie virus B4 myocarditis in which the immediate clinical signs suggested the acute phase of myocardial infarction, apparently antero-lateral in the first case in a context of cardiogenic shock and infero-lateral in the second case, in the context of acute pulmonary edema. Both cases were characterized by the severity of the initial signs. Numerous other cases of acute Coxsackie virus B myocarditis, simulating myocardial infarction, have been reported in the literature and these contexts deserve to be recognized earlier as they call for specific treatment. The immediate outcome was favorable in both cases but required massive cardiological intensive care in the first patient. Long term follow-up was excellent.

Acute Disease↗
PubMed1993

[Systematic cardiovascular evaluation and hypercholesterolemia. Results in 200 asymptomatic patients].

This study reports the results of routine evaluation to detect coronary and carotid atherosclerosis in 200 asymptomatic and hypercholesterolemic patients (48 +/- 10 years: 72.5% men). All patients underwent physical examination, blood lipid profile, an exercise test and cervical echo-doppler. If the exercise electrocardiogram was abnormal, a thallium isotope scan and/or coronary arteriography were performed. Hypercholesterolemia was severe (3.03 +/- 0.52 g/l). 77.5% of patients had pure hypercholesterolemia. Carotid atherosclerosis in the form of plaque (27.5%) or stenosis (3.5%) was found in 31% of patients. This carotid atheroma was commoner in older patients (51.9 +/- 9 years as against 47 +/- 10 years, p < 0.01). Twenty patients (10%) had electrical signs of ischemia provoked by exercise. Six of them had a normal thallium isotope scan and did not undergo coronary arteriography. Coronary arteriography was abnormal in 10 patients (5%): 7 had stenotic lesions and 3 showed evidence of spasm during the methylergometrine test. In total, the hypercholesterolemic patients investigated here were characterised by subclinical atherosclerosis which was frequent but certainly underestimated by non-invasive studies. The existence of an atherosclerotic lesion is an additional argument in favour of starting cholesterol-lowering treatment.

Adult↗
PubMed1992

Evaluation of plasmatic leucocyte elastase levels in coronary artery disease.

Leucocyte elastase may be involved in the structural modification observed in the atherosclerotic process. Therefore, we tested the usefulness of leucocyte elastase plasma level determination as a marker for atherosclerosis. Plasma levels of elastase were determined by ELISA in 100 consecutive patients (mean age 56 +/- 9.8 years) admitted to hospital for coronary angiographic investigation of chest pain. Eighty-seven patients had evidence of atherosclerosis, and 13 patients had normal coronary vessels. No significant difference in leucocyte elastase was found between the 2 groups, nor was there any relationship between elastase levels and the severity of atherosclerosis. However, relationships between plasma leucocyte elastase levels and various lipid fractions (Apo AI, LDL) and daily tobacco consumption were found. Leucocyte elastase may thus play a role not only by direct modification of the vessel wall, but also indirectly via risk factors such as dyslipoproteinemia and leucocyte toxicity.

Coronary Angiography↗
PubMed1992

[Intravenous thrombolysis by recombinant plasminogen activator (rt-PA) in unstable angina. A randomized multicenter study versus placebo].

Fifty patients (38 men) with unstable angina pectoris defined by: pain lasting > 15 minutes+percritical electrocardiographic changes+significant coronary narrowing on coronary angiography (Coro 1) performed within 24 hours, were treated in a double blind protocol with rt-PA (n = 25) 100 mg/90 minutes (10 mg bolus + 90 mg/90 minutes or placebo (n = 25). All received effective intravenous heparin and intravenous nitrates. Calcium antagonists and betablockers were prescribed in half the cases. Aspirin (100 mg orally per day) was prescribed after control coronary angiography (Coro 2) performed 24 +/- 6 hours after starting treatment. Qualitative and quantitative analysis (CAESAR system) was centralised. There were no differences in the angiographic findings between the two groups. Intracoronary thrombosis was observed in 43% (rt-PA) and 44% (placebo) in Coro 1 and in 17% and 28% in Coro 2. The incidence of myocardial revascularisation procedures was similar in the two groups: angioplasty: 12 (rt-PA) and 13 (placebo); coronary bypass surgery: 5 (rt-PA) and 6 (placebo). Seven patients developed myocardial infarction (5 rt-PA, 2 placebo), one of whom died of cardiogenic shock (placebo). Eighteen patients had haemorrhagic complications (14 rt-PA, 4 placebo; p < 0.002) mainly at the puncture sites (12/14, 3/4). Spontaneous haemorrhage occurred in 7/25 (28%) of patients on rt-PA (haematuria 3, gastrointestinal haemorrhage 2, haematuria + gastrointestinal haemorrhage 1, epistaxis 1) and in 1/25 patients on placebo (gastrointestinal haemorrhage) This study shows that intravenous thrombolysis with rt-PA in severe unstable angina pectoris doe not modify the clinical outcome or the angiographic lesions but exposes patients to a high risk of haemorrhagic complications.

Adult↗
PubMed1992

[Cardiocirculatory arrest after administration of combined mifepristone (Mifegyne) and sulprostone (Nalador) for induced abortion. Possible role of coronary vasospasm].

Reversible ventricular fibrillation occurred in a 35 year old multiparous woman after the administration of the association mifepristone (Mifegyne) and sulprostone (Nalador) for therapeutic abortion. A coronary spasm induced by the analogue of the prostaglandin PGE 2x was though to be the causative mechanism and was reproduced by the Ergonovine test. The evolution of the ECG and myocardial scintigraphy suggested a slowly regressive stunned myocardium.

Abortifacient Agents, Nonsteroidal↗