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Biomedical subjects

A Edouard

Publications and source records attributed to A Edouard.

At least 55 records · Page 3Linked to original sources
PubMed1991

The use of calcium antagonists to treat intra-operative hypertension--evaluation of efficacy and safety of a new dihydropyridine derivative, intravenous isradipine, during abdominal surgery.

Twenty-three patients who developed intraoperative hypertension (mean arterial pressure greater than 110 mmHg) during abdominal surgery under balanced general anaesthesia were randomly assigned to two groups. The isradipine group (n = 12) received 0.5 mg of isradipine, and the placebo group (n = 11) received 10 ml of isradipine solvent over a 5-min period in a blind manner. Arterial pressure was recorded 12 min after the injection was started. If the mean arterial pressure had not decreased by at least 10% at 12 min, patients received in an open manner 0.5 mg of isradipine. None of the patients in the isradipine group received isradipine in an open manner, in contrast with nine of the 11 patients in the placebo group (P less than 0.0001, Fisher's exact test). During both the blind period and the open trial, isradipine induced a 40% decrease in systolic, diastolic, and mean arterial pressures within the first two min of infusion. Arterial pressure remained below the pre-isradipine injection values for at least 45 min. Transient hypotension (mean arterial pressure less than 70 mmHg) was noted in 6/21 patients (29%). Mean heart rate remained statistically unchanged during the decrease in arterial pressure in both groups, but a tachycardia (increase in heart rate greater than 20 beats min-1) was noted in 4/21 patients (19%). This study indicates that intravenous isradipine is an effective therapy with sustained efficacy for intraoperative hypertension during abdominal surgery. The safety of its use needs a close monitoring of arterial pressure.

Abdomen↗
PubMed1991

[Three cases of solid and papillary tumors of the pancreas in black women].

Three cases of solid and papillary epithelial neoplasm of the pancreas are presented. These tumors occur more commonly in young patients with a predilection for young black females. They have a good prognosis allowing conservative surgery. The histological study of the specimens strongly suggests an endocrine tumor but all histological and immunocytochemical endocrine stains are negative. The ultrastructural study of these tumors has revealed the existence of borderline forms between these tumors and endocrine tumors.

Adolescent↗
PubMed1990

[Malignant strongyloidiasis and the HTLV-I virus].

A significant association between Strongyloides stercoralis and HTLV-1 infections has been demonstrated in areas (such as southern Japan and the Caribbean) where HTLV-1 is endemic. Due to the immunomodulating effects of the virus and the parasite, patients with both infections would be at risk for overwhelming strongyloidiasis as well as for T-lymphocyte haemopathy. S. stercoralis is thought to be a cofactor for viral replication and leukaemogenic power.

HTLV-I Infections↗
PubMed1990

[Leiomyosarcoma of the Meckel's diverticulum and multiple diverticulosis of the ileum. Apropos of a case].

We report a case of a leiomyosarcoma arising in a Meckel's diverticulum in a man of 90 years, with multiple ileal diverticulosis. The clinical picture was similar to acute appendicitis and diagnosis was not made until resection of an abdominal mass with histological appearance of leiomyosarcoma. 59 cases of leiomyosarcoma of Meckel's diverticulum have previously been reported in the literature. No case until now has been reported in a patient of Caribbean origin neither in association with ileal diverticulosis. Although rare, leiomyosarcoma is the commonest sarcoma of Meckel's diverticulum, and with full resection of the tumor the prognosis is very good.

Aged↗
PubMed1989

Intravenous nicardipine for treatment of intraoperative hypertension during abdominal surgery.

Twenty patients, American Society of Anesthesiologists class I or II, who developed intraoperative hypertension (mean arterial pressure greater than 110 mm Hg) during abdominal surgery under balanced general anesthesia were randomly assigned to two groups. The nicardipine group (n = 10) received 5 mg of nicardipine hydrochloride, and the placebo group (n = 10) received 5 mL of nicardipine solvent injected intravenously over a 5-minute period in a blind manner. Arterial pressure was recorded for 15 minutes after the injection was started. If the mean arterial pressure did not decrease at least 10% at 15 minutes, the trial was opened and patients received 5 mg of nicardipine. None of the patients in the nicardipine group received nicardipine in an open manner, in contrast with 7 of the 10 patients in the placebo group (P less than 0.03, Fisher exact test). During both the blind period and the open trial, nicardipine induced a 34% decrease in systolic, diastolic, and mean arterial pressure. Minimal values of pressure were noted at 6 minutes; however, arterial pressure remained below the pre-nicardipine injection values and near preoperative values for 45 minutes. No severe hypotension was observed, but the nicardipine injection was stopped at 3 mg in two cases during the blind period because of the rate of pressure reduction. Heart rate remained unchanged during the decrease in arterial pressure in both groups. This study indicates that nicardipine is an effective, long lasting, and safe therapy for intraoperative hypertension during abdominal surgery.

