PubMed Health⌕ Search

Biomedical subjects

C Mounier-Vehier

Publications and source records attributed to C Mounier-Vehier.

At least 37 records · Page 2Linked to original sources
PubMed1999

Anatomic variation in the origin of the main renal arteries: spiral CTA evaluation.

The aim of this study was to provide quantitative data on the origin and trajectory of the main renal arteries using spiral CT angiography and arteriography. Normal renal artery anatomy was assessed on spiral CT angiography (axial transverse sections and shaded-surface-display reconstructions) in 100 patients referred for renal arteriography who had no significant renal artery stenosis. Two hundred major renal arteries were studied. The vast majority of right (88 %) and left (87 %) renal arteries originated between the lower third of the first lumbar vertebra and the lower border of the second lumbar vertebra. In 50 patients both ostia were at the same level; in the remaining 50 patients, the right ostium was located above the left in 37 patients. On the right, the angle of origin varied from -10 to + 55 degrees (mean + 24 degrees ). On the left, the angle of origin varied from + 30 to -55 degrees (mean -11 degrees ). Spiral CT angiography provides additional anatomic data, notably regarding the angle of origin of the renal arteries, that is potentially useful for planning interventional procedures.

Aged↗
PubMed1999

Fibromuscular dysplasia of the renal arteries: comparison of helical CT angiography and arteriography.

OBJECTIVE: We evaluated the role of helical CT angiography rendering techniques in the assessment of renal artery fibromuscular dysplasia. MATERIALS AND METHODS: Twenty hypertensive patients (mean age, 56 years) with angiographically proven renal artery fibromuscular dysplasia were studied by CT angiography. The acquisition protocol was collimation, 3 mm; table speed, 3 mm/sec; and incremental algorithm, one. Maximum-intensity-projection and shaded-surface-display reconstructions and transverse sections were reviewed by a consensus panel to determine the sensitivity and specificity of each technique in revealing renal artery fibromuscular dysplasia. RESULTS: Helical CT angiography enabled successful diagnosis of fibromuscular dysplasia in all 20 patients. Helical CT angiography showed 31 of 34 pathologic arteries and 33 of 38 lesions. Aneurysms (>6 mm) on arteriography (n = 12) were revealed in 83% of transverse sections, 75% of maximum-intensity-projection reconstructions, and 58% of shaded-surface-display reconstructions. Lesions that had a string of pearls appearance on arteriography (n = 19) were shown in 53% of transverse sections, 84% of maximum-intensity-projection reconstructions (p < .05 compared with transverse sections), and 74% of shaded-surface-display reconstructions. Stenoses (n = 7 on arteriography) were revealed in 57% of transverse sections, 71% of maximum-intensity-projection reconstructions, and 57% of shaded-surface-display reconstructions. Maximum intensity projection alone revealed 30 (79%) of the 38 angiographic lesions; however, using both maximum intensity projections and transverse sections increased the sensitivity to 87%. CONCLUSION: Helical CT angiography, especially the combination of transverse sections and maximum-intensity-projection reconstructions, can reliably reveal renal artery fibromuscular dysplasia. However, because some lesions may not be shown, arteriography with pressure measurements remains the only technique that can assess the physiologic significance of the dysplasia.

Adult↗
PubMed1999

[Effect of diltiazem on lipid profiles and heart rate in hypertensive patients].

