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Biomedical subjects

P Tellier

Publications and source records attributed to P Tellier.

At least 37 records · Page 2Linked to original sources
PubMed1988

Asymptomatic diabetic cardiomyopathy: a noninvasive study.

Forty-nine diabetic patients (26 type I and 23 type II), free of cardiovascular disease symptoms, were compared with 32 controls in a noninvasive study of left ventricular (LV) function. Absence of ischemic cardiopathy was confirmed by routine investigations and an exercise electrocardiogram using 12 leads with a thallium-201 myocardial scintigraphy. Diabetic patients had (1) a significantly prolonged mean isovolumetric relaxation time (IVRT) assessed by M-mode echocardiography and phonomechanography; (2) a significantly reduced E-F slope; (3) an increased mean Weissler index (pre-ejection period/LV ejection time). The IVRT and E-F slope abnormalities reflect increased myocardial stiffness and impaired LV compliance. The increased Weissler index reflects impaired myocardial contractility. These abnormalities were not related to sex, age, duration of diabetes or to the presence or extent of complications. No significant difference was found between diabetic patients and controls for mean diastolic and systolic LV diameters, thickness of the posterior wall or of the interventricular septum, assessed by echocardiography, or for the ejection fraction, determined by radionuclide angiocardiography. Finally, more than half of the patients with a frankly abnormal IVRT, Weissler index and E-F slope had had diabetes for less than 5 years, some even less than 2 years, without complications. These data show: (1) evidence of LV dysfunction specific to diabetes and unrelated to ischemic cardiopathy and hypertension; (2) the possible involvement of a metabolic factor in this early asymptomatic LV abnormality rather than microangiopathy.

Adult↗
PubMed1988

Reversibility by dipyridamole of thallium-201 myocardial scan defects in patients with sarcoidosis.

PURPOSE: In order to clarify the significance of anginal pain and myocardial thallium-201 scan defects in cardiac sarcoidosis, the pharmacologic effect of dipyridamole on myocardial perfusion was assessed by planar thallium-201 myocardial scintigraphy in patients with sarcoidosis. PATIENTS AND METHODS: Thallium-201 myocardial scintigraphy was performed at rest and after 0.56 mg/kg intravenous dipyridamole during four minutes in 16 patients with sarcoidosis. The myocardial scan (45-degree and 70-degree left anterior oblique, and anterior views) was divided into 15 segments. Results were evaluated by the number of segmental defects and with a global perfusion score (from 0 to 60) by a semi-quantitative index depending on the size and severity of myocardial thallium-201 defects. RESULTS: Thirteen of the 16 patients showed partial or total reversion of their thallium-201 defects on redistribution scanning either at rest or after dipyridamole. The mean (+/- SD) number of myocardial perfusion defects that were present in all the patients decreased from 5.31 +/- 1.78 at rest to 3.25 +/- 2.52 after redistribution (p less than 0.001) and to 2.19 +/- 2.10 after dipyridamole (p less than 0.001). The mean global perfusion score increased from 53.2 +/- 3.0 at rest to 56.2 +/- 2.9 after redistribution (p less than 0.001) and to 57.2 +/- 2.7 after dipyridamole (p less than 0.001). A significant correlation (r = 0.82, p less than 0.001) was found between the increase of global perfusion score on redistribution and after dipyridamole. CONCLUSION: The reversibility of myocardial scan defects is a common finding in sarcoidosis. It makes unlikely the role of scar fibrosis or extensive confluent granulomas as a mechanism for such defects. The effect of dipyridamole suggests the presence of reversible disorders lying at the coronary microvascular level.

Adult↗
PubMed1988

[Renal hydatid cyst. Contribution of radiology apropos of a case].

Hydatid disease, an infestation of gastrointestinal origin, is essentially localized in the two principal filters of the body, the liver and the lung (80% of localizations); 20% correspond to a random distribution (brain, bones, kidneys, etc.). The observation of a new case of rare renal infestation (1 to 5% of all hydatid cysts) constitutes an occasion to review the role of various radiological investigations in this disease. Computed tomography has a role in the diagnosis which is complementary to that of plan abdominal x-rays and ultrasonography. Intravenous pyelography may be performed subsequently. It has an essential role in the systematic investigation of other localizations.

