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Biomedical subjects

P Larroque

Publications and source records attributed to P Larroque.

At least 37 records · Page 2Linked to original sources
PubMed1993

[Comparative evaluation of diabetic cardiac autonomic neuropathy by spectrum analysis and Ewing's tests].

METHODS: 62 diabetic patients of both sex (age: 46 +/- 16 yr, BMI: 26.1 +/- 4 kg/m2, casual blood pressure: 134 +/- 17/81 +/- 11 mmHg, mean age of diabetes: 11 +/- 9 yr) without cardiovascular medications were recruited. Autonomic involvement was based on the results from a battery of five cardiovascular tests as suggested by Ewing. The result of each test and a scoring system was considered. All patients underwent power spectral analysis (PSA) of digital blood pressure (BP) and RR intervals recorded in the recumbent position and after tilting with a Finapres monitor. The percentage of total power (0.025-0.4 Hz) computed in the low-frequency band (0.070-0.139 Hz) computed in the low-frequency band (0.070-0.139 Hz) was chosen as a sympathetic index (sigma Ind). Results of tests were correlated with sigma Ind. RESULTS: 24 patients (39%) have an autonomic involvement. The most affected tests are: the Valsalva maneuver (VAL): 16% RR response from lying to standing (LS): 25%, sustained handgrip (SHG): 30%, postural hypotension (PH); 57%, deep breathing (DB): 87%. Correlations coefficients of cardiovascular tests and sigma Ind are: VAL/sigma Ind (SBP tilt): r = 0.277, p = 0.029; Val/sigma Ind (DBP tilt): r = 0.318, p = 0.012; VAL/sigma Ind (RR tilt): ns. PH/Ind sigma (SBP tilt): r = 0.391, p = 0.0017; PH/sigma Ind (DBP tilt): r = -0.296, p = 0.019; PH/sigma Ind (RR tilt): r = -0.308, p = 0.015, DB/sigma Ind (SBP tilt): r = 0.417, p = 0.0007; DB/sigma Ind (DBP tilt): r = 0.361, p = 0.0039; DB/sigma Ind (RR tilt): ns. Results of LS and SHG show no correlation with Ind sigma. Correlations between global autonomic score (GAS) and sigma Ind during tilting have the following values: GAS/sigma Ind (SBP tilt): r = -0486, p = 0.0001; GAS/sigma Ind (DBP tilt): r = -0.385, p = 0.002; GAS/sigma Ind (RR tilt): r = -0.411, p = 0.0009. CONCLUSIONS: The so-called sympathetic index computed from PSA are well correlated with autonomic tests. They allow an early detection of sympathetic involvement in diabetics patients. These results are to consider while managing these subjects.

Autonomic Nervous System Diseases↗
PubMed1993

[Cardiovascular autonomic neuropathy and blood pressure variability in insulin-dependent diabetes].

The aim of this study was to analyse the role of cardiac autonomic neuropathy (CAN) in the changes of Blood-Pressure (BP) variability among insulin-dependent diabetics and to determine the relationship between BP variability and diabetic complications. Ambulatory BP monitoring was performed during 24 hours on 93 insulin-dependent diabetics and 77 normal subjects of similar age (Group 1). CAN was assessed by the cardiovascular autonomic function tests described by Ewing and the diabetics were divided in two groups: Group 2 including patients without CAN (n = 46) and Group 3 including patients with CAN (n = 47). The 24 h standard deviation (variability) and the day/night difference for systolic and diastolic BP were calculated for each subjects. Systolic and diastolic BP variability is more elevated in Group 3 than in the other groups during the diurnal period. Furthermore, the day/night difference of systolic and diastolic BP is lower in Group 3 compared to groups 2 and 3. Diabetic complications are also more frequently observed among diabetic patients with CAN (p < 0.001). So CAN seems to have two types of consequences on BP curve among diabetic patients: a decrease of day/night BP difference which can be responsible of relative hypertension during the night and an increase of BP variability. As frequency of diabetic retinopathy and nephropathy is more elevated among diabetic patients with CAN, it is possible that CAN plays a role in the occurrence of these complications. Therefore, a simple juxtaposition of these facts is also possible.

