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Biomedical subjects

P Chiche

Publications and source records attributed to P Chiche.

At least 37 records · Page 2Linked to original sources
PubMed1976

[Isotop cardiac pacemaker during pregnancy. 3 cases].

The authors report three cases of full term pregnancies, without complications, in women with isotopic pacemakers. The newborn infants were normal. In one case, pregnancy occurred in a patient who already had a pacemaker. In two cases, the pacemaker was inserted during pregnancy (at 1 and 1/2 and 5 months respectively), in the treatment of syncopal attacks due to paroxysmal atrioventricular block. This type of pacemaker using a radioactive source (Plutonium 238) is, by virtue of the low degree of radiation, harmless and may be used in women of childbearing age. Under the least favourable conditions (pacemaker box in abdominal situation), the dose delivered during pregnancy (57 mrem) is approximately 20 times less than the authorised dose (1125 mrem).

Abdomen↗
PubMed1976

[Conservative surgical treatment in stage 4 arteritis of the lower extremities. Apropos of 26 cases].

The authors report 26 cases (average age 69 years) of stage IV atheroma of the leg arteries for which a conservative surgical operation was attempted. Aortography (18 times) or femoral arteriography (8 times) were performed without difficulty before operation. During the same operation, a single procedure was performed in 15 cases, 2 or 3 procedures were performed in 11 cases. Thus were carried out: sympathectomy in 7 cases, endarterectomy in 8 cases, a by-pass operation in 23 cases. There were 4 deaths (15%) during the postoperative period. In 18 of the 22 patients who survived the operation, trophic disorders completely disappeared, and the functional result assessed with an average follow up of 15 months (1 to 25 months) on the degree of intermitent claudication was judged good or very good in 16 cases, mediocre in 2 cases. In 4 of these 22 patients, the trophic disorders persisted or reappeared in the short term and amputation was then carried out in 3 of these 4 cases. Conservative surgery remains possible and useful in stage IV arterial disease of the lower limbs. It is however important to operate early in the course of the disease after failure of adequate medical treatment.

Adult↗
PubMed1976

[Isotope study of the effects of a nitrate derivative on pulmonary blood volume. Application in the treatment of cardiogenic pulmonary edema].

Isotopic study of pulmonary and ventricular blood volumes after the ingestion of 5 mg of isosorbide dinitrate showed that cardio-pulmonary blood volume decreased by 380 ml without any change in total circulating blood volume. The demonstration of this effective "internal venesection" explains the fall in capillary pressure seen after the administration of nitrate derivatives. It justifies their use in the treatment of acute pulmonary oedema or refractory cardiac failure and explains the results observed.

Aged↗
PubMed1976

Opening snap and isovolumic relaxation period in relation to mitral valve flow in patients with mitral stenosis. Significance of A2--OS interval.

In 15 patients with pure or predominant mitral stenosis and in a control group of 11 patients without mitral stenosis the blood flow velocity through the mitral valve orifice was recorded by means of a directional Doppler ultrasound velocity catheter introduced transeptally and positioned in the orifice of the mitral valve. A simultaneous surface phonocardiogram was obtained. The timing of the mitral opening snap in relation to the blood velocity record of the flow through the valve supported the hypothesis that the opening snap is due to a sudden tensing of the valve leaflets by the chordae tendineae. Determination of the exact time of mitral valve opening, made possible by the blood velocity record, led to the division of the classical A2-0S interval (aortic valve closure to opening snap) into two components representing respectively the diastolic isovolumic relaxation period and the time of excursion of the mitral valve cusps. The durations of the isovolumic relaxation period were compared with those in the control patients and were found to correlate with the severity of the mitral stenosis, whereas those of the excursion time of the mitral cusps were influenced by the presence or absence of mitral valve calcification.

Adult↗
PubMed1976

Autonomic influences and cardiac conduction in patients with sinus node disease.

