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Biomedical subjects

P Morand

Publications and source records attributed to P Morand.

At least 91 records · Page 5Linked to original sources
PubMed1993

[Cardiac tamponade in severe hypothyroidism. A rare cause].

Pericardial effusion frequently occurs in patients with hypothyroidism, and this fully justifies the use of echocardiography at the time of diagnosis and during the follow-up of hypothyroidism. Signs indicating that the pericardial effusion is poorly tolerated are rare, and the development of pericardial tamponade is exceptionally reported. A case of tamponade in an elderly woman with severe hypothyroidism is described here. Some physiopathological particularities are emphasized, together with the value of echocardiography for the diagnosis and that of pericardial drainage for the treatment.

Aged↗
PubMed1993

[Cardiac toxicity of anthracyclines. Clinical forms, incidence, surveillance].

Anthracyclines have greatly contributed to improvement in the prognosis of certain cancers, but their beneficial effect is impaired by an unquestionable toxicity affecting notably the heart. Changes in blood pressure or electrocardiograms, benign pericardial reactions and rare but severe myocarditis may occur at an early stage of treatment. The cumulative toxicity of anthracyclines limits their use. With a cumulative dose of 550 mg/m2 the mean incidence of toxicity varies from 5 to 10 percent. The occurrence of toxicity largely depends on the total dose, but other factors such as patient's age and general condition, and previous treatments with chemo- or radiotherapy must be taken into account. The best methods to monitor the cardiotoxicity of anthracyclines are echocardiography, radionuclide study of ejection fraction and myocardial biopsy for histological study. The rational use of these three types of examination must be adjusted to each individual patient. It should reduce the incidence of severe myocarditis which sometimes cancels all the beneficial effects of the anticancer treatment.

Antibiotics, Antineoplastic↗
PubMed1993

Hemodynamic effects of prolonged enoximone infusion (7 days) in patients with severe chronic heart failure.

This study investigated the hemodynamic effects and tolerance of infusion of 10 micrograms/kg/min enoximone over 7 days in 12 patients (mean age 64.3 years) with severe chronic heart failure (10 NYHA Class III and 2 Class IV) with idiopathic dilated cardiomyopathy. Hemodynamic parameters were measured 10 minutes, 3 hours, 6 hours, 18 hours, 24 hours, and 7 days after the start of infusion. Catecholamines were assayed before the start of the infusion and on day 7. The heart rate increased on an average from 90.8 +/- 13.7 before infusion to 108.5 +/- 8.2 beats/min (p < 0.05) on day 7 (+20%). The mean arterial pressure decreased by approximately 10% (p < 0.05) between the start and end of the infusion. The pulmonary artery diastolic pressure dropped by a maximum of 30% at the 24th hour (23.1 +/- 5.1 to 16 +/- 5.4 mm Hg; p < 0.01). This decrease remained significant on day 7; the index cardiac was increased a maximum of 40% between the 18th and the 24th hour; p < 0.01). This increase was still significant on day 7 (2.35 +/- 0.44; p < 0.05; +22%). Finally, the decrease in systemic arterial resistance, which reached a maximum of 30% of the 24th hour, persisted on day 7 (-22%); 2076 +/- 451 to 1612 +/- 283 dynes/sec/cm5; p < 0.05). The norepinephrine level did not change significantly (4.5 +/- 1.2 nmol/l before infusion vs. 4.2 +/- 1.1 nmol/l on day 7). Infusion had to be stopped in one patient after 30 minutes because of prolonged severe hypotension.(ABSTRACT TRUNCATED AT 250 WORDS)

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PubMed1993

[Functional classification of cardiac insufficiency].

Several systems have been proposed for assessing the degree of functional impairment of chronic cardiac failure in order to be able to compare patients and to appreciate progression of the condition in individual patients. The NYHA classification is subjective, not very reproducible, and does not provide a good prediction of exercise capacity. The Canadian classification is not much better. Feinstein's classification is too complex, impractical and has never been validated. The specific activity scale proposed by Goldman indicates the degree of functional incapacity by comparison with activities of everyday life selected for their variability and classified according to the effort required to perform them. This classification has a good reproducibility and correlates well with exercise stress testing (exercise duration, VO2 max). However, it is not particularly well suited to the French population. The examples are not very precise; in addition, contradictions are possible, making it difficult to classify some patients. The authors propose a specific activity scale adapted for French patients. This classification was studied in 45 patients with chronic primary dilated cardiomyopathy. It was reproducible and correlated well with peak VO2. The progressive design of the symptom questionnaire avoids contradiction. This classification could be useful both in everyday practice and for multicentre research studies.

