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Biomedical subjects

P Morand

Publications and source records attributed to P Morand.

At least 163 records · Page 9Linked to original sources
PubMed1986

Reciprocal ST segment changes in acute inferior myocardial infarction: clinical, haemodynamic and angiographic implications.

Reciprocal ST segment changes are frequent during acute inferior myocardial infarction, yet their significance remains controversial. In order to investigate the implications of these changes, the ECG obtained on admission for 83 patients with acute inferior myocardial infarction was compared with the clinical course and the results of angiographic and coronary arteriographic studies performed an average of 3 weeks after the onset of symptoms. Group 1 consisted of 59 patients with at least 1 mm of horizontal on downsloping ST segment depression in at least 1 of leads V1 to V4. Groups 2 consisted of 24 patients without precordial ST depression in this area. Group 1 patients were generally older than group 2 patients (59.6 +/- 6.4 versus 54 +/- 5.3 yr, P less than 0.01) had higher total creatine kinase (CK) levels and MB fractions (1835 +/- 940 versus 875 +/- 305, P less than 0.01, 269 +/- 102 versus 95 +/- 35 for MB fraction) and more complications during the hospital course (80% versus 38% P less than 0.01) and greater left ventricular dysfunction (ejection fraction 52.2 +/- 6% for group 1 versus 59.2 +/- 7% for group 2; cardiac index 2.75 +/- 0.41 min-1 m-2 for group 1 versus 3.25 +/- 0.31 min-1 m-2 for group 2 P less than 0.005). No difference was observed on biplane angiography as far as left ventricular wall kinesis was concerned.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiography↗
PubMed1986

Dilated cardiomyopathy and the level of alcohol consumption: a planned multicentre case-control study.

The association between clinical or environmental factors and dilated cardiomyopathy (DCM) has been assessed in a planned case-control study. Patients and controls were men aged between 20 and 65 years, matched for age, profession and geographic location. DCM was defined by strict radiologic and angiographic criteria excluding multiple-vessel coronary disease. Controls were recruited from the surgical centres after excluding diseases usually linked with alcohol or tobacco consumption. Univariate and multivariate analyses were used to ensure adequate techniques for matched pairs. The prevalence of diabetes and hypertension and the exposure to toxic substances, drugs and tobacco was identical in both groups. Alcohol consumption before the onset of first symptoms was higher in patients than in controls (101 vs 64 ml day-1, P less than 0.001); the excess of consumption concerns all kinds of alcoholic beverage (wine, beer, etc.). The relative risk (RR), estimated from the odds ratio, increased only among heavy drinkers (greater than or equal to 110 ml day-1; RR: 7.6, P less than 0.001) with an independent contribution of both wine (RR: 4.7, P less than 0.001) and other alcoholic beverages (RR: 4.1, P less than 0.01). In conclusion, alcohol is a strong risk factor for DCM, but the excess of risk is limited to heavy drinkers and is independent of the type of beverage.

Adult↗
PubMed1986

[Efficacy and tolerability of enalapril compared to altizide combined with spironolactone in patients with moderate arterial hypertension].

The aim of this study was to compare the efficacy and safety of enalapril and a combination of a thiazide diuretic (altizide) and a diuretic that reduce potassium excretion (spironolactone), in patients presenting moderate essential hypertension. The four-month, double-blind study of two parallel groups involved 20 patients (12 males, 8 females) of mean age 54 years. All patients first received placebo for 15 days. Subsequently, 10 patients received 20 mg enalapril per day and 10 patients 15 mg altizide combined with 25 mg spironolactone in the same tablet. Blood pressure was measured every five minutes for 30 minutes with an automatic apparatus (Dynamap 845), before administration of placebo, before treatment and one, two and three months after treatment. There was no significant change of pulse rate with enalapril or with the diuretic combination. Both treatments produced an identical significant drop in systolic pressure. On the other hand enalapril seemed more efficacious in reducing diastolic pressure at the fourth month: respective pressures 98.2 +/- 13.3 mmHg and 81.0 +/- 8.5 mmHg (p less than 0.005) with enalapril, 98.6 +/- 7.4 mmHg and 86.0 +/- 6.1 mmHg (p less than 0.001) with the diuretic association (17% versus 12%, p less than 0.05). Safety was good with both medicinal preparations and the few side-effects noted did not necessitate withdrawal of treatment.

Adult↗
PubMed1986

[The diagnostic exercise test in coronary disease. Proposal for a more rigorous and efficacious interpretation].

