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Biomedical subjects

P Reynaud

Publications and source records attributed to P Reynaud.

At least 55 records · Page 3Linked to original sources
PubMed1989

Captopril test in the detection of renovascular hypertension in a population with low prevalence of the disease. A prospective study.

The value of the captopril test as a screening test for identifying renovascular hypertension has been outlined by several studies performed in populations with a high prevalence of renovascular disease (20% to 50%). We prospectively assessed the value of the test in 103 hypertensive patients referred to our center for evaluation of their hypertension. They had taken no diuretics and no converting-enzyme inhibitors for more than four days. The interpretation of the results of the test was done according to the criteria defined by Muller et al. All patients underwent a digital venous angiography and when positive or doubtful, a conventional angiography. Eleven patients (10%) had unilateral or bilateral artery stenosis greater than 70%. The sensitivity of the test was 73% with a specificity of 84% and a positive predictive value of 35%. The three patients with a false negative test underwent a surgical treatment or a transluminal angioplasty of the stenosis but remained hypertensive. Thus, the captopril test is a useful screening test for identifying patients with renovascular disease, even in a population with a low prevalence of the disease.

Captopril↗
PubMed1989

Relationship between left ventricular mass and noninvasive monitoring of blood pressure.

We studied the relationship between left ventricular mass index (LVMI) and blood pressure (BP) monitored during 24 hours in 35 normotensive and 58 hypertensive patients with no treatment for more than three months. We found a close correlation between LVMI and the average daytime systolic BP (r = 0.68). Other parameters derived from BP monitoring were also correlated with LVMI: daytime diastolic BP (0.54), nighttime systolic and diastolic BP (0.61 and 0.54), pulse pressure (0.58), the average of the five highest systolic and diastolic BP (0.57 both), and the percentage of systolic BP above 140 mm Hg (r = 0.64). However, in a stepwise multiple regression analysis only daytime systolic BP was independently correlated to LVMI. The standard deviation of systolic BP was not significantly correlated to LVMI. The same positive correlation between daytime systolic BP and LVMI was found in normotensive and hypertensive patients, males and females, and patients with and without left ventricular hypertrophy. So, at least regarding the prediction of the degree of left ventricular hypertrophy, the average systolic BP during daytime seems to be the only valuable parameter to look at in ambulatory BP monitorings of untreated hypertensive patients.

Adult↗
PubMed1989

[Epidemiology of severe cranial injuries in children and the prognosis of injured patients hospitalized in neurosurgery units].

Over five years (1979-1983), 1,058 children who sustained injuries in the Val de Marne District (near Paris) were treated by the Emergency and Intensive Care Mobile Unit. Among these patients, 17.8% had an isolated, severe head injury (Glasgow score less than 12) and were admitted to a neurosurgical unit; the age and sex distribution in this group was comparable to that of the entire group of injured children (2/3 boys). The severe head injury was caused by a motor vehicle accident in 47% of cases and a fall in 34% of cases. One half of patients had a skull fracture; all patients with an extra-dural (14 cases) or sub-dural (7 cases) hematoma had a skull fracture. Seventy per cent of patients had cerebral edema and 25% had a meningeal hemorrhage. Immediate severe neurologic disorders (Glasgow score less than 9) were present in 53% of cases and 27% of patients had focal neurologic signs. Mean duration of the stay in the neurosurgical unit was 6 to 15 days. Mortality was 15.3%; in most cases (75%) death occurred within the first 48 hours. One-year morbidity was very significant; 67% of surviving children had residual disease, and 40% had severe sequelae.

Adolescent↗
PubMed1988

[Cardiac Doppler ultrasonography in the diagnosis and surveillance of chronic aortic insufficiency].

Chronic aortic insufficiency is, since a few years, a topic of renewed interest because of the development of non-invasive monitoring methods: sonocardiography, cardiac Doppler. The problem raised is that of deciding the most opportune time for surgery in asymptomatic chronic AI, the course of which may quietly evolve towards irreversible myocardial lesions. The severity of AI may be determined by numerous sonocardiographic and Doppler criteria. In sonocardiography, three types of parameters have especially been studied: ventricular expansion (telediastolic, telesystolic diameter), the systolic function (percentage of diameter decrease), volume/mass ratio (R/h). To be valid, these measurements are a precious guide for patient's monitoring and therapeutic approach. The more recent Doppler criteria must be validated on large series and evaluated according to the context or a pathological association; they all have limitations and cannot be interpreted separately.

