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Biomedical subjects

A Ferrier

Publications and source records attributed to A Ferrier.

At least 37 records · Page 2Linked to original sources
PubMed1985

Circulating and tissue concentrations of pregnancy-associated plasma protein-A (PAPP-A) in tubal ectopic gestation.

Concentrations of pregnancy-associated plasma protein-A (PAPP-A), human chorionic gonadotrophin (hCG) and pregnancy specific beta 1-glycoprotein (SP1) were measured by radioimmunoassay in 164 serum and 29 tissue samples obtained from 87 non-pregnant and 29 pregnant women with either tubal (n = 16) or intrauterine (n = 13) pregnancies. Of the 47 serum samples obtained from patients with a tubal pregnancy only two were positive for PAPP-A, whereas in excess of 94% of the samples were positive for both hCG and SP1. Serial measurements of hCG, and SP1, demonstrated an apparently normal growth rate for the tubally implanted trophoblast for the first 6 weeks of pregnancy. Thereafter, the tubal trophoblast is compromised since the tissue content of PAPP-A and hCG was significantly lower than that in intra-uterine derived trophoblastic tissue. By contrast, the content of both PAPP-A and hCG was significantly greater in the trophoblastic, both intra or extra-uterine derived, than in the endometrial/decidual, tissue. Furthermore, the absence of immunoreactive PAPP-A and the severely depressed circulating levels of PAPP-A in women with tubal pregnancies can be attributed to diminished secretion of PAPP-A into the maternal circulation. Therefore, in conjunction with a positive pregnancy test and the patient's clinical history, a severely depressed or absent serum PAPP-A level may aid in the diagnosis of extrauterine pregnancy.

Chorionic Gonadotropin↗
PubMed1985

[Isolated stenosis of the anterior interventricular artery. Comparison of the effects of medical and surgical treatment (in a randomised series)].

Forty-five patients presenting with unstable angina having 70 p. 100 stenosis of the left anterior descending artery judged acceptable for coronary bypass surgery were randomly allocated, using a table of random numbers, for medical (21 patients) or surgical treatment (24 patients). There were no significant differences between the two groups with regards to age (53 +/- 10 years for the medical group; 55 +/- 9 years for the surgical group), the length of follow-up (55 +/- 26 vs 61 +/- 28 months), left ventricular end diastolic volumes (87 +/- 27 vs 84 +/- 18 ml/m2) or ejection fraction (62 +/- 8 vs 59 +/- 11 p. 100). There were no deaths in the medical group; two patients developed uncomplicated myocardial infarction 19 days and 7 months after coronary angiography, respectively. 5 patients had recurrent angina and were referred for surgery. This operation of second intention did not pose any special problems. 6 of the 14 patients with stenosis of the LAD before the origin of the first septal artery had complications (infarction in 1 case, recurrent angina in 5 cases). In the surgical group, 1 patient died in the immediate postoperative period, of resistant cardiac arrhythmia; 2 patients developed uncomplicated peroperative myocardial infarction; 21 patients had no complications at all. The surgical patients were heparinised in the immediate postoperative period and anticoagulant therapy was continued with oral vitamin K antagonists for 6 months to 1 year, followed in some cases, by platelet antiaggregant therapy. 20 patients in this group underwent maximal exercise stress testing which was negative in 19 cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗
PubMed1985

[Left-right shunt caused by anomalous implantation of the left coronary artery in the trunk of pulmonary artery. Detection by contrast echocardiography].

The authors describe a case of an anomalous left coronary artery arising from the main pulmonary artery in an 11 year old child suffering from chest pain on effort and with a continuous murmur in the second left intercostal space. Two dimensional echocardiography (2D E) showed dilatations of the first segment of the right coronary artery and the anomalous origin of the left main coronary artery. A peripheral injection of microbubbles showed a left-to-right shunt between the left coronary artery and the pulmonary artery. Semi-quantitative evaluation of LV regional wall motion showed abnormal contraction of the anterolateral walls. Haemodynamic, angiographic data and the operative findings confirmed the diagnosis. The abnormal coronary ostium was closed and a bypass graft from the aorta to the left anterior descending artery was performed. Clinical and echocardiographic follow-up 7 months after surgery was completely normal.

