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Biomedical subjects

G Grollier

Publications and source records attributed to G Grollier.

At least 127 records · Page 7Linked to original sources
PubMed1990

[Immediate or delayed angioplasty during the acute phase of myocardial infarction. Apropos of 118 cases].

The results of immediate percutaneous transluminal coronary angioplasty (PTCA) (260 +/- 167 minutes after onset of pain and an average of 56 minutes after thrombolysis) and deferred PTCA (average 9.6 days, range 1 to 30 days after infarction) were compared in 118 consecutive patients with acute myocardial infarction. The overall primary success rate of PTCA was 82.2 per cent; it was higher in those patients undergoing deferred angioplasty (96% vs 78%; p less than 0.05). The primary success rate of immediate PTCA was related to the severity of the stenosis before dilatation: 75 per cent success in occluded compared to 84 per cent in suboccluded vessels (over 90% stenosis) and 100 per cent success in vessels with under 90 per cent stenosis. Eighty one per cent of failed angioplasties occurred in patients with occluded arteries, the majority being left anterior descending (LAD) arteries (71.4%). The incidence of restenosis was 13.4 per cent. This complication was diagnosed at coronary arteriography performed 40 days after PTCA in 1 case, 47 days after PTCA in another case and at the 6 month control in 11 cases. Reocclusion was observed in 21 patients (21.7% of immediate successes). The occlusion was diagnosed at the first control after an average of 8 days in 15 cases. The interval between the onset of pain and thrombolysis and dilatation was significantly longer in the group with reocclusion compared with patients without reocclusion (314 minutes vs 193 minutes for thrombolysis, p less than 0.01; and 356 minutes vs 204 minutes fort PTCA, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[In vitro bactericidal rate of amikacin at concentrations realizable in vivo].

The bactericidal rate of amikacin in vitro was established by varying bacterial cell density (10(5) and 10(6) CFU/ml) and physiological state (lag phase and onset of exponential growth) at the moment the antibiotic was introduced. This was done with nine strains belonging to five different species. Antibiotic concentrations were those obtained in vivo at the valley (4 micrograms/ml) and the peak (20 micrograms/ml) with a dosage of 5 mg/kg. The concentration of 40 micrograms/ml is the peak value in the context of hypothesis of a short-term treatment with reinforced dosage (10 mg/kg). The bactericidal effect of amikacin, generally rapid, increased with increasing drug concentration. A bactericidal effect of 99.9% or even 99.99% was obtained in one hour or less at the concentration of 40 micrograms/ml. Above all, this concentration prevented regrowth or rebound, observed at lower concentrations. This results from a rapid but above all powerful bactericidal effect, practically total and constitutes a bacteriological argument in favor of an increase in dosage combined with a reduction in the length of treatment.

Acinetobacter↗
PubMed1990

[Comparison of the efficacy of verapamil and diltiazem in stable exercise angina. A double-blind and crossover study].

Calcium channel blockers are now recommended for the treatment of stable angina but few studies have been carried out comparing the efficacy of verapamil and diltiazem in this indication. The short-term efficacy of these two drugs was compared in a double-blind crossover trial in 12 patients. The following protocol was used, 24 hour selection period followed by two crossover treatment periods versus double placebo. Exercise stress tests were performed 2 hours after the last dose at the end of each treatment period. Each patient underwent 3 stress tests: the first during the selection period whilst taking verapamil and diltiazem placebo (ET0), the second after the first treatment period at day 7 (ET1) and the third after the second treatment period at day 14 (ET2). A comparison of exercise capacity (ET0 to ET1 and ET2) showed improved effort tolerance and an increase in the ischaemic threshold with calcium blocker therapy. The duration of effort, the maximum sustained load, the rate-pressure product and the time to ST depression were all significantly increased. On the other hand, there were no significant changes in the percentage theoretical maximum heart rate attained, the heart rate at which ST depression occurred, the maximum ST depression and the incidence of angina. A comparison between ET1 and ET2 did not show any difference in the parameters of maximum effort or of the appearance of myocardial ischaemia. The comparison of exercise stress tests performed after treatment with verapamil and after diltiazem showed that the total duration of exercise, the maximum sustained load (in watts) and the rate-pressure product were identical.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

[So-called uremic heart diseases].

