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Biomedical subjects

P Morand

Publications and source records attributed to P Morand.

At least 73 records · Page 4Linked to original sources
PubMed1995

[Refractory sinus tachycardia: late complication of radiotherapy].

The authors describe a case of sinus tachycardia, an unusual cardiac complication of mediastinal radiotherapy; occurring in two patients by the first days of treatment and persisting for several years. No other cause for this tachycardia could be detected in either case. Electrophysiological investigation of one of the two patients was normal. Despite the risk of a high-degree conduction disorder, "symptomatic" beta-blocker treatment was prescribed, but only induced a limited effect.

Adult↗
PubMed1995

[Severe arrhythmia in the elderly: a prospective hospital study].

The prevalence of arrhythmia increases with age. Considered as an "ordinary" event in elderly patients, these arrhythmias may nevertheless have serious consequences. This study was undertaken to determine the clinical, aetiological and prognostic features of serious arrhythmias in a population of elderly subjects (> or = 70 years) hospitalised over a 20 months period and comprising 202 patients (103 women, 99 men, mean age 79.6 +/- 5.9 years). Supraventricular arrhythmias are the most common by far (84.2%): 51.4% of patients had atrial fibrillation, 15.3% had atrial flutter; 12.9% had focal atrial tachycardia, 4.5% had junctional tachycardia. Of the ventricular arrhythmias (15.8%), there were 12 sustained ventricular tachycardias, 4 torsades de pointes and 1 ventricular fibrillation. The increased duration of hospital stay (10 +/- 6 days on average) is related not to age but to the type of arrhythmia (longer for ventricular arrhythmias) and to left ventricular dysfunction. The main complications of arrhythmias were cardiac failure (52.4%), neurological deficits (37.4%) and angina (18.6%). Electrocardiographic signs of atrioventricular block were present in 62% of cases and QRS changes in 47.3% of cases. Ventricular arrhythmias were more commonly associated with intraventricular conduction defects, signs of myocardial necrosis and prolongation of the QT interval; they were also common in patients with left ventricular dysfunction and when the left ventricle was dilated. The aetiology of ventricular arrhythmias was mainly iatrogenic (50%) and ischaemic (21.8%), whereas the aetiologies of the supraventricular arrhythmias were varied, 14.7% of cases being idiopathic. Conversion to stable sinus rhythm was obtained in half the patients. A pacemaker was implanted in 10.8% of cases. The hospital mortality was 4.9%.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1995

[Pulmonary hypertension caused by talcoma in a couple of drug addicts].

The authors report a case of severe pulmonary hypertension (PHT) in a couple of HIV seropositive heroin addicts. The parallel clinical course in these two patients with only mild immunodeficiency and the fact that they both had the same supplier were in favour of PHT secondary to talcoma. In the light of these cases, one wonders whether, as suggested by certain epidemiological studies currently underway, drug addiction should be considered to be a cause of PHT in its own right. According to the authors, this approach would underestimate the incidence of this disease in this particular population and would therefore bias the epidemiological data.

Adult↗
PubMed1995

[Duration of antivitamin K therapy in venous thromboembolic disease].

The necessity for anticoagulant treatment after pulmonary embolism or deep vein thrombosis has been demonstrated. The modalities of this treatment have been established, especially the value of initial heparin relayed by oral antivitamin K therapy with a target INR value between 2 and 3. The last question remaining in this protocol is that of the duration of anticoagulant treatment. The choice of duration of anticoagulation should take into consideration two potential complications: haemorrhage due to over-anticoagulation and excessive duration of therapy, and recurrent thromboembolism which could result from an inadequate duration of therapy. Several trials have addressed this question and have led to a consensus of opinion: therefore, secondary venous thrombo-embolic disease, occurring under known, special circumstances, the cause of which has been treated, should be given 4 to 6 weeks anticoagulant therapy. In the other cases, so-called idiopathic venous thromboembolism (the proportion of which is on the increase), recent studies are inadequate to reach a consensus. These "idiopathic" forms are characterised by a higher incidence of recurrent thromboembolism of "secondary" cancer and coagulation abnormalities. The search for the optimal duration of anticoagulant therapy in these forms requires prospective trials taking their features into account and should lead to further therapeutic options. The evaluation of longer treatment protocols with less intensive degrees of anticoagulation and of alternatives to oral vitamin K antagonists is justified.

Anticoagulants↗
PubMed1995

[Epidemiology of pulmonary embolism].

