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Biomedical subjects

G Grollier

Publications and source records attributed to G Grollier.

At least 109 records · Page 6Linked to original sources
PubMed1992

Identification and susceptibility testing for obligate anaerobic bacteria using a semi-automated API ATB plus system.

We evaluated the reliability of the API systems, Rapid ID 32 A and ATB ANA, for the identification and susceptibility testing of obligate anaerobic bacteria in a clinical laboratory that does not possess either an anaerobic chamber or a chromatograph. Tested were 105 clinical isolates. Identifications were compared with those obtained according to the criteria of the Virginia Polytechnic Institute Manual using the API 20 A system with incubation in an anaerobic chamber and gas chromatography. Identifications were concordant in 86.3% of cases. The Rapid ID 32 A system was inaccurate in distinguishing Bacteroides of the fragilis group. Susceptibility to 10 antibiotics of the ATB ANA system was compared to that obtained by MIC determination on Wilkins Chalgren agar. Overall, concordance was 78.2%. Disagreements were mostly minor (16.4%): resistant strains classified as intermediate or intermediate classified as susceptible. When the ATB ANA strip cannot be inoculated in an anaerobic chamber, it is possible that a denser inoculum would decrease the percentage of minor disagreements.

Anti-Bacterial Agents↗
PubMed1992

[ST segment elevation in anterior precordial leads and right ventricular infarction. Apropos of 6 cases].

ST segment elevation in the anterior precordial chest leads may be observed in some cases of right ventricular infarction alone or associated with left ventricular inferior wall infarction. Six out of 700 patients admitted to our Coronary Care Unit over a 2 year period had right ventricular infarction with these electrocardiographic changes. In three cases, isolated right ventricular infarction was due to occlusion of a right marginal artery (N = 2) or of a small right coronary artery (N = 1) which only vascularised the right ventricle. In 2 cases, right ventricular infarction was associated with a recent or chronic left ventricular inferior wall infarct. This type of ST segment elevation may suggest a left ventricular anterior wall infarct especially when there are no changes in the inferior leads, as was the case in our first patient. However, the dome-like appearance of the ST segment, the reduction in amplitude of ST elevation from V2 to V5, the progressive regression of the ST changes without the appearance of Q waves, are more suggestive of the diagnosis of right ventricular infarction. In addition, normal left ventricular dilatation on echocardiographic examination rapidly confirms the diagnosis.

Adult↗
PubMed1992

[Myocardial infarction complicating exercise test performed 72 hours after coronary angioplasty].

The authors report a case of myocardial infarction complicating an exercise stress test performed 48 hours after successful angioplasty of a stenosed left anterior descending artery in a patient with unstable angina. Three similar cases have been previously reported. The probable mechanisms of coronary obstruction in this context are rupture of an atheromatous plaque, thrombosis and coronary spasm.

Aged↗
PubMed1992

[Left coronaro-ventricular fistula after myocardial infarction. Apropos of a case].

Coronary artery-cardiac fistulae are uncommon and usually congenital abnormalities. The majority of these fistulae communicate with the right heart chambers. Acquired coronary-left heart fistulae are very rare: secondary to trauma, cardiac surgery, angioplasty or endomyocardial biopsy. Fistulae secondary to myocardial infarction are rare but have been described. The authors report the case of a man with anterior wall infarction treated by fibrinolysis and by angioplasty of the left anterior descending artery (LAD) 48 hours later. This dilatation was complicated by repeated occlusion but a good result was obtained after in situ and then systemic fibrinolysis. Control coronary angiography after angioplasty performed 6 months later showed the presence of micro-fistulae between the distal part of the LAD, the left diagonal entry and the left ventricular chamber which were not present on the coronary angiogram before the angioplasty. The fistulae appeared to be secondary to a localised infarct which occurred after distal thrombosis of the LAD during angioplasty.

Angioplasty, Balloon, Coronary↗
PubMed1992

[Myocardial dissection in infarction of the right ventricle. Clinical echocardiographic and pathological aspects].

