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Biomedical subjects

F Fernandez

Publications and source records attributed to F Fernandez.

At least 163 records · Page 9Linked to original sources
PubMed1983

[Effects of diltiazem on cardiac and coronary circulation, at rest and during rapid auricular electric stimulation].

The effects on cardiac performance and systemic and coronary blood flow of rapid atrial pacing alone and associated with an intravenous infusion of a slow calcium channel inhibitor, diltiazem, at a dose of 20 mg/kg were studied in 20 patients with chronic coronary artery disease. Atrial pacing increased coronary flow and myocardial oxygen consumption: it decreased coronary arterial resistance and the coronary arteriovenous difference in lactates. Left ventricular end diastolic pressure rose significantly compared to the basal state in the period following pacing. The administration of diltiazem was associated with a significant fall of femoral arterial pressure, of coronary arteriovenous difference and myocardial consumption of oxygen, and an increase in the coronary arteriovenous difference in lactate. Left ventricular end diastolic pressure did not differ significantly from the basal values recorded after terminating atrial pacing. Left ventricular end diastolic volume decreased. Diltiazem opposed or cancelled the undesirable effects of rapid atrial pacing with respect to coronary arteriovenous difference in lactate content. The beneficial action of diltiazem does not seem to be closely related to its hemodynamic effects. It could be related to a reduction in myocardial oxygen demands due to a decrease in systolic ventricular strain and the specific metabolic effects of the drug, and also to an increase in myocardial oxygen supply due to the reduction in left ventricular end diastolic stress and the coronary vasodilation caused by the drug.

Adult↗
PubMed1982

Longitudinal anthropometric measurements in patients with growth hormone deficiency. Effect of human growth hormone treatment.

The effect of human growth hormone (6IU/m2 twice weekly i.m.) on standing, sitting, and subischial leg height, on arm length, head circumference, fronto-occipital and biparietal head diameter, bi-iliac (pelvis) and bihumeral (shoulder) width, body weight, triceps and subscapular skinfold thickness, and upper arm and calf circumferences was studied longitudinally over a period of 2 years in 37 prepubertal growth hormone deficient patients (29 boys, 8 girls). Thirteen of them had isolated growth hormone deficiency, 18 combined defects with other anterior pituitary hormone deficiencies, and 6 had been operated for a craniopharyngioma. The most retarded height and length measurements were influenced most markedly by treatment in the fashion of a characteristic catch-up growth, while head circumference, which was less retarded initially, increased more slowly. With exception of craniopharyngioma patients, who became slightly eunuchoid, both proportions (sitting height versus subischial leg height) were not changed by treatment. The disproportions of shoulder and hip width (relatively wide pelvis, narrow shoulders before treatment) tended to be normalized. The results in patients with operated craniopharyngioma were not as good as in those with idiopathic growth hormone deficiency.

Adolescent↗
PubMed1982

[Rate-pressure product and myocardial oxygen requirements].

The relationship between the rate-pressure product, myocardial oxygen consumption and the production or uptake of lactate by the myocardium was studied in 45 patients under basal conditions and rapid atrial pacing (except in 3 cases with atrial fibrillation). The underlying pathology was ischemic heart disease in 25 cases, non obstructive cardiomyopathy in 9 cases, and obstructive cardiomyopathy in 11 cases. Contrary to what has been reported in normal subjects, a significant linear relationship between the rate-pressure product or indexed rate-pressure (multiplied by body surface area) and myocardial oxygen uptake. The divergence of these results may be due to the method of measuring coronary sinus blood flow, these authors having used the N 20 whereas in this study the flow was measured by thermodilution. In particular, it is possible that this divergence results from abnormalities of ventricular volume, compliance and contractility in the patients under study: these abnormalities may disturb the relationship between the rate-pressure product and myocardial oxygen consumption in normal subjects. A double linear relationship, different in each of these groups, was observed at rest between the indexed rate-pressure product and oxygen uptake, and the uptake or production of lactate: in myocardial ischemia without ischemia at rest, in non obstructive cardiomyopathy in sinus rhythm. The significance of these relations differed in each of these groups. Under atrial pacing, the increase in indexed rate-pressure product compared to basal conditions was proportional to the presence of absence of ischemia. Variations of the indexed rate-pressure product seem to be related to myocardial oxygen consumption and not to myocardial oxygen requirements. The variations of the rate-pressure product, during the administration of drugs, for example, do not reflect myocardial oxygen needs. During exercise ECG, the maximal increase in the indexed rate-pressure product reflect the functional reserve of the myocardium.

