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Biomedical subjects

E Moncada

Publications and source records attributed to E Moncada.

At least 19 recordsLinked to original sources
PubMed1997

Effects of cholinergic blockade on nocturnal thyrotropin and growth hormone (GH) secretion in type I diabetes mellitus: further evidence supporting somatostatin's involvement in GH suppression.

To investigate the influence of cholinergic pathways on somatostatin (SS) tone in type I diabetes mellitus, we studied the effect of the muscarinic receptor antagonist pirenzepine ([PZP] 100 mg orally) on spontaneous nocturnal growth hormone (GH) and thyrotropin (TSH) secretion and on their response to GH-releasing hormone (GHRH) in the morning in a group of nine insulin-dependent diabetic patients with poor diabetic control. When the nocturnal period was divided into two phases (11:00 PM to 2:30 AM and 3:00 AM to 6:00 AM), both GH and TSH mean concentrations during the first phase were higher than those seen in the second half of the night following placebo administration (GH, 13.4 +/- 1.1 v 4.15 +/- 0.9 ng/mL, P < .001; TSH, 1.9 +/- 0.21 v 1.57 +/- 0.1 microU/mL, P < .05). Pretreatment with PZP induced a significant reduction of GH secretion (3.17 +/- 1.1 v 13.4 +/- 1.1 ng/mL, P < .001) and TSH secretion (1.61 +/- 0.21 microU/mL, P < .05) in the first phase of the night, accounting for a 64% and 11% reduction in the GH and TSH nocturnal peak, respectively. PZP reduced the GH response to GHRH in the morning (17.9 +/- 2.7 v 36.7 +/- 6.3 ng/mL, P < .05), but did not induce any change in TSH values at that time. A positive relationship (r = .73, P < .01) was observed between the percent reduction of the GH response to GHRH and that of the nocturnal GH peak following PZP administration. PZP caused a significant reduction in glucose levels during the second phase of the night (6.4 +/- 0.92 v 9.81 +/- 0.85 mmol/L, P < .05). These results demonstrate that administration of PZP reduces GH and TSH secretion, providing further support for the involvement of SS in the inhibition of GH secretion induced by cholinergic antagonists in type I diabetics. The inhibitory effect of PZP on GHRH-induced GH secretion may help to predict nocturnal GH behavior following administration of the drug.

Administration, Oral↗
PubMed1996

Symptomatic pericardial disease associated with patch electrodes of the automatic implantable cardioverter defibrillator: an underestimated complication?

Constrictive pericarditis can be associated with ICD patch electrodes. During a mean follow-up of 24 months, in a population of 35 patients who received ICDs with a patch electrodes configuration, we identified three patients with clinical and hemodynamic signs compatible with this event. Patient 1, a 35-year-old male, underwent implantation of an ICD because of a primary electrical disease complicated by cardiac arrest. Fourteen months later he complained of exertional dyspnea without any signs of heart failure. Right heart catheterization showed high filling pressures and diastolic dip and plateau in pressure curves. Thoracotomy and pericardial exploration were performed. Three months after removal of the patches and insertion of an endocardial lead system, the patient had normal respiration. Patients 2 and 3, who suffered from coronary heart disease without heart failure, exhibited a hemodynamic profile suggestive of constrictive pericarditis: in one patient, 10 months after ICD implantation, associated with right heart failure; and in the other, 18 months after ICD implantation with left heart failure. Patch electrodes were removed in these two patients and replaced by endocardial lead electrodes with subsequent clinical improvement. It is concluded that constrictive pericarditis related to epicardial patch is not an uncommon occurrence during ICD therapy and should be considered in patients who show clinical signs of cardiac decompensation.

Adult↗
PubMed1995

[Radiofrequency ablation of intranodal tachycardia].

