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P Gosse

Publications and source records attributed to P Gosse.

At least 145 records · Page 8Linked to original sources
PubMed1987

[Echocardiographic diagnosis of aortic dissection: contribution of pulsed Doppler. Apropos of 29 cases].

Echocardiography is universally recognized as a first-line examination easy to perform at all times in patients with thoracic pain suggestive of aortic dissection. But like all diagnostic methods, it has its limitations and pitfalls. The present study, based on 29 consecutive cases, demonstrates the value of pulsed Doppler echocardiography in the diagnosis and monitoring of aortic dissection. When the echocardiographic images are typical of the disease, the Doppler technique helps evaluate the lesions (aortic insufficiency, number of patent channels), but it is mainly in cases with doubtful echocardiographic findings that the Doppler technique provides elements that clinch the diagnosis, notably by showing the presence ot two patent channels with different blood flows. In addition, we would like to draw attention to a new and useful sign: flapping ot the dissected intima when the Doppler window is over it; we observed this sign in 24 of our 29 patients.

Adult↗
PubMed1986

[Left ventricular hypertrophy of the hypertensive patient. Approach to its pathogenesis and consequences].

The knowledge of the characteristics and consequences of left ventricular hypertrophy (LVH) in the hypertensive patient has greatly progressed in the past few years, owing to echocardiography. This examination provides a reliable and reproducible measurement, and therefore the left ventricular mass is used more and more as a severity index of hypertension and a mean of evaluation of the efficacy of the treatment. This attitude is justified in part by the poor prognosis of LVH. However, the pathogenesis of LVH in hypertension still presents numerous unknown facts. If the elevation of the post-charge seems to be the essential mechanism, other factors seem to have an important influence and explain the uneven effect of different hypertensive drugs at this level. Presently, there are several arguments in favor of the beneficial character of the regression of LVH in the hypertensive patient under treatment, but we will have to wait for the result of prognostic studies to use this property as a major objective of anti-hypertensive treatments.

Cardiomegaly↗
PubMed1986

Short- and long-term treatment of mild to moderate hypertension with verapamil.

Forty-three patients with mild to moderate hypertension (supine diastolic blood pressure 95 to 115 mm Hg) were entered into a short-term (3 months) study. All received verapamil, 120 mg 3 times a day. After 1 month of treatment on verapamil alone, supine diastolic blood pressure was normalized (less than 95 mm Hg) in 29 patients (67%). These patients continued with verapamil at the same dosage. In 14 nonresponders (supine diastolic blood pressure greater than 95 mm Hg) a combination of althiazide (15 mg/day) and spironolactone (25 mg/day) was added. This resulted in diastolic blood pressure normalization in 9 additional patients. Verapamil induced a slight but moderate decrease in heart rate after 1 month, but no further decrease was observed thereafter. During the trial, 21% of patients reported adverse effects, mostly transient and mild. No patient had to discontinue treatment because of them. Twenty-six patients on verapamil alone were followed for 1 year. Systolic and diastolic blood pressure was adequately controlled in all patients except 1. In 13 the dosage was decreased to 120 mg 2 times a day. There were no significant differences in blood pressure between this group and patients given 120 mg 3 times a day. It is concluded that verapamil is an effective and safe antihypertensive agent in mildly to moderately hypertensive patients. Because a dosage of 120 mg 2 times a day was as effective as 120 mg 3 times a day, the former should be recommended, as it may improve patient compliance.

Blood Pressure↗
PubMed1986

[Left ventricular hypertrophy of the hypertensive patient: relation to exertional and ambulatory blood pressure].