Aortic Valve Insufficiency↗
PubMed1988

[An adult case of Leigh's subacute necrotizing encephalomyelopathy].

Leigh's encephalomyelopathy has been mainly observed in infancy and childhood. A later onset, during adolescence or adulthood has been rarely reported. Our patient was a 35 year-old man who died after 10 months of evolution of a subacute neurological syndrome, beginning with behavioural changes then a confusional state, epileptic fits, ataxia, autonomic disorders, abnormal alimentary behaviour and dementia. Diagnosis was only obtained by neuropathology, as in most of the published reports. However this diagnosis is suggested when exists an acute or subacute neurological pattern, beginning with visual defects and alimentary and social impairment, followed by a brain-stem syndrome. CT and M.R.I. will make it more easy. An earlier diagnosis could perhaps allow to discover the suspected enzymopathy responsible for Leigh's encephalomyelopathy and make clearer the relationship between Leigh's disease and encephalopathies with abnormal mitochondria.

Adult↗
PubMed1988

[Circadian rhythm of blood pressure. Importance of the severity and not the cause of arterial hypertension].

Recent work have raised the possibility of a lack of circadian blood pressure variability in secondary hypertension. To test this hypothesis, we compared 11 patients with renovascular hypertension (RVH) and 11 essential hypertensive patients (EH) matched for sex, age, body weight, height and the average level of SBP from 7 a.m. to 10 p.m. monitored every 15 minutes with a Spacelabs 5200 device. All patients had BP monitored during 24 hours, inside the hospital, after all anti-hypertensive drugs were discontinued for more than 5 days. Paired t test revealed no difference between the two groups. Differences (D - N) between average day time (7 a.m.-10 p.m.) and night time (10 p.m.-7 a.m.) systolic and diastolic BP were not different in the two groups. (Table: see text). To test the influence of BP level on circadian BP variation, we studied the correlation between the difference in day and night average SBP, as a % of average day time SBP, and the average day time SBP in 25 normal subjects and 64 hypertensive patients without treatment. A weak but significant correlation was demonstrated (r = -0.29; p less than 0.01). The higher the average day time SPB, the lower the difference between day and night. In conclusion, circadian variation of BP is not different between essential and renovascular hypertensive patients, but there is a trend to a smaller variation in patients with the higher BP.

Adult↗
PubMed1987

[Effectiveness of double fibrinolytic treatments in subacute deep vein thrombosis of the lower limbs].

The purpose of this study was to evaluate the effectiveness and desirability of a double fibrinolytic treatment in subacute venous thrombosis of the lower limbs. Thirty-four patients (mean age 55.2 +/- 15.4 years) hospitalized for thrombosis of deep lower limb veins were treated with two different fibrinolytic drugs administered successively: 23 patients received streptokinase first followed urokinase, and 11 patients received urokinase first followed by streptokinase. The overall results that improvement of the phlebographic score (Ph.s) was significantly greater in double fibrinolytic treatment (delta Ph.s. = 4.41 +/- 6.45, p less than 0.001) than after a single fibrinolytic treatment (delta Ph.s. = 3.14 +/- 4.76, p less than 0.001). Individual analysis of the results showed that 28% of the patients were improved by a second fibrinolytic treatment. It would appear that two fibrinolytic treatments are truly effective, albeit inconstantly and in most cases partially. We were unable in this study to determine the characteristics of patients likely to benefit from a double treatment.

Adult↗
PubMed1986

Penetration of ciprofloxacin into bronchial secretions.

The penetration of ciprofloxacin into bronchial secretions was evaluated in 21 patients after a single oral dose of 500 mg of ciprofloxacin. Ten successive serum samples were collected in the interval 0-12 h after administration, and bronchial samples were taken 2, 3, 4 and 6 h after administration. Concentrations were measured in all samples using a standard microbiological assay. The results showed that the kinetics in serum did not differ from those determined in previous studies, a peak level of 2.2 +/- 1.3 mg/l being achieved at 2 h followed by a slow decrease of the levels to 0.6 +/- 0.4 mg/l at 6 h. The bronchial concentrations reached about 0.5 mg/l at 2 h and remained stable until 6 h, ranging between 0.5 and 0.8 mg/l. The ratio between simultaneous bronchial and serum levels ranged from 0.19 at 2 h to 0.95 at 6 h. These data indicate that ciprofloxacin might be suitable for treatment of severe respiratory infections, especially pneumonia caused by Pseudomonas aeruginosa, since the MICs of ciprofloxacin for most bacteria involved in bronchopulmonary infections are very low and tissue diffusion of the drug in the respiratory tract is good.