Abdomen↗
PubMed1988

[Sero-epidemiology of viral hepatitis A, B and delta in Martinique].

In view of the ethnic and geographical peculiarities of the French department of Martinique and of the endemic character of hepatitis in tropical countries, we studied the prevalence of infections with hepatitis A, B and delta viruses in that region. A group of 10,109 blood donors and a group of about 100 patients were selected on account of their liver symptoms. As regards hepatitis A, the study of the 2 groups was completed by a sero-epidemiological survey of 509 children and teenagers aged from 1 to 18 years. The prevalence of the HB antigen among blood donors was 1.3 per cent, i.e. about 10 times higher than in Europe and 7 times lower than in hyperendemic tropical areas. It was 2.5 times higher in the male than in the female population; 84 per cent of HBs-positive donors had anti-HBe antibodies, 9 per cent had HBe antigen and 7 per cent had neither one nor the other. This distribution is coherent with a population of symptomless carriers. The prevalence of anti-HBs-positive sera was 34 per cent as against 70-95 per cent in highly endemic countries and 4-20 per cent in Europe; 1.9 per cent of the HBs donors studied and 8.8 per cent of the patients had anti-delta antibodies; 11 of the 13 anti-delta-positive subjects had anti-HBe antibodies and 2 had neither HBe nor anti-HBe. Between the ages of 1 and 3 years very few anti-HAV-positive subjects were observed. From 3 to 10 years, the percentage of seroconversions increased moderately. Between 10 and 20 years, the number of positive cases increased considerably reaching 67 per cent at 20 years and 100 per cent at and above 45 years. Among the patients, 97 were positive for IgG (96 per cent) and only 5 for IgM (4 per cent).

Adolescent↗
PubMed1988

Forearm vascular tone and reactivity during lumbar epidural anesthesia.

Forearm vascular tone and sympathetic reactivity were investigated in ten unpremedicated patients during two levels of epidural sensory blockade, neither of which levels was high enough to block cardiac sympathetic pathways. An 8-MHz pulsed Doppler blood flowmeter was used to determine brachial artery diameter and flow characteristics. Measurements were made before and during sympathetic stimulation induced by a contralateral isometric handgrip. The lower level of sensory blockade (T11) in the absence of sympathetic stimulation was associated with decreases in right atrial pressure, brachial artery diameter (3.9 +/- 0.2 vs 4.2 +/- 0.2 mm, P less than 0.05) and brachial blood flow (42 +/- 5 vs 66 +/- 7 ml.min-1, p less than 0.001), whereas forearm vascular resistance increased significantly (2.2 +/- 0.3 vs 1.5 +/- 0.2 mm Hg.ml-1.min-1, P less than 0.01). Neither heart rate nor mean arterial pressure changed. At the higher level of blockade (T7), right atrial pressure and systemic arterial pressure decreased further without change in heart rate. Brachial artery diameter (3.8 +/- 0.2 mm) remained unchanged while brachial blood flow additionally decreased (30 +/- 3 ml.min, P less than 0.05), and forearm vascular resistances further increased (3.0 +/- 0.2 mm Hg.ml-1.min-1, P less than 0.01). Changes in heart rate and in mean arterial pressure associated with isometric exercise were similar before and during epidural anesthesia at both levels of epidural blockade.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Ketanserin and the arterial baroreceptor reflex in normotensive subjects.

The effects of oral ketanserin 40 and 120 mg on the responses to baroreflex activation and deactivation by phenylephrine and nitroglycerin, respectively, were investigated in normotensive subjects. Plasma catecholamine levels were measured at the same times. Two hours after the administration of ketanserin, and regardless of its effect on arterial pressure (no change after 40 mg, decrease after 120 mg), there was no alteration either in resting heart rate or baroreflex sensitivity during baroreceptor activation or deactivation. The lack of reflex tachycardia in response to the drug-induced hypotension may be related to the alpha 1-adrenoceptor blockade-mediated sympathoinhibitory effect of ketanserin, which leaves unaffected both plasma catecholamines and the normal reactivity of the sympathetic system.

Adult↗
PubMed1987

Bupivacaine accentuates the cardiovascular depressant effects of verapamil in conscious dogs.

