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Biomedical subjects

G Roul

Publications and source records attributed to G Roul.

At least 37 records · Page 2Linked to original sources
PubMed1995

Determination of free triiodothyronine by six different methods in patients with non-thyroidal illness and in patients treated with amiodarone.

We performed a methodological comparison of free triiodothyronine (FT3) estimates in patients with liver cirrhosis and renal failure. Patients were classified in terms of severity of illness on the basis of their total triiodothyronine, total thyroxine and reverse triiodothyronine profiles. FT3 levels, measured in direct dialysis, microchromatography, labelled analogue and two-step immunoextraction assays were significantly (P < 0.01) lower than the control group in all patient categories. However, FT3 measured by a labelled antibody radioimmunoassay was significantly reduced only in the most severely ill sub-group of patients. In a further group of patients on long-term amiodarone therapy for cardiac disease all FT3 methods, with the exception of the labelled antibody radioimmunoassay and an analogue method, yielded significantly (P < 0.01) reduced levels. A significant negative association between FT3 and subject age was demonstrated for all methods except the labelled antibody radioimmunoassay, and a weak but significant negative correlation between log thyrotropin and FT3 was only seen with this assay. Three methods demonstrated a correlation (P < 0.02) with albumin levels in patients with the 'low T3 syndrome'. In this group, albumin had a predictive value (P < or = 0.02) for four out of six assays as determined by stepwise variable selection. Our findings suggest that users of FT3 assays should exercise caution in interpreting results in non-thyroidal illness and amiodarone treated patients, as there are method-related differences in the profiles obtained.

Adult↗
PubMed1995

[The timing of cardiac transplantation].

The considerable progress realised over the last 20 years in the domain of cardiac transplantation has had, as a corollary, an ever increasing demand and a cruel shortage of available grafts, responsible for a high mortality of some of the candidates on the waiting list. This situation justifies a review of the objective criteria of eligibility for a more pertinent attribution of donor organs. A review of the recent literature suggests a logical process in the evaluation of candidates. The first step consists of optimisation of medical therapy. This allows classification of patients with respect to the clinical condition obtained, which may be "critical", "unstable" or "stable" and thereby retain the indication for transplantation in the first two groups in the absence of a contra-indication. The timing of the transplantation is more difficult to determine for the 60% or so of patients with a low ejection fraction and who have been stabilised. The measurement of peak VO2 on exercise, which appears to be the most powerful prognostic variable in these patients, with respect to a normal subject of the same age, allows identification of urgent indications for transplantation. Moreover, a 3 monthly follow-up of peak VO2 of patients on the waiting list or deferred also enables reconsideration of their inscription or non-inscription.

Eligibility Determination↗
PubMed1995

[4-year mortality of heart failure with intact systolic function: a retrospective studies].

Heart failure with normal systolic function has been recognised in 30-40% of patients investigated for congestive heart failure. The authors undertook a retrospective study of global and cardiovascular mortality at 4 years in two groups of patients with a history of congestive heart failure documented by equilibrium angioscintigraphy: group I (n = 109) with poor left ventricular systolic function (EF = 26 +/- 9%) and group II (n = 40) with normal systolic function (EF = 58 +/- 8%). The 4 year cardiovascular mortality was less in group II (21.6% vs 49%; p < 0.004) whereas the global mortality was comparable in the two groups. The only discriminating parameters for cardiovascular mortality between the two groups were age of more than 60 years and values of diastolic blood pressure exceeding 90 mmHg which were associated with a higher mortality in the group with normal systolic function. These results indicate a better prognosis in terms of cardiovascular mortality from congestive heart failure in patients with normal systolic function compared with those with poor systolic function.

Aged↗
PubMed1994

Variation in von Willebrand's Factor according to the treatment of acute myocardial infarction: physiopathological and clinical implications.

To investigate whether von Willebrand's Factor (vWF) changes as a result of the reperfusion strategy during acute myocardial infarction (AMI), vWF was measured on days 0, 1, 2, 3, 4, 5 and 15 in 34 patients with AMI. Thrombolysis was initiated in 22 patients and followed by a coronary angiogram 90 min later. In 13 patients the infarct-related artery was then patent (THR group). In nine patients the infarct-related artery was occluded and rescue percutaneous transluminal coronary angioplasty was performed (group THR+rPTCA). In 12 patients, primary PTCA was carried out (pPTCA group). Admission values of vWF were similarly high in the three groups, while changes in vWF over the following days were statistically different among the groups. No significant change was observed in THR, whereas a significant and prolonged increase was found after failed thrombolysis with PTCA (peak increase at day 5:1.54 +/- 0.04 U.ml-1). In the pPTCA group, a significant increase could only be found on day 3 (0.96 +/- 0.04 U.ml-1). Absence of a statistical rise in vWF might be a late indicator of successful thrombolysis. The prolonged increase in vWF after failed thrombolysis needing rescue PTCA probably reflects a higher resistance to thrombolysis, while the slight but significant increase in vWF following primary PTCA could be due to vascular injury.