Diltiazem is an antihypertensive belonging to the class of heart rate-slowing calcium channel blockers; its antihypertensive efficacy has been demonstrated for a long time. Controlled trials have also demonstrated that it does not interfere with lipid parameters. This open multicentre trial was designed to verify the absence of any action of diltiazem on lipid parameters as well as its effect on the heart rate of hypertensive patients. The patients included had to take one capsule of diltiazem 300 mg sustained release formulation, developed by Laboratoires Synthélabo, in the morning for 6 months. A lipid assessment and an electrocardiogram were performed before and at the end of the trial. One hundred and forty-six patients were included: 81 underwent a complete lipid assessment (7 parameters) before and after treatment and 69 underwent an electrocardiogram at rest to the same study times. Total cholesterol (p = 0.0007), LDL cholesterol (p = 0.005) and apoprotein A1 (p = 0.0002) were significantly decreased. Blood pressure decreased progressively throughout the study and was "controlled" (supine diastolic blood pressure < or = 90 mmHg) after six months of treatment in 77% of patients. Heart rate decreased significantly at the end of the study; no pathological variation of PR, QRS and Qt intervals was observed. The effect on heart rate, also studied in patient subgroups defined by their baseline values, was more marked when the baseline heart rate was increased. The investigators considered the safety to be good at each visit, in 80% of cases. Sixteen patients dropped out of the trial because of adverse effects or intercurrent disease. The adverse effects most frequently reported were oedema of the lower limbs (7.5%), headache (4.8%) and hot flushes (2.7%). No harmful effect of diltiazem on lipid parameters was observed during this open trial; some lipid parameters even decreased at the end of treatment. Clinically, diltiazem lowered blood pressure and decreased heart rate. The reduction of heart rate was more marked in the case of high baseline heart rate. Safety was satisfactory.

Aged↗
PubMed1998

Compliance and antihypertensive efficacy of amlodipine compared with nifedipine slow-release.

Poor compliance is a principal cause of treatment failure in hypertensive patients. Once-daily dosing improves compliance, but 24-h antihypertensive activity should be provided. The compliance, efficacy, and safety of amlodipine and nifedipine slow-release (SR) were compared in patients with mild-to-moderate essential hypertension recruited among 24 centers in France. After a 2-week washout period, 103 patients were randomized to 12 weeks of 5 to 10 amlodipine mg once daily (n = 55) or 20 mg nifedipine SR twice daily (n = 48). Compliance was calculated by electronic drug monitoring. Efficacy was measured by ambulatory and casual BP recordings. Patients receiving amlodipine demonstrated better compliance than patients receiving nifedipine SR with respect to compliance index (the total number of doses taken divided by the total number of doses prescribed, expressed as a percentage; 98.3% v 87%; P < .0001), days on which the correct number of doses were taken (92.5% v 74.8%; P < .0001), and prescribed doses taken on schedule (88.7% v 71.6%; P < .0001). Absolute and relative therapeutic coverage were higher in patients receiving amlodipine than nifedipine SR (P < .0001). Mean SBP and DBP decreased equally in both groups, although amlodipine offered better BP control compared with nifedipine SR at specific times of day. Fewer patients had high nocturnal SBP with amlodipine (39.3%) than nifedipine SR (71.4%; P = .042). Adverse events and treatment withdrawals occurred less frequently in amlodipine-treated patients than in nifedipine SR-treated patients. Amlodipine (5 to 10 mg) once daily provides improved compliance, better 24-h BP control, and fewer adverse events than 20 mg nifedipine SR twice daily in patients with mild-to-moderate hypertension.

Adolescent↗
PubMed1998

[Heart rate and diabetes mellitus].

Diabetic neuropathy, particularly autonomic disorders, is early and frequent. When it affects the heart, it is also called cardiac autonomic neuropathy (CAN) and its clinical manifestations, especially increased heart rate, and subclinical manifestations are reported here, together with the techniques used to study this disease: Ewing's test, "Finapres", Holter ECG. Tachycardia, occurs early, is almost constant during diabetes and has a prognostic value.

Autonomic Nervous System Diseases↗
PubMed1996

A prospective study of helical computed tomography angiography versus angiography for the detection of renal artery stenoses in hypertensive patients.