Activities of Daily Living↗
PubMed1993

[Mediators of the vascular endothelium as markers of myocardial ischemia and reperfusion].

Myocardial ischaemia may occur during spasm or thrombosis of the coronary arteries. The vascular endothelium plays an essential role in the lesions observed during ischaemia and myocardial reperfusion by the intermediary of the numerous endothelium-derived vasoactive factors. These include the "endothelium-derived relaxing factors" (EDRFs) nitrous oxide, prostacyclin, which are vasodilators and platelet antiaggregants ant the "endothelium-derived contracting factors" (EDCFs), endothelin, PGH2, oxygen-free radicals which are vasoconstrictive. The endothelial cells also produce the platelet activating factor and factors essential for coagulation. The metabolism and biological properties of these different mediators are reviewed. During the phenomena of myocardial ischemia-reperfusion, endothelial regulation is activated by tissue hypoxia and reduction of coronary flow and perfusion pressure. This regulation also depends on the functional state of the arteries (macroscopically normal or pathological). These vasomotor phenomena are associated with the effects of platelet aggregation and myocardial accumulation of neutrophil polynuclear blood cells. During the second phase of reperfusion cellular lesions are produced by the generation of cytotoxic oxygen-free radicals. Assays of mediators present a clinical interest when the modalities of sampling have been fixed (systemic blood samples or during cardiac catheterisation, sites of sampling, choice of timing of sampling with respect to the biological half lives of the mediators). Determining a correlation between the in vitro biological effects on those in isolated organs and clinical data has become possible with the improvement in techniques of sampling and the increasing collaboration between biologists and clinicians.

Endothelins↗
PubMed1993

Nitrates improve detection of ischemic but viable myocardium by thallium-201 reinjection SPECT.

Thallium-201 reinjection imaging improves myocardial viability detection when compared to standard 3-4-hr redistribution imaging, however, the extent of ischemic but viable myocardium is still underestimated. We tested whether the sensitivity of reinjection imaging could be increased by giving nitrates postexercise to improve blood flow during the redistribution period. Twenty patients with coronary artery disease were included, 11 of them with a recent myocardial infarction. All patients underwent two exercise/4-hr redistribution 201Tl SPECT protocols: one with reinjection alone and the other with nitrates and reinjection. In the latter case, 20 mg of Isosorbide Dinitrate were given to patients immediately after postexercise imaging. Fifteen patients had reversible defects with reinjection alone, three additional patients were defined as ischemic with nitrates/reinjection protocol. Reinjection alone identified 41 reversible segmental defects, all except one were also evaluated as reversible with nitrates/reinjection. However, among the 54 segments showing fixed defects after reinjection only, 14 (26%) presented as reversible with the nitrates/reinjection protocol. The redistribution extent (segments/patient) was 2.05 +/- 0.41 segments with reinjection alone and 2.75 +/- 0.38 (p < 0.01) with nitrates/reinjection. In 15 patients showing reversible defects with both protocols, the redistribution extent was 2.73 +/- 0.41 segments with reinjection alone and 3.20 +/- 0.40 (p < 0.05) with nitrates/reinjection. Thallium-201 SPECT with nitrates and reinjection improves the detection of ischemic but viable myocardium in comparison to SPECT with reinjection alone.

Coronary Disease↗
PubMed1993

[Compression of the coronary trunk by aneurysm of the antero-left Valsalva sinus associated with acute mitral insufficiency caused by rupture of the chordae following valvular prolapse. Successful triple surgical operation in a 66-year old patient].

Tearing of the chordae is a common complication of prolapse of the mitral valve; which becomes increasingly common with age. In contrast, aneurysm of the Valsalva sinus is rare in patients over 65 years of age. The antero-left sinus is an unusual location, but may be complicated by compression of the left coronary artery, which is reported in 16 cases in the literature. The case reported is unusual due to the combination in a 66-year old subject of acute mitral incompetence, due to tearing of the chordae following prolapse of the mitral valve, and an aneurysm pressing on the coronary trunk whilst remaining asymptomatic. Complete correction of the lesions was successfully achieved by surgery.