Adult↗
PubMed1993

[Unusual complication of venous thrombosis of the upper limb: pulmonary hypertension].

Although less frequent than that of the lower limbs, venous thrombosis of the upper limbs may cause pulmonary embolism. This embolism is usually moderate and facilitated by the delay or absence of anticoagulant treatment. We report the case of a young man who had multiple and recurrent embolism consecutive to thrombosis of the axillary and subclavian veins and who rapidly developed pulmonary arterial hypertension on previously healthy lungs. There was no venous disease of the lower limb. After a more than 2 years' period, the pulmonary arterial hypertension is still moderate, but the patient remains under long-term antivitamin K therapy, this being the only available treatment capable of preventing a deterioration that would result in post-embolic cor pulmonale and ultimately require lung transplantation.

Adult↗
PubMed1992

Short-term representatives of daytime and night-time ambulatory blood pressures.

OBJECTIVE: To see whether measurements of ambulatory blood pressure during short-term daytime and night-time periods can represent complete daytime and night-time pressures accurately. DESIGN: Short-term measurements would be less uncomfortable for patients, easier to perform and could lead to fewer missing values, outliers or artefacts than full-day measurements, especially when repeated monitorings are required. METHOD: Ambulatory blood pressure was measured every 15 min for 24 h in 254 subjects with normal or borderline office blood pressure. Each pressure profile included at least 80 valid readings. Mean blood pressures for different 1-, 2-, 3-, 4-, 5- and 6-h spans were calculated and compared with mean daytime and night-time values using paired Student's t-test. RESULTS: One or two-hour spans of daytime blood pressure poorly represented mean daytime pressure. In contrast, 4-h readings, selected between 1000-2200 h represented daytime blood pressure with good accuracy. Over the total sample, 4-h mean blood pressure readings from 1000-2200 h differed from daytime readings by less than 2 mmHg and 2-h mean readings from 0300-0700 h differed from mean night-time readings by less than 1 mmHg. CONCLUSION: We suggest that 4-h measurements of ambulatory blood pressure during the daytime and 2-h measurements at night (with time spans selected as indicated as above) may be of value.

Adolescent↗
PubMed1992

Ambulatory blood pressure monitoring: a critical review of the current methods to handle outliers.

OBJECTIVES: To examine the methods to handle marginal readings in the analysis of ambulatory blood pressure. DESIGN: Data obtained from automatic ambulatory blood pressure monitoring include several 'outliers', i.e. readings at the frontier of physiologically acceptable ranges. Several methods have been used to handle these readings. We need to know whether using different methods to reject outliers leads to different results in the analysis of the data. If so, then it is important that a common method be used by different authors. METHODS: Ten reported methods to handle outliers were selected and applied to a large set of unpublished blood pressure profiles (Novacor Diasys system). We compared the effects of data rejection by these methods on the mean values and standard deviations (calculated over 24 h, daytime and night-time) of the remaining data. RESULTS: The different methods had quite different effects on the same data set. Depending on the method used, the discarded data varied from 1 to 17% of the total number of readings. Among the rejected data, readings that occurred in the daytime varied from 14 to 56%. Also, 'high-value' outliers varied from 1 to 60% of the rejected data. On average over the total sample, the rejection of outliers had only a small effect on the mean values of blood pressure. In contrast, it may strongly reduce the standard deviation of the readings. CONCLUSION: The study emphasized the need to use a common method to handle outliers in the analysis of ambulatory blood pressure data.

Adult↗
PubMed1992

[Chaotic aspect of heart rate and blood pressure in diabetic patients].

