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Biomedical subjects

R Maire

Publications and source records attributed to R Maire.

At least 37 records · Page 2Linked to original sources
PubMed1993

[Arthropathy in hemochromatosis].

Early diagnosis of hemochromatosis may prevent the numerous risks of iron overload. One of the most common early manifestations of this disease is arthropathy. The clinical and radiologic findings of hemochromatosis arthropathy are discussed. Diagnosis is suggested by simple laboratory tests and confirmed by liver biopsy with measurement of hepatic iron content. Treatment includes the removal of the excess body iron by phlebotomy. Unfortunately, symptoms of arthropathy tend to be resistant to phlebotomy.

Aged↗
PubMed1992

[How does oligo- en asymptomatic non-tropical sprue present itself?].

According to the computerized ICD registration, 20 new cases of non-tropical sprue were detected in our outpatient clinic between 1979 and 1990. 8 of these patients had an oligo- or asymptomatic form of this disease (40%). The clinical presentation and spectrum of abnormal laboratory findings in these 8 cases are described in detail. It is concluded that laboratory parameters indicating malabsorption, especially hematologic changes, are helpful for the detection of the oligo- and asymptomatic form of non-tropical sprue, and that, in cases with undetermined anemia, this form of sprue must be considered in etiologic differential diagnosis. Finally, it seems advisable to perform a biopsy as a routine procedure during endoscopy in cases with unclear anemia.

Adult↗
PubMed1992

[Incidence and clinical aspects of scombroid fish poisoning].

An impressive case of scombroid-fish poisoning in a 34-year-old woman prompted us to investigate the incidence, clinical findings and follow-up of this disease, the syndrome of which resembles histamine intoxication. In 25 years (1966-1991) a total of 76 incidents after intake of tuna fish were reported to Swiss Toxicological Information Centre. 27 reports came from physicians, and of these 18 fulfilled the criteria of scombroid-fish poisoning. Thus, this intoxication occurs rarely in Switzerland. The symptoms in 31 well documented cases are described. Most patients had erythema (87%), half complained of headache and one third had gastrointestinal symptoms. The clinical course was benign in all patients, and the symptoms had disappeared after a mean period of 8 hours.

Acute Disease↗
PubMed1992

[Cardiovascular causes of falls].

Falls with transitory loss of consciousness (syncopes) are mainly due to cardiovascular incidents and show a significant higher risk of injuries than falls without loss of consciousness. The frequency of syncope is increasing with advancing age. Syncope represents an important disease with epidemiologic consequences in the older age group. The broad etiologic spectrum of syncope and the significance of diagnostic methods are discussed. Five case reports are added as illustration. Medical history, clinical examination and ecg-recordings are the most important diagnostic tools in the evaluation of syncope. An in depth investigation of patients with syncope reduces the rate of recurrence and risk for injury, it increases the quality of life and results in lower medical costs.

Accidental Falls↗
PubMed1992

[What does echocardiography contribute to heart failure?].

When examining patients with heart failure, it is often impossible to assess the underlying cardiac disease only on the basis of clinical examination, electrocardiogram and chest X-ray. As an additional noninvasive method, echocardiography provides a high level of diagnostic accuracy for heart diseases. Different cardiologic ultrasound methods and procedures, applied in patients with heart failure during a modern echocardiographic routine examination, are shown. Despite an increasing availability of this imaging technology, inappropriate use without clear indication must be avoided. Criteria of indication are discussed, followed by an illustrating case report.

Aged↗
PubMed1991

Reduced exercise capacity in patients with tricuspid regurgitation after successful mitral valve replacement for rheumatic mitral valve disease.

OBJECTIVE: To determine how severe tricuspid regurgitation influences exercise capacity and functional state in patients who have undergone successful mitral valve replacement for rheumatic mitral valve disease. DESIGN: 9 patients in whom clinically significant tricuspid regurgitation developed late after mitral valve replacement were compared with 9 patients with no clinical evidence of tricuspid regurgitation. The two groups were matched for preoperative clinical and haemodynamic variables. Patients were assessed by conventional echocardiography, Doppler echocardiography, and a maximal treadmill exercise test in which expired gas was monitored by mass spectrometry. SETTING: University Hospital of Wales, Cardiff. SUBJECTS: 18 patients who had been reviewed regularly since mitral valve replacement. MAIN OUTCOME MEASURE: Objective indices of exercise performance including exercise duration, maximal oxygen consumption, anaerobic threshold, and ventilatory response to exercise. RESULTS: Mitral valve prosthetic function was normal in all patients and estimated pulmonary artery systolic pressure and left ventricular function were similar in the two groups. Right ventricular diameter (median (range) 5.0 (4.3-5.6) v 3.7 (3.0-5.4) cm, p less than 0.01) and the incidence of paradoxical septal motion (9/9 v 3/9, p less than 0.01) were greater in the group with severe tricuspid regurgitation. Exercise performance--assessed by exercise duration (6.3 (5.0-10.7) v 12.7 (7.2-16.0) min, p less than 0.01), maximum oxygen consumption (11.2 (7.3-17.8) v 17.7 (11.8-21.4) ml min-1 kg-1, p less than 0.01), and anaerobic threshold (8.3 (4.6-11.4) v 0.7 (7.3-15.5) ml min-1 kg-1, p less than 0.05)--was significantly reduced in the group with severe tricuspid regurgitation. The ventilatory response to exercise was greater in patients with tricuspid regurgitation (minute ventilation at the same minute carbon dioxide production (41.0 (29.9-59.5) v 33.6 (26.8-39.3) l/min, p less than 0.01). CONCLUSIONS: Clinically significant tricuspid regurgitation may develop late after successful mitral valve replacement and in the absence of residual pulmonary hypertension, prosthetic dysfunction, or significant left ventricular impairment. Patients in whom severe tricuspid regurgitation developed had a considerable reduction in exercise capacity caused by an impaired cardiac output response to exercise and therefore experienced a poor functional outcome. The extent to which this was attributable to the tricuspid regurgitation itself or alternatively to the consequences of right ventricular dysfunction was not clear and requires further investigation.

