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Biomedical subjects

P Maurice

Publications and source records attributed to P Maurice.

At least 73 records · Page 4Linked to original sources
PubMed1982

Self-injurious behavior prevalence and relationships to environmental events.

A survey of 2,858 persons in three institutions indicates an overall prevalence of 14.1% for SIB. Topography of SIB, number of forms in each subject, and intensity and frequency are related to the circumstances surrounding SIB, personnel reactions, age, sex, diagnosis and degree of retardation. Analyses of these relationships provide an SIB profile for the aggressive/severely-profoundly retarded. Direct observation of SIB in the wards indicates a low rate of antecedent and subsequent events. These findings are interpreted in relation to alternative explanatory hypotheses of SIB.

Adolescent↗
PubMed1981

Non-invasive diagnosis of mitral regurgitation by Doppler echocardiography.

The value of Doppler echocardiography for the non-invasive diagnosis of mitral regurgitation was studied blindly in 161 consecutive invasively investigated adult patients. Regurgitation was graded from 0 to 3 at selective left ventricular angiography. The Doppler echocardiographic examination was considered to be positive when a disturbed systolic flow was found within the left atrium behind the aorta or the anterior leaflet of the mitral valve. The test was considered to be negative in the absence of a regurgitant jet. The level of the signal to noise ratio was checked by the recording of the ventricular filling flow. The study was performed in 131 cases from the left side of the sternum and in 101 cases from the apex. There were no false positives and thus the specificity was 100 per cent. The 20 false negatives were all in patients with grade 1 regurgitation. Thus only some (33%) instances of mild regurgitation were misdiagnosed, and the sensitivity for moderate to severe mitral regurgitation was 100 per cent.

Adolescent↗
PubMed1981

[Sudden death during continous electrocardiographic recording by Holter's method].

The case of a 79 year old patient who died during continuous electrocardiographic recording by Holter monitoring is reported. There was a previous history of respiratory insufficiency, postero diaphragmatic myocardial infarction and left hemiplegia. Death occurred suddenly at home after defecation. Analysis of the recording showed multiple polymorphic ventricular extra-systoles, often occuring in doublets at the beginning of the record. Death was caused by a salvo of three ventricular extrasystoles triggering ventricular tachycardia which rapidly degraded to irreversible ventricular fibrillation. This major arrhythmia may have been due either to adrenergic stimulation from the effort of defecation or to acute myocardial infarction. This case underlies the value of Holter monitoring in the assessment of the gravity of an arrhythmia. It is also of interest because of the absence of an R on T phenomenon before the terminal event.

Aged↗
PubMed1981

[Contribution of the exercise test to the diagnosis of sinus dysfunction. Correlation with endocavitary explorations].

Standardised exercise electrocardiography was performed in 50 patients undergoing endocavitary electrophysiological investigation of sinus node function. There was no previous history of cardiac failure or coronary insufficiency, and the patients, who were not trained athletes, were investigated after interruption of any medication which could affect sinus node function. The endocavitary investigations comprised overdrive suppression with rapid atrial pacing (Mandel) premature extrastimulus method (Strauss) and stimulation at a relative constant prematurity of 50% (Normal values: A2 A3 - 2d - return cycle - sinoatrial conduction time - = 0,77 A1 A1 - spontaneous cycle - +345). A significant difference in the maximal heart rate on stress testing between normal subjects and patients with sinus node dysfunction was observed only when values obtained with the relative constant prematurity method was taken into consideration (24 cases) the relative constant prematurity method became more significant (p less than 0,001). This held true to a lesser degree for Mandel's method (p less than 0,02), but no significant difference was obtained with Strauss' method. The ratio of maximal heart rate to theoretical maximal heart rate for age gave similar results. The correlation between stress testing and the relative constant prematurity method is probably related to intra sinusal shift of the dominant pacemaker. Both investigations would seem to test the functional properties and the reserve of the sinus node, taking extrinsic factors such as vago sympathetic stimulation into account. Patients with functional sinus node dysfunction increase their heart rates normally on exercise (average maximum of 170 bpm); a maximal heart rate of less than 120 bpm is very suggestive of organic sinus node dysfunction.

