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Biomedical subjects

P Maurice

Publications and source records attributed to P Maurice.

At least 37 records · Page 2Linked to original sources
PubMed1986

Efficacy and clinical cross-resistance of a new combination therapy (AMSA/VP16) in previously treated patients with acute nonlymphocytic leukemia.

We investigated the tolerance, efficacy, and clinical cross-resistance of a new combination chemotherapy in 38 patients with previously treated acute myeloblastic leukemia (AML). It consisted of 120 mg2/d 4'(9-acridinylamino) methanesulfon-m-Anisidide (m-AMSA) in a one-hour infusion and 80 mg/m2/d etoposide (VP-16) in a 24-hour infusion, both administered for 5 days. The first 27 patients also received vinblastine, 6 mg/m2 on day 8, but this therapy was discontinued because of intestinal complications. Thirteen of 23 patients (56%) at first or subsequent relapse and five of 15 patients (33%) who were primarily resistant to an anthracycline/cytarabine combination achieved a complete response (CR) (hemoglobin level not taken into account) with a median CR duration of 5 months and 2 months, respectively. The response rate was as high as 63% for patients at first or second relapse whether the remission was maintained or not. The median times to recovery of normal bone marrow cellularity, of blood granulocyte counts greater than 500/microL, and of platelets greater than 20,000/microL were 34, 27, and 22 days, respectively. Marked but reversible gastrointestinal toxicity was observed in 24% of the patients, and two patients died of infection during induction. The one-hour AMSA/continuous VP-16 combination is effective for patients with relapsing AML and shows no cross-resistance in a proportion of patients refractory to the standard anthracycline-cytarabine combination.

Adolescent↗
PubMed1986

[Abnormal origin of the left coronary artery. Pre- and postoperative hemodynamic and metabolic studies].

The authors report the case of an asymptomatic 45 year old man in whom an abnormal origin of the left coronary artery was discovered fortuitously. Coronary angiography was carried out for electrocardiographic signs of anterior myocardial infarction and showed the left coronary artery arising from the pulmonary artery: there was apical dyskinesia with alteration of global left ventricular function. The ostium of the left coronary artery was closed and a saphenous vein aorto-left anterior descending artery bypass was performed. There were no complications. Left ventricular function has not improved 8 months after surgery. The haemodynamic and coronary signs of myocardial ischaemia demonstrated preoperatively regressed after surgery: the coronary "steal" caused by the malformation which led to poor perfusion of the territory of the left coronary artery has therefore been corrected by surgery. This procedure should be carried out as early as possible in order to limit extension of the myocardial lesions.

Coronary Artery Bypass↗
PubMed1985

[Transplantation of allogeneic bone marrow treated in vitro with Campath-1 monoclonal antibody].

5 patients underwent bone marrow transplantation for severe aplastic anemia (2) and acute leukemia (ALL) in first remission (3). Graft versus host disease prophylaxis was performed by depleting T lymphocytes in the donor bone marrow with the rat monoclonal Campath-1 and autologous complement. In addition, patients received cyclosporin A. Engraftment occurred normally in all 5 patients but 1 patient (SAA) had a late graft failure. Two patients suffered mild degrees of GvHD. All patients are currently in complete remission, one having undergone a second transplantation.

Adult↗
PubMed1985

[Clinical and electrophysiological aspects of median intra-His bundle block with normal electrocardiogram at rest].

The clinical and electrophysiological features and the natural history of median intra-His block with a normal resting electrocardiogram were studied: 11 patients had a fixed split H1-H2 potential with a spontaneous or induced block between H1 and H2. The patients (5 men and 6 women) were aged 17 to 70 years (average 53 years). Associated pathology included 2 cases of aortic stenosis (1 severe), 1 case of ischaemic heart disease (effort angina), 1 case of mitral valve prolapse and 2 cases of hypertension. The presenting symptoms were syncope (4 cases), dizziness (2 cases), effort angina (1 case) and tiredness (3 cases); 1 patient was asymptomatic. Holter monitoring (24 hours) was performed in 8 patients and s-owed paroxysmal conduction defects in 6 cases; 4 Mobitz II 2nd degree AV block, 1 3rd degree AV block with narrow QRS complexes and 1 case of blocked atrial extrasystoles at coupling intervals longer than 480 ms and sinus cycle lengths of over 800 ms. Exercise testing by bicycle ergometry (4 patients) was normal in 1 case and revealed Mobitz II 2nd degree AV block in 3 cases. Baseline electrophysiological studies showed an A-H1 interval ranging from 60 to 100 ms (average 78 ms), a H1-H2 interval of 20 to 40 ms (average 31 ms) and a H2-V interval of 30 to 50 ms (average 32 ms). Block between H1 and H2 was observed: "spontaneously" during electrophysiological investigation in 6 cases, after IV atropine in 1 case, during overdrive atrial pacing at rates slower than 150/min in 7 cases, after atrial extrastimulus with a functional intra-His refractory period of over 420 ms in 7 cases, after ajmaline in 3 of the 4 cases in which this test was performed. A cardiac pacemaker was implanted in 10 patients in whom the initial symptoms have all regressed; the remaining patient considered to be "epileptic" had another syncopal attack under therapy and was finally paced. This series demonstrates that the diagnosis of median intra-His block depends on precise electrophysiological criteria and should be looked for even when the presenting symptoms are atypical; some of our patients complained only of tiredness. The value of Holter monitoring and careful endocavitary investigation is emphasised. Median intra-His block should be distinguished from longitudinal and functional His bundle dissociation.