The overall cardiovascular mortality in patients with chronic renal failure is about 30 per cent of which 10 per cent is attributed to myocardial infarction. This prevalence led some workers to propose a hypothesis of "accelerated atherosclerosis" due to the hyperlipidaemia observed in 30 to 70 per cent of patients. However, the concept of accelerated atherosclerosis, which was based essentially on clinical studies, has been questioned. Pericardial effusion is a common complication of chronic renal failure and has been reported in over 62 per cent of patients in echocardiographic studies. There are many causes and symptoms are often mild; systematic echocardiographic examination of patients with renal failure undergoing haemodialysis has shown 32 per cent of pericardial effusions to be asymptomatic. There are two potential complications: cardiac tamponade and, lesser frequently, constrictive pericarditis. Cardiac failure is a common cause of death in patients undergoing long-term dialysis. The myocardial histological appearances are those of fibrosis, the etiology of which is not fully understood although the dialysis membranes and hypotensive episodes occurring during haemodialysis have been thought to play a role. Left ventricular hypertrophy and fibrosis may give rise to ventricular arrhythmias which could explain some of the cases of sudden death observed in patients with renal failure and often wrongly attributed to ischemic heart disease. Another form of myocardial disease which is observed later is characterised by an alteration of systolic function with left ventricular dilatation and hypokinesia and increased end diastolic pressures without an increase in left ventricular wall thickness. Valvular heart disease may also result from renal failure.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiomyopathies↗
PubMed1990

[Cardiac sarcoidosis responsible for localized left ventricular ectasia and refractory ventricular tachycardia. Anatomoclinical study].

The authors report the case of a 63 year old woman admitted to hospital for recurrent refractory ventricular tachycardia. Echocardiography and cardiac scintigraphy showed global left ventricular function. Ventriculography confirmed the left ventricular dysfunction and also showed a localised aneurysm of the anterior left ventricular wall. Surgical resection of the aneurysm and an encircling endocardial ventriculotomy were performed but the patient died of a low output syndrome. Pathological examination of the excised tissue showed granulomatous lesions associated with fibrosis interrupting the striated myocardial bundles. The granulomata consisted in a large number of epithelioid histiocytes and very large giant cells with many nuclei. The diagnosis made retrospectively was that of cardiac sarcoidosis causing a ventricular aneurysm and global left ventricular dysfunction. The diagnosis of cardiac sarcoidosis is difficult in the absence of systemic extracardiac involvement because the clinical manifestations and complementary investigations are non specific. The diagnosis may be made by endomyocardial biopsy in 25 per cent of cases, thereby leading to specific treatment with steroids which is sometimes effective.

Cardiomyopathies↗
PubMed1990

[Transient reduction of ventricular tachycardia with adenosine-5'-triphosphate. A possible action of ATP on purinergic receptors].

The authors report the case of a 46 year old man in whom a regular, wide complex tachycardia was terminated temporarily by the injection of adenosine-5'-triphosphate (ATP:Striadyne); endocavitary electrophysiological studies showed the tachycardia to be of ventricular origin. After aminophylline, an inhibitor of certain purinergic receptors, the tachycardia could be reproduced at will and was sustained whereas only short runs of tachycardia could be induced under basal conditions. The mode of action of the ATP on this type of tachycardia could be a direct effect of the molecule on the purinergic receptors specifically inhibited by aminophylline.

Adenosine Triphosphate↗
PubMed1990

[Right-left shunt caused by sarcoma of the right atrium].

A 70 year old woman was admitted for right ventricular failure and cyanosis of recent onset. Echocardiography showed a very large, homogenous, immobile, smooth-contoured mass filling the right atrium. Right atrial pressures were raised but the other intracardiac pressures were normal at catheterisation. Right heart angiography confirmed the voluminous right atrial mass and dilatation of the hepatic veins and showed early opacification of the left heart chambers. A right-to-left shunt was confirmed by oximetry which showed significant desaturation of the blood in the left atrium and ventricle (saturation 78% in the left ventricle). The tumour was also documented by a thoracic CT scan. At surgery, a very large, malignant right atrial tumour was resected which histological examination showed to be an angiosarcoma. The interatrial septum seemed to be intact: there was no true atrial septal defect but a persistent foramen ovale was found. After resection of the tumour the right atrium was reconstructed. The initial postoperative period was uncomplicated but the patient died nine months later of metastatic disease particularly affecting the liver and brain. The clinical presentation of malignant cardiac tumour is very variable but a right-to-left interatrial shunt through a patent foramen ovale has only been reported previously in 2 cases of primary malignant tumours (a rhabdomyosarcoma and an angiosarcoma) and in 1 case of a secondary cardiac metastasis.

