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S Witchitz

Publications and source records attributed to S Witchitz.

At least 37 records · Page 2Linked to original sources
PubMed1995

Nicorandil safety in the long-term treatment of coronary heart disease.

The results of an open prospective study that evaluated the long-term clinical safety of nicorandil are presented. This study included 199 patients with severe chronic stable angina treated over a 1-year period. The most often reported adverse event was headache, which was responsible for most of the study withdrawals due to clinical intolerance (9.6%). When using a progressive titration scheme, this incidence was substantially reduced to 2.7%. As with other less frequent adverse events (dizziness, gastrointestinal disorders), headaches were reported as being mild to moderate in severity, were experienced during the first days of treatment, and, if treatment was maintained, usually resolved within a few days. The incidence of adverse events was not modified when nicorandil was given in combination with a beta-blocker, a calcium antagonist, or both agents. Cardiovascular safety was satisfactory and laboratory parameters were not altered. At the end of the study, 70% of patients were maintained on nicorandil. These results are in agreement with those reported from the nicorandil safety database, which gathered 1152 patients treated by nicorandil, including those of the present study. In comparative studies of nicorandil versus beta-blockers, calcium antagonists, or nitrates, the overall incidence of adverse events was no different between the two treatment groups, although the safety profile differed according to the drug category.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗
PubMed1995

Prosthetic valve endocarditis in the ICU. Prognostic factors of overall survival in a series of 122 cases and consequences for treatment decision.

We carried out univariate and multivariate analysis of outcome among 122 patients with prosthetic valve endocarditis (PVE) admitted to our ICU between 1978 and 1992. The predominant pathogens were Staphylococcus aureus (33%), streptococci (20%), coagulase-negative staphylococci (12%), enterococci (10%), and Gram-negative bacilli (9%). At 4 months, overall survival was 66% (42 deaths). Staphylococcus aureus was the main predictor of death (75% vs 15% with other pathogens). In S aureus PVE, multivariate analysis identified the following predictors of death: prothrombin time < 30% (relative risk [RR]: 8.3), concomitant mediastinitis (RR: 4.9), heart failure (RR: 4.4), and septic shock (RR: 2.6). In PVE due to other pathogens, prothrombin time < 30% (RR: 32.26), renal failure (RR: 7.31), and heart failure (RR: 6.07) were associated with death. In S aureus PVE, survival was higher in patients who received medical-surgical therapy than in those who received medical therapy alone (9/20 [45%] vs 0/20) (p < 0.01). In PVE due to other pathogens, there was no difference in survival between patients who underwent prosthesis replacement (89%) and those who received only medical treatment (81%). Among the 65 patients who underwent heart surgery, the mortality rate and incidence of postoperative paravalvular leakage did not correlate with positive prosthesis cultures. We conclude that non-S aureus and uncomplicated PVE may be managed without valve replacement but that prompt surgical intervention should be required in all other situations.

Adult↗
PubMed1995

[Prognostic value of exercise gamma-angiography in coronary insufficiency].

The predictive value for cardiac events in stable coronary artery disease was analysed with resting and exercise radionuclide angiography and conventional exercise stress testing under medical therapy. The population comprised 93 men and 12 women, followed up for 1 to 8 years (mean 51 months). The patients were divided into two groups. Group I without cardiac events; Group II including spontaneous complications and myocardial revascularisations. The analysis was performed at 2 years and at the end of follow-up. At 2 years, 30 events (15 spontaneous complications, 15 revascularisations) were observed, and at the end of follow-up, there were 61 uncomplicated outcomes and 44 cardiac events (22 spontaneous complications, 22 revascularisations). Two independent prognostic factors distinguishing patients in Group I from those in Group II were identified at 2 years and at the end of the study: exercise EF and occurrence of exercise (on: chest pain on exercise) chest pain. Four parameters were significantly different between the two groups at 2 years: exercise EF, resting EF, difference between exercise-resting EF (all p < 0.005) and duration of exercise testing (p = 0.04). The 3 radionuclide parameters remained different between the 2 groups as well as chest pain on exercise stress testing (p = 0.03) throughout the study. The predictive value of these parameters depended on the type of cardiac event. The exercise EF was the best predictive factor of cardiac death. Pain and ST depression on exercise ECG were the best predictive factors for myocardial revascularisation. In 12 patients undergoing myocardial revascularisation, the clearest improvement was observed in exercise EF (p = 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Outcome of prognostic factors of infectious endocarditis over a 16 year period. Apropos of 471 cases].