We applied a simplified version of the method suggested by Sugihara-May (Nature 1990: 344: 734-41) to study the control of heart rate (HR) in subjects with diabetes mellitus. The method aims to predict the future of an observation, if a series of observations on the same phenomenon is available. The method quantifies the fact that the series is predictable more or less longtime in the future. A random series is only shortly predictable in the future. HR and blood pressure were measured from beat to beat (by the Finapres system) for about 0.5 hours in 11 subjects with diabetes mellitus and normal blood pressure (group D) and in 10 controls subjects (group N). The subjects were sitting in a temperature-controlled quiet room, isolated from all external stimuli. The 2 groups were matched for age, and had the same weight and height. No difference was observed in mean-value and standard deviation (SD) of BP and HR between the 2 groups. Groups N/D: SBP = 112 +/- 11/123 +/- 11 mmHg, NS; DBP = 64 +/- 9/67 +/- 12 mmHg, NS; HR = 70 +/- 10/69 +/- 7 b/min, NS. Standard deviation of PAS = 5.5 +/- 1.6/5.7 +/- 1.9 mmHg, NS and SD of DBP = 3.5 +/- 0.9/3.4 +/- 1.2 mmHg, NS. The SD of HR (3.0 +/- 0.5/2.3 +/- 1.0 b/min in groups N/D) was somewhat lower in diabetics than in control subjects but the difference was not significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗
PubMed1992

[Leg muscle bed syndrome: medical aspects of chronic forms].

Ninety two patients with lower leg pain of unknown cause underwent intramuscular pressure measurements by the needle technique described by Whitesides. Fifty four patients (59%) were found to have a chronic compartment syndrome. In these patients the intramuscular pressure was significantly increased at rest and after exercise as compared with normal subjects (13) and patients without the syndrome (38). Increased pressure at rest after exercise and a prolonged time for normalisation are the most commonly parameters in diagnosing chronic compartment syndrome. Tissue pressure measurement remains the basis of diagnosis for patients suffering from chronic compartment syndrome, indeed the clinical findings alone were found to be insufficient. Effective treatment consists of reduction of exertional activities or decompression by fasciotomy. The clinical results after fasciotomy were good and consistent with the findings of others.

Adult↗
PubMed1991

Atrial natriuretic factor and ambulatory blood pressure in young male subjects with normal or borderline office blood pressure.

Plasma levels of immuno-reactive atrial natriuretic factor (ANF) and ambulatory blood pressure were studied in 42 male subjects, aged 18 to 31 y, including 24 subjects with normal BP and 18 with borderline essential hypertension. ANF was measured in the morning (9 a.m.-12 a.m.), with the subjects in the supine and in the upright positions. Ambulatory BP was determined in all subjects every 15 minutes, for a whole 24 hour period. A scatter plot of office SBP or DBP versus upright or supine ANF suggested negative relationships (not significant). In contrast, the plasma ANF level was significantly correlated to ambulatory BP, especially to daytime BP (r = -0.52, p less than 0.001, between daytime SBP and upright ANF; r = -0.50, p less than 0.001, between daytime DBP and upright ANF). The data suggested that ANF is decreased in borderline hypertension, but the decrease can be evidenced only when BP is repeatedly determined to afford reliable data. An inhibition of the atrial release of ANF might be one possible mechanism contributing to the genesis of borderline essential hypertension.

Adult↗
PubMed1991

Ambulatory blood pressure in young subjects with familial history of hypertension.

Office blood pressure (BP), ambulatory blood pressure, (one determination every 15 min, over an entire 24 h span), were measured in 206 young male subjects, including 96 individuals having first degree familial history of hypertension (the F group) and 110 control subjects, matched for age, having no familial history of hypertension (the C group). In both groups, age ranged from 19 to 25 y. After a complete clinical and laboratory examination, all subjects were diagnosed as in good health. In particular, none had cardiac, renal or neurologic involvement. No subject received medication. Over the whole sample, 126 subjects had normal office BP and 80 had borderline office BP. No difference was found in office diastolic BP between the C and F groups. Office systolic BP was somewhat higher in the F group, when compared to the C group, but the difference was in the limit of statistical significance (0.05 less than p less than 0.10). In contrast, ambulatory systolic BP was significantly higher in the F group, when compared to the C group, the difference (0.05 less than p less than 0.001) occurred in daytime and at night. The above difference was more significant (p less than 0.02 to p less than 0.005) and persisted over larger time-spans when only subjects with normal office BP in the C and F groups are compared. In contrast, when restricted to the borderlines only, office and ambulatory BP was the same in subjects with and without familial history of hypertension.