The first radical approach to the treatment of atrioventricular nodal reentrant tachycardia was surgical dissection of the perinodal region. This technique has been replaced by the delivery of radiofrequency energy by an ablation catheter to the region of the atrioventricular node. The aim of this report is to describe the authors' experience of atrioventricular nodal application of radiofrequency current. The study comprised 53 cases (32 women and 21 men, mean age 46 +/- 17 years) with frequent attacks of reciprocating tachycardia. Endocavitary electrophysiological investigation confirmed the intranodal reentrant mechanism. The region of application of the radiofrequency current was located radiologically and then the precise site determined by the recording of nodal electrical activity. The appearance of junctional rhythm during the procedure was also used as a means of identification of the zone of ablation. Dual conduction persisted after ablation in 35 patients. However, no episode of tachycardia could be induced after the procedure. The AH interval increased during application of radiofrequency current in 3 cases but this abnormality regressed in the 2 months following the procedure. Recurrences of nodal reentrant tachycardia were observed in 14 cases (26%), 24 hours to 2 months after ablation. The rate of recurrence was significantly higher in patients who did not have a junctional rhythm during application of the radiofrequency current (62% vs 4%, p < 0.05). The number of recurrences was also greater in the group of patients with persistence of slow intranodal conduction after the radiofrequency ablation (p < 0.04). A second session of radiofrequency ablation was undertaken in 14 patients and a third session was required for 2 of them.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Benign indomethacin-responsive headaches presenting in the orofacial region: eight case reports.

Indomethacin-responsive headaches can present in the orofacial region. According to the classification of headache by the International Headache Society, indomethacin-responsive headaches include chronic paroxysmal hemicrania, hemicrania continue, benign cough headache, benign exertional headache, and sharp, short-lived headache pain syndrome. The mechanism by which indomethacin produces its therapeutic effects in these headache disorders remains speculative. A review of indomethacin-responsive headaches and eight cases in which the presenting symptom was orofacial pain are reported. Because these headache disorders are rare but may present as facial pain, they should be considered in the differential diagnosis of orofacial pain. A comprehensive evaluation prior to performing irreversible treatments is essential when an idiopathic facial pain presents to the dental clinician.

Adult↗
PubMed1994

Radiofrequency ablation of atrial flutter. Efficacy of an anatomically guided approach.

BACKGROUND: Previous reports have shown that radiofrequency ablation can terminate atrial flutter and prevent recurrences. However, different methods have been used, and the current experience remains limited. The objective of the present study was to determine the efficacy of radiofrequency ablation of atrial tissue in patients with atrial flutter using an anatomically guided approach. METHODS AND RESULTS: We treated 22 patients aged 30 to 73 years. Atrial flutter was recurrent for a mean of 5 years despite the administration of multiple antiarrhythmic drugs. Radiofrequency current was directed to the atrial isthmus between the inferior vena cava and the tricuspid ring, regardless of the morphology of local electrograms. Radiofrequency energy was applied during typical atrial flutter in 12 patients, atypical atrial flutter in 2 patients, and successively both forms in 8 patients. In 19 patients, atrial flutter abruptly terminated. In 3 patients, atrial flutter persisted despite 37, 48, and 25 applications, respectively. Atrial recordings demonstrated that atrial flutter termination occurred as a consequence of conduction block at the site of radiofrequency energy application, regardless of the type of atrial flutter. The number of applications before termination ranged from 1 to 82 (mean, 32). Atrial flutter could no longer be induced in every case. There were no complications. During a 13-month mean follow-up, atrial flutter recurred in only 2 of the 19 patients who had a successful ablation. Four patients experienced chronic atrial fibrillation, and 2 of them returned to sinus rhythm with antiarrhythmic therapy. CONCLUSIONS: Radiofrequency ablation of atrial flutter using anatomic guidance is feasible and effective. Further experience is needed to delineate its role as an alternative approach to the management of refractory atrial flutter.

Adult↗
PubMed1994

[Hemomediastinum caused by spontaneous rupture of the thoracic aorta].