Adolescent↗
PubMed1984

Acute myelogenous leukaemia: maintenance chemotherapy after early consolidation treatment does not prolong survival.

To investigate the value of maintenance chemotherapy after early consolidation treatment, an attempt was made to induce remission in 162 previously untreated patients, age-range 7-65 years (median 43). The 74 patients who were still in remission after early consolidation treatment (given for 3-5 months) were assigned to either maintenance chemotherapy every 8 weeks for 2 years or to observation only. After a median observation period of 44 months there was no difference between the groups in duration of remission or survival. Surprisingly, patients above 40 survived longer after early consolidation (median 4 years) than did patients aged 40 and below (median 1.6 years, p = 0.0002).

Adolescent↗
PubMed1984

[Measured and estimated sinoatrial conduction during variations in rhythm. Microelectrode study of the isolated rabbit atrium].

Strips of isolated atrium were obtained from 10 rabbits to study the validity of indirect methods of estimating sinoatrial conduction time during variations of the sinus rhythm. Direct recordings of the trans-membrane action potential of the sinus node were made. Mapping of the sinus region was undertaken to determine the site of the dominant pacemaker. A quadripolar surface electrode was positioned on the lower part of the crista terminalis for stimulation and recording of the atrial potential. This enabled a comparison to be made between the indirect estimated and the directly measured conduction times. An intrasinusal shift of the dominant pacemaker was obtained by cooling from 38 degrees C to 35 degrees C. This shift occurs progressively in the cranino-candal direction. The estimated and measured conduction times were compared under basal conditions and after cooling. The sinus cycle was significantly longer (p less than 0.001) at 35 degrees C (318 +/- 68 ms) than at 38 degrees C (255 +/- 48 ms). The mean measured anterograde conduction time also decreased from 36 to 31 ms (p less than 0.01) and the mean measured retrograde conduction time also decreased from 39 to 33 ms (p less than 0.02); the total conduction time decreased from 75 to 64 ms (p less than 0.001). The results of the total estimated conduction times were discordant. The associated effects of stimulation and cooling can cause conduction defects and an overestimation of the conduction time.(ABSTRACT TRUNCATED AT 250 WORDS)

Action Potentials↗
PubMed1984

[Comparison of quantitative data from two-dimensional echocardiography and anatomical examination in mitral stenosis].

This prospective study was undertaken to assess the results of 2D echocardiography in the assessment of valvular and subvalvular lesions in mitral stenosis. The echocardiographic findings (E) were compared with peroperative and laboratory anatomical examination of the excised valve (A). The following criteria were compared: 1) planimetry of mitral valve surface area, 2) mobility of the anterior leaflet, assessed anatomically by the flexibility of the tissue, and echocardiographically by the amplitude of early diastolic excursion, 3) length of anterior and posterior leaflets, 4) presence of calcification, 5) length of the longest tendinae chordae, measured from the papillary muscle to the insertion of the valve, 6) thickness of the thickest tendinae chordae attached to each leaflet. Echocardiography was carried out preoperatively by two different operators without knowledge of the haemodynamic and later anatomical findings. The anatomical results were taken as reference. Mitral valve surface area measured by both methods was comparable (A = 0,96 +/- 0,28 cm2; E = 1,04 +/- 0,33 cm2, N = 17, t = NS) and a good correlation was found between the two measurements (r = 0,79; p less than 0,01). 2D echo assessed the loss of valvular mobility by limitation of early diastolic opening of the AML with a sensitivity of 71 p. 100 and a specificity of 70 p. 100. Measurement of valve length of the anterior (N = 14) and posterior leaflets (N = 15) may be difficult in the presence of severe calcification. The results of both measurements were comparable. AML, 25,2 +/- 1,9 mm (A) and 24,6 +/- 2,1 mm (E); PML, 13,9 +/- 1,9 mm (A) and 14,2 +/- 2,2 (E) correlated well, r = 0,71 and r = 0,71 respectively (p less than 0,01).(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1984

[Magnesium deficiencies in cardiovascular diseases].

