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Biomedical subjects

C Cottier

Publications and source records attributed to C Cottier.

At least 19 recordsLinked to original sources
PubMed1996

[Syncope in elderly patients--which studies are sensible?].

In the elderly the cause of a syncope often is difficult to elucidate. A prospective study at the Kantonsspital Liestal (Switzerland) confirmed that history and physical examination together with an ECG at rest are the most important diagnostic tools in the investigation of a syncope. Further investigations such as 24-hour ECG, echocardiography or tilt test should be restricted to situations where history and physical examination support the suspicion of rhythm disturbances or valvular disorder or a vasovagal mechanism. Thus, if an arrhythmia is suspected a 24-hour ECG may produce useful information. Implantable pacemakers are particularly successful in bradycardic arrhythmias. Echocardiography and Doppler-ECG allow to quantify the severity of an aortic stenosis. The insertion of a prosthetic aortic valve is successfully performed also in the elderly. Tilt testing may elucidate the neurocardiogenic mechanism of a vasovagal syncope or a hypersensitive carotis sinus. In such cases a pacemaker or appropriate medication may be indicated.

Aged↗
PubMed1993

Multiple organ failure and coma as initial presentation of pheochromocytoma in a patient with multiple endocrine neoplasia (MEN) type II A.

The unusual case of a 65-year-old woman with intermittent hypotension, fever, pulmonary edema and coma as initial presentation of pheochromocytoma is reported. The patient developed respiratory, cardiac and renal failure, disseminated intravascular coagulation and liver dysfunction. She had to be defibrillated on multiple occasions, occurring in periods of severe hypertension. After successful surgical removal of a pheochromocytoma a thyroid medullary carcinoma was detected. Several members of the patients family had presented with multiple endocrine neoplasia (MEN II).

Adrenal Gland Neoplasms↗
PubMed1990

Cardiac evaluation of candidates for kidney transplantation: value of exercise radionuclide angiocardiography.

In view of the high incidence and mortality of coronary artery disease (CAD) in patients with kidney transplantation, a systematic cardiac evaluation was prospectively performed in 103 uraemic patients eligible for transplantation. After clinical examination, 28 patients with symptoms of CAD or diabetes mellitus were referred directly for coronary angiography, whereas the remaining 75 patients had rest and exercise radionuclide angiocardiography for evaluation of possible asymptomatic CAD. Among them, left ventricular ejection fraction was below 40% at rest or fell during exercise by at least 5 EF% in 12 patients; coronary angiography in nine showed CAD in four and hypertensive heart disease in five. In the remaining 63 (of 75) patients without severe resting left ventricular dysfunction or exercise ischaemia, the follow-up of 28 +/- 7 months revealed no clinical manifestation of CAD. Overall incidence of CAD in symptomatic and asymptomatic patients during a follow-up of 27 months after cardiac evaluation was 20 and 25% in nondiabetic and diabetic candidates for kidney transplantation, respectively (P = n.s.). Thus, clinical examination combined with exercise radionuclide angiocardiography in patients without signs or symptoms of heart disease had a high predictive accuracy for presence or absence of late manifestations of CAD. Exercise radionuclide angiocardiography is therefore a useful method for screening kidney transplantation candidates for asymptomatic CAD.

Adult↗
PubMed1989

[Acute digitoxin poisoning].

We report a case of severe digitoxin poisoning with--as to our knowledge--the highest plasma concentration reported so far (376 ng/ml). On admission, the patient suffered from nausea and vomiting. The ECG showed a complete AV-block which was managed temporarily by pacing. Phenytoin was given for ventricular tachycardias. The plasma potassium level was 7.4 mmol/l. The elimination of the digitoxin was enhanced with cholestyramine and hemoperfusion. Because of persisting arrhythmias, hyperkalemia and a very high digitoxin level, purified Fab fragments of digoxin-specific antibodies (cross-reacting with digitoxin) were administered. After a first dose of 480 mg nausea disappeared readily, and with a second dose of 480 mg cardiac rhythm disturbances and hyperkalemia were overcome. There were no adverse reactions to treatment. We confirm the effectiveness of digoxin-specific Fab antibody fragments in life-threatening digitoxin intoxication.

Adult↗
PubMed1988

Atrial natriuretic factor in mild to moderate chronic renal failure.