Child↗
PubMed1984

Controlled, eight-hour haemodynamic study of a sustained-release formulation of isosorbide dinitrate in moderate left ventricular failure.

The aim of the study was to assess the duration of the haemodynamic effects of a new sustained-release oral formulation of isosorbide dinitrate (ISDN). Twenty patients (17 men and 3 women; mean age 60 years) with acute myocardial infarction (10 anterior, 10 inferior) complicated by moderate left ventricular failure took part in a randomized controlled trial. Ten patients were randomly assigned to the placebo group and 10 to the ISDN group, who received 40 mg sustained release isosorbide dinitrate. Haemodynamic variables were measured before treatment, after 0.5 and 1 h and then every 2 hours up to the 8th hour after treatment. There was no significant change in any haemodynamic parameter in the placebo group, during the study period. In the ISDN group there was a significant fall in pulmonary artery diastolic pressure at 4 and 8 h, from 19.0 +/- 1.0 mm Hg to 16.5 +/- 1.2 mm Hg and 15.5 +/- 0.8 mmHg, respectively. The mean pulmonary capillary wedge pressure fell progressively from 17.9 +/- 1.0 to 12.5 +/- 1.2 mmHg at 2 h (p less than 0.001 in comparison with the placebo group. The fall remained significant up to 8 h. There was no statistically significant change in heart rate, cardiac index, systemic blood pressure or systemic and pulmonary vascular resistances. On the whole the cardiac index remained unchanged. There were numerous individual variations of cardiac index in relation to the initial mean pulmonary capillary wedge pressure and the magnitude of its fall following administration of ISDN. The change in cardiac index was inversely correlated with the control cardiac index (r = -0.69, p less than 0.02).

Delayed-Action Preparations↗
PubMed1984

Contrast echocardiographic visualization of cough-induced right to left shunt through a patent foramen ovale.

In a series of 24 consecutive patients referred to the echocardiography laboratory because of suspected patent foramen ovale, contrast two-dimensional and M-mode echocardiographic studies were performed during normal breathing and during two provocative tests: the Valsalva maneuver and cough. A right to left shunt was visualized in 8 patients during normal breathing, in 11 patients during the Valsalva maneuver and in 17 patients during the cough test. Cardiac catheterization performed in all 24 patients and postmortem examination available in 3 patients confirmed the patency of the foramen ovale in only 15 patients. In these 15 patients, echo contrast appeared in the left heart cavities in early systole and almost simultaneously with complete right heart opacification. In contrast, for the two false positive results during the cough test, ultrasound contrast appeared at any time of the cardiac cycle when the right heart cavities had been partially cleared of contrast material. Right and left atrial pressures were simultaneously measured in four patients, and the normal interatrial pressure gradient was reversed during the Valsalva maneuver and the cough test. Echocardiography during both provocative tests showed that the interatrial septum flattened or became convex toward the left atrium. The cough test appears to be more reliable and easier to perform in critically ill patients than the Valsalva maneuver for the detection of right to left shunting through a patent foramen ovale.

Adolescent↗
PubMed1984

Aneurysms of sinus of Valsalva: two-dimensional echocardiographic diagnosis and recognition of rupture into the right heart cavities.