Although exercise stress testing does not allow certain diagnosis of coronary artery disease, its interpretation should not necessarily be vague. By using the Bayes theorem and the many studies available we can now quantify the probability of a correct result for each individual case. Three parameters need to be known to undertake this calculation; the prevalence of the disease and the sensitivity and specificity of the investigation. The prevalence of the disease is beginning to be recognised taking into account the character of the pain. Four groups of increasing prevalence can thereby be defined: absence of chest pain, non-anginal pain, atypical pain and typical pain. Within each of these groups the prevalence of coronary disease is higher in men and increases with age. Information about the prevalence of multivessel disease after infarction is more limited. Only two groups can be distinguished which do not take symptoms, age or sex into consideration. The prevalence is 57% after anterior and 65% after inferior infarction. The sensitivity and specificity of stress testing can be determined by comparison with coronary angiography or, when this is available, by following up the patients. These parameters depend mainly on the methodology which should be strictly defined. When only significant ST depression is considered, the overall sensitivity and specificity of exercise stress testing is 70% and 80% respectively. These results vary according to the particular context; in women, the sensitivity and specificity are 72% and 75% respectively; in asymptomatic subjects the sensitivity and specificity are 50% and 85% respectively. With regards to the detection of multivessel disease after anterior infarction, the sensitivity and specificity are 58 and 85% respectively and after inferior infarction, 85 and 84% respectively. The use of diagnostic probability based on these parameters should lead to unambiguous practical management of patients related to the degrees of probability obtained. The underlying principles of this diagnostic approach cannot be questioned as they are based on a well established mathematical formula. However, much work remains to be done, on the one hand to determine the exact prevalence of coronary disease, and on the other hand to improve the sensitivity of exercise stress testing.

Adult↗
PubMed1986

[Surface recording of abnormal post-QRS micropotentials. Description and frequency in ventricular tachycardias after myocardial infarction].

In order to study abnormal post-QRS micropotentials, so called late potentials, and to determine their frequency in post myocardial infarction ventricular tachycardia (VT), high amplification electrocardiogrammes were recorded in 180 patients classified in 3 different groups: Group A comprising 36 patients who developed sustained VT after myocardial infarction; Group B comprising 124 patients with myocardial infarction uncomplicated by VT. This group was subdivided into subgroup B1 (retrospective study of 35 patients with chronic myocardial infarction, dating on average 10 months--range 7 days to 8 years) and subgroup B2 (prospective study of 89 patients investigated on the 7th and 60th days after infarction); Group C comprising 20 young, normal control subjects. Using computer assisted high amplification electrocardiography, all patients underwent at least 3 successive recordings of the following parameters: averaging 100 cycles; sampling: 1 kHz; band pass 20-300 Hz and 80-300 Hz; gain setting 10,000 and 25,000. Late potentials usually appears, after the end of the S wave, as high frequency oscillations with an amplitude (10 to 20 microV) significantly greater than that of the background noise. Our recordings also showed: the frequent presence, especially in intraventricular blocks, of fragmentation of the end of the R wave and of the S wave or terminal potentials; the presence of an abnormal giant low frequency high amplitude wave (40 to 80 microV) in 5 patients with a large left ventricular aneurysm.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

[Efficacy and tolerability of a delayed-action vasodilator agent, cadralazine, in severe chronic cardiac failure].

The aim of this work is the evaluation of the hemodynamic effects during the 24 hours following a single administration of a new arterial vasodilator, cadralazine, in 12 patients whose mean age is 66 years and who present severe cardiac insufficiency. A clinical and hemodynamic examination was made before administration of the medicine in 3 doses at 12 hour intervals in order to check the stationary state of the patients, and then at 1 h, 2 h, 4 h, 6 h, 8 h, 12 h, 20 h and 24 h after 30 mg, and then 60 mg of cadralazine. We did not observe any significant change in cardiac frequency, nor in the systolic arterial pressure nor in the diastolic arterial pressure of the pulmonary artery, after either 30 mg or 60 mg. On the other hand, with 30 mg of cadralazine we observed a significant increase of the cardiac index, with a maximum between the 6th and 8th hour (1.58 +/- 0.51 l.min-1.m-2 before treatment to 2.66 +/- 0,75 l.min-1.m-2 8 hours after, p less than 0.001) and a fall of total systemic resistance which declined from 2,478 +/- 421 dyn.s-1.cm-5 before treatment to 1,449 +/- 369 dyn.s-1.cm-5, p less than 0.001, 8 hours after, as well as an increase in the power of the left ventricule (from 2.80 +/- 0.8 before treatment to 4.73 +/- 1.2 kg/min 8 hours after, p less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1986

[Should the new criteria of positivity in the exercise test be used?].