The authors report the rare case of spontaneous rupture of the aortic isthmus in the absence of preexisting aortic aneurysm or dissection in a hypertensive woman presenting with chest pain and haemomediastinum. The history of trauma 30 years previously, could have been a predisposing factor. The diagnosis of this condition remains difficult and is often missed. The physiopathological, aetiological, clinical and diagnostic features are reviewed. Transoesophageal echocardiography showing an intraparietal haematoma confirmed the aortic origin of the haemomediastinum. Conventional angiography was of no value in the reported case because of the absence of rupture of continuity or of an intimal tear.

Aged↗
PubMed1994

[Long-term course after electric ablation of the bundle of His in the treatment of supraventricular tachycardia].

The authors report the long term results of His bundle ablation for supraventricular tachycardia in a series of 49 patients. This retrospective study was based on a patient population of 27 men and 22 women with an average age of 59 at the time of ablation, between 1984 and 1993. The indication for His bundle ablation was invalidating supraventricular tachycardia resistant to antiarrhythmic therapy in all cases. One group of patients (Group I, n = 31 patients) underwent high energy electrical shock and the second group (Group II, n = 18 patients) recruited after 1991, underwent radiofrequency catheter ablation. Complete atrioventricular block was obtained in the first group in 1 to 4 sessions whereas 17 patients of Group II were treated in a single session. During a follow-up period of an average of 40 months, 2 patients were lost to follow-up and 6 died, 3 of cardiac failure, 1 of a cerebrovascular accident, 1 of pulmonary carcinoma and 1 of unknown cause. In Group I, atrioventricular conduction persisted in 1 patient (primary failure) and reappeared in one other patient, but, in Group II, complete atrioventricular block persisted even in the patient in whom the interruption was not obtained with a single session of radiofrequency ablation. The patients were generally physically improved and satisfied not to have any palpitations. A decrease in exercise capacity estimated by the NYHA classification was observed in 38% of patients without apparent cardiac disease who developed dyspnea. On the other hand, 43% of patients with cardiac disease and in NYHA class > or = 2 were improved.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Intracardiac treatment of atrial flutter by radiofrequency currents].

Though not as common as atrial fibrillation, atrial flutter is frequently encountered in everyday cardiological practice. Though generally thought to be benign, it may be difficult to treat both in respect to its conversion to sinus rhythm and prevention of recurrences. It is often poorly tolerated. There are resistant, invalidating forms for which catheter ablation of the His bundle may be considered as a last resort. This is only a palliative measure even if effective from the functional point of view. A new technique for treating atrial flutter by a direct action on the atrial tissue has been recently introduced. The basis of this method is the concept of circus movement of the activation in the right atrium, the wave front circulating in an anti-clockwise direction in common atrial flutter. The postero-inferior region of the right atrium, at Koch's triangle, is the site of slow conduction and the target of choice for catheter ablation. The detection of this zone is determined by the endocavitary recording of fragmented, prolonged electrogrammes and by atrial stimulation techniques. The application of radiofrequency currents on these bases (high energy shocks are rarely used nowadays) results in interruption of atrial flutter. However, there are no data available concerning the long-term efficacy of this technique. Since 1992, our group has used an anatomical approach for catheter ablation. This aims to apply the radiofrequency current on the isthmus of atrial tissue between the orifice of the inferior vena cava and the tricuspid annulus through which the flutter wave front passes to reach the interatrial septum.(ABSTRACT TRUNCATED AT 250 WORDS)

Atrial Flutter↗
PubMed1993

Cough headache presenting as a toothache: a case report.

Benign cough headache (BCH) presents as an intermittent, usually bilateral, severe bursting or explosive pain brought on by coughing. Some of the known conditions which can mimic the pain experienced in BCH are subarachnoid hemorrhage, increased intracranial pressure, intracranial tumors, and even toothache. Careful evaluation must be carried out in order to differentiate between these conditions. A case of BCH which presented as a toothache is reported. The evaluation for exertional headaches, and for headaches brought on by coughing, is discussed.