Angioplasty, Balloon, Coronary↗
PubMed1994

Exercise peak VO2 determination in chronic heart failure: is it still of value?

The prognostic value of exercise peak VO2 is still controversial. We therefore prospectively studied 75 patients in New York Heart Association functional class II or III with chronic heart failure stabilized by drug treatment. The patients (mean age of 58 +/- 10 years) were submitted to a clinical examination, a radionuclide determination of left ventricular ejection fraction, and a haemodynamic study at rest (right side catheterization); their plasma sodium, plasma creatinine and blood urea nitrogen levels were measured in addition to exercise peak VO2. An exercise peak VO2 threshold value of 14 ml.kg-1.min-1 was used to define two groups: GI (23 patients), with an exercise peak VO2 < or = 14 ml.kg-1.min-1 and G2 (52 patients) with an exercise peak VO2 > 14 m.kg-1.min-1. G1 and G2 were comparable in terms of age, heart rate, left ventricular ejection fraction, cardiac index and mean arterial pressure. Apart from exercise peak VO2, G1 and G2 also showed differences in right and left ventricular filling pressures, plasma sodium, plasma creatinine, blood urea nitrogen levels and exercise duration (all P < 0.01). Moreover the prognosis was worse in G1 than in G2: nine deaths vs 0, and seven major events--major events being defined as pulmonary oedema, hospitalization for heart failure, or severe ventricular arrhythmias--vs three (P < 0.001). A sub-group analysis (deceased patients, living patients with and without major events) was performed. Out of 20 clinical and paraclinical parameters, exercise peak VO2 proved to have the greatest prognostic value.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Comparison of treadmill and bicycle exercise in patients with chronic heart failure.

The general opinion that treadmill exercise elicits circulatory reserve more than bicycle exercise derives from studies conducted in normal subjects or subjects with coronary artery disease. To investigate if this also occurs in patients with chronic heart failure (CHF), 40 patients (mean ejection fraction: 26 +/- 9 percent) with normal pulmonary function underwent in random order both treadmill (Naughton modified protocol, holding on handrails permitted) and bicycle (10 W/min) maximal exercise over a 1-week period. Peak oxygen uptake (19.6 +/- 5.3 vs 17.6 +/- 5.1 ml/min/kg, p < 0.0001), ventilatory threshold (14.4 +/- 4.7 vs 12.0 +/- 3.5 ml/min/kg, p < 0.0001), and minute ventilation (59 +/- 18 vs 55 +/- 15 L/min, p < 0.05) were greater on treadmill than on bicycle. Heart rate, systolic blood pressure, breathing rate, respiratory exchange ratio, perceived exertion scale, and lactate were identical. The coefficient of the correlation between oxygen uptake and time was greater with bicycle than with treadmill (r = 0.97 +/- 0.04 vs 0.90 +/- 0.07, p < 0.001). Thus, treadmill exercise is more suitable for determining peak oxygen uptake in patients with CHF. However, the increase in oxygen uptake is more regular with bicycle exercise.

Anaerobic Threshold↗
PubMed1994

[Role of the conditions of recording and analysis of the atrial signal on the results of ECG signal averaged P wave].

Several studies have shown that high amplification and averaging of the electrocardiographic P wave may soon enable better identification of people at high risk of paroxysmal atrial fibrillation. The results of this technique are closely dependent on the conditions of recording and analysis of the atrial signal but this factor has not been widely appreciated. The authors, therefore, undertook a study of the reliability of the manual method of measuring P wave duration, the influence of the filters used and the level of background noise on the 3 parameters of analysis: the duration of the P wave (DUR), the root mean square of the amplitude of the terminal 20 milliseconds (RMS20) and the integral under the P curve (IN). The recorder was a Predictor II 5.0 (Corazonix) with a special programme to identify and analyse the P wave in 3 bipolar non-orthogonal leads. DUR was determined manually after amplification and averaging; RMS20 and IN were calculated automatically. In order to assess the reliability of manual determination of the P wave, 48 consecutive patients were studied: two analyses were made with a least a 2 months' interval by entering the data through two filters (unidirectional and FIR). The role of the filters was then studied by passing the preceding 48 recordings to an analysis with three filters: unidirectional, bidirectional and FIR, and comparing the results.(ABSTRACT TRUNCATED AT 250 WORDS)

Atrial Fibrillation↗
PubMed1994

[Effects of amiodarone on thyroid hormonal profile. Updating based on new assay methods].