To investigate the potential risk of regional anaesthesia in a verapamil-treated patient, the cardiovascular effects of a combined intravenous infusion of bupivacaine and verapamil were studied in seven conscious and chronically instrumented dogs and were compared to those obtained when each drug was infused separately in the same animals. During verapamil infusion, the decrease in arterial pressure and myocardial contractile force, and the increase in heart rate were constant during the infusion. The lengthening of PR interval correlated with the plasma level of verapamil. During infusion of bupivacaine alone, there was an increase in heart rate and arterial pressure at the end of infusion, whereas the initial depression of myocardial contractile force was compensated. PR interval remained unchanged throughout the infusion of bupivacaine. During combined infusion of bupivacaine and verapamil, there was a time-dependent decrease in heart rate, arterial pressure and myocardial contractile force. A further increase in PR interval correlated with verapamil plasma concentrations which were higher than when verapamil was infused alone; bupivacaine plasma levels were in the same range as during bupivacaine infusion alone. Short periods of second-degree atrioventricular block developed in three out of the seven dogs but no relation was found between QT interval and heart rate in the whole group. Calcium chloride during bupivacaine-verapamil returned heart rate, arterial pressure and myocardial contractile force to their control values within 5 min. Atrioventricular block disappeared and PR interval was shortened following administration of calcium. Bupivacaine and verapamil have additive cardiovascular effects which lead to atrioventricular conduction dysfunction. The effects, at these doses, are reversed by calcium chloride.

Animals↗
PubMed1986

Influence of venous return on baroreflex control of heart rate during lumbar epidural anesthesia in humans.

The role of variation of venous return on baroreflex control of heart rate during lumbar epidural anesthesia was investigated in 12 unpremedicated patients. Group 1 patients (n = 6) received 8 ml of 0.5% plain bupivacaine in the epidural space (L3-4) (mean upper level of analgesia at T10). Group 2 patients (n = 6) received 8 ml of saline at the same level in the epidural space. Following the epidural injection, phenylephrine (PHE) and nitroglycerin (NTG) were employed to alter the stimulation of baroreceptor sites before and during application of lower body positive pressure (LBPP). Plasma bupivacaine, catecholamines, renin activity, and vasopressin were assayed. In contrast to saline, epidural bupivacaine induced a decrease in systolic arterial and right atrial pressures (-11 +/- 4 and -3.2 +/- 0.7 mmHg, respectively, mean +/- SEM) without change in heart rate, an increase in baroreflex slopes during PHE and NTG injections (+5.9 +/- 1.6 ms/mmHg and +2.8 +/- 0.9 ms/mmHg, respectively), and a decrease in plasma norepinephrine (-248 +/- 89 pg/ml). The application of LBPP restored hemodynamic and reflex variables to preepidural analgesia values, whereas plasma catecholamines decreased further. Plasma renin activity and vasopressin were not modified at any time in either groups. This study indicates that lumbar epidural anesthesia enhances cardiac vagal tone mainly through a decrease in venous return.

Adult↗
PubMed1986

Effects of lidocaine on myocardial contractility and baroreflex control of heart rate in conscious dogs.

The effects of intravenous lidocaine (30 and 60 micrograms X kg-1 X min-1 during 30 min) at steady-state plasma levels (1.9 +/- 0.2 and 3.5 +/- 0.2 micrograms/ml, respectively) were investigated in conscious dogs, previously instrumented for measurements of arterial and left ventricular (LV) pressures, isometric myocardial contractility indexes (LV peak rate of tension development [dP/dt] and LV [dP/dt]/DP40), and heart rate. In addition, before and at the end of lidocaine infusions, arterial baroreflex responses were tested by bolus injections of nitroglycerin and phenylephrine. Whereas LV peak dP/dt and LV (dP/dt)/DP40 were significantly decreased after the low dosage of lidocaine, these indexes returned to control values after the 10th min of infusion of the high dosage. Moreover, eight out of 14 dogs exhibited continuous tremors, tachycardia, hypertension, and increase in contractility after the 10th min of lidocaine infusion (60 micrograms X kg-1 X min-1), although their lidocaine plasma levels (3.7 +/- 0.2 micrograms/ml) did not differ from those of the whole group. When these dogs were pretreated by combined alpha- and beta-adrenoceptor blocking drugs, none of them had tremors, and there was a constant depressant effect on cardiac chronotropism and inotropism. A specific enhancement of baroreflex sensitivity after phenylephrine injection was observed at the high lidocaine dosage. It is concluded that a central stimulation of both components of the autonomic nervous system modulates the direct effects of therapeutic plasma levels of lidocaine on cardiac chronotropism and inotropism in conscious dogs.