OBJECTIVE: To compare helical computed tomography angiography with arterial digital subtraction angiography in the diagnosis of renal artery stenoses. METHODS: Fifty hypertensives (24 men; mean age 53 years) were prospectively studied with computed tomography (Somaton Plus S, Siemens) and digital angiography (double-blind evaluation). Computed tomography was performed both in the sequential (the length of the abdomen) and in the helical (6 cm around renal arteries) modes during injection of 120 cm3 contrast medium. RESULTS: Digital angiography visualized 16 significant (< 50% on quantitative angiography) stenoses (16/131 renal arteries, including 32 accessory), in 14 (28%) patients. On helical computed tomography, 16 stenoses were detected, in 49 patients (16/122 renal arteries, seven accessory arteries were not identified because they were located out side the scan area); two patients had false-positive helical computed tomography results. The computed tomography sensitivity, specificity, positive and negative predictive values were 87.5% (14/16), 98.2% (111/114), 87.5% and 98.2%, respectively. In the sequential mode, two cases of bilateral adrenal hyperplasia, two aortic aneurysms and one renal neoplasm were detected. None of these patients had renal artery stenosis. CONCLUSIONS: Helical computed tomography is a suitable new non-invasive diagnostic modality for the detection of renal artery stenosis or adrenal pathology. With continued development and evaluation computed tomography could prove useful as a screening tool or as a replacement for digital angiography in patients with possible secondary hypertension.

Adolescent↗
PubMed1995

Cardiovascular reactivity to a new mental stress test: the maze test.

The response to the maze test was studied in 31 subjects on no medication, including seven subjects with mild essential hypertension. Beat-by-beat finger blood pressure (BP) was measured with a Finapres device. Pulse interval from which heart rate (HR) was derived was obtained from the BP signal. A period of 5 min baseline was used to define resting levels of systolic BP and HR using 20-s averaged values for the calculation of the 95% confidence limit of the two variables. The average test duration was 10 min. During this period a series of video-displayed mazes had to be solved with easy mazes preceding difficult ones. No subject had been exposed to the test before. The maximal BP elevation associated with the test was 27 mmHg. The HR response averaged 11 beats/min. Significant elevations were observed for half the test duration. No significant relationship between these two responses was observed and some subjects exhibited isolated systolic BP or HR responses. When indices obtained during this active mental stress were compared to resting values, positive correlations were observed. When the resting standard deviation (SD) of systolic BP was higher the systolic response was greater. A similar relationship was observed for HR. In addition, when the systolic BP level at rest was higher, the systolic BP reactivity index was greater. However, systolic BP or HR at baseline were not predictive of the systolic BP or HR responses. This study demonstrates the applicability of a new test to assess cardiovascular reactivity.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[Evaluation of spiral computed tomography of the renal arteries alone or combined with Doppler ultrasonography in the detection of renal artery stenosis. Prospective study of 114 renal arteries].

A renovascular etiology occurs in 0.2 to 2% of hypertensive patients. Recently, spiral computed tomography (CT) has evolved as a new minimally invasive tool for the diagnosis of vascular pathologic conditions. The purpose of this study was to compare both spiral CT and color Doppler ultrasonography (US) with intraarterial digital subtraction angiography (DA) in the detection of renal artery stenosis (RAS) in hypertensive patients. Between December 1993 and April 1994, 44 hypertensives (men 22, mean age 52 years) suspected secondary hypertension were prospectively studied with spiral CT (Somatom Plus S, Siemens) US (Acuson, 3.5 MHz probe) and DA (double-blind evaluation). DA visualized 11 significant (> 50%) stenoses (11/114 renal arteries, including 27 accessory). On spiral CT, 9/11 were detected and 2 additional stenoses considered false positive. On US 5 stenoses were detected whereas 11 were demonstrated by DA; 2 patients had false positive US results. [table: see text] We conclude that combined spiral CT and color Doppler ultrasonography is an effective and relatively non invasive alternative to intraarterial digital angiography for the detection of renal artery stenosis in a hypertensive population screened for renovascular hypertension.

Adolescent↗
PubMed1994

[Evaluation and surveillance of blood pressure during pregnancy].

Despite a large body of literature or hypertension in pregnancy, there still is no recognized prognosis factor for this frequent and severe disease. Management still relies on clinical features (occasional blood pressure measurements, weight curve) and appropriate tests including fetal and maternal echodoppler, urinary uric acid, 24 h proteinuria and fetal heart rate monitoring. Recent developments including self measurement and ambulatory monitoring of blood pressure have helped improve follow-up and therapeutic management in high risk pregnancies. By repeating the measurements, these techniques require more intensive medical follow-up and an adapted therapy near the term of pregnancy. They do not however provide a means of predicting outcome or recurrence of preeclampsia. These techniques have effectively been shown to reduce the number and duration of hospitalizations.