Dissection of the inferior wall of the right ventricle during the acute phase of myocardial infarction with right ventricular involvement is a mechanical complication which has been recently identified, the diagnosis being almost exclusively post-mortem. The authors report the clinical, echocardiographic and pathological features of myocardial dissection in four patients. Between 1985 and 1988, the diagnosis of myocardial dissection was made by echocardiography in 4 patients aged 77 to 80 years, admitted to hospital for an acute inferior wall myocardial infarction. All 4 patients had signs of acute right ventricular failure indicating right ventricular necrosis and a loud systolic murmur at the left sternal border; 2 patients were in shock. The ECG showed signs of inferior wall infarction with, in 2 patients, electrical changes suggestive of right ventricular involvement. Echocardiography showed dissection of the inferior wall of the right ventricle as a pulsatile, echo-free space in the diaphragmatic wall of the right ventricle which appeared to obstruct right ventricular ejection in end systole to a variable degree. The outcome was fatal in all cases with death resulting from refractory myocardial failure. Pathological analysis confirmed biventricular inferior wall infarction also involving the posterior part of the interventricular system, the site of a small tear on the left side which communicated with a neo-cavity dissecting the RV posterior wall. The right coronary artery was totally occluded in all cases. The anatomical lesions were fully concordant with the echocardiographic data: the dissection filled with blood from the left ventricle at each systole creating a pulsatile space in the diaphragmatic wall of the ventricle obstructing ejection.

Aged↗
PubMed1991

Serum digoxin levels related to plasma propafenone levels during concomitant treatment.

Nine patients with supraventricular rhythm disorders were treated during 5-day periods with different oral doses (300, 450, 600, and 900 mg daily) of propafenone concomitantly to long-term digoxin treatment. A poor correlation (r = .398; P less than .05) was obtained when the difference between the mean digoxin serum level (calculated with the Cmin data determined each of the 5 days) observed during a given propafenone dose and the mean digoxin serum level observed before propafenone treatment, was correlated with the dose of propafenone; but an evident correlation (r = .778; P less than .01) was found when the difference in digoxin level was correlated with the plasma propafenone concentration. The propafenone effect of increasing digoxin blood levels was thus concluded to be poorly dose dependent but strongly concentration dependent. The association of propafenone to a long-term digoxin treatment can be considered with a low risk of toxicity when plasma propafenone concentration does not exceed about 1000 ng/mL. Propafenone plasma levels are unpredictable in view of their wide interindividual variation for a given dose, so their measurement is advised to detect high levels and consequently to prevent a rise in digoxin serum concentrations with the possibility of toxicity. In clinical practice, when propafenone concentration determinations are not readily available, digoxin serum levels at least have to be carefully monitored.

Administration, Oral↗
PubMed1991

Malignant ventricular tachycardia during propafenone treatment in a child with junctional automatic tachycardia: effectiveness of intravenous molar sodium lactate.

Propafenone may aggravate the preexisting arrhythmia or induce another one. Usually, such proarrhythmic effects occur in patients with spontaneous ventricular arrhythmias and/or coronary heart disease with poor left ventricular function. We report the case of a 5-year-old girl with junctional automatic tachycardia and no structural heart disease, in whom malignant ventricular tachycardia occurring during propafenone treatment could be terminated by molar sodium lactate (MSL) infusion. The serum propafenone level obtained before MSL infusion was within the therapeutic range. Two hypothesis could explain the beneficial effects of MSL in our patient: (1) alkalinization facilitates the cell membrane hyperpolarization and thus can decrease the voltage-dependent effect of Class Ic drugs, (2) alkalinization could displace propafenone from its tissue receptor sites by an increase in the nonionized fraction.

Atrioventricular Node↗
PubMed1991

Nosocomial legionnaires' disease in a bone marrow transplant unit.