Blood Pressure↗
PubMed1982

[Coronary arteriovenous fistula. Apropos of a case with thallium myocardial scintigraphy and study of pre- and postoperative myocardial metabolism].

Coronary angiography performed in a 62 year old man with spontaneous chest pain revealed a congenital fistula in the form of a vascular network arising from the proximal part of the left anterior descending artery and draining into the main pulmonary artery. A single severe atheromatous stenosis of the right coronary artery was observed. Thallium 201 myocardial scintigraphy at rest showed a large area of hypofixation in the artero-septo-apical zone. Myocardial and aorto-right coronary bypass, myocardial scintigraphy became almost normal, leaving a small antero-septal and apical deficit: myocardial metabolism returned to normal. The fact that lactate metabolism is a particularly sensitive index of myocardial hypoxia in the territory of the left coronary artery suggests a probable coronary steal syndrome induced by the fistula; this is probably also the cause of the isotopic hypofixation in the territory of the left anterior descending artery which emphasizes the value of Thallium myocardial scintigraphy in the study of congenital malformations of the coronary artery.

Arteriovenous Malformations↗
PubMed1982

[Prevalence and electrocardiographic forms of the Wolff-Parkinson-White syndrome].

In a routine electrocardiographic study of 133929 subjects aged from 20 to 73, 136 cases of the Wolff-Parkinson-White syndrome were detected, 6 with intermittent pre-excitation. In this study, the prevelance of WPW was about 1 in a 1000, the highest incidence being in the 20-40 year age group with an equal sex ratio. The ECG analysis of the 136 cases consisted in determining the orientation of the delta wave in the precordial leads to establish the right or left ventricular origin of the pre-excitation, calculating the direction of the delta wave vector in the frontal plane to find out the anterior, lateral or posterior origin of the pre-excitation and analyse the position of the QRS axis to assess the appearances of the latest ventricular activity. The 136 ECGs were then classified according to electrophysiological criteria and the results of mapping: 1. Left ventricular pre-excitation; 74 cases characterised by a dominant delta wave in the right precordial leads. These cases were subdivided into: - 30 cases with posterior paraseptal pre-excitation, axis of the delta wave deviated superiorly and to the left, between -30 degrees and -60 degrees; - 20 cases of lateral pre-excitation with the vector of the delta wave deviated inferiorly and to the right between +100 degrees and +120 degrees; - 24 cases of anterior paraseptal pre-excitation with high amplitude delta and QRS deflections in all precordial leads and a delta wave axis between +50 degrees and +80 degrees. 2. Right ventricular pre-excitation; 62 cases characterised by a negative or isoelectric delta wave in the right precordial leads, including: - 14 posterior paraseptal pre-excitation with significant delta wave axis deviation between -30 degrees and -60 degrees; - 33 lateral pre-excitation with the delta and QRS axis pointing directly to the left at about 0 degrees; - 15 cases of anterior paraseptal pre-excitation with the delta wave axis between +50 degrees and +80 degrees. The cases with terminal forces of left ventricular activation in the same direction as the delta wave, superiorly and to the left at -60 degrees or inferiorly and to the right at +120 degrees, forming a single deflection of over 0,12 seconds' duration, are the result of delayed activation of the anterior or posterior fascicle of the left bundle after a long delay. On the other hand, the cases in which the direction of the pre-excitation is the same but the final part of ventricular activation moves away from the delta are probably the result of tension between the activation of the normal and accessory pathways.

Adult↗
PubMed1982

[Obstructive hypertrophic myocardiopathy and Osler's endocarditis].

Four cases of bacterial endocarditis (BE) complicating hypertrophic obstructive cardiomyopathy (HOCM) were observed between 1978 and 1980. The causal organism was a streptococcus in all cases and the portal of entry, dental. The mitral regurgitation (MR) observed in HOCM as an epiphenomenon of the obstruction became autonomous in 2 patients as shown by phonocardiography with methoxamine. In one case, the MR became severe and justified mitral valve replacement; at surgery, the chordal rupture suspected on echocardiography was confirmed. Antibiotic therapy was effective on the infectious process in all cases. However, 2 of the 4 patients died, one of thrombosis of the mitral prosthesis on the 15th postoperative day, and the other of a cerebrovascular accident. None of the patients had a detectable aortic or septal infectious lesion. Eight of 27 reported cases (30 p 100) of HOCM complicated by BE were operated; 10 (37 p. 100) died as a result of the endocarditis. These cases underline the incidence of BE in HOCM (5 p. 100) its gravity and the necessity for systematic antibiotic prophylaxis, especially before dental treatment.

Adult↗
PubMed1981

[Obstructive cardiomyopathy and stenosing coronary atherosclerosis. Apropos of 5 cases].