The aim of this study was to evaluate the role of echocardiography in the diagnosis of sinus of Valsalva aneurysms projecting toward the right heart cavities. Three patients who had a ruptured aneurysm of a sinus of Valsalva diagnosed by echocardiography and confirmed by catheterization underwent cardiac surgery. In two patients, the aneurysm originated from the right coronary sinus and had perforated into either the inflow or outflow tract of the right ventricle. In the third patient, the aneurysm, which originated from the noncoronary sinus, ruptured into the atrium. A fourth patient was also investigated and had an unruptured aneurysm of the right coronary sinus projecting into the right ventricular outflow tract. M-mode, two-dimensional and contrast echocardiographic studies were performed before cardiac catheterization in all patients and after surgery in three patients. M-mode echocardiography was useful only when the aneurysm had an anterior projection, whether or not the aneurysm was ruptured. Conversely, two-dimensional echocardiography was always able to identify the aneurysmal sac which appeared as an abnormal circular thin-walled structure protruding into the right heart cavities. By using multiple views, it was possible to investigate the whole abnormal structure and locate the sinus from which the aneurysm originated. The use of the echo contrast technique allowed more precise definition of the aneurysmal sac and diagnosis of a left to right shunt by demonstrating a negative contrast image in the right cavities. On the other hand, no negative contrast image was recorded in the patient with an unruptured aneurysm or in the two instances of a successful surgically reconstructed aorta.

Adult↗
PubMed1983

[Patency of the foramen ovale in paradoxical embolism. Detection by contrast echocardiography and the cough provocation test].

Five patients with suspected paradoxical embolism were investigated for patent foramen ovale by contrast echocardiography. Right-to-left shunting was demonstrated in 3 patients: during a Valsalva manoeuvre in one and during coughing fits in all three. Patency of the foramen ovale was confirmed by cardiac catheterization in these 3 patients. In 2 patients the foramen was not patent and the diagnosis of paradoxical embolism was not confirmed. In two other patients, the right and left atrial pressures were measured simultaneously during a Valsalva manoeuvre and during coughing. The normal pressure gradient between the two atria was suppressed during the relaxation stage, resulting in decreased curvature of the interatrial septum which facilitated the flow of blood from the inferior vena cava into the left atrium. Coughing appears to be a simpler and more sensitive test than the Valsalva manoeuvre to induce transient right-to-left atrial shunting.

Cough↗
PubMed1983

[Two-dimensional contrast echocardiography during the drainage of hemopericardium with tamponade].

In patients with cardiac tamponade, withdrawing blood during pericardiocentesis raises questions as to its origin: pericardium or cardiac cavities? These questions can be answered by bidimensional contrast echocardiography after reinjection of a few millilitres of the blood-stained fluid removed. Microcavitations surrounding the heart and vanishing within a few minutes indicate that blood comes from the pericardium. Microcavitations obscuring the right atrium or ventricle and washed away by the blood flow in a matter of seconds indicate that these cavities have been punctured.

Adult↗
PubMed1983

[8-hour hemodynamic study of 2 sustained-release nitrate derivatives. Comparative double-blind study against placebo].

The aim of this study was to evaluate the duration of the hemodynamic effects of a new slow release preparation of isosorbide dinitrate and to compare its action with placebo and a slow release nitroglycerin preparation whose hemodynamic efficacity has already been demonstrated. The study was undertaken in 30 patients admitted to the intensive care unit during the acute phase of myocardial infarction complicated by left ventricular failure less than 12 hours after the onset of the chest pain. The patient population was uniform: 24 males, 6 females, mean age 61 years. Fifteen patients had anterior infarcts and 15 posterior infarcts. The drugs were administered double blind in a randomised fashion to 3 groups of 10 patients, the initial clinical and hemodynamic characteristics of which were comparable: 10 patients received placebo (placebo group); 10 patients received slow release nitroglycerin in a 7,5 mg gelule (NTG group) and 10 patients received 40 mg slow release isosorbide dinitrate (ISDN group). The following parameters were compared: heart rate, right atrial pressure, pulmonary artery and capillary pressures, systemic arterial pressure, cardiac index and systemic and pulmonary arterial resistances. These parameters were measured before therapy, half an hour, one hour and every two hours up to the 8th hour after drug administration. All patients were in moderate left ventricular failure with an initial mean capillary pressure of 18 mmHg +/- 1,3 mmHg. In the placebo group, none of the parameters studied changed significantly during the study. Pulmonary artery pressure fell significantly by 11 p. cent in the NTG group and 7,5 p. cent in the ISDN group. Mean pulmonary capillary pressure fell progressively in both treatment groups; the change was significant compared to the placebo group from the first hour for the ISDN group, and from the second hour for the NTG group. The fall remained significant at the 8th hour for the ISDN group but not in the NTG group. Cardiac index, systemic blood pressure, systemic and pulmonary arterial resistances did not change significantly. The cardiac index remained stable in the 30 patients, but with a number of individual variations depending on initial mean pulmonary capillary pressure and the importance of its fall after nitrate administration. The authors conclude that the hemodynamic effects of slow release NTG and ISDN in the acute phase of myocardial infarction complicated by moderate left ventricular failure are comparable. Pulmonary capillary pressure was the hemodynamic parameter which underwent the greatest variation in the two treatment groups. Its fall was more prolonged in the ISDN than in the NTG group.