UNLABELLED: In a prospective study the relation of left ventricular hypertrophy and exercise versus ambulatory blood pressure was analysed in 31 patients with essential hypertension (10 females, 21 males, mean age 44 +/- 14). Hypertension is borderline and has never been treated in 8 patients, mild to moderate in 24 patients who had discontinued therapy at least 8 days prior to the study. M mode echocardiogram, bicycle exercise testing and ambulatory blood pressure monitoring (spacelabs 5200) were performed within a 7 days period. Left ventricular wass (LVM) was calculated from M. mode echo data according to Devereux's formula and used to determine a LVM index (LVM/Body surface area). Correlations between LVM index and rest (R) SBP, end exercise (EE) SBP, the average of approximatively 60 SBP recordings from 7H to 22H (A-SBP) and the average of the 5 highest (5H) SBP recordings in the day are reported: (Formula: see text). There is no significative correlation with diastolic blood pressure. CONCLUSION: 24H A-SBP and EE-SBP appears to correlate better with severity of LVH than does the R-SBP. The selection of the 5 highest SBP in a day do not improve the correlation compared with R-SBP.

Adolescent↗
PubMed1986

[Thromboses of the right atrium: echocardiographic aspects, practical management. Apropos of 8 cases].

Right atrial (RA) thrombosis is rare. The aim of this study was to determine their clinical and echocardiographic features and therapeutic implications. In the last 7 years, 16 RA masses were detected by 2D echocardiography. The diagnosis of thrombosis was made in 8 cases based on anatomo-pathological examination (6 cases) or their disappearance with medical treatment (2 cases). The clinical presentations were: pulmonary embolism (4 cases), anterior myocardial infarction (2 cases), Ebstein's anomaly (1 case), thrombosis of a Leveen catheter (1 case). Only 1 patient had atrial fibrillation. Two echocardiographic appearances were observed: 1) a long, very mobile thrombus floating between the RA and right ventricle (4 cases), 2) a relatively immobile mass (4 cases). The 4 patients with relatively immobile thrombi survived: 2 underwent surgery and 2 were treated medically. All cases of floating thrombi had pulmonary embolism: 2 patients underwent surgery but the postoperative course was complicated; 2 patients died suddenly before surgery. These cases show that 2D echo is the diagnostic method of choice for detection of RA thrombosis. The floating RA thrombus is a therapeutic emergency and has a poor prognosis.

Adult↗
PubMed1986

[Major tricuspid insufficiency and absence of systolic valvular coaptation. Echocardiographic study. Apropos of 6 cases].

In a retrospective series of 960 cases of tricuspid regurgitation studied by two-dimensional echocardiography 6 patients presented a systolic defect of valvular coaptation. The origin of this defect varied: one case was due to carcinoid, two to rheumatic cardiopathy, two to papyraceous right ventricle and one to sclerodermia associated with pulmonary arterial hypertension. The mechanism of the lacking coaptation varies according to the etiology: valvular retraction in carcinoid cardiopathy, right-ventricle dilatation, dilatation of the tricuspid ring and altered kinetics of the right ventricle in the other cases. Changed contractility of the right ventricle is the only element allowing to distinguish tricuspid regurgitation with and without a coaptation defect. Clinically this abnormality always points to an advanced stage of severe tricuspid regurgitation.

Aged↗
PubMed1985

[Evaluation of left ventricular mass by M-mode and bidimensional echocardiography].

The aim of this study was to validate an echocardiographic method of evaluating LV mass by assessing the reproducibility and comparing the results with those of angiography. 20 patients without abnormal regional wall motions or asymmetric septal hypertrophy underwent left ventriculography in the RAO plane and three successive M mode and 2D echocardiograms. Three 2D echo methods of measuring volumes and mass were used: the monoplane ellipsoid model obtained from apical views, the biplane ellipsoid model from an apical and a short axis parasternal view and the hemi-ellipsoid-cylinder model (HEC). The M mode evaluations showed good reproducibility with respect to volume (variation coefficient (VC): inter observer 9.8 p. 100 and intra patient 15.6 p. 100). The reproducibility of 2D echo measurements was much poorer (intra patient volume: VC = 34 to 45 p. 100; mass 29 to 46 p. 100). A close correlation was observed between the results of M mode echo and angiography; volume r = 0.85, SD = 60 g. With respect to the 2D method, the best results were obtained with the HEC model; volume r = 0.90, SD = 31 ml; mass r = 0.82, SD = 41 g. We suggest a method combining the M mode and 2D techniques, using a HEC model in which the long axis is obtained by 2D echocardiography and the short axis and wall thickness by M mode recordings. The following correlations with the angiographic method were obtained: volume r = 0.91, SD = 36 ml; mass r = 0.89, SD = 27 g.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Treatment of hypertension by a new transdermal form of clonidine.

