Biomedical subjects

F Philippe

Publications and source records attributed to F Philippe.

At least 19 recordsLinked to original sources

PubMed2006

[Erectile dysfunction, a new symptom for the cardiologist].

During many years, the symptom of erectile dysfunction was a matter for the urologist or the sexologist without efficacious treatment. Since 1999, the unexpected efficacy of sildenafil initially tested as a coronary vasodilatator emphasized the major role of an endothelial dysfunction potentially corrected by type 5 phosphodiesterase inhibitors (5-PDEI), which are able to reinforce the NO-dependant vasodilatation of cavernous arteries. Due to the medicalisation and the mediatisation of erectile dysfunction during the past five years, this symptom is now a matter for the cardiologist. The first reason was the query of cardiovascular safety of 5-PDEI. American and Britannic registries have established a good cardiovascular tolerability of these drugs including in patients with coronary heart disease according to the respect of contraindication in cases of coprescription with nitrates. The second was the association of erectile dysfunction with many cardiovascular risk factors concerned by the cardiologist. The third reason was the observation that erectile dysfunction could be a potential marker to identify patients with silent myocardial ischemia and relevant coronary artery disease. The Princeton consensus provides guidelines to help the cardiologist in the evaluation of patients with erectile dysfunction according to the cardiovascular risk level. Henceforth, erectile dysfunction should be considered by the cardiologist as "a sound of silence" of myocardial ischemia and should encourage to more aggressive evaluation and treatment of cardiovascular risk factors.

Cardiology↗

PubMed2006

[Effects of video information in patients undergoing coronary angiography].

BACKGROUND: informed consent is a fundamental and legal obligation for each interventional cardiologist. The effect of consent form describing risks of invasive procedure on anxiety is controversial. This trial was aimed to assess the added value of video information to the standard informed consent process. METHODS: 200 consecutive patients undergoing coronary angiography were enrolled. The first one hundred were assigned to conventional education conducted by the physician (no video group) and the second one hundred had consent obtained in the conventional manner assisted by video information (video group). The outcome variables for this comparison consisted of a standard anxiety score (Spielberger Statement Anxiety Inventory questionnary) plus hemodynamics measurements of heart rate, systolic and diastolic blood pressure obtained at baseline and immediately after written informed consent In addition, before discharge, patients graded the tolerability and satisfaction on a 4-point scale. RESULTS: The groups were similar with regard to their baseline characteristics and anxity score (37+23 vs 37+23). Patients who had not had prior experience of catheterization had higher baseline anxiety than those who had prior angiography (45 + 22 vs 31 + 20; p = 0.027). Patients who watched the video were significantly less anxious after informed consent (28 + 21 vs 34 + 22; p = 0.048) and had a significantly lower heart rate (65 + 10 vs 71 + 12; p = 0.03). The benefits of video information were especially prominent in those with higher anxiety scores at baseline (score after 45 + 24 vs 57 + 26; p = 0.046). Tolerability were higher in the video group compared with no video group (98% vs 86%; p = 0.003). Finally, satisfaction of information for informed consent process was higher in video group than in no video group (99% vs 76%; p = 0.001). CONCLUSION: a video information decreased anxiety level after written informed consent and improved tolerability and satisfaction scales in patients undergoing coronary angiography. The most likely to benefit from video information are patients with higher anxiety level at baseline. Beneficial effect on informed refusal should be investigated in larger population.

Adaptation, Psychological↗

PubMed2005

[Management of acute coronary syndromes in a new French coronary intensive care unit. The first four years of activity in the GRACE registry (Global Registry of Acute Coronary Events)].