Until recent years the negative deflection of the ST-segment of an ECG was almost the only means of interpreting exercise tests in the diagnosis of heart disease. Recent publications have suggested new criteria of positivity. Most of these studies have focused on the absence of a decrease in the amplitude of the R wave in V5 or CM5 derivation, but the results tend to disagree and suffer from lack of reproducibility thus rendering interpretation of this criterion uncertain. Claims have also been made for other criteria with a predictive value at least equal to that of the ST-segment, but very few studies have been devoted to these criteria. The absence of the Q wave in V5 (three studies on a total of 278 patients) has a sensitivity of 82 per cent and a specificity of 76 per cent. Inversion of the U wave in CC5 (one study on a total of 248 patients) has a sensitivity of 21 per cent and a specificity of 99 per cent. Traces of the pressure in abnormally increased recovery (a study on a total of 87 patients) has a sensitivity of 95 per cent and a specificity of 90 per cent. These results cannot replace those obtained with the ST-segment which relate to hundreds of studies on tens of thousands of patients. For this reason it is important to specify better the value of these new criteria and to assess their contribution in association with changes in the ST-segment.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Disease↗
PubMed1985

[Clinical and hemodynamic tolerance of intravenous diltiazem in the acute phase of myocardial infarction].

The aim of this paper is to study the clinical and haemodynamic tolerance of intravenous diltiazem in a bolus dose of 10 mg followed by an infusion of 360 mg over 24 hours in 12 patients in the acute phase of myocardial infarction. We did not observe any significant modification in the heart rate or in the pulmonary artery diastolic pressure. The mean blood pressure decreased from 111.5 +/- 11.8 mmHg to 92.8 +/- 12.7 mmHg (p less than 0.001) after a 24 infusion. The cardiac index increased from 2.34 +/- 0.62 1 X min1 X m-2 to 3.05 +/- 0.95 1 X min-1 X m-2 (p less than 0.05) and the systemic vascular resistance decreased from 2 150 +/- 640 dyn. s.cm-5 to 1 403 +/- 308 dyn.s.cm-5 (p +/- 0.005). Three patients presented a rise in the pulmonary artery diastolic pressure of more than 30 mmHg and in one of these patients, the diltiazem had to be stopped. These three patients all had a high initial pulmonary capillary pressure (greater than 18 mmHg). The drug was well tolerated clinically. On electrocardiography, four patients presented conduction disorders, all of which regressed when the diltiazem was stopped (a 3rd degree atrioventricular block with narrow QRS complexes, a Luciani-Wenckebach type of 2nd degree atrioventricular block and two cases of 1st degree atrioventricular block. Overall, intravenous diltiazem was well tolerated in terms of clinical and haemodynamic parameters in these patients in the acute phase of a myocardial infarction, provided the left ventricular filling pressure was not excessively elevated.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1985

T cell chronic lymphocytic leukemia with lymphocytes of unusual immunologic phenotype and function.

This report discusses a case of T cell chronic lymphocytic leukemia (T-CLL) in an elderly white man whose lymphocytes expressed a post-thymic phenotype except for the coexpression of T4 and T8 on 80% to 95% of the cells. Because of the uncommon phenotype, in vitro functional assays were performed that showed decreased mitogenic responses but normal helper activity for B cell immunoglobulin secretion and normal suppressor activity of lectin-induced mitogenesis. Morphologic evaluation by both light and electron microscopy and cytochemical staining were consistent with the "knobby" type T-CLL. Adenosine deaminase and terminal deoxynucleotidyl transferase (TdT) levels were low, but the acetylcholinesterase level was normal, which is consistent with the peripheral T cell phenotype. The patient underwent splenectomy, and the spleen cells showed very low levels of T3 and T4 by immunoperoxidase and undetectable levels by immunofluorescence. The morphology of the splenic infiltrate was not significantly different from that in the initial bone marrow. Human T cell leukemia virus (HTLV) antigen and antibody tests were negative. The cells in this leukemia apparently are derived from a transitional stage of maturation between the cortical and medullary thymocyte. A small subset of lymphocytes of identical phenotype to this leukemia has been identified in normal individuals.

Antigens, Surface↗
PubMed1985

[A method of processing information on cineangiography of the right ventricle].