There are few conditions in medicine as difficult to diagnose as pulmonary embolism. This is certainly not due to the rarity of the disease which is probably as common as myocardial infarction in France. The circumstances surrounding pulmonary embolism and the risk factors of deep venous thrombosis have been well identified. The risk of thromboembolic venous disease has been assessed for each type of surgery. The methods of treatment and prevention have progressed over a number of years. However, in practice, these advances have not "transformed" the frequency of the disease or reduced its mortality. Further progress could come from improved identification of patients at risk, especially by biological tests and new abnormalities of blood coagulation.

Adult↗
PubMed1994

[Transesophageal echocardiography in the etiological evaluation of ischemic cerebral vascular accidents. Value in young subjects].

OBJECTIVES: We conducted this study to evaluate the role of transoesophageal echocardiography in the aetiologic diagnosis of ischaemic cerebral vascular events in young subjects. METHODS: Over a 16-month period, 70 consecutive patients under 55 (mean age 49 years; range 32-55; 34 females, 36 males) underwent transoesophageal echocardiography as part of a complete work-up after a recent (< 1 month) cerebral event considered to be ischaemic in nature. Exclusion criteria were age over 55, vascular stenosis or ulcerated plaque, embologenic heart disease and valve prosthesis. 24-h Holter recordings were also obtained in all patients. RESULTS: The cerebral event was temporary in 11 subjects and permanent in the other 59. The ischaemic nature of the event was confirmed in all patients with computed tomography or magnetic resonance imagery. All patients were in sinus rhythm at examination and supraventricular paroxysmal arrhythmia was observed in 7 during the Holter recordings. The transoesophageal echocardiography was normal in 37 patients (52%) and pathologic in 33 (48%). The source of the embolus was identified in 4 cases (6%) and the probable cause of the cerebral event was found in 29 (42%). Among the abnormal structures observed were permeable oval foramens, inter-atrial septum aneurysms and plaques on the ascending aorta. CONCLUSIONS: In our selected population of patients under 55 years of age, transoesophageal echocardiography detected the certain or probable source of the ischaemic cerebral event in 48% of the cases, a diagnostic yield better than most other methods. Nevertheless, there is no known therapeutic response to several of the potential sources of embolus observed.

Adult↗
PubMed1994

Blood monocytes infected in vivo by HIV-1 variants with a syncytium-inducing phenotype.

Extensive data have been obtained on sequence changes in the V3 region of the HIV-1 envelope protein that are associated with in vitro biological properties such as cell tropism and syncytium-inducing capacity. However, so far this concerned viruses isolated from peripheral blood mononuclear cells and thus did not discriminate between variants present in T lymphocytes or in monocytes. In this study, we analyzed viral sequences derived separately from uncultured T lymphocytes, blood monocytes, and plasma of an HIV-1-infected patient showing a neurological evolution of the disease. Sequences related to the V3 region and 18 amino acids downstream were obtained from 48 clones after PCR amplification. One predominant viral sequence close to the monocytotropic/non-syncytium-inducing (NSI) consensus sequence was observed in the three blood sources. Two viral species were specifically identified in monocytes (43% of the clones), showing clear differences from the consensus sequence and exhibiting the genetic determinants associated with the SI phenotype. Plasma-derived viruses with a similar V3 loop were obtained on in vitro isolation. Analysis of the biological properties of these selected viruses confirmed their monocytotropism and the syncytium-inducing phenotype as expected by the cell type in which the sequences were observed and the charge of the V3 loop. Structural analysis of these variants suggested an intermediate structure between NSI/monocytotropic and SI/lymphotropic V3 loops. Thus, in vivo circulating monocytes could be a reservoir for distinct HIV-1 variants with potential SI characteristics, at least in later stages of infection. Studying such variants over the course of the infection may shed light on their involvement in disease manifestations.

Amino Acid Sequence↗
PubMed1994

Changes in the dominant Epstein-Barr virus type during human immunodeficiency virus infection.