Adolescent↗
PubMed1981

[Calcification of the tricuspid annulus].

Tricuspid annular calcification was observed on cardiac screening of a 50 year old woman with congenital valvular pulmonary stenosis and confirmed by angiography. At operation, the tricuspid annular calcification was palpable but there was no interference with valvular function. There was no associated disease process in this patient. Phosphate and calcium metabolism was normal. Tricuspid annular calcification is very rare: 7 other reported cases, aged 42 to 51 years old. All patients had right ventricular hypertension usually caused by pulmonary stenosis. Tricuspid valve function was normal in all cases. The pathogenesis is discussed: a premature degenerative process favored by right ventricular hypertension may be responsible. This would appear to be the first case to be published in France.

Calcinosis↗
PubMed1981

[Left ventricular relaxation in myocardial diseases. Hemodynamic study].

Left ventricular relaxation as opposed to contraction, was studied by recordings of left ventricular pressure and its first derivation in primary hypertrophic cardiomyopathy without obstruction (25 cases, Group II) in primary dilated cardiomyopathy (33 cases, Group III) and in normal subjects (22 cases, Group I). Simultaneous recording of the pressure, the first derivation and intraventricular and intraaortic phonocardiogrammes showed the significance of certain features of the tracings and allowed a simplified protocol: ventricular relaxation was then defined from the pressure tracing (high fidelity recording) and its first derivation. The onset of isovolumic relaxation corresponded to the point of inflection on the descending part of the first derivation tracing, preceding its negative peak by an average of 0.02 s. The end of isovolumic relaxation corresponded to the crossing point of the atrial and ventricular pressure curves. In the absence of atrial pressure tracings the initial part of the rapid filling phase was included as far as the return of the first derivation tracing to its baseline (early diastole on the ventricular pressure tracing) as the duration of this period seemed remarkably constant (0.07 s). The parameters studied were: duration of isovolumic relaxation or the period defined above including the rapid filling phase; the average rate of fall of left ventricular pressure during this part of diastole; the value of the negative peak of the first derivation (dp/dt min); the rate of lengthening of the contractile elements at minimum dp/dt (dp/dt min/28P). Changes in relaxation were obvious in the pathological groups. The duration was increased and its average speed, dp/dt min, and dp/dt min/28 P were reduced. In the hypertrophic group, however, these changes seemed to be primary and contractility was usually unaffected. In dilated cardiomyopathy these changes could be considered secondary to decreased contractility. The hypothesis that changes in relaxation are specific for hypertrophic forms, and that changes in contractility are specific for dilated forms of primary cardiomyopathy may therefore be proposed.

Adolescent↗
PubMed1981

[Clinical application of the alkalosis induction test for coronary artery spasm].

Alkalosis was used for stress testing for coronary artery spasm in 70 patients (average age: 56 years) with resting angina. A rapid intravenous infusion of an alkaline buffer (THAM) immediately followed by 5 minutes' maximal ventilation increased the arterial pH to 7.67 +/- 0.5. Anginal pain and ECG changes were observed in 24 Patients, with ST elevation in 10 cases and ST depression in 14 cases. The ischaemic changes occurred during hyperventilation in 16 cases and in the 3 minutes following the test in 8 cases. The heart rate increased from 66 +/- II to 71 +/- 14 bpm (p less than 0,01) but systolic blood pressure fell from 139 +/- 12 to 130 +/- 12 mm Hg during hyperventilation; there was no significant change in the rate-pressure product (1130 +/- 1750 to 8990 +/- 2690). In all cases, the angina and ischaemic changes regressed after intravenous Trinitrin. Coronary angiography was performed in 56 patients: in the 24 patients with positive responses (Group I) and in 30 of the 46 patients with negative responses (Group II). Significant coronary artery narrowing (greater than 70%) was observed in 21 patients of Group I: in the 3 patients without coronary lesions an intravenous injection of 0.4 mg methylergometrine provoked coronary spasm. In Group II, significant narrowing was demonstrated in 18 patients: in the 12 other patients, coronary spasm could not be induced by methylergometrine. Therefore, in the absence of organic coronary lesions, an excellent correlation has been shown between the alkalosis and methylergometrine tests. This stress test was repeated in 16 of the 24 patients in Group I one hour after administration of 20 mg of Nifedepine: the test was negative in all cases. We conclude that the alkalosis test could be useful in the coronary care unit as a stress test for coronary spasm to determine the antianginal treatment of choice and to evaluate its efficacity.

