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Biomedical subjects

A Egre

Publications and source records attributed to A Egre.

At least 19 recordsLinked to original sources
PubMed1983

[Comparative study of quinidine and disopyramide in the treatment of stable ventricular extrasystole].

The antiarrhythmic efficiency of quinidine arabogalactan-sulphate (QAGS) and disopyramide were determined in 38 patients showing chronic, stable frequency premature ventricular beats (PVB). The study which was carried out in 4 medical Centers, used a longitudinal cross-over design. After a baseline evaluation which consisted of two 24 hours electrocardiograms, the patients were randomised to one of the two drugs during a period of 6 or 7 days. The drug sequence were followed by a placebo sequence. A 24 hours electrocardiogram was performed at the end of each sequence. The daily doses were equivalent to 660 mg of quinidine base for QAGS and 600 mg for disopyramide. Among the 38 patients who entered in the study, 32 went through each sequence of the test. The average number of PVB was significantly reduced by QAGS and disopyramide (p less than 0.0001). With QAGS 18 patients had more than 65 p. 100 reduction of PVB and 12 of them more than 80 p. 100. With disopyramide, 14 patients had more than 65 p. 100 reduction of PVB and 12 of them more than 80 p. 100. There was no statistical difference in the overall efficiency of the two drugs. Three patients died, one from myocardial reinfarction, one from ventricular fibrillation; in one other case, the cause of the death remained undetermined. QAGS was better tolerated than disopyramide; adverse effects occurred in 6 patients with QAGS and in 10 with disopyramide. The responsibility of disopyramide in the occurrence of two severe ventricular arrhythmia may be questioned.

Adult↗
PubMed1982

[Block of the autonomic nervous system in the study of sinus function].

Blockade of the autonomic nervous system by injection of propranolol (0,2 mg/Kg) and atropine (0,04 mg/Kg) was carried out in a series of 48 patients classified in 3 groups:--Group I:sinus bradycardia (22 cases)--Group II:suspected tachycardia-bradycardia syndrome (14 cases)--Group III:suspected sinus node dysfunction (12 cases). Two parameters were studied after autonomic blockade: observed intrinsic sinus node frequency (OIF) and corrected "adjusted" sinus node recovery time (CASRT). The results were compared with those obtained during basal electrophysiological investigation. The OIF was abnormal in 26 cases (54%) and junctional rhythm was observed 9 times (19%). Prolongation of the post-stimulation pause occurred in 32 cases (67%), transformation from a normal to a pathological pause in 15 cases and normalisation of a pathological pause in 4 cases (8%). Sinus node recovery time did not change significantly in the other cases. There was a good correlation between OIF and CASRT when the OIF was abnormal and mediocre (48%), when the OIF was normal. The following conclusions were made:--CASRT improves diagnosis of organic sinus node dysfunction which may escape detection by basal electrophysiological investigation and excludes functional abnormalities.--OIF is of good diagnostic value when pathological. However, the integrity of sinus node function cannot be affirmed when this parameter is normal.

Aged↗
PubMed1982

[Phlebography in venous thrombosis of the lower limbs (author's transl)].

Phlebography is the best diagnostic technique for deep venous thromboses of the lower limbs. The authors use the "free flow" technique which they have modified by visualisation of the I. V. C. and I. V. A lacunar appearance or cupola-shaped interruption are indicative of a recent thrombosis, whilst the absence of a main venous trunk and a collateral circulation are more common in the presence of an old thrombosis. They emphasise the possible sources of error in interpretation and the difficulty in determining how long the thrombosis has been present. Despite its disadvantages, phlebography remains the essential examination in order to select treatment in patients in whom there is a suspicion of venous thrombosis or pulmonary embolism. Venous Doppler and rheoplethysmography, less sensitive and less specific, have a place in routine detection and the surveillance of treatment.

Diagnosis, Differential↗
PubMed1982

[Angiography imaging in pulmonary embolism (author's transl)].

