We assessed the effects of labetalol on pulmonary wedge pressure (PWP) and other hemodynamic variables in 18 patients with acute myocardial infarction (AMI) and systemic hypertension (systolic blood pressure greater than 150 mm Hg). According to the initial value of PWP, the patients were separated into two groups of nine patients each: Group 1 (PWP greater than or equal to 15 mm Hg) and Group 2 (PWP less than or equal to 12 mm Hg). Labetalol was infused at increasing rates to lower systolic blood pressure below 130 mm Hg; this optimal rate (mean rates for Groups 1 and 2: 1.8 and 2.1 mg/min, respectively) was maintained for 1 h. Hemodynamic variables were measured before and after 1 h of infusion. Labetalol normalized blood pressure in both groups by a significant decrease in total systemic resistance [22% (p less than 0.001) and 13% (p less than 0.02)] and in cardiac index [17% (p less than 0.005) and 12% (p less than 0.02)]. While the hemodynamic responses were rather similar in both groups, the PWP decreased significantly (from 22 to 15 mm Hg, p less than 0.01) in Group 1, but did not change significantly in Group 2 (from 7 to 10 mm Hg, NS). The possible mechanisms behind these different responses are discussed. We conclude that labetalol is an effective drug for treating systemic hypertension in AMI which acutely decreases total systemic resistance and preload in patients with moderate left ventricular failure.

Adult↗

PubMedDate not supplied

[Diagnostic aspects of cerebral arterial occlusion in infants and children (author's transl)].

The authors have studied the bases of the clinical and CT diagnosis of cerebral arterial occlusion in children from a series of 16 cases. The sequential evolution of the CT appearance seems characteristic depending on the time elapsed since the onset. Contrast enhancement, concerns mainly the grey matter, is maximum during the second and third weeks and should be looked for during this period. The aetiology remains usually hypothetic. Some data, including the angiographic aspect of "endarteritis" may suggest an infectious pathogeny.

Adolescent↗

PubMedDate not supplied

[Ataxia-opsoclonus-myoclonus syndrome].

The ataxia-opsoclonus-myoclonus syndrome that was well individualized by Kinsbourne is mostly observed in young children (less than three years old in 90 percent of the cases). From six personal cases, and from a review of ninety cases of the literature, the clinical and etiological features, as well as the evolution of the syndrome, are studied. Prodromes (infectious and digestive manifestations) and comportmental changes usually precede the sudden onset of the clinical triad. Neurologic complementary investigations are typically normal during the acute phase. The frequent association (46 percent of the cases) of this syndrome to a neuroblastoma (usually thoracic) makes it very particular from the etiological point of view. The evolution is identical whatever the type ("isolated" or "tumoral"). Corticotherapy (ACTH or corticoids) is efficient in 60 percent of the cases. But recurrences and cerebral sequelae (mental deficiency and speech disorders) are frequent.

Adrenal Cortex Hormones↗

PubMedDate not supplied

[Sulmazole: a new positive inotropic agent].

Sulmazol (AR-L 115 BS) is a new positive inotropic agent with arterial and venous vasodilator properties. The authors studied the effects of a 24 hours intravenous infusion (an injection of 0.5 mg/kg over 1 minute, followed by an infusion of 1.4 mg/min) on the major haemodynamic parameters of 17 patients with heart failure: 10 patients with chronic decompensation (group I) and 7 patients with heart failure as a result of acute myocardial infraction (group II). The haemodynamic criteria of inclusion were a cardiac index less than or equal to 2.5 l/min/m2 and a pulmonary capillary pressure greater than or equal to 18 mm Hg. After 6 hr of the infusion, the cardiac index increased in both groups (45%, p less than 0.001 and 40%, p less than 0.001 respectively); the pulmonary capillary pressure decreased (32%, p less than 0.001 and 30%, p less than 0.001) and the right atrial pressure decreased (51%, p less than 0.005 and 31%, NS). The total systemic resistance was also decreased (32%, p less than 0.001 and 34%, p less than 0.001), but there was no significant change in the systolic blood pressure. The heart rate increased only in group II (17%, p less than 0.001). These beneficial hemodynamic effects lasted for the 24 hours of the infusion. Sulmazol was therefore found to be very effective in the treatment of acute and chronic heart failure; its long term tolerance still needs to be demonstrated.

Aged↗