Adult↗
PubMed1988

Assessment by dipyridamole-thallium-201 myocardial scintigraphy of coronary risk before peripheral vascular surgery.

From October 1983 to January 1985, 46 patients (38 men and 8 women; average age, 60 years; range, 37 to 83 years) underwent peripheral vascular surgery of either the internal carotid artery or the arteries of the lower limbs. Each patient had a thorough clinical examination, an ECG, and a dipyridamole-thallium-201 myocardial scan before operation. On the basis of results, they were divided into two groups: 20 patients with and 26 patients without chronic ischemic heart disease. Three major cardiac events were noted during or after a period of 1 month after surgery: There were two deaths due to cardiac ischemic events and one patient had postoperative unstable angina pectoris. These three patients were classified in the coronary group (NS). When the patients were classified on the basis of whether or not there was thallium redistribution on serial images after infusion of dipyridamole, 14 with redistribution and 32 without redistribution were noted. The three patients who had major cardiac events were in the former group (p less than 0.04). Our data suggest that patients in whom redistribution occurs have a high incidence of postoperative ischemic events. These patients should be considered for particular preoperative coronary care to avoid major postoperative cardiac events and to increase chances of survival.

Adult↗
PubMed1987

[Evaluation by myocardial thallium-201 scintigraphy using dipyridamole of the coronary risk in peripheral vascular surgery].

From October 1983 to January 1985, 46 patients (38 men and 8 women; mean age 60 years, range 37-83) underwent peripheral vascular surgery either of the internal carotid artery or of arteries of the lower limbs. All patients had thorough clinical examination, ECG and thallium dipyridamole myocardial scanning before operation, as a result of which they were divided into 20 with, and 26 without chronic ischemic heart disease. Three major cardiac events were noted during or following a period of one month after surgery: two deaths due to a cardiac ischemic event and one post-operative unstable angina pectoris. The three patients with these complications were classified in the coronary group (NS). When the patients were reclassified according to the presence or absence of thallium redistribution on serial images after dipyridamole, 14 had redistribution and 32 had no redistribution. The three major cardiac events were found to have occurred in the group with redistribution (P less than 0.04). Our study suggests that patients with redistribution have a high incidence of postoperative ischemic events. They should be considered for a particular pre-operative coronary management to avoid post-operative major cardiac events and to improve survival.

Adult↗
PubMed1985

Paradoxical technetium-thallium subtraction scan in a case of parathyroid adenoma.

A technetium-thallium (99mTcO4-201Tl) subtraction scan was performed in a patient with clinical and biological evidence of hyperparathyroidism. The 201Tl image indicated a normal thyroid gland. The 99mTcO4 image revealed a left inferior thyroidal extension with an intense and transient focus corresponding to an ultrasonographic nodule. The transient character of the focus was not explicable in terms of vascular kinetics. A supplementary scintigram using 123I confirmed the presence of an inferior extension of the thyroid, but no increased uptake was found. A nodule weighing 250 mg containing a parathyroid adenoma surrounded by normal thyroidal tissue was excised at the focus site. Biological serum levels returned to normal after the operation. It is concluded that the analysis of 99mTcO4 dynamic data could improve the accuracy of parathyroid subtraction scintigraphy.

Adenoma↗
PubMed1985

Cardiac sarcoidosis: reversion of myocardial perfusion abnormalities by dipyridamole.

A Tl 201 scan was performed on one young patient who met all of the criteria for the diagnosis sarcoidosis. A resting scan before treatment showed marked defects which were not resolved on the redistribution scan, thus leading to the diagnosis of cardiac sarcoidosis, which was also suspected from clinical signs. After dipyridamole infusion (0.142 mg/kg per minute over 4 min), his 201Tl scan was quite normal. Haemodynamic investigation showed a low coronary sinus blood flow with a low lactate extraction: these abnormalities were fully reversed by i.v. dipyridamole infusion. Afterwards, the patient was given oral dipyridamole (450 mg/day) over 4 weeks; at the end of this treatment, his resting 201Tl scan was quite normal. These results suggest that myocardial perfusion abnormalities in sarcoidosis may be reversible after pharmacological vasodilation. Thus, in order to assess cardiac sarcoidosis, a resting myocardial scan should be performed before a scan after dipyridamole infusion. These results may have clinical, pathophysiological and therapeutic implications with regard to cardiac sarcoidosis.