The principal angiography images found in cases of recent pulmonary embolism include intravascular lacunae, dome-shaped obstructions, a "dead tree" appearance and an avascular region. The first two are specific, but are mainly observed during the few days following the embolism. Highest quality images are obtained by selective angiography of the pulmonary artery, but this technique, which involves transfer of the patient to a specialized unit and catheterization of the pulmonary artery, is not without risk and, more particularly, does not explore the veins of the lower limbs. However, in a series of 110 cases of recent pulmonary embolism, venous thrombosis, usually femoroiliocaval, was present in 102 patients. A new technique is therefore proposed, ascending venous angiopneumography, which has two advantages: --It can be performed in any radiological department as a catheter does not have to be inserted. --It explores both pulmonary and venous systems. Though pulmonary images are less specific (false positives occur more frequently), the simultaneous exploration of the veins allows logical determination of therapy based on the size and site of the embolus and possible associated extension of the venous thrombosis.

Angiography↗
PubMed1981

[Use of intramuscular lidocaine in the acute stage of myocardial infarction].

Methods of using intramuscular lignocaine and its relay with an intravenous infusion were studied in 34 patients with reference to serum levels. A first group of 9 patients with myocardial infarction received an intramuscular injection of 300 mg lignocaine into the deltoid or gluteral muscles at five day intervals. The deltoid appears to be the better site of injection in patients confined to bed because of its quick absorption, higher serum levels between the 15th and 90th minute (+47%), and longer duration of action (180 compared to 120 minutes). The difference is not observed in ambulatory patients and seems to be related to sluggish circulation in the gluteral muscles during bed rest. Its relay with intravenous infusion was studied in 14 patients. In the first 6 patients, intradeltoid injection was immediately followed by an infusion of 2.5 mg/mn, giving an average plasma lignocaine level between the 15th and 60th minute greater than 5 mu/ml. In the 8 other patients, a period of I hour was allowed to elapse before starting the infusion. The plasma levels were found to be within the therapeutic range in all patients and no side effects were observed. The administration of an intravenous infusion of 150 mg/hr of lignocaine for 48 hours led to excessively high plasma levels in 8 patients at the 24th hour, 3 of whom had side effects. Reducing the dosage to 100 mg/hr from the 12th hour onwards in II patients avoided this complication. A 300 mg intradeltoid injection of lignocaine is easy to give in the patient's home and therefore, is the best adapted method for the pre hospital treatment of myocardial infarction. When necessary, it may be relayed with an intravenous infusion one hour later, in the coronary care unit.

Aged↗
PubMed1981

[The intravenous nitroglycerin test during coronary angiography].

The effects of intravenous nitroglycerin (Lenitral) on the calibre of coronary arteries and their lesions was studied in 100 consecutive patients undergoing coronary angiography. The coronary arteries were divided into segments (3 for the right coronary, 2 for the left anterior descending, and 2 for the circumflex artery). 510 segments were assessed (279 normal, and 231 pathological). The diameter of each was measured through the mid point before and after injection of a bolus of 0.3 mg nitroglycerin. The calibre of the coronary segments increased in 325 cases (63.7%). In 49 cases, the increase was greater than 50%. It remained the same in 151 cases (29,6%) and decreased in 84 cases (6,7%). The average increase in calibre was 16% (p less than 0.01). This had little relation to the artery under study, the location of the segment or whether the segment was pathological or normal. However, two findings were of interest: - the percentage of segments which increased their calibre was significantly higher in the normal segments (191 out of 279 cases, 68%) than in the pathological segments (134 out of 231 cases, 58%) (p less than 0.01). - Coronary lesions may change in appearance: images of stenosis or obstruction completely regressed in 4 cases, the degree of stenosis seemed to increase in 11 cases because of dilatation of the coronary vessel proximal and distal to the narrowing, and distal vessels appeared much more dilated in 5 cases. The factors which seem to affect the vasomotor response are multiple, and include the state of the arterial wall, the presence of vasodilatation or vasoconstriction prior to injection and the mode of administration of the nitroglycerin. The test should be performed by intravenous or intracoronary injection at the end of coronary angiography so as not to mask spastic phenomena. Some errors in the interpretation of the degree of stenosis or the quality of the distal post-stenotic coronary bed could thus be avoided.

Blood Pressure↗
PubMed1981

[Ascending venous angiopneumography. A new method of exploration in pulmonary embolism].

