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Biomedical subjects

P Morand

Publications and source records attributed to P Morand.

At least 145 records · Page 8Linked to original sources
PubMed1990

[Ventricular arrhythmias disclosing myocardial abscess in infectious mitro-aortic endocarditis].

The authors report the case of a myocardial abscess in an infectious endocarditis with a double localization, mitral and aortic. The way it is revealed, by severe and recurring ventricular arrhythmias, differs from the conduction disorders usually described. The diagnosis is suspected by non-invasive examinations, echocardiography and nuclear magnetic resonance. It is backed up by angiographic exploration. The intervention confirms the data obtained by cardiac imaging, and enables the ablation of the abscess which is cleaned out, and the cure of the valvular lesions. Taking into account the gravity of this complication, a close clinical, electrocardiographic and echocardiographic surveillance of all infectious endocarditis is necessary.

Abscess↗
PubMed1989

[Treatment of essential hypertension with felodipine or atenolol as first line therapy. Comparative double-blind randomized study].

This study involved 113 patients (mean age 50 +/- 14 years) with diastolic blood pressure above 95 mmHg. The patients abstained from taking any antihypertensive drug and received a placebo for one week before entering felodipine, a new calcium antagonist (5 mg x2/day for 2 weeks, then 10 mg x2/day) or atenolol (100 mg/day). There was no significant difference between the two treatment groups. Atenolol tended to be more effective in young subjects and felodipine in subjects aged 60 years or more. Heart rate was more reduced by atenolol than by felodipine (P less than 0.01). Undesirable side-effects were recorded by means of an open questionnaire. Their incidence was 23 per cent during the week under placebo and 84 per cent and 80 per cent respectively during treatment with felodipine or atenolol. The most frequent side-effects were oedema of the ankles and headache under felodipine, fatigue and headache under atenolol. Alkaline phosphatase levels were higher in the felodipine group (P less than 0.05), and a slight rise in blood potassium level (0.2 mmol/l) was noted in the atenolol group (P = 0.001), but these values remained within normal limits.

Adult↗
PubMed1989

[Pressure profile during exertion in subjects aged 70 years and older].

One hundred and fifty-four patients from 70 to 85 years old (mean 74.5 +/- 4.5 years), including 105 men and 49 women, underwent a bicycle exercise test, in the upright position, with 3 minutes triangular levels (levels of 20 watts or more often 30 watts). Blood pressure (BP) was measured at rest and at the end of each level, using the auscultatory method and a mercury manometer. These 154 patients were divided in 59 "healthy" old people, 21 patients suffering from coronary insufficiency but with normal BP, 12 hypertensive patients and 62 patients receiving antihypertensive therapy. The results showed, as in younger people, a linear relation between BP and heart rate (HR). The slope of BP reported to HR determined the exercise BP of each subject. The mean value of "healthy" old people defined the normal exercise BP of people over 70 years old. Slope of systolic blood pressure (SBP) was higher in men than in women, but declined in both sexes in people over 80 years old. Slope of SBP was lower in the case of coronary insufficiency. In hypertensive patients, slope of SBP was the same as in normotensive patients, but was shifted upward. Finally mean exercise BP was lower in patients receiving antihypertensive therapy, compared to non-treaded patients with equal rest BP. The knowledge of exercise BP is useful for the right interpretation of exercise testing in old people suffering from coronary insufficiency or hypertension, as well as in presumed healthy old people.

Aged↗
PubMed1989

Changes in lymphocyte beta-adrenoceptor density after dilevalol oral treatment.

Dilevalol (R,R'-isomer of labetalol) is an antihypertensive agent combining non-specific beta blockade with peripheral vasodilatation due to beta 2-receptor agonism. The aim of this study was to determine the effects of chronic dilevalol administration on lymphocyte beta 2-adrenoceptor density. The investigation was conducted as a double-blind, placebo-controlled comparison. Ten days of chronic dilevalol (400 mg) or placebo treatment was administered to 12 healthy normotensive volunteers. Clinical and biochemical parameters: heart rate (HR) systolic and diastolic blood pressure (SBP, DBP), electrocardiogram, norepinephrine (NE), epinephrine (E), MHPG (3-methoxy-4-hydroxyphenylethylene glycol; one of the major brain metabolites of NE) were analysed on the first day (D1) before (H0) and 3 h after oral treatment (H3) and on the tenth day (D10). Clinical results showed no significant changes in HR, DBP, SBP in the two groups (placebo, n = 6; dilevalol, n = 6). NE increased 3 h after the first oral dilevalol intake (p less than 0.05). This increase is greater than that due to the circadian variation observed in the placebo group. Acute dilevalol treatment seems to increase the plasma circulating NE level, which returns to normal values after 10 days of chronic treatment. Binding assays were performed before and after 10 days of treatment. In the placebo group, no change in beta-adrenoceptor density was observed (36.6 +/- 8.3 versus 38.3 +/- 9.4 femtomol/mg of protein). Lymphocyte beta-adrenoceptor density (Bmax) significantly decreased after 10 days of dilevalol treatment without any changes in affinity (KD). Results were 40.3 +/- 11.6 (D1) and 30 +/- 7.6 (D10) (p less than 0.05). It was concluded that dilevalol down-regulated lymphocyte beta 2-adrenoceptor density, suggesting that beta 2 agonism of dilevalol is predominant.