UNLABELLED: The GRACE registry provides the opportunity to analyse management of acute coronary syndromes in the real word and the impact of hospital characteristics. In this setting, we compare the activity of a new coronary intensive care unit with regional data. METHODS: From January 2000 to December 2003, 376 eligible patients were involved (22% of regional inclusion). GRACE standard diagnosis were the following, for our centrer (for the cluster): ST elevation myocardial infarction 28% (37%), non-ST elevation myocardial infarction 32% (31%), unstable angina 33% (24%). Demographic characteristics were similar with a median age of 64 (vs 66) and a large majority of male (74 vs 81%). Medical history and cardiovascular risk factors were comparable. Predictors of hospital mortality were observed at the same rate: cardiogenic shock (3 vs 3%), congestive heart failure > Killip 2 (4 vs 4%), left ventricular ejection fraction (LVEF) lower than 40% (17 vs 16%), recurrent ischemic symptoms (8 vs 8%). Coronary artery bypass grafts were required in 5% (vs 2%). RESULTS: Drugs prescription rates were similar: aspirin at admission (95%) and at discharge (95%), betablocker at admission (70%) and at discharge (85%), statin at admission (< 30% in 2000, > 60% in 2003) and at discharge (< 60% in 2000 and > 80% in 2003), ticlopidin-clopidogrel at admission (< 20% in 2000 and > 40% in 2003), ACE inhibitor for LVEF < 40%, intravenous GPIIblIIa, and low molecular weight heparin (90%). Cardiac catheterisation (90%) and percutaneous coronary interventions (80%) were performed at the same rates in our center and in the cluster. Hospital death was similar (2 vs 4%). Discharge status was home for a large majority of patients (63 vs 76%). The median length of stay was five days and shorter than three days for patients with unstable angina. CONCLUSION: Based on GRACE registry data, the present evaluation revealed that our new center offered evidence-based medical and interventional therapy in patients with acute coronary syndromes at the same level than experienced institutions with similar results for hospital death and length of stay.

Aged↗

PubMed2005

[Drug eluting stents: from evidence based medicine to clinical practice].

Drug eluting stents have been developed in order to reduce in-stent restenosis observed with a 20 to 40% rate in bare-stents. Neoinitimal smooth muscular cells proliferation have been characterized as the corner stone of in-stent restenosis. Consequently, many anti-mitotic and anti-inflammatory drugs have been evaluated in a new stent generation, so called coated stents or drug eluting stents. Three major components must be considered to evaluate the beneficial effects: the bare-stent, the drug, and the deliverance system, most usually a polymer. For the present, sirolimus eluting stent and paclitaxel eluting stent are available in the market with the european conformity label considering evidence based medicine established in randomized trials. Both stents have been shown to reduce in-stent restenosis incidence to less than 7%. Long-term follow-up still remain expected and would give answers to two safety queries: what is about the incidence of late stent thrombosis, what is about mal-apposition consequences in clinical feature. Utilization of drug eluting stent in clinical practice must considered materials with european conformity and must applied French society of cardiology guidelines restricting implantation to patients who meet high-risk restenosis criteria. Medicoeconomic approach must be considered beneficial at the present only in patients with high restenosis risk. Long-term antiplatelet regimen of aspirin and clopidogrel must be considered to avoid late stent thrombosis.

Clinical Trials as Topic↗

PubMed2005

A nationwide study of granulosa cell tumors in pre- and postpubertal girls: missed diagnosis of endocrine manifestations worsens prognosis.

BACKGROUND: There are very few data on the natural history of ovarian granulosa cell tumors (OGCT) in children. The aim of this study was to determine whether early recognition and diagnosis of the initial endocrine signs could improve the outcome of these tumors. METHODS: In a nationwide study from 1990 to 2004, we analyzed the clinical, biological and pathologic data from 40 pre- and postpubertal girls presenting an OGCT. RESULTS: 1. Among the prepubertal girls (n = 29), 17 OGCTs were diagnosed on the basis of precocious pseudopuberty. None of the 17 girls had a peritoneal spread of the tumor (100% FIGO stage Ia). Diagnosis based on a tumoral or acute abdomen (12 cases) was associated with frequent intraperitoneal ruptures of the tumor (50%) and a risk of relapse (2 cases). Of the eight girls who had had a misdiagnosed precocious pseudopuberty, five had a pre- or perioperative tumoral rupture. 2. Among the postpubertal girls (n = 11), endocrine manifestations such as secondary amenorrhea or virilization had been underevaluated in three of them and the diagnosis was established from a tumoral abdomen. This clinical presentation was associated with frequent ruptures of the mass in the peritoneum (80%) and a higher risk of recurrence (30%). 3. A delayed diagnosis of OGCT despite previous endocrine signs (11 cases; 8 pre- and 3 postpubertal) was associated with a high risk of pre- or peri-operative peritoneal tumor spreading (70% FIGO stage Ic or IIc, p <0.05). The mean delay for diagnosis ranged from 3 to 11 months. CONCLUSION: This study highlights the critical role of early diagnosis of OGCT in pre- and postpubertal girls, particularly at the first seemingly banal signs of endocrine disorder. Peritoneal spread of the tumor may thereby be prevented, which improves the prognosis.