Adult↗
PubMed1985

[Existence of asymptomatic changes in left ventricular function in the diabetic. Noninvasive study].

49 diabetics (D) (26 IDD and 23 NIDD) were compared to 32 controls (C). Absence of ischemic cardiopathy (IC) was confirmed by routine investigations and noninvasive cardiovascular techniques, including an exercise ECG using 12 leads and a thallium 201 scintigraphy. Our results show: a) a prolonged mean isovolumetric relaxation time (IVRT) as studied by the M mode echocardiography and phonomechanography: D = 0,10 sec +/- 0,04; C = 0,05 sec +/- 0,02; p less than 0,0001; b) a reduced mean EF slope: D = 97,48 +/- 37,08 mm / sec; C = 125,68 +/- 34,35; p less than 0,005; c) a high mean Weissler index (ratio of PEP to LVET): D = 40 +/- 0,08; C = 33 +/- 0,05; p less than 0,01. IVRT and EF slope abnormalities are related to increased myocardial stiffness and impaired LV compliance. In the absence of changes in preload and afterload, the high Weissler index reflects impaired contractility of the myocardium. These abnormalities are related neither to the duration of diabetes nor to the presence or severity of the complications. With the M mode echocardiography, mean diastolic and systolic thickness of the septum is greater in D with retinopathy than in C (p less than 0,005 and p less than 0,03 respectively); mean diastolic and systolic thickness of the posterior wall is greater in NIDD than in C (p less than 0,001 and p less than 0,025). We conclude that there is evidence of left ventricular functional abnormalities specific to diabetes and unrelated to IC and hypertension. Our findings support the hypothesis that they may be due to metabolic disorders and/or myocardial microangiopathy.

Adult↗
PubMed1985

[Detection of anterior interventricular involvement after primary posterior wall infarct].

Forty-five patients (average age 53.3 +/- 9.4 years) underwent exercise stress testing coupled with exercise myocardial scintigraphy and right heart catheterisation on exercise during the 3rd week after primary posterior wall infarction. Coronary angiography and ventriculography were carried out 24 to 48 hours later. Significant (greater than or equal to 75%) left anterior descending disease was present in 9 patients (Group I) and absent in 36 patients (Group II). Tolerance of maximal exercise stress testing was good in all patients. The results were uninterpretable in on third of the cases because the theoretical maximal heart rate was not attained. No significant difference was noted between groups I and II with respect to: mean age, percentage of theoretical maximal heart rate attained, mean pulmonary capillary pressures at rest and during exercise, basal and exercise cardiac index, end diastolic index and angiographic left ventricular ejection fraction. The sensitivity and specificity for the detection of LAD disease were 80% and 84% for the exercise stress testing (n = 30), 44% and 75% for exercise right heart catheterisation (n = 30), 60% and 92% for exercise myocardial scintigraphy (n = 30), 100% and 75% for combined exercise stress testing and myocardial scintigraphy (n = 30) and 78% and 64% for combined exercise stress testing and myocardial scintigraphy and exercise right heart catheterisation (n = 45). These results show that in patients capable of performing maximal exercise stress tests, the best method of early detection of significant LAD disease after primary posterior infarction was combined exercise stress testing and exercise myocardial scintigraphy. These investigations are useful for the selection of candidates for coronary angiography.

Adult↗
PubMed1985

[Exercise test coupled with thallium-201 myocardial scintigraphy after a primary posterior wall infarct. Apropos of 123 patients subjected to coronarography].

