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Biomedical subjects

P Gosse

Publications and source records attributed to P Gosse.

At least 127 records · Page 7Linked to original sources
PubMed1989

[Persistent arterial hypertension].

Antihypertensive therapy has markedly improved, in the last few years, but, in some patients, the blood pressure remains high despite an association of several medications. We are proposing to consider as persistent or refractory, any essential hypertension remaining higher than or equal to 165/95 despite a well administered triple therapy, initiated since at least one month. With such patients, the first step consists in verifying the various terms of the definition: measurement of the blood pressure under standard condition and, at best, over a long period of time, in ambulatory conditions; re-evaluation of the drug combination (synergistic action); observance of the treatment by the patient; re-investigation of the etiology; determination of the resistance factors to the treatment. The treatment should then be patiently and methodically reviewed, based on the most potentialized combinations, taking into consideration the first signs of occurrence of the hypertension, without neglecting hygieno-dietetic measures. Sometimes, it will be necessary to resort to more potent treatments, which are more delicate to handle.

Drug Resistance↗
PubMed1989

[Low blood pressure].

When facing a chronic hypotension, underlying chronic diseases must be ruled out. In most cases, it concerns a "constitutional" benign, low blood pressure, however ill-tolerated and associated with neurovegetative dystonia. In so far as it is not a disease, there is no specific treatment. The long-term prognosis is excellent since symptoms usually improve with years and a low blood pressure is a sign of longevity.

Humans↗
PubMed1988

Accuracy of M-mode and two-dimensional echocardiography in the diagnosis of aortic dissection: an experience with 128 cases.

The accuracy of combined M-mode and two-dimensional echocardiography in the diagnosis of aortic dissection was evaluated in 673 patients with a clinical suspicion of aortic dissection, over a six-year period. In 128 cases, the diagnosis of aortic dissection was confirmed by angiographic, tomographic (CT scan), or autopsy findings, or during surgery. Two echocardiographic features were found to support a diagnosis of aortic dissection: a dilation of at least one segment of the aorta (sensitivity 95%, specificity 51%) and a typical abnormal linear intraluminal echo corresponding to the intimal flap (sensitivity 67%, specificity 100%). This pathognomonic intimal flap was observed in 86 cases, of which three types could be distinguished: (1) a long oscillating flap (n = 15), (2) a long but minimally mobile linear echo which was duplicated and parallel to one or two aortic walls (n = 64), (3) a short, double linear image with a rapid systolic motion and high frequency oscillations. These features were found to have a high sensitivity in type I aortic dissection (88%), although in types II and III the sensitivity was much lower. In some cases, a fourth type of abnormal image could be detected: a small intraluminal echo moving in parallel to the aortic wall. This feature should be interpreted with caution since its predictive value for a positive examination was low (48%). Out of 23 cases in which the diagnosis of aortic dissection was suspected on the basis of this doubtful abnormal echo, it was confirmed in only 11 patients. The results in these 128 cases of aortic dissection indicate that two-dimensional echocardiography, which is easily performed at the patient's bedside, could take priority in investigations of this condition. It is extremely sensitive in the diagnosis of ascending aortic dissection, but much less so in the diagnosis of descending aortic dissection.

Aortic Dissection↗
PubMed1988

High night blood pressure in treated hypertensive patients: not harmless.

UNLABELLED: The left ventricular mass index (LVMI) is better related to activity than resting systolic blood pressure (BP) in treated hypertensive patients. Many recommend ambulatory BP monitoring only during the day. However, 24-hour BP monitoring may be useful in treated patients to check adequate control of BP during the entire 24-hour period. We tested the influence of night BP on LVMI in treated versus nontreated patients. We compared two groups of hypertensive patients: A: 40 patients who had discontinued therapy at least 8 days prior to the study; B: 24 patients treated for more than 3 months with the same drugs (beta-blockers in 14 cases). Ambulatory BP was recorded every 30 minutes during night and every 15 minutes during day (Spacelabs 5200). The LVMI was calculated from M mode echo blind reading (Devereux's formula). Correlation coefficients between LVMI and casual, systolic BP were calculated for both day (7:00 AM to 10:59 PM) and night time (11:00 PM to 6:59 AM). Day systolic BP is better related to LVMI than casual and night systolic BP in group A. In contrast, a significantly higher correlation existed between night BP and LVMI in B, though average night BP level was lower. CONCLUSION: 24-hour BP monitoring may be useful in treated hypertensive patients. Inadequate lowering of night BP may partially account for persistent LVH in treated hypertensive patients.