Abdominal Pain↗

PubMed2005

[French modalities of myocardial revascularisation in 2001].

UNLABELLED: French modalities of myocardial revascularization were unknown, whereas beneficial effect on outcome was controversial. The study describes current practices in 2001 and analyzes those data according to regional coronary heart disease incidence and mortality. METHODS: Data are obtained from the French hospital national database (PMSI). Mortality is obtained from French mortality registry, and myocardial infarction incidence is estimated with French registries of MONICA project. RESULTS: Myocardial revascularization utilization fluctuate from 25% of patients hospitalized for coronary disease in Limousin to more than 40% of patients in Provence-Alpes-Côte d'Azur (PACA), Languedoc-Roussillon and Ile-de-France. Standardized rate per 100,000 individuals is 109 in Pays de la Loire and 309 in Corse. Medical care offers seem to influence the practice. In the six regions where the rates are the lower, the density of interventional unit and on-pump center are below the national average, and the cardiologist density is very low. Consequences on regional clinical outcome of coronary heart disease are discussed based on mortality rate and levels of evidenced based medicine in myocardial revascularization. CONCLUSION: For the first time, we describe a wide variation of regional practices for myocardial revascularization in France. A part of those variations can be attributed to regional differences in medical care offers. Finally, the impact on clinical outcome appears clearly but seems limited. Cardiovascular prevention strategy remains of first line importance and emphasizes this main mission of cardiologists.

Age Distribution↗

PubMed2004

[Drug prescription in the post-percutaneous coronary interventions period: results of the ECART study].

Among 1000 French cardiologists, the ECART study investigated drug prescription in 1041 patients with coronary heart disease, before and after percutaneous coronary interventions. The baseline drug prescription rate CAD patients were the following: beta-blockers 96%, antiplatelets agents 85%, statines 56%, nitrates 36%, calcium blockers 26% and ACE inhibitors 8.7%. The main changes in patients having undergone PCI were: a significant increase in antiplatelets agents (to 97%), ACE inhibitors (to 29%) and statins (to 94%), a significant decrease in nitrates (to 23%). The calcium blockers rate remains unchanged at 26%. Those results are discussed in the field of evidence based medicine and are compared with data from previous drug prescription studies in post myocardial infarction or in secondary prevention.

Adrenergic beta-Antagonists↗

PubMed2004

[Utilization of the principle therapeutic classes for cardiovascular prevention in elderly patients seen by cardiologists. The ELIAGE survey].