Adult↗
PubMed1991

[Role of nocturnal hypertension in the deterioration of diabetic nephropathy].

UNLABELLED: Nocturnal hypertension (HTA), even a relative one, consequence of the change of the circadian pattern of blood pressure, may increase the whole day blood pressure in diabetic patients. MATERIALS AND METHODS: blood pressure has been measured every 15 minutes for 24 hours in 101 diabetic patients (43 insulin-dependent: type 1, 58 non insulin-dependent: type 2) by ambulatory blood pressure monitoring. 39 of them are hypertensive patients. Among these 101 patients, 19 have a nocturnal relative HTA corresponding in a lack or a negative difference between the diurn and the nocturn systolic or diastolic pressure (Group 1). The Group 2 is constituted by the 82 other patients; 24 hour-microalbuminuria was assayed by immunoturbidimetry for two days on end. RESULTS: patients of Group 1 were significantly older (p less than 0.01) than in the Group 2 (61 +/- 9 years vs 54 +/- 13 years). There was no significant change between the two Groups concerning the kind of diabetes (type 1 or type 2), the glycosylated hemoglobin and the frequency of degenerative complications. Microalbuminuria was significantly higher (p less than 0.01) in Group 1 (72 +/- 104 mg/24 h) than in Group 2 (20 +/- 30 mg/24 h). Both nervous dysautonomic cardiac failure and HTA treated were significantly higher in Group 1 than in Group 2, respectively (14/19 vs 28/82; p less than 0.01) and (15/19 vs 24/82; p less than 0.001). The causal blood pressure measurement was similar in the two Groups, but the whole day ambulatory blood pressure monitoring revealed a significant increase of the average of systolic (Group 1: 133 +/- 14 mmHg vs Group 2: 119 +/- 12 mmHg; p less than 0.001) and diastolic (Group 1: 81 +/- 12 mmHg vs Group 2: 75 +/- 8 mmHg; p less than 0.01) blood pressure during 24 hours. COMMENTS: the causal blood pressure measurement fails to appreciate the increase of the whole day blood pressure consequent to the suppression of nocturnal hypotension and sometimes to the occurrence of real nocturnal hypertension. This observation is probably in relation with the nervous dysautonomic cardiac failure and is associated with an increase of the microalbuminuria (patients with microalbuminuria greater than 30 mg/24 h--Group 1: 9/19 vs Group 2: 17/82; p less than 0.05). This situation can lead to an aggravation of degenerative complications. Such results should urge practitioners to assess the circadian pattern of blood pressure in diabetic patients more accurately.

Aged↗
PubMed1991

[Baroreflex and blood pressure variations in borderline hypertension of the young adult].

Blood pressure (BP) variability depends on external and internal factors. Among these, arterial baroreflex play an important role. The matter of this study is to assess the relationship between these two parameters in borderline hypertension (BL). Twenty six BL male hypertensive were recruited for the study, all gave informed consent. Age: 21 +/- 2 years, height: 177 +/- 8 cm, weight: 77 +/- 14 kg. An ambulatory BP monitoring was performed in each one using a Diasys (Novacor) recorder. Measurements were obtained each 15 minutes for 24 hours. Mean, standard deviation and variation coefficient (VC) of BP and heart rate (HR) were computed for 24 hours, daytime (9a.m.-7 p.m.), nighttime (11 p.m.-7 a.m.). Baroreflex sensitivity (BRS) was determined as the ratio of HR variation on systolic BP variation recorded with a Finapres device from the fourth phase of a Valsalva manoeuvre. Mean systolic and diastolic BP values for 24 hours, daytime and nighttime are: 129 +/- 11/73 +/- 13, 137 +/- 14/76 +/- 15, 114 +/- 11/69 +/- 12 mmHg. VC are: 12 +/- 3/15 +/- 3, 9 +/- 3/13 +/- 3, 10 +/- 3/13 +/- 4%. HR values are: 73 +/- 10, 84 +/- 14, 58 +/- 7 b/min, VC are: 24 +/- 5, 17 +/- 4, 17 +/- 7%. Index for BRS = 1.76 +/- 0.65%. There is no correlation between BRS and systolic BP or HR. BRS is correlated to the inverse of systolic daytime BP VC: r = -0.556, p = 0.003. There is no correlation with other parameters. This study provides evidence for a link between BRS and daytime BP variability in borderline hypertension.