Animals↗
PubMed1985

Effects of epidural anesthesia on catecholamines, renin activity, and vasopressin changes induced by tilt in elderly men.

Mean arterial pressure, heart rate, plasma catecholamines, renin activity, and vasopressin changes induced by a 30-degree head-up tilt were studied before and during epidural anesthesia with bupivacaine in eight elderly patients (ages 58-82 yr). The tilt performed before epidural anesthesia did not modify mean arterial pressure, heart rate, plasma catecholamines, renin activity, and vasopressin at 5 and 15 min. During epidural anesthesia, the superior level of analgesia ranged from T4 to T10. Epidural anesthesia induced significant (P less than 0.05) decreases from control values in mean arterial pressure and plasma norepinephrine (from 85 +/- 6 to 67 +/- 8 mmHg and from 600 +/- 108 to 307 +/- 77 pg/ml, respectively, mean +/- SEM) without significant changes in heart rate, plasma epinephrine, renin activity, and vasopressin. However 5 and 15 min after tilt, significant decreases from pretilt values were measured in mean arterial pressure (from 67 +/- 8 to 57 +/- 6 and 55 +/- 6 mmHg, respectively) and in heart rate (from 70 +/- 8 to 63 +/- 7 and 62 +/- 7 beats/min). Simultaneously, an increase in plasma vasopressin (from 14.8 +/- 5.5 to 36.2 +/- 10.3 and 40.0 +/- 10.5 pg/ml) was recorded, whereas plasma norepinephrine and epinephrine remained unchanged. Posttilt plasma renin activity values at 5 and 15 min were increased significantly when compared with the preepidural values (2,752 +/- 1,168, 2,410 +/- 1,214 and 713 +/- 190 pg X ml-1 X h-1, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1985

The effect of enalapril on baroreceptor mediated reflex function in normotensive subjects.

The effects of enalapril, 20 mg orally, on the responses to baroreflex activation and deactivation by respectively phenylephrine and nitroglycerin were investigated in normotensive subjects on a normal sodium diet, with simultaneous measurement of plasma renin activity (PRA), converting enzyme activity (PCEA), aldosterone and catecholamines. Enalapril, 4 h after administration, lowered artificial blood pressure without modifying heart rate and plasma catecholamines. PCEA was abolished, PRA increased and plasma aldosterone decreased. Enalapril (a) displaced to the left the baroreflex set-point, (b) did not affect baroreflex sensitivity since the slopes of the RR-interval/systolic blood pressure regression lines remained unchanged during both activation and deactivation and (c) did not modify baroreflex efficacy since the maximal RR-interval responses as well as the overall RR-interval-time products to identical blood pressure variations were not modified. Thus, enalapril induced a resetting of the baroreflex, which probably accounts for the lack of reflex tachycardia observed during the drug-induced fall in blood pressure.

Adult↗
PubMed1984

Attenuation by diltiazem of arterial baroreflex sensitivity in man.

The effect of oral diltiazem 120 mg, on the responses to baroreflex activation and deactivation by phenylephrine and nitroglycerin, respectively, were investigated in normotensive subjects, with simultaneous measurement of plasma catecholamine levels. Diltiazem significantly reduced the tachycardia induced by bolus injections of nitroglycerin and abolished the concomitant increase in plasma noradrenaline. It also significantly decreased the bradycardiac response to phenylephrine infusion. Diltiazem reduced, although not significantly so, the bradycardia induced by boluses of phenylephrine. The overall reduction in baroreflex sensitivity, which might contribute to the limited tachycardiac effect of diltiazem in man, is consistent with the drug-induced attenuation of the sympathetic and also of the parasympathetic components of the baroreceptor reflex.

Adolescent↗
PubMed1984

Tissue extraction of amiodarone and N-desethylamiodarone in man after a single oral dose.

The hepatic extraction of amiodarone and N-desethylamiodarone has been investigated in seven patients following catheterization of the portal and hepatic veins under general anaesthesia. Amiodarone (600 mg) was administered orally 4 h before regional blood sampling. Concentrations of amiodarone and N-desethylamiodarone, determined by h.p.l.c., were about twice as high in the portal vein compared with those in the hepatic vein, the calculated hepatic extraction ratios of both compounds being 0.39 +/- 0.07 and 0.34 +/- 0.03, respectively. The presence of N-desethylamiodarone in the portal vein in higher concentrations than in the hepatic vein strongly suggests that N-dealkylation of amiodarone occurs in the gut wall or lumen, a finding which might account for the low and highly variable intersubject amiodarone bioavailability.

Administration, Oral↗