Cough↗
PubMed1993

[Ablation of accessory pathways by radiofrequency current. Towards a simplified approach of Wolff-Parkinson-White syndrome?].

From December 1990 to April 1992, 41 consecutive patients (22 men and 19 women with an average age of 35 +/- 16 years -6-72) underwent ablation of accessory atrioventricular conduction pathways (Bundles of Kent) for poorly tolerated and/or medically resistant supraventricular tachycardias. In 33 cases, the arrhythmia was a paroxysmal SVT, in 7 cases atrial fibrillation, and in 1 patient incessant junctional tachycardia causing left ventricular dysfunction. The Wolff-Parkinson-White syndrome was apparent in 30 patients and concealed in 11 cases. The location of the Kent bundle was left lateral in 22 cases (53.7%), posterior paraseptal in 9 cases (21.9%), right lateral in 5 cases (12.2%) and anterior paraseptal in 5 cases (12.2%). The Kent bundles were ablated by radiofrequency currents in 38 cases (92.7%); in 2 patients (4.9%) in whom radiofrequency could not be used (increased impedance) high energy electrical shock was successful. In one patient (2.4%), it was not possible to suppress the Kent bundle. A single session of radiofrequency ablation was sufficient in 33 cases: 7 cases (17.5%) required 2 (4) or 3 (3) sessions. The average number of sites of application per patient was 8.8 +/- 8.8. The duration and intensity were respectively 32.2 +/- 9.3 (5-60) seconds and 25 +/- 15 (20-30) watts. With an average follow-up of tachycardia or of ventricular preexcitation have been observed in the 40 patients. In addition, in 36 patients, electrophysiological control studies confirmed the initial result with absence of any disturbance of nodohisian conduction.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

[Multiple hepatic-splenic abscesses. A favorable result with antibiotic treatment].

The authors report a case of multiple and spleen pyogenic abscesses caused by Peptostreptococcus spp., in a patient who recently underwent laparotomy due to duodenal perforation. He was successfully treated by means of intensive and extended antibiotherapy. We would like to stress the importance of an early and etiological diagnosis performed by percutaneous puncture and bacteriological study, in order to start a selective antibiotherapy. Other therapeutical possibilities are discussed.

Abscess↗
PubMed1993

[Prognosis and long-term development of arrhythmogenic dysplasia of the right ventricle].

The authors studied the clinical, angiographic and electrophysiological features, and the long-term outcome of patients with arrhythmogenic right ventricular dysplasia (ARVD). The study was retrospective and involved 22 patients (3 women and 19 men) with an average age of 36 years at the time of their first documented ventricular tachycardia (VT) and admitted to hospital between 1971 and 1989. The diagnosis of ARVD was based on the association of monomorphic VT with a left bundle branch block morphology and right ventricular abnormalities on angiography. Fifteen patients were treated by antiarrhythmic drugs alone, 5 by antiarrhythmic drugs and tachycardia ablation and 2 by antiarrhythmic drugs and cardiac transplantation. An automatic defibrillator was implanted in one patient. After the first episode of VT, the beginning of follow-up, the criteria of evaluation were mortality, right heart failure and the evolution of the arrhythmia. The study population had the following characteristics. Familial forms or ARVD were observed in 18%. The mitral ventricular arrhythmia was often induced by exercises (45%). Twenty-one patients had a sustained VT and 1 patient had non-sustained VT. The resting ECG in sinus rhythm was abnormal in all cases. Thirty-two different VT morphologies were recorded. The abnormalities of the right ventricular wall motion on ventriculography were localised in 45% of cases and diffuse in 55% of cases. Seventy per cent of patients undergoing electrophysiological investigation had inducible sustained VT. The clinical outcome after an average of 10.7 years' follow-up was: 17 survivors, 3 sudden deaths and 4 cases of right ventricular failure. The 10 year actuarial survival rate was 75%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