Adult↗
PubMed1991

[Mechanism of clinical onset and outcome of coronary disease before 40 years of age. 148 cases].

This study reviewed the clinical histories of 148 coronary patients aged 34 +/- 5 years (20-40 years) documented in the same cardiology unit. Myocardial infarction was the presenting condition in 114 patients (77%): inaugural 65%, with prodrome 7%, asymptomatic 4%. The presentation was angina pectoris in 32 patients (22%): effort angina 15%, unstable angina 7%. Two patients had other symptoms (1%). The coronary lesions were significant (greater than 50%) in 112 patients (77%) which included 41% single vessel diseases and 36% multiple vessel diseases. The coronary lesions were insignificant in 10 patients (7%) and absent in 21 (15%) (33% under and 11% over 30 years of age). After an average follow-up of 48 months (range 1 to 10 years), 20 of the 32 patients presenting with angina developed myocardial infarction and 6 had episodes of unstable angina (65% in the first year following diagnosis). Six patients had no serious coronary events, but thereafter, 3 died. Fifteen patients (47%) are asymptomatic (including 8 after coronary bypass surgery). Ten patients are symptomatic. Of the 114 patients with inaugural myocardial infarction, 3 have died, 67 (58%) are symptomatic; the average number of risk factors per patient was related to age and to the degree of coronary artery disease. The left ventricular ejection fraction was significantly higher in asymptomatic patients than in those who had presented a coronary event after myocardial infarction.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1990

Inverse relationship between upright plasma renin activity and twenty-four hour blood pressure variability in borderline hypertension.

Office, i.e. measured by the physician at rest, and 24 h ambulatory systolic (SBP) and diastolic (DBP) blood pressures, heart rate, supine and upright plasma renin activities, supine and upright aldosterone concentrations and plasma and urine sodium and potassium were measured in 61 young male subjects aged 19-25 years, including 40 normotensive subjects (office DBP less than or equal to 90 mmHg and office SBP less than or equal to 140 mmHg) and 21 borderline hypertensive subjects (non-normal blood pressures with office DBP less than or equal to 95 mmHg and office SBP less than or equal to 160 mmHg). No significant differences were found in the plasma or urine K+ or Na+, upright or supine plasma renin activity or aldosterone concentration between normotensives and borderline hypertensive subjects. No correlation was detected between plasma and urine K+ or Na+, upright and supine aldosterone concentration or supine plasma renin activity and blood pressure. In contrast, significant inverse correlations were observed between upright plasma renin activity and blood pressure. The correlations were approaching statistical significance when upright plasma renin activity was related to office SBP and office DBP (r = -0.22, P = 0.097 and r = -0.25, P = 0.049, respectively), and were more significant when plasma renin activity was related to 24 h mean DBP (r = -0.32, P = 0.013) and to SBP and DBP standard deviations (r = -0.37, P = 0.004 and r = -0.26, P = 0.04, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Study of representative periods of day-time and night-time levels of blood pressure].