Two types of Epstein-Barr virus (EBV), EBV-1 and EBV-2, were identified on the basis of DNA sequence divergence in the genes for nuclear proteins EBNA 2, 3a, 3b and 3c. In the present study, we conducted an immunological and genomic analysis in a human immunodeficiency virus (HIV)-infected population to determine the prevalence of the two types, and whether the identified type was stable over years. The EBNA-2 serotyping and genotyping showed that HIV-infected patients were highly infected by EBV-2, and that the dominant strain was mostly retained. However, during a follow-up study, a change in the dominant viral strain was observed in two patients. A first HIV-positive patient (patient A), although having a stable level of anti-EBNA-2A and -2B antibodies, showed a change in the genotype and antigen produced in spontaneously established lymphoblastoid cell lines (LCL). The sequence analysis of LCLs confirmed the emergence of the EBV-2 type population. A strain from a second HIV-positive patient (patient B) was clearly identified as EBV-2: the genotype from a saliva sample and from sequential LCLs belonged to EBV-2, as well as the antigen produced from LCLs, and serum antibodies. After a 5-year continuous EBV-2 infection, a reactivation of the EBV-1 strain was observed. In both cases, sequence analysis of the EBNA-2 gene showed, only with EBV-1, the presence of EBV variants related to the B95-8 prototype. Two mutations (at nucleotides 49212 and 49304) were found in both patients A and B, whereas an additional mutation (at nucleotide 49237) was characteristic of the patient A. No mutation relative to the prototype B95-8 strain was observed in a subsequent analysis of this EBNA-2 region from LCLs obtained from two HIV-negative patients predominantly infected by EBV-1. Therefore, we speculate that these mutations may be EBV-1 mutations specifically occurring during HIV infection.

Antigens, Viral↗
PubMed1994

[Heart rate variability in chronic cardiac failure insufficiency. Effect of severity and etiology].

The variability of the heart rate is a sign of the activation of the autonomic nervous system. This parameter was studied in 21 control subjects and 72 patients with chronic cardiac failure (20 stage II, 37 stage III and 15 stage IV of the NYHA) due to ischaemic heart disease in 48 cases and idiopathic in 24 cases. Spectral and non-spectral analysis of the variability of the heart rate recorded during 24 hour Holter monitoring was performed with the Marquette Electronics 8000 software. Plasma noradrenaline was measured in whole blood by HPLC. The left ventricular ejection fraction was measured by echocardiography. There was a superior to 40% decrease in non-spectral and over 50% decrease in spectral parameters in patients with cardiac failure. This was more pronounced when the cardiac failure was in an advanced stage. The decrease in sinus rhythm variability was proportional to the functional class (SDANN stage II: 96 +/- 34 ms; stage III: 63 +/- 34 ms; stage IV: 54 +/- 33 ms). Moreover, the non-spectral parameters were correlated to the ejection fraction and plasma noradrenaline levels (p < 0.01). In addition, with the same NYHA stage, plasma noradrenaline concentration, ejection fraction and heart rate, the SDNN and the pNN50 were over 50% lower in idiopathic cardiomyopathy than in ischaemic cardiomyopathy. In conclusion, the variability of the heart rate is reduced in chronic cardiac failure in relation with the severity and aetiology of the underlying disease.

Aged↗
PubMed1994

[Coronary angioplasty during the acute phase of myocardial infarction in the aged subject].

Myocardial infarction is a common and serious condition in patients over 70 years of age. The aim of this study was to assess the feasibility and efficacy of angioplasty without thrombolysis for revascularising an occluded artery in this age group. Between March 1986 and December 1989, 32 patients over 70 years of age (average 76 +/- 3 years) underwent angioplasty without thrombolysis in the acute phase of myocardial infarction. During the same period, 83 patients under 70 years of age were treated in the same manner. In the elderly subjects, the initial lesion was a total occlusion in 26 out of 32 cases (81%) and 99% stenosis in the other 6 cases (19%), and was successfully revascularised in 28 of the 32 patients (87.5%). Three episodes of ventricular fibrillation occurred during the procedure, one of which was lethal. A recurrence of pain during the hospital period was observed in 3 patients, 1 of whom died and the other 2 underwent repeat angioplasty. The hospital mortality was 5 patients (16%), all of whom were over 75 years of age. The comparison with patients under 70 years of age showed a comparable primary success rate, 87.5% (28/32) versus 92% (76/83) (p = 0.5), but a higher mortality, 16% (5/32) versus 4% (4/83) (p < 0.05) and a tendency to worse left ventricular function (ejection fraction 51% versus 62%) and to more extensive coronary artery disease; on the other hand, the post-hospital outcome was the same in both groups; Globally, emergency coronary angioplasty is a valuable alternative to thrombolysis for the treatment of myocardial infarction in patients over 70 years of age.

Aged↗
PubMed1994

[Severe pulmonary hypertension complicating a long treatment with dexfenfluramine].

The authors report a case of severe pulmonary hypertension after long-term dexfenfluramine treatment in a 48 year old man with no previous medical history. Dexfenfluramine, which has previously been reported to cause pulmonary hypertension, is an amphetamine-like anorexic agent, a pharmacological group known to predispose to this type of side effect. The possibility of this complication should be born in mind before prescribing the drug. In particular, it would seem to be particularly important not to exceed the recommended length of treatment especially as potential reversibility of pulmonary hypertension on withdrawal of the drug has been reported in one case.

Dose-Response Relationship, Drug↗