Administration, Oral↗
PubMed1982

[Update on the study of true and false left ventricular aneurysms by 2-dimensional echocardiography].

2D echocardiography is a great advance in the study of left ventricular aneurysms. The wide field of visualisation and the numerous planes of examination obtained from different transducer positions allow precise spatial orientation and reliable analysis of regional wall movement. An aneurysm appears as a clear and constant bulge of a segment of left ventricular wall in both diastole and systole. Antero apical aneurysms are the commonest variety. The sensitivity and specificity of 2D echo in the detection of ventricular aneurysms are high. Thrombosis within the aneurysmal bulge may also be detected (33-38%). Pseudo-left ventricular aneurysms are easily identified as a chamber communicating with the ventricle by means of a narrow neck; the width of this neck is the main echocardiographic feature differentiating pseudo and true ventricular aneurysms. 2D echocardiography gives valuable information on the state of the remaining contractile area, an important prognostic factor when surgical resection of the aneurysm is being considered.

Diagnosis, Differential↗
PubMed1979

[Coronary by-pass operations in diabetic and non-diabetic patients with angina. Results of 102 coronary arteriographies (author's transl)].

The results of coronary arteriography were compared in 102 patients (55 non-diabetics and 47 diabetics) with angina. The lesions noted an arteriography were more severe in the diabetic patients: more frequent stenosis in the common trunk and three branches, and present in greater numbers (more than 4 in more than a half of the patients), with only a moderate proximal bed in 65% of the cases. By-pass operations can only be performed, therefore, in 32% of these patients as against 54% for the non-diabetic anginal patients. The operative risk also appears to be increased (1 death and 6 complications in 10 by-pass operations). It was also demonstrated that with similar lesions of the common trunk, the diabetics have radiological signs of a greater incidence of cardiomegaly and generalized hypokinesia of the left ventricle than non-diabetics. By-pass operations are impossible in about 85% of patients because of ischemic signs or evidence of necrosis in the ECG recordings of diabetic patients with angina.

Adult↗
PubMed1975

[Chronic respiratory insufficiency. Incidence in the results of surgical valvular replacement].

Out of 400 files of patients who underwent valvar correction between 1968 and 1974 under extra corporeal circulation by the thoracic route through median sternotomy 180 were kept for this study. All these 180 patients had a complete functional spirometric examination before operation, analysed in correlation with their valve disease. 39 of them had severe ventilatory insufficiency. Nevertheless the post-operative period was usually simple, and respiratory insufficiency was responsible for one death only of this series. These data were confirmed by the study of 45 autopsied patients who died after operation. At distance from operation, 80 patients were studied, 25 of whom had severe ventilatory insufficiency. In more than half the cases, and particularly in the mitral ones, the ventilatory deficiency was improved. Thus it is concluded that, respiratory insufficiency is rarely a contra-indication to valve replacement surgery in habitual conditions of the median sternotomy as a thoracic route.

Adolescent↗