Blood Pressure↗
PubMed1988

[Treatment of renovascular arterial hypertension: angioplasty versus surgery].

Percutaneous transluminal angioplasty is being more and more performed as the first choice treatment of renovascular hypertension. However, very few studies are devoted to the comparison of angioplasty versus surgery in treating renovascular hypertension and no one is prospective. A group of 25 patients with renovascular hypertension who underwent surgical treatment in the years 78-82 was compared to a group of 32 patients who underwent transluminal angioplasty in the years 82-86. Age, sex, etiology and severity of the arterial stenosis, blood pressure before treatment were similar in both groups. Average follow up was 44 +/- 33 months in the surgical group (S), 18 +/- 15 months in the angioplasty group (A). In the surgical group, we noticed one death, 20 p. 100 of major complications (thrombosis or stenosis of bypass grafts). In the angioplasty group, there was no death, 82 p. 100 of initial success, 12 p. 100 of major complications which needed surgery, 22 p. 100 of restenosis which were treated with a second angioplasty. Patients were classified as cured (BP less than 140/90 without treatment and perfect renal vascularisation) improved (BP less than 160/100 without treatment or with treatment if reduced and renal artery stenosis less than 50 p. 100), unchanged (BP greater than 160/100 and/or renal artery stenosis greater than 50 p. 100 or thrombosis). (Table: see text). Results are similar in both groups. The simplicity of the procedure, a lower cost and the absence of lethal complications are in favour of the transluminal angioplasty as the first choice treatment of renovascular hypertension.

Adult↗
PubMed1988

[Doppler echocardiography of ventricular diastole].

Non-invasive studies of left ventricular relaxation and filling by means of doppler-echocardiography are of considerable interest owing to easy recording and good reproducibility. However, such physiological parameters as site of measurement, heart rate and, chiefly, age may interfere with the curves obtained. The interpretation of tracings must also take into account the presence of mitral valve pathology (stenosis or regurgitation), aortic stenosis, disorders of atrioventricular (prolonged PR complex) or intraventricular (left bundle branch block) conduction and medication (e.g. vasodilators). In clinical practice, one of the main advantages of the technique is that it makes it possible to distinguish between the physiological left ventricular hypertrophy (LVH) of top-class sportsmen (without impaired ventricular filling) and the pathological LVH of hypertrophic cardiomyopathy. The purpose of this study, with a review of the literature, was to take stock of the value and limitations of the doppler indices.

Cardiomegaly↗
PubMed1988

[Cardiac Doppler ultrasonography in the diagnosis and surveillance of chronic aortic insufficiency].

Chronic aortic insufficiency is, since a few years, a topic of renewed interest because of the development of non-invasive monitoring methods: sonocardiography, cardiac Doppler. The problem raised is that of deciding the most opportune time for surgery in asymptomatic chronic AI, the course of which may quietly evolve towards irreversible myocardial lesions. The severity of AI may be determined by numerous sonocardiographic and Doppler criteria. In sonocardiography, three types of parameters have especially been studied: ventricular expansion (telediastolic, telesystolic diameter), the systolic function (percentage of diameter decrease), volume/mass ratio (R/h). To be valid, these measurements are a precious guide for patient's monitoring and therapeutic approach. The more recent Doppler criteria must be validated on large series and evaluated according to the context or a pathological association; they all have limitations and cannot be interpreted separately.

Aortic Valve Insufficiency↗
PubMed1988

[Evaluation of aortic to pulmonary blood flow ratio by Doppler echocardiography in septal defects].