Four hundred and seventy one cases of infective endocarditis (IE) were reviewed: 338 native valve IE and 133 prosthetic valve IE (42 early and 91 late IE). Two periods were compared: 1973-1980 (250 cases) and 1981-1988 (221 cases). There was a decrease in native valve IE (78% to 64%) and an increase in late prosthetic valve IE (13% to 27%), little change with respect to age, causal cardiac disease, delay in diagnosis (except in native valve IE, 39 to 29 days), or frequency of complications, especially cardiac (50% and 51%). However, global mortality decreased from 41% to 27% (p < 0.001). The evolution of the frequency of cardiac complications, cardiac surgery and mortality for the two periods was: for native valve IE respectively 53% to 42%, 41% to 37%, 37% to 20% (p < 0.005); for early prosthetic valve IE respectively, 45% to 55%, 41% to 55%, and 82% to 50% (p < 0.05); for late prosthetic IE, respectively 34% to 69%, 34% to 69% and 37% to 36%. The frequency of surgery had therefore little influence on prognosis except in early prosthetic valve IE. The percentage of infections which could not be controlled medically decreased from 17% to 11%. The mortality of unoperated patients decreased from 46% to 28% (p < 0.01), suggesting more effective antibiotherapy, and the mortality of operated patients fell from 34% to 26%. Global surgical mortality was 35% in the acute phase (positive valve culture), 14% after sterilisation (p < 0.001) and the corresponding frequencies of paravalvular leaks was 17% and 4% (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

[Treatment of essential hypertension with felodipine or atenolol as first line therapy. Comparative double-blind randomized study].

This study involved 113 patients (mean age 50 +/- 14 years) with diastolic blood pressure above 95 mmHg. The patients abstained from taking any antihypertensive drug and received a placebo for one week before entering felodipine, a new calcium antagonist (5 mg x2/day for 2 weeks, then 10 mg x2/day) or atenolol (100 mg/day). There was no significant difference between the two treatment groups. Atenolol tended to be more effective in young subjects and felodipine in subjects aged 60 years or more. Heart rate was more reduced by atenolol than by felodipine (P less than 0.01). Undesirable side-effects were recorded by means of an open questionnaire. Their incidence was 23 per cent during the week under placebo and 84 per cent and 80 per cent respectively during treatment with felodipine or atenolol. The most frequent side-effects were oedema of the ankles and headache under felodipine, fatigue and headache under atenolol. Alkaline phosphatase levels were higher in the felodipine group (P less than 0.05), and a slight rise in blood potassium level (0.2 mmol/l) was noted in the atenolol group (P = 0.001), but these values remained within normal limits.

Adult↗
PubMed1989

Prognosis of ruptured intracranial mycotic aneurysms: a review of 12 cases.

Intracranial mycotic aneurysms (IMA) occur in 1-3% of all infective endocarditis. Although spontaneous resolution was evidenced on serial angiograms in many asymptomatic cases, the prognosis, if they rupture, is reported to be worse and partly contingent on the therapeutic approach. Among 12 patients (six acute and six subacute endocarditis) with ruptured IMA, six were treated surgically and four were treated medically. Two patients died during rupture before any treatment could be started. Six patients had a sudden rupture manifested by coma, less clear consciousness seizures, hemiparesis unilateral mydriasis. CT-Scan showed intracerebral, intraventricular and subarachnoid haemorrhage. Ten angiograms showed 11 IMA. For patients with ruptured IMA, the decision for surgical treatment was made in the presence of deepening coma and extensive mass-lesion on CT-scan (one of six died in the postoperative period). Others received medical treatment (four cases: all survived) and were followed-up with serial angiographies. Of the nine patients who survived, five remained free of any disability 1-4 years later. We suggest that the prognosis of ruptured IMA (25% mortality rate) is not as bad as previously reported if surgery following angiography is performed early in the presence of deepening coma and extensive lesion.

Adolescent↗
PubMed1989

[Prognostic value of the normalization of the exercise test under medical treatment in coronary insufficiency].