UNLABELLED: Limited data are available regarding drug prescription for cardiovascular prevention in elderly patients seen by cardiologists. METHODS: The ELIAGE survey was conducted in France between March and September 2003 among 507 cardiologists. 1952 consecutives elderly patients (> or = 70 years old) were enrolled. Mean age was 76 years, 40% were between 70 and 74, and 26% were more than 80. Sixty-two of patients were men. Sixteen percent of patients had no history of cardiovascular disease but presented at least one of major cardiovascular risk factor: hypertension (91%), hyperlipemia (58%), diabetes (28%), and/or smoking (6%). Eighty-four percent had a known history of occlusive, atherosclerotic vascular disease: coronary heart disease in 76%, peripheral artery disease in 17%, and prior stroke or transient ischemic attack in 13%. Heart failure was observed in 21%. RESULTS: The rates of prescription in the overall survey population were respectively 68% for antiplatelet agents, 67% for lipid lowering drugs (of which 85% were on a statin), 51% for beta-blockers and 41% for angiotensin converting enzyme inhibitors. Among patients with coronary heart disease, prescription rates were 42% for ACE-inhibitors, 58% for beta-blockers, 76% for antiplatelet agents and 72% for lipid-lowering agents, 85% of whom received a statin. The ELIAGE survey shows a high prevalence of persistent dyslipidemia, with 46% of patients having a LDL-cholesterol equal to or greater than 1.25 g/l and 15% > or = 1.60 g/l. Despite lipid-lowering therapy, LDL-cholesterol remained equal to or greater than 1.25 g/l in 40% of treated patients and > or = 1.60 g/l in 13%. Blood pressure control was not better with 61% of patients having systolic blood pressure > or = 140 mmHg and 21% > or = 160 mmHg. In multivariate analysis, increase was inversely associated with the prescription of lipid-lowering therapy. CONCLUSION: The ELIAGE survey in France shows the persistence of poor control of modifiable risk factors among elderly patients seen by cardiologists. Both primary and secondary cardiovascular prevention appear to be unsatisfactory. Improved utilisation of proven therapeutic classes may lead to improvements in cardiovascular prevention.

Aged↗

PubMed2004

[Comparison of the radial and femoral arterial approaches for coronary angioplasty in acute myocardial infarction].

AIM: As compared to the femoral approach, the use of radial arterial access has been demonstrated to reduce the incidence of access site bleeding complications in staged procedures. The purpose of this study was to evaluate clinical outcomes comparing radial and femoral approaches in the treatment of acute myocardial infarction with emergency angioplasty. METHODS: Between September 1999 and December 2002, we prospectively enrolled 162 consecutive patients undergoing primary angioplasty with abciximab (n=127) or rescue angioplasty after thrombolysis failure (n=35) comparing in a non-randomized plan radial (n=87) and femoral (n=75) access. RESULTS: Cannulation time (from patient arrival at the catheterization laboratory to the effective placement of arterial sheath) and procedural time was not significantly different in radial and femoral groups (respectively 8.5 +/- 5.2 vs 9.0 +/- 5.8 minutes, p=0.81, and 42 +/- 28 vs 44 +/- 27 min, p=0.74). Nevertheless, time of radiation (23.1 +/- 11 min vs 16.5 +/- 10.9 min; p=0.01) and dose-area product (229 +/- 133 vs 151 +/- 86 Gy.cm2, p=0.01) were significantly higher in the radial group. Angiographic success rate is comparable in both groups. Freedom from ischemic recurrent events at 1-month follow-up occurred in 84 (96%) and 69 (92%) patients in the radial and femoral groups, respectively (p=0.12). There were no major access site bleeding complications in the radial group, as opposed to six (8%) in the femoral group (p=0.01) all requiring transfusions and surgical repair necessary in four. Uncomplicated clinical course occurred in 83 (92%) of patients in the radial group and 65 (85%) in the femoral group (p=0.03). Total hospital length of stay was significantly higher in the femoral group (5.9 +/- 2.1 days vs 3.5 +/- 1.2 days; p=0.009). CONCLUSION: In patients with acute myocardial infarction treated with coronary angioplasty, the transradial access is efficacious with fewer major access site complications than transfemoral access. Transradial approach produces a shorter length of stay, as compared to the transfemoral approach although with longer times of radiation and higher dose area-product.

Angioplasty, Balloon, Coronary↗

PubMed2004

[Invasive angiography, computed tomography or magnetic resonance imaging for coronary imaging and cardiovascular risk stratification? Regulatory and practical considerations].