18 patients with sinus bradycardia (8 SB) and tachycardia-bradycardia syndrome (10 TBS) were investigated using various vagan reflex manoeuvres, atrial pacing (AP), pharmacological tests and His bundle (HB) recordings, to assess autonomic influences, sinus node function and atrioventricular (AV) conduction. Three types of responses (R) were defined as normal (N), supernormal (SN), poor autonomic (PA). Poor reflex responses to vagal manoeuvres, performed in 12 patients, have no statistical significance. MxCSRT at AP suppression was measured in 13 patients: it was normal (less than or equal to 500 msec) in 8 and increased (from 680 to 4,200 msec) in 5 patients with appearance of junctional escapes. Moreover, AP suppression revealed a sinoatrial block (SAB) in 1 patient with normal MxCSRT. Isoprenaline, administered intravenously (3-6 mug) in 9 patients, showed 4 NR, 3 PAR und 2 SNR (unusual sinus tachycardia, 1; atrial fibrillation, 1). Atropine (0.5-1 mg), used in 15 patients, revealed 5 PAR and 1 SNR. Prostigmine (0.5 mg), used in 11 patients, induced 6 NR and 5 PAR. Lanatosid C (0.08 mg), administered in 16 patients, showed 10 NR, 5 PAR and 1 SNR. Finally, ajmaline (100 mg), given in 13 patients, revealed 5 junctional rhythms and one 2:1 SAB. HB recorded in 17 patients showed an increase of AH interval (greater than 140 msec) in 5 patients and a slight increase (60 msec) of HV interval in 2 patients. Three patients developed 2nd-degree AV block at paced rates greater than or equal to 110/min. Abnormal responses at AP suppression and reduced drug responses were noted in 5 patients suffering from Adam-Stokes attacks; a permanent pacemaker was inserted in 4 of these 5 patients. In conclusion, provocative tests, in 18 patients with SB or TBS, suggest a diffuse process disease involving the autonomic function of both sinus node and AV junction (11 patients) and the AV system (6 patients). These immediate results must be correlated with histological findings in the conduction system, as shown in one of our cases previously reported.

Adult↗
PubMed1976

[Pitfalls of the normal electrocardiogram].

The authors report the cases of 7 patients with a normal basal electrocardiogram, whereas they were all affected with a high risk cardiovascular condition: coronary insufficiency in 3 cases, paroxysmal arrhythmia in 4 cases. They recall the limits of the conventional ECG and emphasise interest of dynamic recordings, with effort tests, and/on continuous ECG recording in the identification of certain transient heart manifestations.

Adams-Stokes Syndrome↗
PubMed1976

[Anti-arrhythmic effects of injectable amiodarone. Apropos of 100 cases].

The effects of amiodarone by injection have been studied in 100 patients. 50% of these patients were in cardiac failure. Amiodarone was given intravenously over 30 seconds in a dose of 300 mg; in 15 of the patients a further dose of 150 mg was given after ten minutes. Amiodarone was found to be particularly effective in the tachy-arrhythmias (90% successful) in which it brought about slowing (18 cases out of 30) or conversion (17 cases out of 30). Just as good results were obtained for the atrial tachycardias (90% success rate) and in the junctional tachycardias. This treatment is less effective for atrial flutter (50% successful) and for ventricular arrhyrthmia, in which the success rate was only 60%. It is possible to use the defibrillator after amiodarone has been administered. This drug is well tolerated, and no increase in cardiac failure has been noted in these patients. There does remain, however, the possibility of hypotension and perhaps of circulatory collapse, which is rapidly reversable; this is probably due to vasodilator activity. Intracavitary studies in 8 patients have shown that amiodarone causes slowing of sino-atrial and of atrio-ventricular conduction. Amiodarone may equally worsen a distal conduction defect. The uses for this anti-arrhythmic drug, which is particularly effective at the atrial level, are discussed in this paper.

Aged↗
PubMed1976

[Treatment of obstructive cardiomyopathy using myotomy in a 67-year-old patient. Pharmacological and angiographical studies].

The case is reported of a 67 year old man with obstructive cardiomyopathy treated by an extended myotomy. Serial phonomechanographic tracings and the pre- and post-operative angiograms show the steady progress of the disease towards a major disturbance of left ventricular compliance which became resistant to propranolol, and was partially reversed by myotomy.

Age Factors↗
PubMed1975

[Spontaneous angina with ST elevation. Significance and prognostic value].

The authors report 36 cases of spontaneous angina occurring in the absence (group A) or presence (group B) of a myocardial infarct (MI), either recent or old, and accompanied, during the attacks, by transient ST elevation (T ST E) and normal enzyme levels. Group A (16 cases) was characterised by : a) the severity of the prognosis with the development of rhythm disturbances during the attacks in 10 out of 16 cases, and of a MI and/or sudden death in 4 of the 6 cases treated medically; b) the presence, in 12 of the 14 cases explored of surgical stenosis of a major coronary trunck. The simple association of attacks of spontaneous angina and T ST E is in general sufficient to define severe angina, regardless of the height of the elevation, and for which a surgical indication (95 p. cent of our cases) with the same problems as those posed by Prinzmetal angina strictly defined on a series of clinical and electrocardiographic criteria. Group B (20 cases) :a) differed from group A by the incidence of cardiac failure (15 out of 20 cases), the widespread nature and degree of the anatomical lesions, not usually amenable to by-pass; b) the severe prognosis, reflected in 6 of the 17 cases treated medically by extension of the MI and/or sudden death, did not differ fundamentally from that of any subsequent relapse, regardless of its electrocardiographic signs. In these cases, the T ST E related to the presence of the MI does not have the same significance as in Prinzmetal angina, and progressive relapses of MI should no longer be classified in this group on the pretext that they are accompanied by T ST E.

Aged↗