Aged↗
PubMed1991

[Secondary Menière's disease].

Among 93 patients presenting the typical symptoms of a Ménière's disease associating an unilateral fluctuating hearing loss of sensorineural type, tinnitus and vertiginous attacks lasting minutes to hours, 40 patients (43%) presented in their personal history a particular otologic insult in the ear which later on developed into the full Ménière's symptomatology, or a particular systemic disease with otologic manifestations. The Ménière's triad appeared in these patients six months to twenty nine years after the initial otologic or systemic lesion. Among these initial lesions were 16 cases of sudden partial or complete deafness related to viral or bacterial infection, 3 cases of sudden cochleo-vestibular deficit and 1 case of vestibular neuritis, 5 cases of temporal bone fractures and 4 cases of significant acoustic trauma, 2 cases of otosclerosis, 1 case of chronicotitis media and 1 case of severe hearing loss after otologic surgery, 5 cases of meningo-encephalitis and 2 cases of acquired syphilis. These particular lesion could be, in our opinion, the releasing factor of the inner ear dysfonction leading eventually to a secondary Ménière's syndrome.

Electronystagmography↗
PubMed1991

[Hennebert's sign in Menière's disease].

The fistula sign without middle-ear lesion, also known as the Hennebert's sign, was observed in 7 (14%) subjects among 50 patients with unilateral Ménière's disease. The Hennebert's sign was obtained in 4 cases (57%) by negative pressure in the external auditory canal, by positive pressure in 2 cases and by both positive and negative pressures in 1 case. The Hennebert's sign is characterized by a few beats of horizontal nystagmus seen under Frenzel glasses. Caracteristically this nystagmus is of low frequency and amplitude. Most patients indicate simultaneous sensation of dizziness. The presence of Hennebert's sign seems to indicate in most cases the existence of an endolymphatic hydrops with contact of the saccular wall up to the internal face of the footplate (internal sacculostapedopexy). The test was also performed on the controlateral healthy ear used as a control. No Hennebert's sign was obtained on the healthy side. None of the patients showed any complication following the provocation of Hennebert's sign.

Adolescent↗
PubMed1990

[Heart contusion].

This 40 year old patient was involved in a car accident which resulted in a thoracic trauma with fracture of the sternum and the left radius. The ECG showed a complete right bundle branch block and a left anterior fascicular block (= bifascicular block). These electrocardiographic findings and an elevated CK-MB fraction after thoracic trauma were indicative for the diagnosis of myocardial contusion. The ECG was normal after 24 hours, the CK-MB after two days. The patient left the hospital after one week. Five weeks later, a control examination showed no cardiological abnormalities.

Electrocardiography↗
PubMed1990

[Comparison of enalapril and captopril in the treatment of chronic heart failure].

The long-term effect of enalapril (group 1) and captopril (group 2) on clinical symptomatology and left ventricular function was evaluated in 29 patients with severe congestive heart failure (13 ischemic and 12 dilated cardiomyopathy, four valvular heart disease). During the 6-month observation period, five patients died (two on enalapril and three on captopril therapy = 6-month mortality rate 18%). Nine patients showed no beneficial effect of enalapril or captopril on clinical and hemodynamic findings (= nonresponders). The initial findings on these nine patients were, however, not significantly different from the clinical and hemodynamic findings on the patients who improved. Enalapril had to be discontinued in two patients because of side effects (progressive renal failure and gastrointestinal symptoms, respectively). A total of 22 patients completed the study, 11 treated with enalapril (mean dosage 25 +/- 10 mg/day) and 11 treated with captopril (mean dosage 77 +/- 26 mg/day). After 6 months there was a significant improvement according to the New York Heart Association (NYHA) classification, from 2.4 to 1.9 in group 1 (p less than 0.01) and from 2.7 to 1.9 in group 2 (p less than 0.001). The cardio-thoracic ratio (chest x-ray) decreased significantly from 0.59 to 0.56 (p less than 0.001) in group 1 and from 0.56 to 0.53 (p less than 0.001) in group 2. Physical working capacity (bicycle ergometry) showed a significant increase in both groups from 61% to 81% in group 1 (p less than 0.01) and from 66% to 83% in group 2 (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗
PubMed1987

[Clinical significance of serum carnitine in the course and prognosis of dilated cardiomyopathy].