We studied one or two adhesive systems per week of clonidine TTS (2.54 or 5.08 mg/week). The results showed a more marked antihypertensive action with these adhesive systems than with 0.15 or 0.30 mg/day of the oral form. The transdermal system was better tolerated systemically and local cutaneous reactions prevented its use in only one case in our series. Overall, the patients were satisfied with the treatment. In our opinion, the simplicity of administration of clonidine TTS should improve the long term patient compliance with antihypertensive treatment.

Adhesiveness↗
PubMed1985

[Comparative effects of intracoronary fibrinolysis and conventional treatment of myocardial infarction].

57 patients with a complete coronary thrombosis were treated by intracoronary fibrinolysis during the first 6 hours of inaugural myocardial infarction. The artery was revascularised in 37 cases (65 p. 100). Eleven patients had isolated stenosis of the left anterior descending artery and 16 patients isolated stenosis of the right coronary artery. These patients were compared with 27 other patients admitted between the 6th and 18th hours of primary myocardial infarction treated conventionally, in whom coronary angiography performed between the 14th and 21st day after infarction showed isolated left anterior descending disease in 14 cases (9 thromboses and 5 stenoses) and isolated right coronary disease in 13 cases (7 thromboses and 6 stenoses). The haemodynamic data and heart rates were identical in both groups during control coronary angiography between the 14th and the 21st days. Global left ventricular function and regional wall motion were studied by 30 degrees right anterior oblique ventriculography using the Stanford method before fibrinolysis in the first group and at the end of the 3rd week in both groups. In LAD, repermeabilisation by fibrinolysis, significant improvements were observed in ejection fraction (EF p. 100 = 42 +/- 9 vs 50.6 +/- 14 p. 100, p less than 0.05); fractional shortening of the hypokinetic segment (FS p. 100 = 4.5 +/- 4.6 vs 12.4 +/- 8.8 p. 100, p less than 0.001), and in the number of hypokinetic or akinetic segments (6.0 +/- 1.1 vs 4.2 +/- 2.1, p less than 0.05). Segmental and global left ventricular function was much poorer in the group treated conventionally at the 21st day (EF p. 100 = 44 +/- 11 p. 100, p less than 0.05; FS p.t100 = 5.8 +/- 9.7 p.t100, p less than 0.05; number of diseased segments: 6.0 +/- 1.4, p less than 0.01). On the other hand, the improvement was less marked in patients with inferior wall infarction; the results in the two groups were comparable.

Adult↗
PubMed1985

[Myxoma of the mitral leaflet. Apropos of a case].

This case of an intracardiac myxoma observed in a 15 year old girl had several points of interest: the mode of presentation: the clinical signs were exclusively systemic and articular; the mode of diagnosis: 2D echocardiography demonstrated an immobile, dense mass about the size of a walnut implanted on the ventricular surface of the posterior mitral leaflet along the whole of its base and seemingly adherent to the ventricular wall; the intraventricular location of the tumour (exceptionally rare) and its mitral valve origin. The site of the tumour imposed mitral valve replacement but we were able to discuss the surgical approach using the results of echocardiography before surgery and a bioprosthesis was inserted to protect the maternal future of the patient.

Adolescent↗
PubMed1984

[Echocardiography in the study of left ventricular function].

Ultrasound provides anatomical (wall thickness, diameter) and functional (thickening of the wall, ventricular ejection, ventricular filling) information about the left ventricle. The reliability and reproducibility of these measurements have been improved by the development of mono and bidimensional techniques, so that, today, ultrasound is the method of choice for the investigation and surveillance of left ventricular function, provided it is of good quality. Apart from the indirect information about left ventricular function drawn from mitral or aortic traces, the echocardiogram has proven to be a reproducible method for estimation of the thickness of the ventricular wall, the ventricular diameters and the left ventricular muscle mass. Whatever the geometry of the left ventricle, the ventricular volume is assessed most accurately by bidimensional ultrasound.