This paper describes our experience in making a programme for computer processing of biplane right ventricular cineangiography for the measurement of volumes and analysis of wall motion. The volumes were determined by a method of integration to the geometric model of a triangular pyramid i.e. trunco-pyramidal (IM.TP). The classical ellipsoidal integration method i.e. trunco-conal (IM.TC) and biplane and monoplane planimetry based on the model of a triangular pyramid (PM.TP) were used as references. Nineteen post-mortem RV casts were used to validate the programme. The correlations between the true volumes and the angiographic measurements were excellent (r = greater than 0.99) with both methods of integration, very good (r = 0.99) using the biplane PM.TP and very satisfactory (r = 0.91) with the monoplane PM.TP. The line of regression was very close to unity with the IM.TP and 0.9 with the PM.TP; this indicates the excellent adaptation of the triangular pyramid model to the shape of the RV. The IM.TP was used in a group of 20 right ventriculographies of patients without cardiac disease: the following results were obtained: EDV = 70.3 +/- 6.6 cm3/m2; ESV = 31.7 +/- 3.9 m3/m2; systolic index = 38.6 +/- 4.5 cm3/m2; ejection fraction = 0.55 +/- 0.04. The correlation of the values of systolic index by cineangiography and thermodilution (39.9 +/- 5.7 cm3/m2) was good (r = 0.86; p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Volume↗
PubMed1985

[Significance of ST segment depression in the precordial leads during the acute phase of inferior myocardial infarction].

Reciprocal changes of the ST segment in the acute phase of inferior myocardial infarction are common but their significance remain controversial. We studied this problem by comparing the ECG on admission of 83 patients with acute inferior myocardial infarction, with the clinical outcome and haemodynamic and angiographic data obtained on average 3 weeks after the onset of symptoms. Fifty nine patients (Group I) had ST depression greater than or equal to 1 mm in at least one of the leads V1 to V4; 24 patients (Group II) had no ST depression in this territory. The patients in Group I were older (59.6 +/- 6.4 vs 54 +/- 5.3 years, p less than 0.01), had higher total CPK (1 835 +/- 940 vs 875 +/- 305, p less than 0.01) and MB fractions (269 +/- 102 vs 95 +/- 35), more complications during the hospital period (80%, mainly haemodynamic vs 38%, p less than 0.01) and more severe left ventricular dysfunction: ejection fraction 52.2 +/- 6% vs 59.2 +/- 7%, p less than 0.05; cardiac index 2.75 +/- 0.4 l/min/m2 vs 3.25 +/- 0.3 l/min/m2, p less than 0.005). There was no difference in left ventricular wall motion between the groups on biplane angiography. However, coronary angiography showed left coronary disease to be more common in Group I (84%) than in Group II (37%), p less than 0.005. Left anterior descending and left circumflex disease was equally common. Patients with persistent ST depression after 48 hours had lower ejection fractions than those in whom it regressed within 48 hours.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1985

[Epidemiology of arterial hypertension in students at the University of Nice].

These students, as representative of french population, were examined in 1983. Right humeral arterial blood pressure was measured three times on dorsal decubitus with a mercury manometer by a medical doctor. People with a systolic arterial pressure greater than or equal to 150 mmHg and/or diastolic arterial pressure greater than or equal to 90, were considered as hypertensive. These hypertensive people came then for a new complete examination, six months later. A witness group, drawn by lot, were examined in the same conditions. Systolic, diastolic and mild arterial blood pressures (in mmHg) were for: (table; see text) Prevalence of hypertension is 2.2 p. 100 (46) for girls and 11.9 p. 100 (184) for boys. The most important difference between high blood pressure people and normal blood pressure people lies in morphological characters. (Table: see text). Sport activities, coffee and diet concerning sodium are identical in the two groups. High blood pressure people smoke less than normal blood pressure people. Previous history of hypertension are more frequent in high blood pressure people than normal blood pressure people. Upright posture induce modification in pressure on high blood pressure people. Meanwhile, stress induced by mental arithmetic, does not bring more elevation pressure about high blood pressure people than normal blood pressure people. Six months later: 58 p. 100 of high blood pressure group have still a high blood pressure, 26 p. 100 have a borderline blood pressure (systolic greater than or equal to 140, diastolic greater than or equal to 85).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

[Exercise test in patients over 70 years of age].

One hundred and sixty-four out of 171 prescribed tests were carried out (96 p. 100) in 48 women aged 70 to 85 years (mean 74,3 years), and 116 men aged 70 to 84 years (mean 73,4 years). The indications were: coronary artery disease (113 cases), cardiac arrhythmias (44 cases), cardiac failure (12 cases), hypertension (9 cases) and assessment of apparently normal subjects (7 cases). The tests were performed on a bicycle ergometer in the upright position; the work load was increased stepwise every 3 minutes with automatic electrocardiographic recording. 37.2 p. 100 of subjects exceeded 90 p. 100 of the maximal predicted heart rate for age; 23.2 p. 100 failed to achieve 75 p. 100 of the target heart rate. There were no serious complications but 4.2 p. 100 minor incidents occurred. The mean maximum work load was 66,5 watts (71.9 W for men and 53.5 W for women). These results show that exercise testing is possible in geriatric patients and provides information of comparable value to that obtained in younger patients. The investigation is safe when performed under strict medical supervision.

Aged↗