Acute Disease↗
PubMed1992

[Anti-typhoid vaccines].

There are three commercially available vaccines against typhoid fever: parenteral inactivated whole cell vaccine, oral live attenuated (strain ty21a), parenteral polysaccharide vaccine (capsular antigen-Vi). Their protective efficacy is 50 to 88% (inactivated vaccine), 50 to 96% (live attenuated vaccine) and 75 to 80% (polysaccharide vaccine). The frequency of notable adverse reactions with the inactivated vaccine justifies the use of the new vaccines.

Contraindications↗
PubMed1992

[Treatment of chronic heart insufficiency with dobutamine. Value and limitations].

Most positively inotropic drugs are available only as intravenous injection, which restricts their use in chronic heart failure. A single and brief infusion of dobutamine--a synthetic catecholamine and potent beta 1-adrenoreceptor agonist--provides a clinical improvement which may last for several weeks. On the other hand, tachyphylaxis to dobutamine may develop after a several days' infusion, so that the drug gradually loses its effectiveness. In patients with chronic heart failure, intermittent infusions of dobutamine result in sustained clinical improvement in more than 50 percent of the cases. The relative preservation of beta-adrenoceptors seems to play a role in the beneficial effects of intermittent infusions. The most significant side-effects of dobutamine are ventricular rhythm disorders. The practical applications and supervision of repeated dobutamine infusions in chronic heart failure are detailed.

Chronic Disease↗
PubMed1992

Influence of the rt-PA dose (1 mg/kg versus 1.5 mg/kg) and duration of administration on the patency of infarct-related coronary arteries in 81 patients.

This open study compared the efficacy and side effects of two dose regimens of intravenous rt-PA initiated before the fifth hour after the onset of myocardial infarction. The first 40 patients (group A) received 1 mg/kg of rt-PA infused over 90 minutes, including a 10-mg initial bolus. The following 41 patients (group B) received 1.5 mg/kg (20-mg initial bolus, 60% over 60 minutes and 40% over 120 minutes). Noninvasive clinical, electrocardiographic, and biochemical parameters of reperfusion were recorded systematically, along with serial measurements of fibrinogen and hemoglobin levels. Coronary arteriography and left ventriculography were performed at the 48th hour or earlier, on an emergency basis, in the absence of signs of reperfusion, or if there were clinical and ECG signs of rethrombosis. Patency of the infarct-related artery (TIMI grades 2 and 3) was achieved in 55% of the group A patients vs. 83% of the group B patients (p less than .01). Twelve emergency coronary arteriographies were performed in each group. No significant difference was observed in the ejection fraction (48% in group A vs. 52% in group B). The peak CPK level was similar in both groups, but the peak occurred earlier in group B (p less than .001). There was no statistically significant difference between the two dose regimens in terms of reduction in fibrinogen or plasminogen levels. Two deaths occurred in group A vs. one death in group B. No cerebrovascular accidents occurred in either group.(ABSTRACT TRUNCATED AT 250 WORDS)

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PubMed1992

Correlations of left ventricular diastolic parameters and heart rate: assessment through right ventricular pacing.

This study evaluated the correlations between left ventricular (LV) diastolic parameters assessed by equilibrium radionuclide angiography (ERNA) and heart rate (HR) through right ventricular pacing. Twelve patients with a permanent right ventricular apex pace-maker were included. Serial ERNA studies were performed under 6 sets of pacing cycle length (heart rate = 52, 62, 72, 82, 92, 104 beats/min) for each patient. The left ventricular ejection fraction was 49.9% +/- 3.1% under pacing HR of 52 bpm and 43.8% +/- 3.1% under pacing HR of 104 bpm. The peak filling rate (PFR) increased very significantly with HR (r = 0.98, P less than 0.001). When the relative changes of end-diastolic volume were taken into account, the correlation between PFR and HR remained significant (r = 0.94, P less than 0.001). The absolute time to PFR (TPFR) did not significantly change with HR, but the ratio of TPFR to cycle length strongly correlated with HR. Our study clearly demonstrates that the PFR assessed by ERNA increases and the TPFR occupies an increasing proportion of the cycle length as HR increases. Therefore, LV diastolic parameters should be normalized for HR in clinical applications. In particular, HR changes should be considered when LV diastolic parameters are used for the assessment of therapeutic interventions.

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