Pulsed Doppler-echocardiography was used to measure systemic and pulmonary blood flows in 22 patients aged from 3 months to 62 years presenting with interatrial (n = 13) or interventricular (n = 9) septal defect. Calculations were based on echographic measurements of aortic and pulmonary orifice areas and on the integral of maximal aortic and pulmonary Doppler velocity curves. Section areas or the arteries, taken as being circular, were deduced from arterial diameter measurements effected above Valsalva's sinus. Doppler velocity curves were recorded at that level, looking for maximal velocities and assuming a flat velocity profile. Blood flow ratios evaluated from Doppler-echocardiography data were compared with data provided by oximetry and showed good correlations (r = 0.92; Y = 0.71x + 0.53; SEE = 0.24). Calculations by categories of lesions showed better results in patients with interatrial septal defect (r = 0.94; Y = 0.73x + 0.507; SEE = 0.22) than in patients with interventricular septal defect (r = 0.83; Y = 0.547x + 0.75; SEE = 0.25). The main difficulties encountered in measuring Doppler-echocardiography blood flow ratios concerned accurate measurement of pulmonary artery diameter, due to problems of lateral resolution, and accurate measurement of turbulent Doppler velocimetry curves. However, this new, non-invasive technique may be useful to determine the best indications for catheterization or even surgery.

Adolescent↗
PubMed1988

[Circadian rhythm of blood pressure. Importance of the severity and not the cause of arterial hypertension].

Recent work have raised the possibility of a lack of circadian blood pressure variability in secondary hypertension. To test this hypothesis, we compared 11 patients with renovascular hypertension (RVH) and 11 essential hypertensive patients (EH) matched for sex, age, body weight, height and the average level of SBP from 7 a.m. to 10 p.m. monitored every 15 minutes with a Spacelabs 5200 device. All patients had BP monitored during 24 hours, inside the hospital, after all anti-hypertensive drugs were discontinued for more than 5 days. Paired t test revealed no difference between the two groups. Differences (D - N) between average day time (7 a.m.-10 p.m.) and night time (10 p.m.-7 a.m.) systolic and diastolic BP were not different in the two groups. (Table: see text). To test the influence of BP level on circadian BP variation, we studied the correlation between the difference in day and night average SBP, as a % of average day time SBP, and the average day time SBP in 25 normal subjects and 64 hypertensive patients without treatment. A weak but significant correlation was demonstrated (r = -0.29; p less than 0.01). The higher the average day time SPB, the lower the difference between day and night. In conclusion, circadian variation of BP is not different between essential and renovascular hypertensive patients, but there is a trend to a smaller variation in patients with the higher BP.

Adult↗
PubMed1988

[Acute aortic insufficiency. Diagnostic and prognostic value of cardiac ultrasonic Doppler].

Although infrequent, acute aortic insufficiency must be identified at an early stage. The clinical picture is often deceptive. Ultrasonic cardiography and cardiac Doppler represent, today, a diagnostic technique of choice which specify the mechanism of the acute valve leakage, the condition of the ascending aorta and the repercussions on the left ventricle.

Acute Disease↗
PubMed1987

An unusual complication of the Le Veen shunt: a right atrial ventricular chamber pseudotumor.

We report the case of a right atrial-ventricular chamber thrombus discovered four years after insertion of a Le Veen shunt for treatment of refractory ascites. A two-dimensional echocardiogram, performed after the discovery of an isolated systolic murmur, demonstrated a "tumorlike" mass seated in both the right atrium and the right ventricle. The mass was surgically removed and histologic examination confirmed that it was a thrombus developed at the tip of the catheter. We propose that two-dimensional echocardiography should be performed periodically for the survey of such intracardiac devices.

Adult↗
PubMed1987

Rapid growth of a left atrial myxoma shown by echocardiography.

Rapid growth of a left atrial myxoma was demonstrated in a patient who showed no echocardiographic evidence of the tumour when he was admitted for coronary artery bypass grafting. Eight months later he complained of dyspnoea and fatigue, and cross sectional echocardiography showed a 6 x 4 cm left atrial myxoma. This was removed and the diagnosis was confirmed by histological examination.

Echocardiography↗
PubMed1987

[Effects of perindopril on left ventricular hypertrophy, coronary reserve and mechanical properties of the papillary muscle of the rat with renovascular arterial hypertension].