In 2003, risk stratification in coronary heart disease is routinely performed by the results of coronary angiogram, the invasive gold standard angiography. Combined with the left ventricular ejection fraction assessment, the classification in one, two or three vessel disease remain the cornerstone of the revascularization strategy despite well-known limitations of this approach. Invasive coronary angiography is a mature technic with recommendations for training program and guidelines for indications. By comparison, the new noninvasive coronary imaging tools, computed tomography (CT) and magnetic resonance (MR) imaging, are just emerging. Coronary artery MR angiography is one of the most challenging areas because of the size and topology of the coronary arteries, as well as cardiac and respiratory motion. Multidetector-row and multisclice spiral computed tomography appear of most value for the detection of coronary artery disease with an excellent negative predictive value for proximal and middle main branches. Together, MR and CT, provide unique information that may predict cardiovascular risk. They identify flow-limiting coronary stenoses and calcified plaques, directly image the atherosclerotic lesions, measure atherosclerotic burden and characterize plaque components. Nevertheless, invasive coronary angiography still remain the first step of percutaneous coronary intervention. Therefore, one of the ultimate goals for the clinicians is the identification of the high-risk patient through a combination of strategies such as assessment of conventional risk factors, blood markers, and imaging. Indifferently to the imaging tool, the treatment should consider a human being and not only a picture.

Contraindications↗

PubMed2003

[Value and role of lipid lowering therapy for cardiovascular prevention in the elderly].

Most of elderly people die of coronary and cerebrovascular disease events or become disabled after non fatal stroke or dementia. Most of evidence of benefits shown in both primary and secondary prevention comes from randomized trials done on middle-aged men. The elderly population exposed to major cardiovascular events and dementia regularly increase due to the lengthening of life expectancy. If the benefit of anti-hypertensives agents is now well-established in isolated systolic hypertension in the elderly, evidence of efficacy with statins remained unclear and needed to be investigated. Observational studies and post-hoc analysis of randomized trials have raised the possibility that statins could reduce the rate of cardiovascular events and the rate of dementia in elderly individuals. In this setting occur the results of two recent trials investigated the effects of simvastatin in a high cardiovascular risk population of whom 30% were aged 70 or older (Heart Protection Study), or the effects of pravastatin for primary or secondary prevention in high risk elderly patients with a middle-age of 75 (Prosper). Major cardiovascular events are significantly reduced in both trials but the relative risk reduction is lower than in previous trials in middle-aged patients. In Prosper, the most beneficial group of patients are those with baseline HDL cholesterol under 0.40 g l-1 (1.1 mmol l-1); coronary heart disease events is the principal component of treatment benefit whereas cerebrovascular events are not significantly reduced at 3-years follow-up probably due to the short duration of the trial. The outcome do not provide evidence for benefit in dementia. However, there is a non significant trend to reduction of transient ischaemic attacks. Recent publications suggest that stroke benefit from statins does not begin to appear until after 3 years of treatment. Hence, those evidence suggests that the strategy for vascular risk management in middle aged people should also be applied to elderly individuals with a greatest benefit in the subgroup with the lowest HDL cholesterol.

Age Factors↗

PubMed2003

Factors influencing fluoroscopy time and dose-area product values during ad hoc one-vessel percutaneous coronary angioplasty.

