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Biomedical subjects

P Louis

Publications and source records attributed to P Louis.

At least 127 records · Page 7Linked to original sources

Metoprolol v. clonidine in the prophylactic treatment of migraine.

In a double-blind, cross-over trial, the migraine prophylactic effect of the beta 1-adrenoceptor antagonist metoprolol was compared with that of clonidine. The dosage of metoprolol was 50 mg b.i.d. and of clonidine 50 micrograms b.i.d. Thirty-one patients were included; twenty-three completed the entire study. Six patients withdrew during clonidine treatment, one during metoprolol treatment and one during the wash-out period (placebo). Metoprolol had a significantly better migraine prophylactic effect than clonidine regarding such parameters as the attack frequency, the number of migraine days and the sum of intensity score. Compared to baseline (placebo), metoprolol decreased these parameters, while clonidine did not. Metoprolol, but not clonidine, also reduced the acute consumption of analgesics. No differences were found as regards side effects.

Adolescent↗

[Systemic arterial hypertension caused by discharge of catecholamines following ligation of ductus arteriosus].

A case of severe systemic hypertension due to catecholamines discharge after ligation of a large patent ductus arteriosus in an 8 months old child is reported. The blood pressure was corrected by the association of alpha- and betablocker drugs which were withdrawn on the 15th post-operative day without recurrence. Transient increases in blood pressure are quite common after closure of a patent ductus arteriosus with a large shunt. Persistent hypertension greater than 160/110 mmHg is rare. It always regresses but may sometimes cause complications. Hyperactivity of the sympathetic nervous system has already been suggested as a possible cause. Massive discharge of catecholamines and the spectacular effect of the association of alpha- and betablocker therapy, reported here apparently for the first time, provide additional evidence in favour of this hypothesis.

Catecholamines↗

[Diagnosis of left proximal coronary stenosis using 2-dimensional echocardiography].

The value of two-dimensional echocardiography (2DE) in the diagnosis of proximal left main coronary artery disease was assessed in 63 patients in whom 2DE was performed and interpreted before coronary angiography. The diagnosis of coronary artery disease depended on two groups of criteria, one group based on the lumen of the artery and the other, on the arterial wall. Eighty three pre cent of the investigations were interpretable. The bifurcation of the left main coronary artery was visualised in 23% of cases. 2DE was positive in 8 of the 10 cases (80%) in which coronary angiography showed stenosis of the left main coronary or the very proximal part of the left anterior descending arteries. There were two false negative results (20%). When coronary angiography did not show left main coronary stenosis (42 cases), 2DE was also negative in 39 cases (92%); there were 3 false positive results (7%), one due to calcification and other two to errors in appreciation of the criteria of stenosis. These results show that 2DE is useful before coronary angiography in identifying cases of possible left main stem or proximal left anterior descending disease providing the diagnostic criteria of coronary stenosis are strictly observed.

Constriction, Pathologic↗

[Amiodarone and hyperthyroidism].

22 cases of hyperthyroidism occurring during or following treatment with amiodarone are reported and compared with more than 15 cases in the literature. The specific clinical features of these cases of hyperthyroidism are presented and the problems in interpretation of the laboratory thyroid function tests are discussed. A study of the course of these cases reveals a number of prognostic factors. Finally, the authors describe the practical management of this form of hyperthyroidism.

Adult↗

[Right coronary-cardiac fistulae. Anatomic and clinical study, course and therapy. Apropos of 3 new cases].

Three cases of coronary-cardiac fistulae diagnosed in the Cardiologic Unit of the Dijon University Hospital are reported. With reference to these cases current knowledge on this rare condition is reviewed. Symptomatology is variable, with sometimes only a systolic and diastolic murmur on the sternal border, usually with good functional tolerance. A thorough investigation, including left angiography, ascertains diagnosis and shows the exact nature of the lesions. Surgery is almost always advocated as it often ensures good results and avoids delayed complications, which are mainly heart failure by coronary insufficiency, and infectious endocarditis.

Adult↗

Comparison of flunarizine (Sibelium) and pizotifen (Sandomigran) in migraine treatment: a double-blind study.

In this double-blind, randomized multicenter study involving 75 patients, the calcium-entry blocker flunarizine (10 mg nocte) was compared with pizotifen (2-3 mg per day in three administrations). Duration of treatment was four months. The results suggest that, in the dosage used, flunarizine is at least as effective as pizotifen in both classical and common migraine as regards effect on attack frequency. Flunarizine might tend to more markedly suppress severity of the attack, though. The weight gain seen with both drugs might be slightly less with flunarizine. A practical advantage of flunarizine is its simple dosage schedule (one intake per day).