Coronary Angiography↗
PubMed1981

Surgical treatment of constrictive fibrous endocarditis.

Between 1971 and 1980, 20 patients with fibrous endocarditis were treated by resection of ventricular endocardium and replacement of the atrioventricular valve. There were 13 male and seven female patients whose ages ranged between 12 and 58 years. Thirteen were white and the remaining seven were black Africans. Nine presented a right-sided form, five a left-sided one, and six presented involvement of both ventricles. The role of hypereosinophilia is discussed in the etiology of the disease. The operation was performed according to the techniques we had developed in our first operative case-excision of the atrioventricular valve. Complete resection of the endocardium, and valvular replacement. There were three operative deaths. Complete atrioventricular dissociation was observed in seven of our patients. particularly in those with right-sided endocarditis. At late follow-up, we have not observed any case of recurrence of the disease. On the basis of our experience and the results previously published in the literature, we believe that endocardiectomy is the best current treatment of this disease.

Adolescent↗
PubMed1981

[Mitral incompetence as presenting feature of idiopathic left ventricular aneurysm (author's transl)].

A further case of the exceptionally rare condition of idiopathic left ventricular aneurysm is reported in which the lesion was detected in a most unusual manner. The patient, a young 22-year-old negro woman, had been admitted for investigation of a mitral incompetence. The true diagnosis was established by angiography, which demonstrated a large multilobular left ventricular aneurysm, also communicating with the left auricle, this being the cause of the mitral incompetence. Surgical correction of the lesion suppressed the mitral leak without touching the normal mitral apparatus.

Adult↗
PubMed1980

[Treatment of left ventricular failure with percutaneous nitroglycerin (author's transl)].

In 12 patients aged from 45 to 75 years (mean : 62.57 +/- 8.37 years) a 2% percutaneous prepartion of nitroglycerin (PCNG) was applied on a square thoracic area measuring 15 x 15 cm, and its efficacy and duration of action were assessed by recording pressures in the right cavities and in the brachial artery. Left ventricular failure was due to recent myocardial infarction in nine cases, ischemic cardiopathy in two and non-obstructive cardiomyopathy in one. The 15 mg initial dose of PCNG was progressively increased until optimal dosage was reached. The efficacy of the drug was reflected in a significant fall in pulmonary artery diastolic pressure (PADP), equivalent to the mean capillary pressure, from 21.8 +/- 7.9 to 12.75 +/- 8.6 mmHg (p < 0.001). The mean systemic arterial pressure was reduced from 92.2 +/- 17.4 to 83 +/- 16.7 mmHg (P < 0.01). The cardiac index rose from 2.7 +/- 1 to 2.8 +/- 0.51/mn/m2 (N.S.) and the systolie index from 30.1 +/- 12.7 to 31.7 +/- 9.1 ml/systole/m2 (N.S.). Changes in PADP were significant (p < 0.05) during six hours and maximal at two hours (p < 0.001). There was a good correlation (r = 0.68 ; p < 0.02) between the time required to return to the initial values and the optimal fall in PADP. This shows that PCNG is undoubtedly long-acting in left ventricular failure, provided the doses are sufficient to induce a marked decrease in PADP.

Aged↗