Blood Pressure Determination↗
PubMed1993

["White-coat" effect in 35 consecutive patients with hypertension. Quantification method, role of physician-patient dialogue].

The "white coat" effect, an alarm reaction to the presence of a doctor, is an important cause of blood pressure variability, the frequency, amplitude and mechanisms of which are only partially understood. In order to evaluate these factors, a prospective study was undertaken in 35 consecutive patients referred for assessment of clinical hypertension. The alarm reaction was investigated during the consultation, at the time of interrogation, in periods of silence, in the sitting and upright positions. Twenty-four to forty-eight measurements (average 36.8) of the blood pressure and heart rate were performed in each patient with a Diasys 200 R monitor. The ambulatory period of 3 to 5 hours after the consultation provided 12 to 24 measurements (average 20.7) which were considered to be the reference for comparison with the consultation period. A total of 2,038 measurement were made and analysed. Analysis of variance (GLM) for each patient and for the whole group gave an assessment of the alarm reaction during the patient-doctor dialogue and periods of silence with reference to the ambulatory period. During the ambulatory period, the average and standard deviation for systolic pressure were 134 +/- 0.7 mmHg, and for diastolic pressure 93.1 +/- 0.6 mmHg. These pressures were significantly lower than during the two periods of consultation, with and without dialogue (p < 0.0001). During the consultation, the systolic and diastolic blood pressure values were significantly higher during the dialogue than during the periods of silence (p < 0.0001). During the dialogue, the systolic pressure attained 153.7 +/- 0.7 mmHg and the diastolic pressure: 107.2 +/- 0.6 mmHg.(ABSTRACT TRUNCATED AT 250 WORDS)

Ambulatory Care↗
PubMed1993

[Ambulatory arterial blood pressure monitoring in the management of hypertension in pregnancy].

Ambulatory blood pressure monitoring (ABPM) completes the diagnostic approach to hypertension of pregnancy, by providing a dynamic study of the blood pressure status of the pregnant woman. It corrects certain erroneous diagnoses of hypertension of pregnancy, in particular those related to the "White coat" effect, especially common in pregnant women. ABPM enables the study of nocturnal blood pressured figures, known for their prognostic value in hypertension of pregnancy. Finally, while loss or reversal of circadian rhythm appears to be of good predictive value regarding the onset of eclampsia, it is above all blood pressure load which appears to be harmful to fetal growth and maturity. ABPM also facilitates management by improving the compliance of pregnant women with regular monitoring and with treatment, by more accurately guiding the surveillance of drug treatment.

Ambulatory Care↗
PubMed1992

[Measurement of blood pressure in obese patients: reliability and value of finger measurement (Finapres)].

Indirect measurement of the blood pressure in obese persons is still inaccurate, especially if the arm circumference deeply differs from one measure point to the other, so that the use of a wide bladder is inappropriate. Some alternative solutions have been described: oscillometric device on the arm or on the forearm, different shapes of the cuff-bladder, auscultation on the radial artery with the cuff on the forearm. We tested the capability of the Finapres device which measures the finger arterial blood pressure, beat to beat, using the volume clamp method of Penâz. In six obese patients (BMI > 30, arm circumference > 35 cm) treated for hypertension were undergoing functional respiratory tests. The finger pressure was measured simultaneously with intrabrachial on homolateral arm. Blood pressure was measured at rest and after a cold pressor test. [table: see text] The use of the Finapres seems to be possible. The correlation with the systolic is excellent, where as the correlation with the diastolic is weaker; which however is usual in any diastolic correlation between non invasive and invasive device. The CPT does not modify the correlations. Moreover the Finapres allows dynamic exploration which is of particular interest in obese persons because their blood pressure is particularly variable.