We report the outcome of nosocomial legionnaires' disease in three patients who were isolated in the same sterile unit after allogeneic bone marrow transplantation. In all three cases the disease presented with dramatic pulmonary symptoms, and diagnosis was ascertained by direct immunofluorescence on bronchoalveolar fluids. None of the patients underwent seroconversion. This report draws attention to: (1) the fact that bacteriological filters do not ensure absolute security; (2) the need for frequent monitoring of the two factors governing legionella growth, water temperature and chlorination; and (3) the effectiveness of quinolones as a curative and prophylactic treatment of legionnaires' disease in transplanted patients avoiding pharmacological cyclosporin interaction.

Adult↗
PubMed1991

[Initial primary sarcoma of the pulmonary valve and trunk of the pulmonary artery].

Primary sarcomas arising from the trunk or branches of the pulmonary artery are exceedingly rare and usually diagnosed at autopsy. The authors report the case of a 31 year old man referred for investigation of recurrent syncope. Echocardiography, right ventriculography and the thoracic computed tomography led to early diagnosis of a pulmonary artery tumour and surgical resection. Histology revealed a primary sarcoma. The early postoperative course was uncomplicated but one month after surgery a local recurrence was diagnosed at routine echocardiographic examination. The syncopal symptoms recurred seven months after surgery and echocardiography showed tumour recurrence on the interventricular septum and in the pulmonary artery. A second palliative operation was attempted but was unsuccessful because of the size of the tumour.

Adult↗
PubMed1991

[Myocardial involvement in AIDS. Echographic study in 85 human immunodeficiency virus infected patients].

Histological and echographic studies of HIV-seropositive patients demonstrated the reality of myocardial involvement during the acquired immunodeficiency syndrome. Eight-five seropositive, asymptomatic patients, 55 of them classified as group IV (CDC criteria), were subjected to echocardiography and measurement of the reduction of the left ventricle fraction. An echographic anomaly was found in 8/85 seropositive patients and in 7/55 group IV patients. This affect on left ventricular contractility seems to occur in patients with a low number of CD4+ lymphocytes (p = NS) and is statistically significantly associated with the level of anti-P24 antibodies/antigenemia (absence of antibodies and positive antigenemia) (p less than 0.05).

Acquired Immunodeficiency Syndrome↗
PubMed1991

[Dissection of aorta after aortic valve replacement].

The authors report 4 cases of aortic dissection after aortic valve replacement. The aorta was dilated in all four cases before surgery. Two patients died within hours of the dissection, illustrating the poor prognosis of this complication and the difficulties of surgical management. The features of these four cases were compared to those of 29 other cases reported in the last ten years. The initial surgical indication for valve replacement was equally divided between aortic stenosis and regurgitation. The onset of dissection after surgery was very variable, ranging from a few hours to several years after valve replacement. Abnormalities of the aortic wall and peroperative trauma play an important role in the pathogenesis of this complication. The prognosis is very poor, which underlines the importance of preventive measures and regular follow-up of these patients.

Aortic Dissection↗
PubMed1991

[Echocardiographic aspects of multiple myxoma in Carney's syndrome].

In Carney's syndrome, the association of cardiac myxomas, spotty pigmentation and endocrine over activity, the myxomas are usually multiple and have atypical locations. The authors report a case in which an accurate diagnosis of these multiple myxomas was made by transoesophageal echocardiography, although transthoracic echocardiography had missed the diagnosis.

Adult↗
PubMed1990

[Cardiac involvement in malignant non-Hodgkin's lymphoma].

Selective cardiac involvement by a malignant non-Hodgkin's lymphoma (primary lymphoma of the heart) is extremely rare. Cardiac lesions occurring in the course of a malignant non-Hodgkin's lymphoma (secondary lymphoma of the heart) are found at autopsy in about 10 per cent of the cases. Secondary lymphoma of the heart may involve all cardiac structures, but lesions of the right heart, and particularly the right atrium, are predominant. Clinical manifestations are usually non-specific and appear at a late stage, reflecting diffuse involvement. When the malignant non-Hodgkin's lymphoma is known, systematic two-dimensional echocardiography should easily detect the lymphomatous cardiac infiltration, irrespective of the presence or absence of symptoms. When the malignant non-Hodgkin's lymphoma is unknown, only histology can show that the heart tumour is a lymphoma, evaluate its extension and confirm that it is limited to the cardiac walls, provided the disease is treated at an early stage, prolonged complete remissions are observed after chemotherapy and/or radiotherapy.