Aged↗
PubMed1986

[Secondary tumors of the right heart. Echocardiographic aspects. Apropos of 6 cases in the adult].

Secondary cardiac tumours are rare but but are now more frequently diagnosed by echocardiography. We report 6 cases of intracardiac metastases affecting the right heart which were diagnosed by 2D echocardiography. In 3 cases, a very mobile, oval-shaped tumour was visualised within the right atrium prolapsing into the tricuspid orifice in diastole like a myxoma but associated in 2 cases with signs of invasion of the inferior vena cava. Two other non-mobile tumours were observed causing massive invasion of the right atrium and the last case was of an infiltrating tumour of the right ventricle resulting in pulmonary infundibular obstruction. In the light of our experience and a review of the literature, it is difficult to distinguish secondary tumours of the right atrium from myxomas especially when the tumours are mobile and when it is impossible to visualise a pedicle inserted on the interatrial septum or tumoral invasion of the inferior vena cava. At the ventricular level, the diagnostic signs differ according to whether there is tumoral invasion of the cavity or infiltration of the muscular wall. These cases illustrate the value of 2D echocardiography in the diagnosis of intracardiac metastases, sometimes even in the absence of clinical signs.

Aged↗
PubMed1984

[Nonsurgical pulmonary embolectomy using catheterization].

Deoppilation of the pulmonary arteries by catheterization is infrequently used in severe pulmonary embolism. This technique can only be contemplated when conventional measures, such as injection of fibrinolytic agents or surgical removal of the emboli, cannot be applied. The catheter is introduced under local anaesthesia through the femoral vein or the internal jugular vein, and the emboli are aspirated by exerting a strong depression at the tip of the catheter. Satisfactory results can only be expected in cases with very recent (less than 72 hours), totally occlusive and proximal embolism. Three out of the authors' 6 attempts have been successful.

Aged↗
PubMed1984

An analysis of the diagnostic methods for acute pulmonary embolism.

In spite of numerous sophisticated investigative procedures, acute pulmonary embolism (PE) is very frequently misdiagnosed. In order to improve the diagnostic approach to PE, the sensitivity and specificity of the commonly used methods were reviewed in a group of 421 patients with angiographically proved PE without associated cardio-pulmonary disease. The specificity of diagnostic procedures was, by decreasing order: positive pulmonary angiography (to affirm) = negative perfusion lung scan (to eliminate) greater than chest X-ray much greater than clinical symptoms, positive perfusion lung scan, ECG, blood gas, serum enzymes.

Acute Disease↗
PubMed1982

[Pharmacokinetics of mezlocillin in bronchial secretions (author's transl)].

This study was designed to measure the penetration of mezlocillin into respiratory secretions taken from tracheostomized patients admitted to an intensive care unit. In these patients admitted to an intensive care unit. In these patients, samples can be taken at set intervals. Eighteen patients were divided into two groups, one group received a single i.v. dose of 5 g. mezlocillin and the other a one day treatment with eight-hourly infusions of 5 g mezlocillin, samples being taken after the fourth infusion. Antibiotic concentrations were measured in simultaneous samples of serum and bronchial secretions by an agar diffusion method. The results showed considerable penetration of mezlocillin into bronchial secretions. Two hours after the end of the infusion, the peak of bronchial mezlocillin concentrations varied from 10 to more than 20 micrograms/ml. The kinetics of bronchial levels exhibited slow elimination, with still measurable levels at the sixth hour (1.5 to 3 micrograms/ml). Important individual variations were seen in patients with different clinical conditions (respiratory insufficiency, acute intoxication in forced diuresis). There was no difference between the two groups of patients, which showed that no cumulation took place. It is concluded that the passage of mezlocillin in the human respiratory tract results in high bronchial concentrations which are bactericidal to most species of Enterobacteriaceae.

Adult↗