Cardiac Volume↗
PubMed1978

[Myocardiopathies during pregnancy. Possible role of beta-mimetics].

The authors report two cases of severe non-obstructive cardiomyopathy presenting at the end of pregnancy in young women treated for long periods and at high dosage with beta 2-adrenoceptor stimulants, prescribed for threatened abortion or premature labour. The circumstances of the presentation, the clinical prescribed for threatened abortion or premature labour. The circumstances of the presentation, the clinical picture and the course towards complete recovery suggest that this might be a pathological process different from "cardiomyopathy of pregnancy" and be an "adrenergic myocarditis" induced or made worse by these drugs. The authors deduce some simple preventive measures.

Adrenergic beta-Agonists↗
PubMedDate not supplied

Comparison of bisoprolol and verapamil in hypertension: influence on left ventricular mass and function--a pilot study.

The objective of this study was to test the influence of bisoprolol and verapamil on left ventricular filling in hypertensive patients in a 6 month randomized, double-blind trial in 54 hypertensive patients not previously treated with beta-blockers or calcium inhibitors. After administration of placebo for 14 days, an M echocardiogram of the left ventricle was recorded to determine left ventricular mass. Blood flow was evaluated by pulsed Doppler sonography. After randomization into two groups, one group received 10 mg of bisoprolol and the other 240 mg of verapamil LP in a single dose in the morning. After 2 months' treatment, the patients whose blood pressure was not well controlled were given a diuretic. Echo-Doppler was performed again by the same operator after 4-10 days on active treatment, after 6 months and after a subsequent 2 weeks of placebo for the patients treated with a single drug. The reduction in blood pressure was comparable in the two treated groups, but there was no significant decrease in left ventricular mass. Left ventricular filling was improved only in the patients receiving bisoprolol. The effect was observed immediately after the first administration and throughout the 6 months' treatment period declining slowly during the placebo wash-out. This effect appeared to be independent of any alteration in heart rate and was thought to be a specific action of this drug.

Adolescent↗
PubMedDate not supplied

[Is arterial hypertension in women different from that in men? Example of the relationship between arterial pressure and left ventricular mass].

In the Bordeaux cohort of never treated, uncomplicated hypertensive patients with office BP > 140/90 on at least 2 occasions, we selected those with good quality 24 H ambulatory BP measurement and LVM measured with M mode echo before any antihypertensive treatment. In this group, we studied the relationships between LVM and average 24 h systolic BP in males and females in univariate and multivariate analysis, taking into account age, weight and height. The population studied included 531 patients whose main characteristics are summarized in the table. The slope of the relationship between LVM and 24 h SBP is significantly steeper in males than in females (1.73 vs 0.58, p < 0.01). In multivariate analysis, the variable showing the higher correlation to LVM is 24 h SBP in males, weight in females. For a similar increase in BP, males hypertensive show a higher increase in LVM than females.

Adult↗
PubMedDate not supplied

[Study of the influence of the time of administration on the antihypertensive effect and nitrendipine tolerance in mild to moderate essential hypertensive patients. Value of ambulatory recording of blood pressure on 24 hours].

Forty-one patients with mild to moderate hypertension were included in a multicentre trial. The objective was to assess the influence of the time at which nitrendipine (Nidrel 20 mg) is taken on its efficacy and tolerance. The drug was administered once daily either in the morning or in the evening during 2 consecutive periods of 28 days. Efficacy was assessed on an ambulatory recording of blood pressure over 24 hours. Globally, nitrendipine results in a statistically significant drop in blood pressure which is not influenced by the time of administration. Treatment response varies greatly according to the initial value of ambulatory diastolic blood pressure. There is a clear antihypertensive effect if ADBP is greater than or equal to 90 mmHg and no hypotensive effect if ADBP is less than 90 mmHg. The incidence of adverse effects did not vary according to the time the drug was taken. Biological tolerance was excellent. Nitrendipine, administered once daily alone appears to be an efficient antihypertensive agent, well tolerated both clinically and biologically. Its efficacy is maintained over a 24-hour period regardless of the time at which the drug is taken.

Adult↗