The prognostic value of exercise testing was studied in 118 patients with angiographically proven chronic coronary disease, positive ET and/or a history of myocardial infarction (MI) who were followed up for 698 years (mean 5.9 years). Medical treatment was instituted step by step and controlled by repeated ET's. ET remained positive (ST depression 1 mm) in 58 cases (group I), was alternately positive and negative in 22 cases (group II) and became normal in 38 cases (group III). The mean duration of follow-up in these three groups was 5.0, 7.6 and 6.4 years respectively. Eight patients were lost sight of. Ergometric data and outcome were similar in groups II and III, but there were differences between group I (58 patients) and groups II + III (60 patients) as regards: (a) ergometric data: total workload (22,077 +/- 9,860 vs 34,856 +/- 15,552 joules), workload causing a 1 mm ST depression (13,892 +/- 9,253 vs 31,555 +/- 15,811 joules) and maximal ST depression (2.5 +/- 0.9 vs 0.9 +/- 0.8 mm); (b) outcome: cardiac deaths (12 vs 3), myocardial revascularization (19 vs 6); but there was no significant difference as regards MI (4 vs 5), heart failure (11 vs 5) and extracardiac deaths (3 vs 4). It is concluded that the persistence of a positive ET under optimal medical treatment is a major argument in favour of myocardial revascularization.

Adult↗
PubMed1989

[Evaluation of rhythm tolerance of cicletanine using continuous electrocardiographic recording].

The effectiveness of cicletanine against hypertension, as well as its clinical, biochemical and electrocardiographic safety, were studied in 52 patients (24 women, 28 men, mean age 60.3 +/- 8.6 years) presenting with permanent, moderate to severe arterial hypertension without severe cardiovascular complications. After three months of treatment, blood pressure had fallen from 182.2/116.8 mmHg, with a mean daily dose of 181 mg of cicletanine at the end of the study. Mean falls of 34 mmHg for the systolic arterial pressure and 25 mmHg for the diastolic arterial pressure normalized BP in 55.8% of the patients treated and significantly reduced the functional symptoms of hypertension. Continuous 24-hour ECG recording (Holter system), performed on days 0, 30 and 90, demonstrated a considerable reduction (about 70%) of ventricular and supraventricular extrasystoles during treatment. No undesirable side-effect, even minor, was reported. There was little change in biochemical parameters: the moderate decrease of natraemia and kalaemia observed was due to the natriuretic effect of cicletanine in doses of 200 mg/day. Plasma creatinine and uric levels remained stable, and an improvement in glucose and lipid metabolism was noted.

Adult↗
PubMed1989

Lisinopril versus slow-release nifedipine in the treatment of mild to moderate hypertension: a multicentre study. The Cooperative Study Group.

The antihypertensive effects of lisinopril 20 mg once daily and slow-release nifedipine 20 mg twice daily were compared in a double-blind, parallel group, 10-week study involving 274 patients with mild to moderate hypertension. During the first 6 weeks of treatment, slow-release nifedipine and lisinopril produced similar reductions in lying and standing blood pressure (BP), except for lying systolic BP (SBP) which was reduced to a greater extent by lisinopril. After 6 weeks of double-blind treatment, hydrochlorothiazide 25 mg once daily was added if BP remained uncontrolled (lying DBP greater than or equal to 95 mmHg); a significantly greater proportion of patients in the nifedipine group than in the lisinopril group required additional diuretic treatment (29% versus 14%, respectively; P = 0.005). Moreover, after a further 4 weeks of treatment BP was adequately controlled (lying DBP less than 95 mmHg) in significantly more lisinopril-treated patients than in the nifedipine group (91.4% versus 78.3%, respectively; P = 0.006). Lisinopril was better tolerated than slow-release nifedipine. The frequency of drug-related events was significantly lower (threefold) for lisinopril than for nifedipine (P = 0.001) and the number of withdrawals from treatment with nifedipine was more than three times that in the lisinopril treatment group (P = 0.009). Lisinopril appears to provide an effective once-daily antihypertensive treatment which is at least as effective as, and better tolerated than, slow-release nifedipine.

Adolescent↗
PubMed1987

[Beta-blockaders in first-intention treatment of exercise angina pectoris].

Effort angina may be treated with nitrates, beta-blockers or calcium antagonists which are equally effective. The choice of the appropriate treatment sometimes depends on clinical data, on the contraindications indications specific to each therapeutic class or on side-effects. In most cases, beta-blockers should be preferred since their side-effects are rare provided their contra-indications are respected, they are easy to administer and above all, they exert a protective effect on the heart demonstrated after myocardial infection and highly probable in angina. The possible occurrence, during prolonged treatment, of unstable angina or myocardial infarction--both conditions in which beta-blockers alone or combined with other drugs have been shown to be effective--is in favour of this treatment. However, the frequent presence of a vasomotor factor in the different clinical forms of coronary disease justifies the use of vasodilators concurrently with beta-blockers, notably in patients with severe angina.