Aged↗
PubMed1990

[Evaluation of ELISA using A60 antigen from Mycobacterium bovis BCG: specific IGG and IGM in mycobacterial infections].

The authors have evaluated an ELISA (A60-Tb, Anda biologicals) allowing the detection of specific IgG and IgM against A60 antigen from Mycobacterium bovis BCG during mycobacterial infections. This study included sera from 110 african subjects and from 71 French subjects distributed in 4 clinical groups: 55 tuberculous patients (I), 41 leprous patients (II), 33 pneumopathies (III) and 52 healthy subjects (IV). Serological results were compared taking as reference for the diagnosis of tuberculosis the positivity of culture and/or that of a direct examination, and for leprosy the positivity of a direct examination associated either with a Mitsuda's reaction or with an histopathological examination. IgG were found to be more discriminative than IgM. Considering together the results of groups I and II, the authors found a sensitivity of 95.8 p. cent and a specificity of 75.3 p. cent with threshold of 200 U/ml for specific IgG. Anti-A60 antigen antibodies obtained for groups I and II were significantly higher (IgG: p less than 0.0001; IgM: p less than 0.001) than those observed in other groups. African subjects presented IgG titers higher than those obtained by French subjects (p less than 0.0001). IgM response was more frequent among group II (97.6 p. cent) than group I (21.8 p. cent). However, IgG (26.9 p. cent) and IgM titers (30.8 p. cent) were detected among group IV. This test would allow a control of therapeutic efficacy with an additional interest for classifying borderline forms of leprosy.

Adult↗
PubMed1990

[Late myocardial infarction after closure of coronary artery fistula].

Congenital coronary cardiac fistulae are rare conditions for which surgery is the usual indication. The authors report on the case of one female patient of 28 years with a coronary cardiac fistula responsible for exertional dyspnoea and relapsing pulmonary infections. The diagnosis was suggested by a continuous murmur and was confirmed by Doppler echocardiography and catheterization which showed a dilated, sinuous circumflex artery (2 cm) leading into the right atrium. Surgical closure of the fistula was complicated by an early myocardial infarction and a relapse in the same area with resulting mitral insufficiency. The surgical treatment of coronary cardiac fistulae is widely documented in the literature and recent series demonstrate that good results are usually obtained: however, a late infarction has not been described. The constitution of thrombi in the collateral vessels deriving from the distended vessel probably accounts for the particular evolution noted in this specific case.

Adult↗
PubMed1989

[Dilatation of the mitral and aortic valves. Current trends].

Following percutaneous endoluminal dilatation of the coronary arteries, new techniques developed in 1984 and 1986 respectively with the purpose of treating percutaneously adult mitral and aortic stenosis. Results of mitral valvuloplasty are excellent from an haemodynamic standpoint as well as an electrocardiographic and clinical standpoint. Anatomical lesions, especially commissural fissure, give a good explanation of these results. But this is a complex procedure, relatively rarely indicated today in France, because of the almost total disappearance of acute rheumatoid arthritis. Degenerative aortic stenosis is the most frequent valvulopathy in France. It occurs in elderly patients, after weak, in whom surgery is always a major risk. Dilatation seemed an interesting alternative to surgery. Unfortunately the results of aortic valvuloplasty are poor and most of the time temporary. However, improvement of the symptoms is observed in one out of two cases. These poor results are due to the nature of the anatomical lesion which respond poorly to valvuloplasty.

Angioplasty, Balloon↗
PubMed1989

[Complications of rheumatoid pericarditis: constriction and tamponade].

