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Biomedical subjects

A Jouve

Publications and source records attributed to A Jouve.

At least 19 recordsLinked to original sources
PubMed1990

[Epidemiologic aspects of polyarterial pathology].

UNLABELLED: With the considerable technical progress in vascular investigations made in the last decade, evaluation of multifocal ischemic pathology (MIP) has become easier and allows better assessment of strategy for reperfusion. In vascular surgery, 50% of post-operative mortality and morbidity are related to coronary heart disease (CHD). Epidemiologic data, not biased by specific recruitment of medical and surgical departments, are needed to assessing the real incidence of MIP. Different clinical date have already shown the problem of MIP: the post-operative cardiac mortality rate in vascular surgery has been evaluated at between 0.9% and 3.5% for abdominal aortic aneurysms and 0.3% and 3.2% for peripheral vascular disease (PVD) according to recent statistics (2, 7, 10, 12, 21) (Table I). The total cardiac mortality rate is between 1% and 2% for vascular surgery and is 0.2% for general surgery (8). Thus, though early post-operative over-risk in vascular surgery is not very high, the long term-prognosis is far more impaired: 25% to 55% of patients will die within 10 years after vascular surgery (4, 10, 13, 20). Hertzer, using systematic pre-operative coronary angiograms, found significant coronary stenosis in 57% of patients referred for vascular surgery (11). POPULATION AND METHODS: This study was performed in a representative sample taken from an ongoing prospective survey of 10,446 council employees in Marseille (5,177 men (M.), 5,269 women (W.)). This sample of 1,883 M. and 1,212 W. (mean age: 42.3 +/- 9 for M., 44.9 +/- 11 for W., range 25-65 years) was submitted to a detailed questionnaire on personal and family history of CHD, risk factors and symptoms of CHD (22), and to a physical examination including height, weight and blood pressure measurements. Every subject underwent an ECG recording and a dietetic (5) and psychologic (1) interview, and a blood sample was taken for plasma glucose, total cholesterol and lipoprotein assay. According to epidemiologic data, the prevalence of MIP appears to be lower as compared to clinical data. Undoubtedly, clinical data from surgical departments overestimate the true prevalence of MIP since patients referred for surgical therapy are usually suffering from more advanced pathology. Epidemiology, mainly based on non invasive data probably underestimates the prevalence of MIP but confirms the highest prevalence of CHD as compared to prevalence of other localisations of atherosclerosis and shows CHD as being the earliest localisation of vascular ischemic lesions in most cases. When unifocal ischemic pathology (UIP) and MIP are compared, risk factors are the same, although different proportions of patients are concerned with some of them: in MIP, age is still the major risk factor, whereas smoking in M. and overweight in W. seem to be more frequent than in UIP. RESULTS: Sixty-eight cases (5%) of ischemic pathology were found in men and 47 cases (4%) in women, with 4.1% cases of unifocal ischemic pathology (UIP) in M. and 3.3% in W...

Adult↗
PubMed1978

Results of a national therapeutic trial conducted in 10,000 hypertensive patients by 2000 general practitioners.

1. 10,294 hypertensive patients were treated and followed by 2200 general practitioners under the supervision of 130 cardiologists and nephrologists. 2. The treatment groups, randomly allocated, were designated to use three distinct antihypertensive drugs, administered alone, and combined two-by-two. 3. Some 75% of patients had a supine diastolic blood pressure of less than 95 mmHg after 4 months treatment. 4. A total of 12% of patients had dropped out by 4 months from entry; no clear relationship was established between side effects and drop out.

Adult↗
PubMed1978

[A rare cause of continuous thoracic murmur. A fistula between the internal mammary artery and the pulmonary circulation].

The authors present a case of a continuous right lateral sternal murmur which led to the discovery of a systemic-to-pulmonary fistula at the origin of the internal mammary artery. The fact that the patient had a right pulmonary abscess with pyopneumothorax drained several years previously has led them to discuss the possible etiology of this fistula. The murmur disappeared after surgical treatment.

Adult↗
PubMed1978

[Application of echocardiography to the diagnosis of tricuspid valve diseases. Apropos of 103 cases].

In a series of 103 consecutive surgical patients, the normal and pathological echocardiographic appearances of the tricuspid valve were analysed and compared with the anatomical findings. It was possible to define the nature of the lesions by echocardiography, which was superior to angiography in this field. The right ventricular index (right ventricular dimension body surface area) correlated well with the mean pulmonary artery pressure (r = 0.75; p less than 0.001). The index may be useful in the long term follow-up of post-operative patients.