Selective angiopneumography is considered to be the best diagnostic investigation for pulmonary embolism. However, the technique has to be performed in a specialised unit, is associated with a certain degree of risk and does not explore the lower limb veins which are the usual site of migratory thrombi. The authors have therefore developed a new angiographic technique, ascending venous angiopneumography (AVAP) which successively opacifies the lower limb veins, inferior vena cava (IVC) and pulmonary arteries. It was used in 180 patients suspected of having a recent pulmonary embolism. It has three main advantages: 1) TECHNIQUE: this only involves injection of a vein on the dorsum of the foot, may be carried out in any radiological centre and is repeatable. 2) DIAGNOSIS: the investigation is more sensitive but less specific than selective angiopneumography when compared in a series of 25 cases: it was never normal in the 16 cases of pulmonary embolism, but in its absence there were 4 doubtful cases out of 8. This lack of specificity is compensated by the data obtained during the initial phlebocavographic times. The diagnosis of pulmonary embolism may be made when the context is suggestive and radiological evidence of venous thrombosis is obtained (124 cases). The diagnosis is very improbable when all phases of AVAP are normal (45 cases). 3) THERAPY: treatment should take the initial venous thrombosis into account, especially with regards to the choice of thrombolytic agents and surgical clipping of the IVC. Finally, this is a low-risk procedure.

Angiography↗
PubMed1980

[Comparative study of three oral nitrate derivatives. A hemodynamic assessment in 10 patients with chronic heart failure (author's transl)].

The efficacy of three long-acting, orally administered nitrate derivatives was assessed in 10 patients with chronic heart failure. The compounds were: isosorbide dinitrate (ID) 5 mg, nitroglycerin microcapsules (NGMC) 7.5 mg and pentaerythritol tetranitrate (PETN) 160 mg. Pulmonary blood pressures were measured at regular intervals until the 6th hour following oral administration of all three compounds successively to 7 patients and of two compounds (ID and NGMC) to 3 patients. In addition, a hemodynamic study was performed in 3 of these patients while under placebo. The results showed a significant decrease in pulmonary artery diastolic pressure with all three compounds. The effects appeared after 30 minutes with ID and NGMC and after 1 hour with PETN. They lasted 1 hour with ID and 3 to 4 hours with NGMC and PETN. Maximal effect occured at 1 hour with ID (-28%; p < 0.001), at 1.5 hour with NGMC (-18%; p (< 0.01) and at 3 hours with PETN (-21%; p <0.01).

Administration, Oral↗
PubMed1980

[Carotid sinus syndrome. Apropos of 6 cases with the cardio-inhibitory type].

The hyperirritable carotid sinus syndrome may have three different expressions: 1. a prolonged ventricular pause, the cardioinhibitory type and the most common; 2. hypotension without slowing of the heart rate, the vasodepressor type; 3. the association of a prolonged ventricular pause and hypotension, the mixed type. The aim of this communication is to present 6 cases of the cardioinhibitory type of hyperirritable carotid sinus syndrome. Three cases were selected from a series of 242 patients investigated for syncopal episodes. The results of carotid sinus massage and electrophysiological investigation could be classified into 4 goups: --Carotid sinus massage reproducing the clinical symptoms negative electrophysiological investigation: pure carotid sinus syndrome. --Carotid sinus massage negative, electrophysiological investigations negative: pure hyperirritable carotid sinus syndrome. --Carotid sinus massage reproducing the clinical symptoms, electrophysiological investigation positive: associated carotid sinus syndromes. --Carotid sinus massage negative: electrophysiological investigations positive: associated hyperirritable carotid sinus syndrome. The diagnosis of the cardioinhibitory type of hyperirritable carotid sinus syndrome was made on four criteria: 1. the association of hyperirritable carotid sinus and spontaneous syncopal or minor syncopal episodes; 2. the reproduction of symptoms together with a ventricular pause of over three seconds by carotid sinus massage under cover of pacing (to exclude the rare mixed forms); 4. the absence of associated sinus node dysfunction or atrioventricular conduction defects on endocavitary electrophysiological recordings. This syndrome should be tested for as a routine in patients with syncope as usually no suggestive trigger factors are found. Carotid sinus massage in this series of patients caused quite long ventricular pauses (average: 7,5 sec.) with serious symptoms (2 syncopes). Therefore, in the investigation of patients with syncope it would seem to be useful to perform this manoeuvre during electrophysiological investigation with pacing cover. The treatment of choice of the cardioinhibitory carotid sinus syndrome is permanent pacing. This was undertaken in 5 out of four 6 patients leading to total regression of all symptoms. It seems justifiable to propose permanent pacing for patients who have syncope with hyperirritable carotid sinus syndrome, easily demonstrated by carotid sinus massage, but in whom massage does not provoke symptoms, reasoning by analogy with patients with atrioventricular conduction defects or sinus node dysfunction.