Adult↗
PubMed1989

[Biology of the Epstein-Barr virus].

Epstein-Barr virus (EBV) displays several biological properties which distinguish it from any other human herpesvirus. The most important of these is that it infects and immortalizes human B lymphocytes, both in vitro and in vivo. These indefinitely growing cells consistently express viral proteins in the nucleus or in the plasma membrane; at least one of these is required for immortalization. In severely immunocompromised hosts such as transplant recipients and AIDS patients, EBV induces B-cell lymphoma. Two strains of EBV (A and B) have recently been recognized; they behave differently in their reaction to EBV-specific cytotoxic T-lymphocytes. Further studies are needed to define more accurately the part played by EBV in Burkitt's lymphoma and nasopharyngeal carcinoma. Besides immortalization, EBV can infect oropharyngeal epithelial cells in vivo, replicating in them at the time of primary infection (infectious mononucleosis) and reactivations. In fact, EBV infects most people throughout the world while rarely causing severe disease.

Animals↗
PubMed1989

[Two-dimensional echocardiography during the acute phase of myocardial infarction. Diagnostic and prognostic value].

A bidimensional cardiac sonogram was performed in 152 consecutive patients with in 24 hours after hospitalization in the intensive care unit for acute myocardial infarction, in order to evaluate the contribution of this technique to the diagnosis, determination of early complication and the prognosis. For this study, the left ventricle was divided in 10.segments. For each segment, systolic mobility as well as thickness were evaluated. It was possible to obtain a proper recording in 134 patients. Abnormal left ventricular kinetics (at least 1 segment) is present in all anterior transmural infarctions with, in 90 p. cent of the cases, a concordance between electrical and sonographic localization and in 89 p. cent of inferior between electrical and sonographic localization and in 89 p. cent of inferior only present in 65 p. cent. Abnormal kinetics is only present in 65 p. cent of non transmural infarctions. In 15 patients with clinical infarction without any electrical sign, the cardiac sonogram permitted to make the diagnosis and establish the localization of the infarction. In 46 p. cent of the cases, a left ventricular asynergy was observed at a distance of the necrosed area. In these patients, the mortality and cardiogenic shock rates during hospitalization were higher than for patients who did not present these abnormal findings (p less than 0.01). In conclusion, bidimensional cardiac sonography is a very specific diagnostic tool, permitting an early prognosis and able to detect early complication, especially of pericardial and mechanical nature.

Adult↗
PubMed1988

[Myxedematous coma. Prognostic and therapeutic re-evaluation].

The prognostic factors and therapeutic approaches in myxoedema coma--a rare but serious medical emergency--were re-evaluated from a retrospective study of 10 cases. The immediate respiratory risk can be prevented by referring these patients immediately to an intensive care unit. The patient's cardiovascular status before and after coma determines the prognosis for life and serves as guideline to treatment. Hormone replacement therapy with initial injection of a loading dose of thyroxine seems to improve the prognosis by ensuring rapid recovery of the principal vital functions.

Aged↗
PubMed1988

[Disseminated coronary thrombosis and thrombopenia induced by pentosan polysulfate].

Pentosan polysulfate may induce severe thrombocytopenia by an immunoallergic mechanism similar to that observed with heparin. We report five cases of serious arterial and venous thrombosis associated with pentosan polysulfate-induced thrombocytopenia: --two cases of fatal circumferential myocardial infarction due to disseminated thrombosis in patients whose coronary vessels were free from atheroma at angiography. Such cases have not previously been published. They seem to represent an unusual and dangerous manifestation of immunoallergic thrombocytopenia complicated by diffuse intravascular coagulation and induced by pentosan polysulfate; --two cases of myocardial infarction with favourable outcome; one of them was associated with hemiplegia with aphasia; --one case of extensive phlebitis of the inferior vena cava. The diagnosis was suspected on the ground that the patients had previously been treated with intramuscular pentosan polysulfate for 8 to 10 days and had less than 100,000 platelets per mm3; it was confirmed by in vitro platelet aggregation tests. Cross-allergy with heparin was present in all cases. Out of 18 published cases of pentosan polysulfate-induced thrombocytopenia, 15 were revealed by thrombosis of a coronary, cerebral or peripheral artery (80 p. 100) or of a vein (20 p. 100). Arterial thrombosis carries a 50 p. 100 risk of death, and for this reason pentosan polysulfate should be subjected to the same rules of prescription and monitoring as heparin.