Adolescent↗

[Aortic insufficiency associated with ventricular septal defect and a coronary-right ventricle fistula after bacterial endocarditis: surgical correction of 3 lesions].

The authors report a case of Staph-aureus endocarditis on preexisting aortic incompetence. Two complications were observed during the course of the infection: ventricular septal defect, rare but classical, and coronary-right ventricular fistula, a complication not previously described to the best of the author's knowledge. Before the onset of endocarditis a continuous murmur had not been detected clinically or by phonocardiography. This sign appeared while the patient was receiving effective antibiotic therapy. The diagnosis, suggested by the clinical signs in a patient in cardiac failure, was confirmed by catheterisation. This type of complication, already described in peripheral vessels, may be understood when the extent of the lesions at the right coronary cusp, near the septum and right coronary ostium, are appreciated. A good surgical result was obtained due to early operation of the three lesions.

Aortic Valve Insufficiency↗

[Chronic active hepatitis and pregnancy. A case report and review of the literature (author's transl)].

Vertical transmission of hepatitis B virus from mother to infant has been studied in chronic HBs Ag carriers. The frequency is low in Europe and USA (5 p. 100), contrasting with about 60 p. cent in Asia. The babies become usually chronic HBs Ag carriers. It is possible that chronic carriers have in fact chronic active liver diseases that are not recognized. Well documented observations of authenticated chronic hepatitis are so rare, that it is impossible to have a good idea of the maternal prognosis and to know the frequency of illness in the baby. We report the case of a 28 years old woman chronic active HBs Ag hepatitis diagnosed 2 years ago and treated with corticoids. After a normal pregnancy a healthy baby is born. THe HBs Ag is negative in the cord blood and in the serum. The maternal hepatitis has a good evolution. Three months later the baby becomes icteric, the HBs Ag is positive in the serum and he dies after 3 days. The prevention of such a bad evolution requires a prophylactic treatment. HBs immunoglobulins given to infants within 48 hours after birth and thereafter monthly for 6 months seems to be the better management.

Adult↗

[Interventricular communication caused by nonpenetrating injury of the thorax].

Previously fatal in the majority of cases, traumatic interventricular communications are now curable by surgery. This is illustrated by the case described here of a 20 year old man. 62 other cases were found in the literature. A systolic murmur is the essential feature in diagnosis but it may be discovered some time after the accident. The demonstration of cardiomegaly has less diagnostic significance than ECG signs suggestive of an infarction. Haemodynamic studies are essential to confirm the diagnosis and to provide an accurate assessment of the lesion. The spontaneous course is serious since death results in two thirds of cases. Surgery is indicated, other than in well tolerated forms with a minimal shunt. The approach used has almost always been right cardiotomy. However, incision of the left ventricle offers better visibility of the lesions which may be masked by the papillary muscles when a right-sided approach is adopted. This was used in the present case with an excellent result since the patient was able to continue the military career for which he had opted.

Adult↗

Clinical trial of Ro 6-0787, a monovalent specific hapten inhibitor of penicillin allergy.

A second clinical trial of the compound Ro 6-0787, which is a specific monovalent penicilloyl hapten inhibitor of allergic reactions to penicillin has been conducted by investigators from 9 different European groups in 90 patients allergic to penicillin. The effect of a combined Ro 6-0787-penicillin therapy was considered as clinically successful in the large majority of cases, since treatment with penicillin could be pursued or resumed without allergic manifestation in 42 from 46 cases (91 percent). The effect of Ro 6-0787 alone on acute allergic manifestations after interruption of penicillin therapy was more difficult to evaluate but was nevertheless considered satisfactory in 17 from 26 patients (65 percent). A depression of skin hypersensitivity to PPL and/or penicillin and penicillin derivatives sometimes persisting for weeks and months was obvious in numerous allergic patients submitted to combined Ro 6-0787-penicillin treatment. A depressing effect on antipenicillin antibody titers detected by passive hemaglutination was also manifest in some patients. Failure to suppress allergic manifestations was reported in 11 cases, among which some may have been due to insufficient dosage of inhibiting hapten. The overall tolerance of Ro 6-0787 in allergic patients has been very good. Nevertheless, the major obstacle to a wider general use of Ro 6-0787 at the present time appears to be the occurrence of positive skin reactions to that compound in approximately 5 percent of patients allergic to penicillin. It is not yet ascertained whether the occasional positive skin reactions and urticaria to Ro 6-0787 may have been due to aggregation, or incomplete dissolution of the compound or whether it reflects hypersensitivity to another antigenic determinant. With the reservation that patients with positive skin test to Ro 6-0787 have for the time being to be excluded from combined treatment, this monovalent hapten certainly offers a new possibility to resume and/or pursue penicillin therapy in patients demonstrably allergic to that drug.

Adolescent↗