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Biomedical subjects

A Barrillon

Publications and source records attributed to A Barrillon.

At least 37 records · Page 2Linked to original sources
PubMed1982

[Nodoventricular Mahaim fibres. 2 cases confirmed by electrophysiological study].

Two adolescents with no obvious cardiac were investigated for paroxysmal tachycardia at a rate of about 200/mn with wide QRS complexes showing left bundle branch block, reduced by vagal manoeuvres. Atrial pacing showed shortening of the HV interval associated with widening of the QRS complex to appearances identical to those of the tachycardia, suggesting right ventricular preexcitation masked in sinus rhythm. The progressive prolongation of the atrio-ventricular conduction time with increasing prematurity of the extrastimulus and atrioventricular block after intravenous injection of ATP were more in favour of right nodo-ventricular Mahaim fibres (NV) than a Kent bundle. These properties of the NV pathway and the recording of a "gap" phenomenon during the measurement of the refractory period of the accessory pathway are explained by the proximal part of the AV node not being short-circuited. Paroxysmal tachycardia was easily induced by atrial and ventricular stimulation; the tachycardia QRS complexes always showed appearances of left bundle branch block with a His potential at the onset of the ventricular complex. The NV pathway therefore always depolarised in the anterograde direction in tachycardia; the retrograde pathway is discussed: His, latent Kent bundle or purely intranodal reentry.

Adolescent↗
PubMed1981

[Haemorrhagic necrosis of the digestive tract consecutive to massive digitalis intoxication (author's transl)].

A 60-year-old man under digitalis treatment for hypertensive heart tried to commit suicide by absorbing a 15 mg dose of digitoxin. Severe intestinal bleeding occurred 12 hours later, followed by pseudo-occlusive syndrome and ischaemia of the distal lower limbs. On abdominal incision the whole gut was found to be invaded by haemorrhagic necrosis and perforated on three points. The patients subsequently died of peritonitis. The responsibility of digitoxin in these events was demonstrated by the absence of any other cause of ischaemia, such as heart failure, shock, arrhythmia, consumption coagulopathy or use of sympathomimetic drugs. This case shows that the vasoconstrictor effect of digitalis, experimentally demonstrated but clinically controversial, is a reality, and that digitalis compounds are contra-indicated in patients with haemorrhagic necrosis of the digestive tract.

Digitalis Glycosides↗
PubMed1981

[Coronary arteriography and long-term prognosis in postero-inferior infarction. Methodological reflections apropos of a preliminary retrospective survey].

Most studies of the long term prognosis after myocardial infarction take only parameters reflecting the quantity of necrosed cardiae muscle and the resulting disturbances in left ventricular function into account. Coronary arteriography should give a more precise assessment by the detection of stenoses on arteries supplying healthy myocardium, especially in small infarcts. This concept was tested in a retrospective study of 100 patients investigated 1 to 12 months after inaugural posterior or inferior myocardial infarction between 1970 and 1979, and followed-up for an average of 32,5 months. THe survival curves of subgroups defined by angiographic parameters were compared by Mantel's method. The 5 year survival rate was 91,2 +/- 3,4%, corresponding to a mortality of 26 deaths per 1000 patients year. This very low mortality rate may be related on the one hand to the selection of the patients, especially those investigated at a distance from the infarct, and on the other hand, to the role of drug therapy. The number of patients required to compare two therapeutic protocols would be necessarily high because of the low overall mortality. The 5 year survival rate without a serious cardiac event (death, recurrent infarction, deterioration to Stages III or IV of the NYHA Classification, acute coronary insufficiency), was 76,8 +/- 6.4%. The only discriminating angiographic sign in this study was the number of diseased vessels: triple vessel disease significantly increased the risk of a serious cardiac event, (p less than 0,04). The preliminary results have led to the establishment of a stricter protocol designed to improve the indications of coronary arteriography in postero-inferior infarction.

Angiography↗
PubMed1980

[Hemodynamic and angiographic aspects of endomyocardial fibrosis. Apropos of 19 cases].