X-ray exposure during radiologically guided interventional procedures may have some deleterious effects. The aim of our study was to analyse the factors affecting patient dose during percutaneous coronary angioplasty (PTCA). We evaluated radiation dose during coronary angiography followed by one-vessel PTCA in 402 consecutive patients who were treated by three experienced physicians using both femoral and radial techniques. Fluoroscopy time (t) and patient dose measured by a dose-area product (DAP) meter were recorded. A good correlation was observed between t and the DAP (r=0.78, p<0.001). To assess the factors affecting radiation exposure, we studied the differences between operators, arterial catheterization access and stenting strategy. Median (25th to 75th percentiles) values for t were 19 (13 to 26) min and for DAP were 191 (145 to 256) Gy cm(2) for operator 3 compared with t=12 (9 to 18) min and DAP=137 (91 to 208) Gy cm(2) for operator 2 (p<0.005 versus operator 3) and t=13 (9 to 17) min, and DAP=134 (93 to 190) Gy cm(2) for operator 1 (p<0.001 versus operator 3). Differences between the radial and the femoral techniques were: t=17 (13 to 24) min versus 12 (8 to 17) min, (p<0.001) and DAP=175 (128 to 246) Gy cm(2) versus 138 (93 to 197) Gy cm(2), (p<0.001). In comparison with stenting without pre-dilation, direct stenting significantly reduced t and DAP [t=12 (9 to 16) min versus 16 (11 to 22) min, (p<0.001) and DAP=130 (95 to 186) Gy cm(2) versus 163 (119 to 230) Gy cm(2), respectively, (p<0.01)]. Radiation exposure to patients and staff are strongly dependent on operators, stenting strategy and the arterial access chosen for ad hoc one-vessel PTCA.

Aged↗

PubMed2003

[Comparison between radial and femoral approaches in ad hoc coronary angioplasty].

Between September 1999 and June 2001, 591 patients required ad hoc coronary angioplasty. The authors compared the group of patients in whom the approach of first intent was radial (n = 328, 55%) with those in whom the femoral approach had been used (n = 263), in terms of immediate local (haematoma or thrombosis requiring surgical intervention or transfusion) and general complications (myocardial infarction, cerebrovascular accident), and major adverse cardiovascular events (infarction, angioplasty, bypass and death) at 1 year. The dose of ionising radiation during the procedures was also compared prospectively. The conversion rate from the radial (R) to the humeral or femoral (F) approach was 10%. The angioplasty, stenting, and stenting without dilatation failure rates were identical in the two groups (5% versus 5%, 0.6% versus 1.9%, 3% versus 4%, respectively). The average irradiation time was greater in the R group than in the F group (23 +/- 12 min vs 17 +/- 4 min, p < 0.001) as was the irradiation per surface unit (242 +/- 137 Gy.cm2 vs 185 +/- 117 Gy.cm2, p < 0.001). The immediate complication rate was comparable in the two groups (2.5% in group R vs 3.6% in group F) as was the major adverse cardiovascular event rate at 1 year (13% in both groups). The authors observed the same rate of immediate complications and late adverse cardiac events in patients undergoing coronary angioplasty followed by immediate angioplasty by the radial or femoral approaches with an acceptable conversion rate from the radial to the femoral approach. The procedures by the radial approach seem to be associated with a greater time and dosage of ionising radiation.

Aged↗

PubMed2003

[Results of heart surgery with extracorporeal circulation in octogenarians].

Cardiac surgery in the octogenarians is increasing in the industrialized countries and therefore represents a growing population. In order to better define the benefits of cardiac surgery in this population, we reviewed all consecutive octogenarians patients operated during the last 10 years. Out of 3,409 patients operated between January 1990 and December 1999, we identified 215 patients (6.3%) aged 80 years or more. Median age was 82.4 +/- 2.45 years, and 52.6% were males. Preoperatively, 52% were in New York Heart Association functional class II, 19.3% in class III, and 28.3% in class IV, with a mean Euroscore score of 7.5 +/- 2.6. Among them, 113 patients (52.5%) had isolated aortic valve replacement, 66 patients (30.6%) had isolated coronary artery bypass graft, 22 patients (10.2%) had aortic valve replacement combined with CABG, and 14 patients (6.5%) had mitral valve operation. The overall hospital mortality was 8%, and multivariate analysis revealed as risk factor for mortality aortic valve replacement combined with coronary artery bypass graft. Median follow up was 36.7 months, with 86% survival at 1 year, 59% at 5 years, and 40% at 7 years. Survival was reduced when aortic valve was combined with revascularisation. Quality of life was improved in 72% of patients. We conclude that for selected octogenarians cardiac surgery can be performed with an acceptable mortality and improves both survival and quality of life.