Aged↗
PubMed1987

[Propafenone in ventricular extrasystole in elderly patients. Tolerance and efficacy].

The tolerance and efficacy of propafenone were studied in cases of chronic ventricular extrasystoles of the elderly (age greater than 70 years). Only patients presenting more than 1,000 extrasystoles per day and requiring a treatment, were included in this study. Patients presenting non-compensated cardiac insufficiency, hypotensive patients, patients with conduction disorders without pacemakers as well as patients presenting a severe renal or hepatic insufficiency, were excluded. After making sure that the rhythm disorder was chronic, a control Holter was performed, then, 600 mg of propafenone per day, in 3 doses were prescribed for 5 days. On the 5th day, a Holter was performed as well as a blood propafenone level. Some patients received then 900 mg per day with a new Holter and plasma propafenone titration on the 10th day. 11 patients were studied in this fashion. The tolerance to 600 mg was good in 10 out of 11 cases. The efficacy, appreciated by the decrease of the number of isolated ventricular extrasystoles (-69%), doublets (-95%), triplets (-98%) and salvos of ventricular tachycardias (-100%), was excellent in 6 cases, average in 2 cases and mediocre in 3 cases. Increase of the dosage to 900 mg does not improve significantly the anti-arrhythmic efficacy while the side effects seem more frequent. It is not possible to establish a relationship between plasma concentrations and efficacy. At a dosage of 600 mg per day, propafenone is therefore effective in the treatment of ventricular extrasystoles in elderly patients and its tolerance is good. Higher doses are not advisable as they seem much less well tolerated without any additional advantage.

Aged↗
PubMed1987

[Treatment of chronic cardiac failure with cadralazine. Short- and medium-term results].

The clinical and haemodynamic effects of a single oral dose of cadralazine were studied in 22 patients with an average age of 64 years presenting with severe chronic cardiac failure. Haemodynamic monitoring during the first 24 hours after oral administration of 30 mg of cadralazine showed a peak increase at the 8th hour of the cardiac index (+ 64 p. 100, p less than 0.001), the systolic index (+ 45 p. 100, p less than 0.001) and the left ventricular work (+ 52 p. 100, p less than 0.001) whilst the systemic and pulmonary arterial resistances decreased by 40 p. 100 (p less than 0.0001) and 30 p. 100 (p less than 0.01) respectively. There was no significant change in heart rate or diastolic pulmonary arterial pressures. The haemodynamic improvement was maintained at the 24th hour (cardiac index + 35 p. 100, p less than 0.01 and systemic arterial resistances - 20 p. 100). These results were confirmed at one month. There were few side effects, none of which necessitated withdrawal of the drug. This study shows the efficacy of a single 30 mg daily dose of cadralazine, an arterial vasodilator, in patients with severe cardiac failure. The treatment was well tolerated over the one month study period.

Aged↗
PubMed1987

[Hepatic involvement in secondary syphilis].

A case of secondary syphilitic hepatitis is reported. A 49-year old woman was admitted for weight-loss, fever, hepatomegaly and splenomegaly. Diagnosis of syphilitic hepatitis was based on cholestasis associated with positive serologic tests for syphilis without other immunological disturbances. Biopsy of the liver showed a moderate infiltration in and around the portal tracts. Immunofluorescence study for treponema was negative. Rapid improvement was obtained with penicillin initially associated with steroid therapy. Liver involvement in secondary syphilis is characterized by anicteric cholestasis, an inflammatory syndrome, and periportal infiltrate inconstantly associated with centrilobular necrosis, granulomatous reaction and presence of treponemas in the lesions. Due to the increasing frequency of sexually transmitted diseases, this diagnosis could become more frequent.

Female↗
PubMed1987

[Prognostic value of hemodynamic results in the acute phase of myocardial infarction].

The prognostic value of right cardiac catheterization in the acute phase of myocardial infarction is presently well established. The objective of this study is to determine the best discriminating threshold of the pulmonary capillary pressure (PCP) on the one hand and the cardiac index on the other hand. 96 patients presenting an acute myocardial infarction were entered in the study. Six thresholds for each parameter were studied. The following results were obtained: there are important clinical and hemodynamic discrepancies, especially for severe cases. The cardiac index (CI) has a better prognostic value than the pulmonary capillary pressure. The threshold greater than 18 mmHg for PCP and less than 2.2 l/min for the cardiac index, proves to be the most discriminating (better sensitivity with better specificity: sensitivity 60 p. cent with specificity at 81 p. cent for PCP; sensitivity at 73 p. cent with specificity at 78 p. cent for CI). A combined analysis of the two parameters, associated to their best discriminating threshold enables to identify a class of high-risk patients presenting approximately an 80 p. cent mortality in a hospital environment. In spite of the development of non-invasive methods to evaluate the prognosis in the acute phase of myocardial infarction, the hemodynamic exploration remains the leading method for its evaluation.

Aged↗