Serum carnitine is an essential cofactor for the transport of free fatty acids into the mitochondria. We determined the free and the total serum carnitine in 99 healthy blood donors and 58 patients with different forms of heart muscle disease. Thirty patients had dilated (DCM), 10 hypertrophic (HCM) and 8 alcoholic (ACM) cardiomyopathy and 10 patients had congestive heart failure of different etiology than cardiomyopathy (CHF). Free and total serum carnitine were determined by an enzymatic-spectrophotometric assay according to Pearson. Mean values for free and total serum carnitine were as follows: 47 and 74 mumol/l in controls (C; blood donors), 74 (P less than 0.01 vs. C) and 83 mumol/l in DCM, 66 (P less than 0.01 vs. C) and 89 mumol/l in HCM, 85 (P less than 0.01 vs. C) and 104 mumol/l (P less than 0.05 vs. C) in ACM and 86 (P less than 0.01 vs. C) and 129 mumol/l (P less than 0.01 vs. C) in CHF. Ten patients died during the mean observation time of 13 months, 8 patients with DCM and 2 with CHF; 9 of these 10 patients had initially a markedly increased serum carnitine. Patients with DCM were divided into two groups with normal (n = 15; 25-68 mumol/l) and increased (n = 15; greater than 68 mumol/l) free serum carnitine. Patients with increased serum carnitine showed a significantly higher mortality rate (47%) than patients with normal serum carnitine. It is concluded that free and total serum carnitine are elevated in patients with congestive heart failure, dilated and hypertrophic cardiomyopathy. The etiology of this carnitine metabolism disturbance is unclear but it is probably due to a secondary phenomenon in patients with congestive heart failure or primary myocardial hypertrophy. An increased serum carnitine is a poor prognostic sign in patients with dilated cardiomyopathy.

Adolescent↗
PubMed1986

[Video-microscopic studies of telangiectases in Osler's disease and scleroderma].

4 patients with hereditary hemorrhagic telangiectasia (Osler's disease) have been studied by clinical means and by fluorescence videomicroscopy. The capillaroscopic image was characterized by convolutes of giant capillaries (diameter up to 150 micron, normal value up to 15 micron) between capillaries of normal shape and size. After intravenous injection of Na-fluorescein the enlarged capillaries filled rapidly and in some loops flow direction changed at irregular intervals. These findings are in contrast to those observed in systemic sclerosis, where generalized microangiopathy with avascular fields, microbleedings, enlarged capillaries and increased transcapillary and interstitial diffusion of the fluorescent dye are typical. In borderline cases capillaroscopy contributes to differential diagnosis of the telangiectatic form of scleroderma and Osler's disease.

Capillaries↗
PubMed1986

[Osteomalacia after intestinal operations--therapeutic effect of calcitriol. Report of a case].

An 82-year-old woman, with clinically and histologically documented osteomalacia associated with a history of several gastrointestinal operations and malabsorption, was successfully treated with low dose calcitriol. Osteomalacia, with particular reference to the gastrointestinal type, and the role of vitamin D and its metabolites are discussed. Therapy with calcitriol is compared with conventional vitamin D treatment. Calcitriol should be considered in the treatment of osteomalacia induced by gastrointestinal disorders.

Aged↗
PubMed1985

[Long-term follow-up and prognosis of dilated cardiomyopathy].

Between 1969 and 1984, 68 patients with dilated cardiomyopathy (mean age 44 years) were observed for an average period of 45 months. 46 patients (68%) died (17 sudden death, 13 congestive heart failure, 5 other causes and 11 unknown causes) during the observation period according to a cumulative 5-year survival rate of 40%. All patients underwent diagnostic cardiac catheterization. Left ventricular ejection fraction was 32%, left ventricular end-diastolic volume index 195 ml/m2, left ventricular end-diastolic pressure 17 mm Hg and cardiac index 2.7 l/min/m2. The initial hemodynamic findings in the non-survivors and the survivors were statistically not significantly different. The prognostic significance of 12 clinical and hemodynamic parameters was evaluated by multivariate regression analysis (Cox model). Only 3 hemodynamic parameters, namely left ventricular end-diastolic volume, left ventricular end-diastolic pressure and cardiac index, showed prognostic significance in regard to survival. Prognostic evaluation of medical therapy (antiarrhythmic drugs n = 14, vasodilators n = 17, anticoagulation n = 37) revealed an improved cumulative 3-year survival rate (87% versus 46%) only for vasodilators.

Adolescent↗