The relationship between kidney function and plasma immunoreactive atrial natriuretic factor (irANF) levels as well as the effects of synthetic human ANF-(99-126) were investigated in 13 patients with mild to moderate chronic renal failure. Under basal conditions, glomerular filtration rate averaged 39 +/- 5 (SEM) ml/min/1.73 m2 and blood pressure (BP) averaged 166/107 +/- 7/2 mm Hg; 12 patients were hypertensive. Plasma irANF levels were significantly increased (98 +/- 16 vs 42 +/- 4 pg/ml in healthy control subjects; p less than 0.001) and correlated (p less than 0.05-0.005) inversely with hematocrit (r = -0.65) and positively with systolic BP (r = 0.75) or fractional sodium excretion (r = 0.75). Human ANF-(99-126) infusion for 45 minutes at 0.034 microgram/kg/min augmented (p less than 0.05-0.01) diuresis and urinary sodium, chloride, calcium, phosphate, and magnesium excretion. During the subsequent 45 minutes of human ANF-(99-126) infusion at a rate of 0.077 microgram/kg/min, diuresis and electrolyte excretion remained elevated (p less than 0.05-0.01). Glomerular filtration rate and effective renal plasma flow were not significantly modified, but filtration fraction rose progressively (p less than 0.01). Human ANF-(99-126) infusion decreased BP (p less than 0.05-0.01), produced hemoconcentration (hematocrit + 7%; p less than 0.01) without negative body fluid balance, and increased (p less than 0.01-0.001) plasma norepinephrine, insulin, and serum free fatty acids; plasma aldosterone and renin activity were unaltered during but rose after cessation of human ANF-(99-126) infusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Acute hemodynamic effects of MDL 19205 in mild congestive heart failure.

MDL 19205 4-ethyl-1-,3-dihydro-5-(4-pyridinylcarbonyl)-2H-imidazol-2-one, a new cardioactive agent, has been shown to increase myocardial contractile force in animals. It is effective by both oral and intravenous routes. We studied 11 patients with congestive heart failure--in 10 cases owing to coronary artery disease, and in one to cardiomyopathy. All patients had symptoms of NYHA class II or III, left ventricular ejection fractions (LVEF) less than 55%, and left ventricular end-diastolic pressures (LVEDP) greater than 15 mm Hg. Following routine coronary angiography and ventriculography, 0.5 mg/kg MDL 19205 was administered intravenously over 5 min to six patients. Thirty minutes after injection, hemodynamic measurements and ventriculography were repeated. Mean LVEF increased from 42 to 49% (p less than 0.05 for baseline vs. 30 min). In five patients ventriculography was repeated 60 min after placebo administration: LVEF decreased from 45 to 40%. LVEDP decreased from 29 +/- 8 to 16 +/- 8 mm Hg after MDL 19205 administration (p less than 0.05) and remained constant at 24 mm Hg in the placebo group. The small although nonsignificant increase of LVdP/dt after MDL 19205 administration (10 +/- 33%), together with a considerable decrease in LVEDP, was consistent with a positive inotropic effect. LVdP/dt/total pressure developed (VPM), a measure of contractility relatively independent of changes in pre- and afterload, increased from 1.0 +/- 0.3 to 1.3 +/- 0.3 s-1 (p less than 0.05). Neither parameter of contractility (LVdP/dt and VPM) changed significantly in the placebo group.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiotonic Agents↗
PubMed1986

Atrial antipressor natriuretic peptide: release mechanisms and vascular action in man.

Atrial natriuretic peptide (ANP) release into the human circulation, responses to cardiopulmonary volume changes and natriuretic and vasorelaxant effects were studied in 45 normal subjects and in 12 patients during diagnostic cardiac catheterization. A new radioreceptor assay with a detection limit of 2 fmol/tube for alpha-human ANP (alpha-hANP) was used. In normal subjects plasma ANP was 27.2 +/- 4 pmol/l (n = 45, range 2-80). Right atrial plasma ANP correlated with right atrial pressure (r = 0.813, P less than 0.01), and in four of the patients increases in ANP paralleled the rise in atrial pressure during bicycle ergometry. Reducing venous return by bilateral thigh-cuff occlusion decreased atrial ANP from 66.8 +/- 17.9 to 19.6 +/- 8.0 pmol/l (n = 6, P less than 0.05). Increasing cardiopulmonary volume during 3-h head-out water immersion was associated with an increase in ANP from 16.0 +/- 5.6 to 92.6 +/- 21.5 pmol/l (n = 7, P less than 0.01) followed by transient urinary sodium excretion. The natriuretic threshold plasma ANP concentration during intravenous ANP infusion was 70-80 pmol/l. Atrial natriuretic peptide infused intra-arterially at a maximal forearm vasodilator dose (0.75 micrograms/min per 100 ml forearm tissue) increased forearm blood flow by 7.0 +/- 1.44 ml/min per 100 ml whereas the increase in sodium nitroprusside was 11.1 +/- 1.47 ml/min per 100 ml. Thus, ANP is rapidly released in response to atrial volume and pressure changes and represents a powerful vasodilating and, at high concentrations, natriuretic hormone in man.