Echocardiography↗
PubMed1990

Evaluation of two media for antibiotic susceptibility testing of anaerobic bacteria using the receiver operating characteristic procedure.

Wilkins-Chalgren agar and Meat-Yeast agar were evaluated as media for antibiotic susceptibility testing using 112 anaerobic bacterial strains. The results obtained with the two media using the diffusion method were compared with those obtained by the dilution method as reference method. The results were analyzed by the receiver operating characteristic (ROC) procedure allowing a graphic representation of sensitivity and specificity of the technique for each cut-off value. The area under the ROC curves was calculated to compare the accuracy of the two methods. Six antibiotics were tested including amoxicillin, cefoxitin, piperacillin, doxycycline and clindamycin. For amoxicillin and clindamycin, the two methods showed a high and identical discriminative power for distinguishing susceptible bacteria from the others. Diffusion in Wilkins-Chalgren agar appeared better than diffusion in Meat-Yeast agar for separating resistant bacteria from bacteria of intermediate susceptibility (amoxicillin p less than 0.005; clindamycin p less than 0.04). For other drugs, diffusion in Wilkins-Chalgren agar always had a discriminative power higher than that obtained with diffusion in Meat-Yeast agar for separating susceptible bacteria from the others (cefoxitin p less than 0.0005; piperacillin p less than 0.02; doxycycline p less than 0.05). The Wilkins-Chalgren agar medium thus appeared superior to the Meat-Yeast agar medium using the ROC evaluation method, which would deserve wider utilization in the field of microbiology.

Anti-Bacterial Agents↗
PubMed1990

Comparative efficacy and safety of enalapril and sustained-release nifedipine in patients with mild to moderate hypertension. The Enalapril vs Nifedipine French Study Group.

The long acting angiotensin-converting enzyme inhibitor enalapril was compared with the calcium channel blocker nifedipine as sustained-release formulation in 136 patients with mild to moderate hypertension. This multicentre study was carried out in a double-blind, double-dummy fashion by 28 cardiologists in private practice. After a 2-week placebo period, patients were randomly allocated to 2 treatment groups; the first group received enalapril 20 mg daily (n = 68), and the second group received sustained-release nifedipine 20 mg twice daily (n = 68). The duration of treatment was 12 weeks. In both groups, hydrochlorothiazide 25 mg was added at week 4 if diastolic blood pressure remained greater than 90 mm Hg. At week 8, if the target diastolic pressure of less than 90 mm Hg was not achieved, the dosage of hydrochlorothiazide was increased to 50mg. The clinical characteristics of the patients in each group were comparable. After 4 weeks of treatment, the reduction in supine diastolic blood pressure was similar in both groups (12.1 mm Hg in the enalapril group vs 10.3 mm Hg in the nifedipine group). Moreover, although the difference between the groups was more noticeable after 12 weeks of treatment (16.3 vs 13.9 mm Hg, respectively), it did not reach significance. The number of patients experiencing clinical adverse effects was significantly greater in the nifedipine group than in the enalapril group [33 (48.5%) vs 18 (26.5%), respectively]. The most common complaints of patients administered nifedipine included swollen ankles, flushing and headaches, whereas complaints in the enalapril group included cough, asthenia, and epigastralgia. Three patients were withdrawn from the study because of side effects in the enalapril group and 10 were withdrawn from the nifedipine group. These results indicate that enalapril and sustained-release nifedipine are equally effective in controlling mild to moderate hypertension. However, enalapril was much better tolerated in this study.

Double-Blind Method↗