Adrenergic beta-Antagonists↗
PubMed1987

[Staphylococcus aureus endocarditis].

Among 409 cases of bacterial endocarditis (BE) observed from 1972 to 1985, 142 were caused by Staphylococcus aureus. Of these 142 cases, 59 affected native valves of the left heart (left BE), 47 affected native valves of the right heart (right BE) (including 36 drug-addicts), and 36 involved prosthetic valves (BEP) and were associated with mediastinitis in 11 cases. Symptoms were acute in 122 cases and subacute in 2 cases. 91 of the BE on native valves were primary (86%). Cutaneous manifestations were present in 38 cases (27%). Of the 67 patients who died (47%), 28/59 had left BE (47%), 7/47 had right BE (15%) (including 2 drug addicts) and 32/36 had BEP (86%); all differences were statistically significant. Complications consisted of: heart failure in 78 cases (55%), including 40 cases of left BE, 8 cases of right BE and 30 cases of BEP; systemic peripheral embolism in 29 cases (left BE 17, BEP 12) and neurological accidents in 58 cases (left BE 34, right BE 24). Thirty of these accidents occurred before the 4th day (left BE 13, BEP 17). Documented neurological accidents included cerebral haemorrhage (13 cases), cerebral infarction (14 cases) and cerebral abscess (4 cases); 4 of the 12 patients who underwent arteriography were found to have one or several aneurysms. Thirty-nine of these 58 patients died, death being directly due to a neurological cause in 20 cases (left BE 10, right BE 10).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

[Treatment of unstable angina. A randomized double-blind study of propranolol, diltiazem and molsidomine].

A randomized, multicentric, double blind study attempted to compare in 41 patients hospitalized for unstable angina, the efficacy of diltiazem (D) 240 mg/day, propranolol (P) 160 mg/day and molsidomine (M) 8 mg/day. The patients included in the study presented one or several spontaneous angina episodes accompanied by a transient and significant lowering of ST and/or an inverted T wave without necrosis. The evaluation criteria were the occurrence of new angina pain and electrical alterations on a continuous Holter for 5 days. 11 patients received diltiazem, 13 patients received propranolol and 15 patients received molsidomine (including an early death). Clinically, the number of painful episodes per day and per patient goes, in an average, from 1.2 to 0.23 diltiazem, from 2.2 to 0.44 for propranolol and from 2.2 to 0.45 for molsidomine. Pain disappeared on the 5th day in 54.5 per cent of patients under diltiazem, 58.8 per cent of patients under propranolol and 53.5 per cent of patients under molsidomine. Electrically, the number of ischemic accidents per day and per patient was 0.45 under diltiazem, 2.12 under propranolol (0.53 in excluding one patient with latent angina) and 0.81 under molsidomine. The number of patients without any ischemic accident was 63.6 per cent under diltiazem, 53.8 per cent under propranolol and 40 per cent under molsidomine. In conclusion, diltiazem, propranolol, and molsidomine have a comparable efficacy in unstable angina. The association of these medications could have a synergistic effect.

Angina Pectoris↗
PubMed1986

[Randomized ergometric study of vasodilators combined with betablockaders].

The ergometric effects of different vasodilator drugs in 5 series of 10 patients with stable angina and persistent effort ischaemia despite beta-offckade, were compared two by two in a random, single blind cross-over study under basal conditions on betablocker therapy and at the peak of their action, the second measurement being performed after a 2 to 7 day interval. The principal criteria of assessment were the work required to induce 1 mm ST depression (WST1), and the maximum ST depression (ST max) at comparable work loads. Molsidomine (2 mg), Risordan 20 mg) and Nifedipine (10 mg) significantly improved both parameters (p less than 0.001). Lenitral (7.5 mg), Langoran (40 mg), Trinitrin skin patch (10 mg) did not produce a significant improvement. Corditrine improved WST1 (p less than 0.05) and slow release Trinitrin (2.5 and 5 mg) improved WST1 at 3 hours (p less than 0.05) and ST max at 15 minutes (p less than 0.001) and 3 hours (p less than 0.05). The fall in resting blood pressure was parallel to the ergometric changes. These results suggest that Molsidomine, Nifedipine, Risordan and slow release Trinitrin (2.5 mg) are the most effective vasodilators when used in association with betablockers.

Adrenergic beta-Antagonists↗