Aged↗
PubMed1979

[Painless ST elevation with syncope. Diagnosis by continuous electrocardiography].

The aetiology of syncope in a 53 year old man was discovered on continuous ambulatory electrocardiography. A ventricular arrhythmia associated with ST elevation was recorded. It proved resistant to medical therapy and a double aorto-coronary bypass graft was performed. Post-operative Holter monitoring showed surgery to have been effective.

Arrhythmias, Cardiac↗
PubMed1978

[Criteria of prognosis in apparently primary hypokinetic myocardiopathies (prospective study of 60 cases)].

The fate of 60 cases of apparently primary cardiomyopathy were studied by angiocardiography and coronary arteriography over a 2 to 6 year period, with a mean of 4 years. Correlations were established between the clinical, paraclinical, haemodynamic and angiocardiographic findings on the one hand, and the quality and length of survival on the other. Among the criteria leading to an improved prognosis, the most precise was the left ventricular ejection fraction.

Adolescent↗
PubMed1978

[Effects of intravenous trinitrine on myocardial function in left ventricular insufficiency].

The effects of intravenous trinitrin on myocardial function have been studied in 40 patients with heart failure (26 cases of coronary artery disease and 14 of apparently primary cardiomyopathy). Each patient had measurements made of left ventricular pressure, of cardiac output by the dye dilution method, of volume, of the left ventricular ejection fraction, and of the segmental parietal kinetics by means of left side ventriculography both before and after trinitrin. The following results were obtained after injection of trinitrin:--no change in rhythm and cardiac index;--an almost constant decrease in left ventricular end diastolic pressure (38 cases out of 40);--a decrease in arterial pressure and ventricular volume in about two thirds of cases;--improvement of the ejection fraction (25 cases out of 40), and of segmental parietal kinetics (26 cases out of 40) in the left ventricle. These findings were equally true in the patients with coronary artery disease and in the cardiomyopathies. In the light of these results, it appears that when used in left ventricular failure, trinitrin almost always decreases the load, but improves ventricular kinetics only in two thirds of cases, while it has no influence on cardiac output. In addition, given the difficulties in establishing a standard dose of trinitrin, the authors discuss the methods of establishing the optimal dose.

Blood Pressure↗
PubMed1977

[Alcoholic cardiomyopathies (author's transl)].

In 108 patients suffering from congestive type cardiomyopathy, there were 42 alcoholics and 66 non-alcoholics. Comparisons between the two groups were made on the basis of clinical data, paraclinical investigations and prognosis. It was possible to distinguish an alcoholic cardiomyopathy which differs from primary cardiomyopathies by the greater severity of the clinical picture and a gloomier prognosis.

Adolescent↗
PubMed1976

[Development of pulmonary embolism].

The authors have made a study of the fate of 118 patients with pulmonary embolism. The mortality (21.8%) is related not only to the embolus itself (especially to the recurrent types) but also to the condition of the affected area. Recurrence is common (34%), serious (9 deaths out of 25), and early (during the first three months.). No treatment or inadequate treatment are the main causes. Treatment works effectively on the pulmonary circulation, which becomes reestablished in the majority of cases, but it carries the risk of a high incidence of haemorrhage (29%) which is severe (2 deaths and 10 tranfusions of more than one litre of blood). In the long term, the prognosis is linked to the developments in the lower limbs, in which there is a progressive failure of venous drainage (46 cases out of 57), even in cases in which there was no local sign of phlebitis at the time of the original embolus.

Adult↗