Pericarditis is frequent in patients with rheumatoid arthritis. It is usually asymptomatic, but cases of constrictive pericarditis or, more rarely, tamponade have been reported. In such cases, the study of pericardial fluid is of special interest for the aetiological diagnosis. Early medical treatment with or without pericardiocentesis is effective in most cases of tamponade, but constrictive pericarditis demands pericardiectomy. We report here three cases of pericarditis responsible for cardiac compression: two cases of tamponade and one case of constrictive pericarditis.

Adult↗
PubMed1989

Quinidine disposition in relation to antipyrine elimination and debrisoquine phenotype in alcoholic patients with and without cirrhosis.

Single dose disposition of oral quinidine (400 mg sulfate) was studied in a control group of subjects (No. = 6) and in hospitalized alcoholic patients involving one group with (No. = 6) and one group without (No. = 11) hepatic cirrhosis. All subjects also underwent an antipyrine and a debrisoquine test. Patients with cirrhosis had a prolonged elimination half-life (29.5 +/- 5.9 h) and low clearance (24 +/- 7 ml.kg-1.h-1) of antipyrine and also a considerably higher debrisoquine metabolic ratio (18.8 +/- 3.3) than the controls, whereas the alcoholics without cirrhosis had metabolic patterns for these two test compounds comparable to those seen in the controls (antipyrine half-life: 8.8 +/- 1.1 h and 9.8 +/- 2.0 h; debrisoquine metabolic ratio: 3.6 +/- 0.7 and 3.8 +/- 1.2 for alcoholics and controls respectively). In patients with cirrhosis the apparent elimination half-life of quinidine was longer (12.8 +/- 1.8 h) whereas after oral administration clearance of quinidine (15.6 +/- 3.5 l.h-1) and quinidine/3-hydroxyquinidine ratio (9.9 +/- 2.1) were not different from controls (quinidine clearance: 13.45 +/- 1.9 l.h-1; quinidine/3-hydroxyquinidine: 10.3 +/- 2.7). A possible change in distribution patterns of quinidine in cirrhotics may explain these findings.

Adult↗
PubMed1989

Nicardipine does not significantly affect serum digoxin concentrations at the steady state of patients with congestive heart failure.

Twenty patients in a stable condition suffering from congestive heart failure were treated with digoxin for at least three weeks and then with nicardipine concomitantly for five days. No statistically significant variation in serum digoxin concentrations determined at seven control times during a 24-hour period or in its mean concentration was found in the two groups of values examined before and after the concurrent nicardipine treatment. The mean increase of 6.8% in the AUC0----24h was not significant either. Since the maximum increase in serum digoxin concentrations at the steady state never exceeded 0.5 ng/ml, a toxic effect is not likely to occur in patients whose digoxin levels are normally monitored.

Aged↗
PubMed1989

[Can septicemia and ascitic fluid infections in cirrhotic patients be treated by the oral route alone?].

The aim of this study was to determine the efficacy of oral antibiotics in the treatment of severe infections in cirrhosis. Twenty-two patients (17 males, 5 females) with spontaneous bacteremia (n = 7) or bacterial peritonitis (n = 15) were treated with oral pefloxacin 400 mg per 24 hr alone (n = 1) or in combination with another oral antibiotic, trimethoprimsulfamethoxazole (n = 13), amoxicillin (n = 6), cefadroxil (n = 2), or metronidazole (n = 1). In patients with spontaneous bacteremia, all organisms were found to be sensitive to oral antibiotics, and a favorable response was elicited in 6 out of 7 (86 p. cent) within 3 days (mean) of treatment. In patients with spontaneous peritonitis, ascitic fluid cultures were positive in 11 cases, and organisms were sensitive to pefloxacin in 9 out of 11 cases. A favorable response was elicited in 13 out of 15 within 2 to 8 days of treatment. Fourteen patients died (64 p. cent), 3 of infection (bacteremia n = 1, peritonitis n = 2), and 11 patients of causes unrelated to infection, mainly variceal hemorrhage, hepatorenal syndrome or hepatocellular carcinoma, although the clinical symptoms of infection were controlled. One-year survival was 57 p. cent in patients with bacteremia and 33 p. cent in those with bacterial peritonitis. Oral treatment was well tolerated in all patients. We suggest that most bacteremia and spontaneous bacterial peritonitis in cirrhotic patients can be treated with oral antibiotics. In some patients, this may be accomplished on an out patient basis.

Administration, Oral↗