We investigate the effect of a new angiotensin-converting enzyme inhibitor: Perindopril (IRIS) on regression of left ventricular hypertrophy (LVH), coronary blood flow and mechanical performance of isolated papillary muscle in renovascular hypertensive (Goldblatt 2 kidneys-1 clip) Sprague-Dawley male rats. Sham operated rats (G1) and half of hypertensive rats (G2) were studied after 8 weeks. The other half of 8 weeks long hypertensive rats (G3) were treated during 8 weeks with Perindopril in drinking water at a dosage adjusted to maintain blood pressure (BP) measured with tail cuff method under 140 mmHg. The study of each rat included 1) coronary blood flow and resistance measurements under resting conditions and after coronary dilation by carbochrome infusion (9 mg/kg) using left atrial injection of radioactive microspheres (method of Wicker and Tarazi) 2) the study of mechanical performance of the isolated papillary muscle 3) weight of left ventricle after separation of septum and free wall whose subendocardial and subepicardial layers were counted separately. Results (mean +/- SD): (table; see text) MAP: mean pressure. LV/BW: left ventricular mass (mg) per gram of body weight; CR (C): minimal coronary resistance after carbochrome (mmHg/ml/min/100 mg); DL/Dt: peak velocity of shortening at L max preload; Vrelax: peak velocity of relaxation; THR: time of half relaxation; p less than 0.05; p less than 0.01 compared to SHAM. In this model, hypertension induced a 50 p. 100 LVH whose regression was nearly complete after 8 weeks of treatment with Perindopril. Minimal coronary resistance after carbochrome were higher in hypertensive rats compared to sham and return to normal after regression of LVH.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1987

[The echocardiogram in arterial hypertension].

Echocardiography seems to be the best non-invasive method for the detection of hypertensive heart disease: it shows early abnormalities of left ventricular compliance, frequently left ventricular hypertrophy and late abnormalities of myocardial contractility. These results are of paramount importance since recent epidemiological data have shown that left ventricular hypertrophy is a factor of severity and should be treated.

Aged↗
PubMed1987

[Should nocturnal arterial pressure be monitored in treated hypertensive patients?].

Ambulatory blood pressure monitorings for diagnosis purpose in non treated hypertensive patients are often performed only during day time for two reasons. First, target organ responses to hypertension, and mainly left ventricular hypertrophy, are more closely related to activity than to rest BP. Second, these automatic devices are frequently not well tolerated during sleep because of their noise during inflation of the cuff. However, 24 h BP monitoring seems of greater interest in treated hypertensive patients to control the efficiency of the treatment. As suggested by our work, incomplete lowering of BP during night may not be harmless. In a prospective study, we evaluated the relationship between BP recorded during 24 h (Spacelabs 5200) and M mode echocardiographic measurements of left ventricular mass index (LVMI) (Devereux's formula) both in non treated hypertensive patients (group A, n = 40) who had discontinued therapy at least 8 days prior to the study and in hypertensive patients treated with the same drugs for more than 3 months (group B, n = 24). More than half of these patients were receiving beta blocking agents. As previously stated day (8 h-22 h), systolic BP is better related with LVMI than clinical (C) and night (23 h-7 h) SBP in group A. In contrast, a higher correlation was found between night BP and LVMI in group B, which was significantly different from the correlation found in group A (Z test, p less than 0.05). (Table: see text). In conclusion, 24 h BP monitoring is useful in treated hypertensive patients. Inadequate lowering of BP during night time may partially account for persistent left ventricular hypertrophy in treated hypertensive patients.

Blood Pressure↗
PubMed1987

[Echocardiographic diagnosis of aortic dissection. Limits, pitfalls and difficulties].

In patients with suspected dissection of the aorta two-dimensional echocardiography has become a fundamental complementary examination which can easily be used in emergencies. In the light of our experience and of published data, a floating dissected intima is the pathognomonic sign. However, false-negative results have been recorded in about 30% of the cases, as against 10% with angiography, computerized tomography and nuclear magnetic resonance imaging. In spite of this drawback, two-dimensional echocardiography still is a good screening examination, since dissection can almost certainly be excluded when the aorta is of normal caliber. False-positive results also constitute a diagnostic pitfall which must be well known and carefully avoided. The mechanisms of these various problems and the way they can be solved are discussed.

Aortic Dissection↗