Plasma (pl), red blood cell (ery) and urinary magnesium (Mg) concentrations were measured by spectrophotometry in over 300 patients at the Cardiology Department of Broussais Hospital. Other biological parameters, including pl and ery potassium, calcium and phosphate concentrations were measured simultaneously. In a control group (54 subjects) the mean pl Mg was 0,851 mmol/l in men and 0,819 mmol/l in women; mean ery Mg was 2,12 mmol/l and 2,09 mmol/l respectively. Magnesium depletion was observed in several pathological cardiovascular conditions: -- mitral valve prolapse: the Mg levels were significantly lower in women (19 cases) (pl Mg 0,740 mmol/l; ery Mg 1,83 mmol/l: p less than 0,001); the deficit was less pronounced in men: pl Mg 0,829 mmol/l, p less than 0,01, and ery Mg 2,01 mmol/l (NS); -- recurrent junctional tachycardia (21 cases): the Mg levels were significantly lower than normal: pl Mg = 0,796 mmol/l in men and 0,763 mmol/l in women; ery Mg = 1,93 and 1,88 mmol/l, respectively; -- coronary insufficiency (86 cases): pl Mg = 0,821 mmol/l in men and 0,768 mmol/l in women (p less than 0,001). In a subgroup with coronary spasm (22 cases), the mean ery Mg was decreased (2,01 mmol/l, p less than 0,05); -- unstable or labile hypertension (24 cases): the decrease was significant, especially in women (pl Mg = 0,796 mmol/l, ery Mg = 1,88 mmol/l). These magnesium deficits were sometimes associated with a low pl Ca, and often associated with a low ery K although pl K was usually raised. In some privileged cases of cardiac arrhythmia and coronary spasm, intravenous Mg repletion was beneficial but did not affect plasma concentrations. The role of magnesium depletion in cardiovascular disease remains obscure and requires further study.

Adolescent↗
PubMed1984

[Acute hemodynamic and coronary effects of captopril in chronic cardiac failure].

The acute effects of captopril on haemodynamics, coronary flow and myocardial metabolism were studied in 12 patients with chronic severe cardiac failure (primary cardiomyopathy: 10 cases; ischaemic: 2 cases) in functional Classes III or IV of the NYHA. All patients were male and their average age was 51.3 +/- 14.1 years (range 27 to 68 years). Measurements were carried out under basal conditions and 90 minutes after a single dose of 50 mg (5 cases) or 100 mg (7 cases) of captopril. Captopril administration leads to an increase in cardiac index from 2.05 +/- 0.32 to 2.34 +/- 0.35 l/min/m2 (p less than 0.05) and a greater increase in systolic index from 23.9 +/- 6.7 to 29.8 +/- 6.9 ml/syst/m2 (p less than 0.01), because the heart rate decreased slightly (p less than 0.05). These changes were the result of a decrease in afterload: mean aortic pressure fell from 85 +/- 11.8 to 68 +/- 19.6 mmHg (p less than 0.01) and systemic arterial resistance fell from 2 886 +/- 745 to 2 010 +/- 610 dynes/cm-5/sec/m-2 (p less than 0.01). Captopril also led to a fall in venous tone, i.e. pre-load: left ventricular end diastolic pressure fell from 26.9 +/- 6.1 to 20.8 +/- 6.6 mmHg: p less than 0.01. There was no change in contractility as shown by the absence of variation of the V.max (0.92 +/- 0.18 under basal conditions, and 0.90 +/- 0.15 after 90 minutes).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

[Reduced dosage of cytosine arabinoside in the treatment of acute myelocytic leukemia. Apropos of 3 cases].

Two out of three patients with acute myeloid leukemia responded to treatment with small subcutaneous doses of cytosine-arabinoside alone. Although marked cytopenia may transiently occur this treatment has no other side effects and is simple to administer. It may therefore be useful for elderly patients. Morphological studies and indirect evidence suggest that this schedule, dosage and route of administration for cytosine-arabinoside may promote differentiation within the malignant clone rather than acting as a cytotoxic agent.

Aged↗
PubMed1983

Non-invasive quantification of aortic regurgitation by Doppler echocardiography.

This study was undertaken to assess the contribution of Doppler echocardiography to the quantification of aortic valve regurgitation. Ultrasound examination was performed by recording aortic arch blood flow from the suprasternal notch. A non-invasive index of valve regurgitation was obtained by calculating the ratio between the maximal amplitude of forward flow during systole and the amplitude of retrograde flow during diastole measured at the onset of the R wave of the electrocardiogram. This index was compared with semiquantitative data derived from supravalvular aortography in 93 patients. In pure aortic regurgitation (67 patients) the results showed a high correlation coefficient between Doppler and angiographic estimates. In cases of associated aortic valve stenosis there were problems in the accurate estimation of systolic blood flow which led to global overestimation in general of the degree of regurgitation and considerable lack of precision in individual patients. But in general Doppler echocardiography appeared to be a successful technique to quantify pure aortic regurgitation.

Adolescent↗
PubMed1983

Quantitative assessment of tricuspid regurgitation using pulsed Doppler echocardiography.

Tricuspid valve regurgitation was assessed quantitatively by measuring blood flow velocity in the vena cava using a pulsed Doppler velocimeter. A non-invasive index of regurgitation was obtained by calculating the ratio between the maximum amplitudes of the systolic and diastolic components of the velocity curves. The index was compared with the angiographic grading of regurgitation in 70 patients after right heart catheterisation; the results were closely correlated. Using the Doppler index the differences between the groups defined according to their angiographic grade were significant. Thus measurement of blood flow velocity in the vena cava appears to quantify accurately the severity of tricuspid regurgitation.

Adolescent↗