Adolescent↗
PubMed1985

[Aortocoronary bypass operation in the elderly patient: favorable long-term course].

Age has been identified as an independent risk factor for coronary artery bypass grafting (CABG). We evaluated, therefore, the perioperative phase and long-term prognosis of all patients over the age of 64 (n = 80), who had been operated on for coronary heart disease at the University Hospital of Basel/Switzerland between 1979 and 1983. These elderly subjects were compared to 80 patients, 50 to 60 years old at the time of CABG, who were matched for degree of angina pectoris, coronary artery disease, left ventricular ejection fraction, sex and year of operation (matched-pairs analysis). Evaluation of long-term prognosis was based on regular clinical controls and on a questionnaire, sent to the patients in June 1984. During the perioperative phase 3 patients over 64 died versus 0 in the group of patients 50-60 years old. There were more complications in the older group (perioperative myocardial infarction 10 vs. 4, pulmonary embolism 2 vs. 0, cerebro-vascular insult 4 vs. 0). Three vs. one permanent pacemaker had to be implanted for irreversible AV-block. The difference in hospital stay, 21 vs. 19 days, was not significant. The cumulative survival rate was in both groups 95% after one year and 86 vs. 92% 5 years after CABG (difference not significant), despite the fact that significantly more elderly patients have had myocardial infarction prior to CABG. After an average follow-up of 28 months, 72% vs. 60% were without thoracic pain; 63 vs. 49% considered themselves in a good overall condition.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1984

Treatment of mild hypertension with progressive muscle relaxation. Predictive value of indexes of sympathetic tone.

Effects of progressive muscle relaxation (PMR) and of attention control were investigated in a prospective randomized trial of borderline or mild hypertensive patients. Both groups received placebo and had the same number of clinic return visits. After 22 weeks the average mean home BP in PMR decreased 3 mm Hg, whereas in controls BP increased 2 mm Hg. Progressive muscle relaxation had no significant effect on the clinic BP. The response to PMR was not uniform. Responders were characterized by faster heart rates and higher plasma norepinephrine levels. The responders also showed a decrease of anxiety scores during the trial. Progressive muscle relaxation is a time-consuming procedure. Blood pressure responses do not substantially exceed the placebo effects in unselected patients. However, relaxation may be suitable for young, anxious patients with mild hypertension who have a high resting sympathetic tone.

Adolescent↗
PubMed1983

Pressured pattern or type A behavior in patients with peripheral arteriovascular disease: controlled retrospective exploratory study.

The question as to whether a specific behavior or type A pattern is limited to patients with coronary artery disease, or is found in atherosclerotic disease, in general, is explored. The interrelationship between a pattern of "pressured" behavior, assessed by open ended interviews, type A behavior, determined by the Bortner test, and peripheral atherosclerotic disease was investigated in a controlled retrospective study which compared three groups of 13 patients each: intermittent claudication (IC), intermittent claudication combined with coronary artery disease (CADIC) and a control group of patients without vascular disease (WVD). A pressured behavior pattern, assessed by interview, was found to be most prominent in the CADIC group, and least in the control group. The subjects with arteriovascular disease tended to exert more control over people compared to the WVD patients (Fisher's exact probability test, p = 0.05). The tendency to type A behavior, measured by means of the Bortner scale, also differentiated the three groups with CADIC scoring highest and WVD scoring lowest (analysis of variance, F = 3.944, p less than 0.05). IC patients present personality features of proneness to coronary disease. The pattern of "pressured" and type A behavior seem to correlate with the number of vascular areas involved in atherosclerotic disease.

Coronary Disease↗
PubMed1983

Use of clonidine and propranolol as monotherapy in borderline hypertension.

The effect of clonidine (average 0.24 mg/day) and propranolol (average 105 mg/day) on home blood pressure readings in 16 patients with borderline hypertension was investigated in a randomized, double-blind, placebo crossover design. Patients could detect small but significant decreases of blood pressure with both active compounds (-8/-5 with propranolol and -11/-7 with clonidine). The larger mean blood pressure decrease from clonidine vs propranolol was significant (p less than 0.015). Small doses of sympatholytic agents might control the blood pressure in patients with borderline hypertension, and the home blood pressure technique is a convenient tool to detect and monitor such changes. Biochemical predictors of the responsiveness to clonidine were investigated. There was no difference in placebo norepinephrine and renin values between better and lesser responders to clonidine. Plasma norepinephrine fell with clonidine treatment, but with no relationship to the blood pressure response. Plasma norepinephrine response to clonidine might reflect not only the central withdrawal of sympathetic tone, but also, in part, the effect of clonidine on peripheral presynaptic alpha 2-receptors.

Adult↗