Five cases of hypertrophic obstructive cardiomyopathy with coronary artery disease are reported; 2 males and 5 females, aged 27, 49, 64, 67, and 70 years respectively. Four patients had angina, the other being asymptomatic. The diagnosis of hypertrophic obstructive cardiomyopathy was based on the presence of at least 4 of the following 5 signs: an ejectional systolic murmur, an external carotid pulse tracing showing a second endsystolic peak, an echocardiogramme showing both systolic anterior motion of the mitral valve and asymmetrical septal hypertrophy biloculation and/or disaxation of the left ventricular cavity on selective angiography, and a spontaneous or provoked intraventricular pressure gradient of over 30 mm Hg. Coronary angiography showed one or more stenoses of over 70% on at least one of the three main coronary arteries in all patients. Two of the 5 patients underwent coronary artery bypass surgery without myomectomy; the remaining 3 patients were treated medically. All patients have been followed up for periods ranging from 8 months to 6 years (average: 4 years) with a favourable outcome in 4 of them who are currently asymptomatic; the other patient has moderate angina (non-operated, treated with propranolol). The frequency of the association of hypertrophic obstructive cardiomyopathy and coronary artery disease was initially underestimated, but in fact it does not appear to be uncommon. The association would seem to be fortuitous. The long-term prognosis is not known and the management is not codified. It would seem logical to propose simultaneous surgical correction of the two conditions by myomectomy and coronary bypass surgery when anatomically possible, when beta blocker therapy fails, despite a relatively high operative risk, according to the few published cases.

Adult↗
PubMed1981

[Coronary arteriography and long-term prognosis in postero-inferior infarction. Methodological reflections apropos of a preliminary retrospective survey].

Most studies of the long term prognosis after myocardial infarction take only parameters reflecting the quantity of necrosed cardiae muscle and the resulting disturbances in left ventricular function into account. Coronary arteriography should give a more precise assessment by the detection of stenoses on arteries supplying healthy myocardium, especially in small infarcts. This concept was tested in a retrospective study of 100 patients investigated 1 to 12 months after inaugural posterior or inferior myocardial infarction between 1970 and 1979, and followed-up for an average of 32,5 months. THe survival curves of subgroups defined by angiographic parameters were compared by Mantel's method. The 5 year survival rate was 91,2 +/- 3,4%, corresponding to a mortality of 26 deaths per 1000 patients year. This very low mortality rate may be related on the one hand to the selection of the patients, especially those investigated at a distance from the infarct, and on the other hand, to the role of drug therapy. The number of patients required to compare two therapeutic protocols would be necessarily high because of the low overall mortality. The 5 year survival rate without a serious cardiac event (death, recurrent infarction, deterioration to Stages III or IV of the NYHA Classification, acute coronary insufficiency), was 76,8 +/- 6.4%. The only discriminating angiographic sign in this study was the number of diseased vessels: triple vessel disease significantly increased the risk of a serious cardiac event, (p less than 0,04). The preliminary results have led to the establishment of a stricter protocol designed to improve the indications of coronary arteriography in postero-inferior infarction.

Angiography↗
PubMed1981

Cerebral infarction associated with Mycoplasma pneumoniae.

An 8-year-old girl with a cerebral infarction and pneumonia developed the acute hemiparesis associated with clinical and serologic evidence of Mycoplasma pneumonia infection. Mycoplasma complement fixation titers increased from 1:1,024 on the tenth day of illness to 1:greater than 16,384 at three weeks and subsequently decreased to 1:512 at seven weeks. Total resolution of her facial weakness, hemiparesis, dysphagia and dysarthria occurred by eight weeks.

Ampicillin↗
PubMed1980

Anthropometric measurements in patients with growth hormone deficiency before treatment with human growth hormone.

In 74 children (52 males, 22 females) with growth hormone (GH) deficiency (30 cases with isolated GH-deficiency, two of them familial; 4 familial and one isolated case with tendency for formation of antibodies against hGH; 29 with other pituitary hormone defects; 10 craniopharyngiomas), various anthropometric measurements were analyzed before treatment with hGH. In all groups, standing height, sitting height, and subischial leg height were equally retarded, and bihumeral width was more retarded than biiliac width; the head was relatively large; fat tissue was increased with subscapular skinfolds being greater than triceps skinfolds, indicating relative obestiy of the trunk; muscle and/or bone mass was reduced. In isolated GH-deficiency, head shape was slightly scaphoid; in combined defects, it was round, and in craniopharyngioma cases, it was brachycephalic. It is concluded that antrhopometric measurements may help in differentiating the type of GH-deficiency.

Adolescent↗