Age Factors↗

PubMed2002

Equation of state data for iron at pressures beyond 10 Mbar.

We present equation of state points for iron, in the pressure range 10-45 Mbar, the first obtained with laser-driven shock waves. The experiment has been performed with the high energy laser Phebus, optically smoothed with Kinoform phase plates. Our results double the set of existing experimental data at very high pressures showing good agreement with the predictions of the quotidian equation of state model and with previous results.

Journal Article↗

PubMed2002

Surface implantation treatments to prevent infection complications in short term devices.

Surface treatments of short term devices are actually evaluated to reduce the risk of infections, which in particular are one of the main causes of complications following catheter insertion. We have investigated the efficacy of ion beam techniques to reduce bacterial adhesion-or to induce bactericidal activity of different polymer materials: PVC, silicone rubber, poly(urethane) and poly(ethylene). Two routes have been evaluated, based on the production of non fouling surfaces, through the production of diamond-like surfaces upon irradiation with rare gases, or the implantation of silver, known for its bactericidal action. In this contribution we discuss more specifically the treatment of poly(ethylene), where a broad range of surface characterisation techniques could show that the biological activity resulted from the formation of metallic colloidal silver near the surface of the polymer, associated to the formation of a dense surface acting as a diffusion barrier. Reduction of the implantation energy to 10 keV, led to activity enhancement resulting from the easier accessibility of surface colloids evidenced by AFM microscopy. This study emphasises the specific processes induced by the formation of silver nano-particles at low energy implantation, which differs basically from Ion Beam Assisted Deposition (IBAD technique) leading to the formation of a continuous silver coating (Artif. Organs 18 (1994) 266; International Patent (PCT) WO 95/18637 (1995)).

Animals↗

PubMed2002

[Iatrogenic lesions of the left main coronary artery].

Reoccurrence of ischemic events several months after a percutaneous transcutaneous coronary angioplasty is usually due to a restenosis. Coronary angiography rarely shows a new stenosis on another site or on the left main coronary artery. In this series, we report 5 cases of left main coronary artery stenosis which have occurred from 3 to 12 months after a prior percutaneous angioplasty. This phenomenon which has previously been described after direct cannulation of the coronaries ostia during aortic valve replacement in the 70'. This complication is related to intimal damage caused by traumatic manipulation of the left main, which can be either already minimally altered or normal. This complication is rare after percutaneous transcutaneous coronary angioplasty (0.2-1.7%) according to various series. We compare our cases to the published cases in the literature.

Adult↗

PubMed2001

[Whole blood viscosity measurement in acute myocardial infarction: feasibility and significance].

Thrombolytic agents and new antiplatelet drugs used in acute myocardial infarction (AMI) could change whole blood viscosity. The aim of this pilot trial is to compare blood viscosity at four shear rate levels among three groups of patients: AMI receiving thrombolysis with alteplase (n: 10), AMI eligible for primary angioplasty with abciximab (n: 10), healthy volunteers (n: 10). Viscosity measurement was obtained in 30 minutes with a Couette hemoviscosimeter. At baseline, blood viscosity level was higher in patients with acute coronary syndromes than in healthy volunteers (72 +/- 32 mPa.s versus 51 +/- 13 mPa.s, p<0.05). After thrombolysis, viscosity was higher at 90 minutes than at third day, paradoxically with fibrinogen elevation (72 +/- 32 mPa.s versus 58 +/- 27 mPa.s, p=0.01). In primary angioplasty with abciximab, viscosity decreased significantly (56 +/- 28 mPa.s versus 43 +/- 13 mPa.s, p=0.01). The effects of ionic contrast agent and abciximab are discussed. In healthy volunteers group, 100 mg aspirin once a day during 7 days reduces blood viscosity at high shear stress. The small size of the study population restricts correlation analysis with major clinical adverse events. A larger trial is necessary to evaluate the predictive value of whole blood viscosity in reocclusive and/or hemorrhagic events in those reperfusion strategies but also in case of thrombolytic agent and abciximab combination.

Adult↗