Adolescent↗
PubMed1978

[Pluri-dimensional study of psychological factors in coronary disease].

To palliate certain criticisms levelled at workers studying psychological factors in coronary artery disease, the authors have applied a pluri-dimensional approach associating a semi-direct psychological interview, a self-evaluation test (Bortner scale), an Eysenck personality test and Sandler and Hazari's test of obsessional behaviour. This protocol was applied to 222 patients hospitalised for coronary artery disease and 522 random controls. The psychological interview and Bortner test showed a significantly higher proportion of A pattern and especially extreme A pattern behaviour in patients with coronary artery disease (32.6 % in coronary patients 9.7 % in controls). The personality questionnaire showed a greater tendency to neurotic behaviour in the coronary patients. These results were independant of age and sex. In the present study, psychological factors are given equal importance to other major risk factors (tobacco, hypertension, hypercholesterolaemia). They are independant of these other factors. A prospective study using the same protocol is being prepared.

Adult↗
PubMed1977

[Use of sodium nitroprusside in cardiology].

Sodium nitroprusside (SNP) is rarely used in cardiology. It is reserved traditionally for severe episodes of arterial hypertension. Certain states of refractory heart failure represent new indications for use, which implies a double haemodynamic monitoring system: continuous control of systemic blood pressure by intra-arterial catheterization; control of pulmonary pressure and repeated measurements of cardiac output. Prolonged treatment requires continuous biological monitoring of toxicity and careful control of kidney function. As a moderator of blood pressure, SNP is remarkably effective. The hypotensive effect is immediate, readily reversible and generally tachyphylaxis is not observed. The effect of SNP on cardiac work is one of double load reduction: mainly a reduction in afterload or pressure and systemic resistance and a reduction in preload or pressure of ventricular filling. In this respect, SNP can be used effectively for severe cases of heart failure intractable to traditional cardio-stimulatory and diuretic treatments and stemming from diverse causes: acute stage of myocardial infarction, ventricular dilatation, mitral papillary syndrome, heart failure, either subacute or chronic, of various causes. As a rule, the immediate results are positive. Taking the patient off the drug can be difficult and may cause a return to the previous haemodynamic situation.

Adult↗
PubMed1977

[Hemodynamic profile of acute myocardial infarction as a function of electrocardiographic localization].

The haemodynamic profiles of 147 cases of myocardial infarction investigated within 30 hours of the clinical onset were studies in relation to the topography of the necrosis on the ECG: there were 36 inferior (I), 29 postero-inferior (PI), 22 antero-septal (AS), 38 antero-lateral (AL), 15 deep septal (DS), and 7 strictly posterior or lateral (PL). Simultaneous recordings of the diastolic pulmonary arterial pressures and the left ventricular diastolic pressures (pre-and post-a) have shown different degrees of correlation with the topographical site. The correlation found in AS, AL and I necrosis are clearer with respect to the pre-a. The PI necroses show no correlation. Graphs of left ventricular function as well as an analysis of the various other parameters show that the DS, the AL, and to a lesser extent the PI are associated with the grossest depression of left ventricular function. A study of the amplitude of the "a" wave also shows that the effect of infacts of the free wall of the left ventricule on the compliance is greater. A study of right ventricular function as well as the correlations between the pulmonary and right atrial pressures confirms the presence of right ventricular disfunction in DS and PI necroses. Impaired left ventricular function, impaired right ventricular function, and disorders of compliance seem to be the determining factors in changing the haemodynamics in the various ECG sites of infarction.

Acute Disease↗
PubMed1977

[Electrocardiagraphic changes of Prinzmetal's angina type in the acute phase of myocardial infarct].

The authors have studied the frequency and severity of anginal attacks of the Prinzmetal type coming on during the acute phase of a myocardial infarction in 13 patients. They have occurred in 5.50% of cases (anginal attacks of all types occurring in 18.34% of cases). The severity of these attacks is shown by their clinical features: the multiplicity of the attacks, the high incidence of arrhythmias, the difficulties encountered with medical treatment. This also confirmed by the enzyme studies: when the curve of myocardial creatinine kinase release is drawn, there is seen to be an extension of the lesion in 2/3 cases, whereas the electrocardiograph does not show this up.

Acute Disease↗