19 cases of endomyocardial fibrosis were studied. Angiocardiography localises the site of fibrosis and seems to be the best diagnostic method. All cases in this series had left ventricular involvement which resulted in changes of the silhouette (square, polylobulated or deformed like the shape of a heart on a playing card) and of the ventricular contour (smooth, lacunar or "doubled"). Ten patients had mitral incompetence. The ejection fraction was normal in 8 patients but significantly reduced in the series as a whole (EF = 0,56, p less than 0,05). 15 patients had right ventricular involvement. Apart from the smooth contour of the anterior wall, the only abnormality in the mild cases, the most suggestive feature was an amputation of the ventricular apex, giving rise to a ventricular appearance of a narrow, akinetic (apart from the infundibular region) tube. The catheter data demonstrated the haemodynamic changes due to the fibrosis. A constrictive syndrome was observed in all the severe poorly tolerated cases. This was not apparent under basal conditions in milder cases. The value of pharmacodynamic testing and endomyocardial biopsy in cases where the diagnosis is uncertain should be stressed. The results of resection of the fibrosis and valvular replacement in severe cases depend to a large extent on the degree of myocardial involvement.

Adolescent↗
PubMed1979

Occlusive coronary thrombosis and oral anticoagulants.

The results of post-mortem examination in 173 patients followed over an average period of five and a half years after their initial myocardial infarction are described. These 173 patients were divided into four groups according to whether or not they had received an oral anticoagulant and if so how adequately. An index of coronary and myocardial lesions was established for each heart. Recent occlusive coronary and myocardial lesions was established for each heart. Recent occlusive coronary thromboses were four times less frequent in the group of patients who had received adequate anticoagulant therapy than in the other three groups of patients (p less than 0,001). There was no significant difference between the inadequately treated groups and the untreated group. The recurrences of myocardial infarction were associated in 90 per cent of the cases with a recent occlusive thrombosis in the corresponding coronary artery and were found four times less frequently in the group subjected to effective long-term anticoagulant therapy (p less than 0,001).

Administration, Oral↗
PubMed1978

[Extensive aortic dissection and aneurysm of the left coronary trunk. 20-year spontaneous development].

A case is reported of dissection of the aorta in a lady of 35. The condition was complicated first by myocardial infarction and secondly by severe aortic incompetence which led, 20 years after the onset of the dissection, to the death of the patient from intractable heart failure. At post-mortem, an extensive dissection was found to involve the whole of the aorta and several of its branches, but did not involve the coronary arteries, which were normal except for the trunk of the left coronary; this was dilated. The natural history of dissections of the aorta is reviewed. The incidence, course and etiology of coronary aneurysms are also discussed.

Adult↗
PubMed1978

[Myocardiopathy of pregnancy in white women].

Over the course of 17 years, 7 women have had heart disease either during the last three months of pregnancy or during the first three months post-partum, which appear to be associated with their pregnancy. Enquiries made throughout the country and relating to the last decade have yielded 11 additional cases so far unpublished. The clinical features of these cases do not differ from those of other non-obstructive cardiomyopathies occurring other than in pregnancy. The prognosis depends essentially on the factor of cardiac volume during the first few months of the disorder: if significant cardiomegaly persists, death will follow in one case out of two. There exists the problem of the criteria for making a diagnosis of myocardial disease of pregnancy. It should be emphasised that only 4 of the 18 cases were different from the usual cases of myocardial disease, in that they progressed to recovery which is unusual in this condition. One case was particularly illustrative of this, as clinical cure was followed by a relapse at subsequent pregnancy. Because the pregnancy itself seems to be the cause in such a tiny number of cases, a new hypothesis seems right; this is that pregnancy does no more than aggravate an associated or already existent myocardial disorder.

Adult↗
PubMed1977

[Coronary thrombosis on oral contraception (author's transl)].

A case of myocardial infarction observed in a 27 years old female taking an oestrogen-progestogen combination for contraception, who died suddenly two months after the resection of a left ventricular aneurysm, provided unprecedented anatomical documents. Their histological examination allowed to state the thrombotic mechanism of the coronary occlusion and brought arguments in favour of an alteration of the coronary arterial wall in the form of thickening of the intima, likely to have been the starting point of this thrombosis.

Adult↗