The following investigations were performed in 123 patients (118 men and 5 women) with an average age of 51 +/- 6 years, between the 3rd and 6 week after primary posterior infarction, a standard exercise stress test on a bicycle ergometer coupled with Thallium 201 myocardial scintigraphy, followed by coronary angiography in the following 15 days. The object of these investigations was to detect severe stenosis (greater than 70%) of the left anterior descending artery and 50% stenosis of the left main stem. Thirteen investigations could not be interpreted because of a submaximal exercise stress test which did not attain 85% of the theoretical maximal heart rate. The sensitivity of exercise stress testing was 73% and that of myocardial scintigraphy 71%. On the other hand, the specificity of scintigraphy was 94% compared to 68% for exercise stress testing. The predictive value of a positive scintigraphy was 88% compared to 47% for stress testing. However, the predictive value of a negative test was similar with both techniques (87% for exercise stress testing, 90% for scintigraphy). When all the positive results were considered, the sensitivity was 93% but the specificity only 66%. The simplest and most rational way of exploiting the information provided by these investigations is to combine the results: when they are concordant they indicate the true diagnosis in 90% of cases. Discordant results pose a more difficult problem with myocardial scintigraphy being the more reliable: its positive predictive value was 71% when exercise stress testing was negative; its negative predictive value was 87% when exercise stress testing was positive.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

[Dyspnea in chronic bronchitis patients. A method for diagnosis and monitoring therapeutic efficacy].

The mechanisms of exercise-induced dyspnoea in chronic obstructive bronchitis are diverse and complex. Dyspnoea develops simultaneously with ventilatory obstruction and constitutes a major symptom in view of its frequency, prognostic value and functional repercussions. It is not the most common reason for seeking medical advice, but because ventilatory obstruction is of poor prognosis it should be systematically looked for by precise, directed questioning in all patients with chronic bronchitis. In some cases, the effects of drugs on dyspnoea can be evaluated by means of a clinical score, but such an evaluation requires a strictly controlled double-blind trial with separate assessments by the clinician and the patient. The effectiveness of almitrine bismesylate on exercise-induced dyspnoea in chronic bronchitis has been demonstrated by this method. A multicentre, drug versus placebo controlled trial conducted on 200 patients during 6 months has shown that almitrine bismesylate significantly lowered dyspnoea scores measured according to the Sadoul scale and that the symptomatic improvement observed correlated with the effects of the drug on blood gases. By promoting tissue oxygenation, almitrine bismesylate may antagonize one or several of the mechanisms underlying exercise-induced dyspnoea in chronic bronchitis patients who have reached the stage of respiratory failure.

Almitrine↗
PubMed1984

[Originality of the mode of action of almitrine dimesylate].

Very few therapeutic measures of proven effectiveness are available for the management of chronic bronchitis with chronic respiratory failure. Long-term oxygen therapy undoubtedly improves functional and vital prognoses in patients with severe hypoxaemia (55 less than or equal to PaO2 less than or equal to 60 mmHg) or chronic post-hypoxia cor pulmonale, but its indications are limited by its cost and by numerous practical problems. Owing to its mode of action and pharmacological effects, almitrine bismesylate corrects the main physiopathological disorders underlying hypoxaemia and its complications in chronic bronchitis. Improvement in arterial and tissue oxygen supply and decrease in hypercapnia result from the specific and original action of the drug on the distribution of alveolar ventilation-perfusion ratios--an action that has been clearly demonstrated by the inert gas method and by radioisotopic techniques. Such a mode of action differentiates almitrine bismesilate from long-term oxygen therapy which has similar effects, at least qualitatively, on tissue oxygenation. The lack of undesirable effects on central nervous system, pulmonary circulation and respiratory mechanics confirms the originality and safety of a drug which unquestionably constitutes a novel and major contribution to the long-term treatment of chronic bronchitis with hypoxaemia.

Almitrine↗
PubMed1984

[Almitrine dimesylate: deductions and therapeutic prospects].

When administered orally, in the usual doses, to chronic bronchitis patients with hypoxaemia and hypercapnia, almitrine bismesylate corrects blood gas disturbances without producing significant changes in haemodynamic and spirometric values. This effect betrays a specific action on the alveolar ventilation/perfusion imbalance responsible for hypoxaemia. The original mode of action of the drug and its clinical and biological effectiveness demonstrated in long-term treatment, as well as its safety, offer new hopes for the management of chronic bronchitis. The possibility of acting on hypoxaemia conveniently and at an early stage should be expected to delay the development of cor pulmonale, but this remains hypothetical and needs to be confirmed, in spite of strong physiopathological bases, by strictly controlled therapeutic trials. It cannot be definitely stated, at this stage, that almitrine will entirely replace continuous low flow rate oxygen therapy, yet it is already certain that the indications for the latter ought to be re-evaluated for physiopathological, practical and financial reasons.

Almitrine↗