UNLABELLED: The aim of this study is to assess whether it is possible to shorten ambulatory blood pressure (ABP) monitoring while getting measurements that precisely reflect 24 hours and daytime blood pressure (BP). METHODS: three hundred and thirty six young male subjects aged: 21 +/- 2 y, height: 178 +/- 7 cm, weight, 75 +/- 12 kg, with normal or "borderline" BP (casual BP: 138 +/- 13/79 +/- 8 mmHg) participated in the study. BP was recorded in each, every 15 minutes on 24 hours with a Spacelabs 5200 device. Systolic and diastolic BP on 24-h, during the 9 a.m. - 8 p.m. period (daytime) and BP related to the different subperiods included between 15 minutes and 6 hours were calculated. BP values obtained from the 196 subperiods were correlated with 24-h, daytime ABP and causal BP. Results were classified according to the value of correlation coefficient, slope and intercept of regressions. RESULTS: no subperiod accurately predict 24-h systolic BP (SBP) or diastolic BP (DBP) (the best correlation are established with the subperiods: 7 p.m.-01 a.m. for SBP; r = 0.916, p less than 10(-9), y = 0.76 x + 30; and 06 a.m.-12 a.m. for DBP; r = 0.914, p less than 10(-9), y = 0.87 x + 9). Four 6 hours subperiods sampled between 09 a.m.-3 p.m. and 12 a.m.-6 p.m. predict alike and in a reasonable way the daytime BP (SBP: r = 0.971, p less than 10(-9), y = 0.94 x + 8; r = 0.973, p less than 10(-9), y = 0.91 x + 7. Best correlations with casual BP are moderate (SBP: r = 0.674, DBP: r = 0.588). COMMENTS: BP measurements of subperiods smaller or equal to 6 hours cannot accurately predict the average 24-h BP. This is related mainly to the night-time/daytime BP fluctuations. Daytime BP can be estimated with short-term monitoring but the duration must not be smaller than 6 hours.

Adult↗
PubMed1990

[Doppler evaluation of blood flow of the lower limb].

UNLABELLED: Regional blood flow measurement in the limbs (BFLL) is of special interest in order to evaluate the consequences of hypertension. The purpose of this study is to assess the interest of the Doppler ultrasound method in the BFLL measurement among normotensive or borderline hypertensives young male adults. BFLL reproducibility was evaluated among 23 healthy subjects aged 21 +/- 2 y, height 177 +/- 8 cm, weight 75 +/- 13 kg at day one (D1) and three day later (D3). Measurements were made basically after 20 minutes lying at rest and after cold pressor test (CPT). BFLL estimation depends on common femoral artery diameter (FAD) echographic measurement at the thigh root and on velocity time interval (VTI) calculation with pulsed wave doppler using controlled incident angle and sample volume. The following parameters were measured: mean arterial pressure (MAP) using Dinamap, heart rate (HR), FAD, common femoral artery cross sectorial area (A), VTI and peripheral arteriolar resistances (PAR). Basic and CPT results at D1 and D3 were compared using paired "t" test. RESULTS: [table: see text] Comparisons between basic state and CPT demonstrate a significant decrease of VTI and BFLL, a significant increase of PAR. D remained unchanged. Doppler ultrasound method is easy to use. Systolic femoral volume measurement is relatively insensitive to small transducer positioning variations so that the method reproducibility is satisfactory.

Adult↗
PubMed1990

[Peripheral neurofibromatosis and involvement of lumbosacral nerves. Value of imaging].

We report a case of giant plexiform neurofibromatosis revealed by a sensori-motor, axo-myelinic polyneuropathy. Only the lumbar and sacral spinal nerves were involved in this peripheral form of Von Recklinghausen's disease. The polyneuropathy was due to compression of the nervous fibers by the neurofibromatous tumors. Ultrasonography DTPA 99 m Technetium scintigraphy, CT and MRI were the diagnostic procedures. MRI proved superior to CT in demonstrating the extent of the lesions. Biopsy confirmed the diagnosis. This form of neurofibromatosis did not involve the central nervous system, cranial nerves of cervicothoracic spinal nerves and roots; nor was there any visceral involvement, particularly endocrine neoplasia.

Adult↗