Blood Pressure↗
PubMed1991

[Dissecting aneurysm of the left iliac artery disclosing Marfan's disease].

Marfan's syndrome only very rarely presents as a peripheral arterial complication. In the case described, dissection of the left iliac artery in a 52-year-old man presented as intermittent claudication of sudden onset and enabled the diagnosis of previously unrecognised Marfan's syndrome on the basis of great height, a dorsal kyphoscoliosis, a positive family history and aortic abnormalities. Treatment based upon vasodilators and platelet antiaggregation enabled a favourable outcome with frequent monitoring.

Aortic Dissection↗
PubMed1991

[Ambulatory blood pressure: methods, equipment, technical problems, validations].

The measurement of ambulatory blood pressure provides a discontinuous recording which reflects the pressure load over a 24 hour period. The latest recorders allow the patient a relative autonomy due to discontinuous but programmable recording and the miniaturisation of the recorder and relative silence during inflation of the cuff. The main disadvantage of the technique is the necessity of interruption of the patient's physical activity at the moment of recording indicated by an audible "beep". The concept of "active pressure load" is therefore illusory. The traditional controversy between supporters of the auscultatory versus those for the oscillometric method is far from being settled and these discussions do not resolve the problem. The use of finger plethysmographic techniques (Finapress-Ohmeda) is an interesting approach but limited for the time being by the necessity of confinement to a laboratory and recordings of short durations requiring strict conditions of ambient temperature. Future developments using ultrasonic techniques may provide a solution to these problems.

Ambulatory Care↗
PubMedDate not supplied

Doppler flow wire evaluation of renal blood flow reserve in hypertensive patients with normal renal arteries.

PURPOSE: To study the vasomotor responses of the renal microcirculation in patients with essential hypertension. METHODS: We studied the reactivity of the renal microcirculation to papaverine, with intraarterial Doppler and quantitative arteriography, in 34 renal arteries of 19 hypertensive patients without significant renal artery stenosis. Isosorbide dinitrate was given to maximally dilate proximal renal arteries. APV (average peak blood flow velocity) was used as an index of renal blood flow. RESULTS: Kidneys could be divided into two distinct subgroups based on their response to papaverine. An increase in APV of up to 55% occurred in 21 kidneys, an increase > 55% in 13 kidneys. Within each group the values were normally distributed. Both baseline APV and the effect of papaverine on mean velocity differed significantly between groups. CONCLUSION: There seems to be a subgroup of patients with essential hypertension that has an impaired reactivity to papaverine, consistent with a functional impairment of the renal microcirculation. Further studies are required to determine whether this abnormality contributes to or results from elevated blood pressure.

Analysis of Variance↗
PubMedDate not supplied

Effects of beta-adrenergic blockade on short-term variability of blood pressure and heart rate in essential hypertension.

Short-term fluctuations in blood pressure (BP) and heart rate (HR) were analysed in a group of twelve males with essential hypertension. Indirect finger BP was measured by a Finapres device. The effect of a 7-day administration of a cardioselective beta-adrenoceptor blocker, acebutolol (400 mg/day), was studied in a double-blind, randomized, placebo-controlled cross-over study. Compared with placebo, acebutolol caused a significant decrease in BP and HR. In addition, the standard deviation (SD) of BP and HR were reduced after acebutolol in the standing position. Spectral analysis of fluctuations in BP showed a reduction in the variability underlying the SD changes of BP and HR. This reduction predominated in the mid frequency (MF) region corresponding to Mayer waves. This effect was marked for HR since the MF component for standing HR after acebutolol was 46% the placebo level. The average reduction in MF component for standing Systolic BP (SBP) was 36%. No significant correlation was found between the Mayer wave reduction and the systolic, diastolic BP or HR lowering effect of acebutolol. No significant changes in the gain of the transfer function between MF SBP and HR fluctuations in the standing position were observed. The reduced MF component of HR and BP variability after acebutolol could be due to a peripheral cardiac and non-cardiac sympatholytic effect of chronic beta-adrenoceptor blockade.

Acebutolol↗