Amiodarone (A) treatment alters the levels of thyroid hormones. We investigated whether new hormonal assays are also altered by this drug. Thyroid function was determined in 21 patients chronically treated with A and in 30 controls. TSH was determined with a third generation assay. Free T3 and Free T4 levels were determined by 5 different immunoassays. Equilibrium dialysis (E.D.) was considered as the reference assay for FT3 and FT4. With this method FT3 is diminished, reverse T3 ans FT4 are increased whereas TSH remained normal. Only FT3 determined by an assay using a labelled monoclonal antibody (MAB) appears not modified by A. Other methods (chromatography, chemiluminescence and radioisotopic) give results in agreement with E.D. Some of these alterations may be explained by a marked increase in plasma levels of non esterified fatty acids. Hormonal changes induced by A are typically with all but one assays. Whatever the method used the determination of TSH remains necessary to avoid misinterpretation of the thyroid function tests in A-treated patients.

Aged↗
PubMed1993

[Left ventricular filling in young insulin-dependent diabetics].

Left ventricular function indices were measured by pulsed Doppler-echocardiography in 17 young patients (mean age: 25 +/- 5) with insulin-dependent diabetes and 17 controls (identical mean age: 25 +/- 5) free of heart disease. All subjects had normal left ventricular systolic function. Twenty three per cent of diabetics showed a left ventricular filling anomaly on the basis of at least two abnormal indices. Isovolumic relaxation time was significantly prolonged in diabetics as compared with normal individuals (83 +/- 7 v. 68 +/- 9 ms, p < 0.00015). Half-pressure time was also prolonged in the patients (46 +/- 9 v. 38 +/- 6 ms, p < 0.01), the same applying to rapid filling deceleration time (158 +/- 32 v. 136 +/- 29 ms, p < 0.05). Peak rapid filling rate, the proportion of total filling accounted for by rapid filling, peak atrial systole velocity and the atrial contribution to total filling did not differ between the diabetics and controls. Systolic blood pressure was significantly higher in diabetics as compared with controls (124 +/- 8 v. 114 +/- 10 mmHg, p = 0.007), although remaining within normal limits. This would not, however, explain the differences seen between the 2 groups regarding left ventricular profile. The filling anomalies reported here were not correlated with the duration of diabetes nor with other parameters such as glycosylated hemoglobin or 24-hour microalbuminuria. Our results suggest that approximately 20 p. cent of young diabetics have sub-clinical left ventricular anomalies.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Should cardiac insufficiency be first treated by angiotensin converting enzyme inhibitors?].

Chronic cardiac failure is an important problem of public health because of its prevalence and high mortality. A better understanding of its physiopathology and the detrimental effect of neurohormonal activation that it induces were the reasons for the utilisation of angiotensin converting enzyme inhibitors leading to symptomatic improvement and also a reduction in the mortality of severe cardiac failure, as demonstrated in the CONSENSUS study published 5 years ago. Since then, cardiologists have presented ACE inhibitors in all stages of cardiac failure, but is this attitude justified? More explicitly, are ACE inhibitors the drugs of choice in cardiac failure? Before acknowledging this label "drug of choice" in the treatment of chronic cardiac failure, ACE inhibitors should fulfill certain reference criteria proposed by Packer for the treatment of this condition: rapid relief of symptoms; reduced mortality; modification of the natural history of the condition; efficacious and well tolerated. The effects of ACE inhibitors are analysed critically taking into account the results of large scale therapeutic trials (SOLVD, V-HeFT II, CONSENSUS II, SAVE), which have been reported recently? The reported results confirm clinical impressions: ACE inhibitors are the drugs of choice of all stages of chronic cardiac failure but in association with diuretic and digitalis therapy.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1993

[Dynamic cartography of flow patterns by cine-MRI. Presentation of the technique and preliminary results for major vessels].

The authors report the principles, experimental evaluation and clinical approach of a method for dynamic imaging of flow patterns by NMRI, based upon the phase modulation technique. The imaging method is based upon gradient echo, functioning in "cine" and "flow compensated" mode. Modifications in this sequence enable attribution to the moving spins phase of a value which is considered to be proportional to the flow rate. A map of rates is then obtained from the phase image. Calibration of this sequence in vitro has shown excellent correlations between flow rate and the phase information thus obtained: r always > 0.98 for rates up to m/s. The first results obtained in vivo for the thoracic and abdominal aorta, in 11 control subjects, show that the technique is suitable for the study of pulsatile blood flow, providing very detailed information concerning the spatial distribution of flow rates. Mean flow in the suprarenal abdominal aorta (4.6 +/- 1.6 l/min) is 32% greater than that in the inferior vena cava (3.1 +/- 1 l/min), corresponding to an estimation of portal vein flow of 1.5 l/min. Practical limitations related to the use of a resistive magnet are nevertheless stressed and the authors list the technical aspects necessary for the better clinical utilisation of this non-invasive flowmetric technique. A review of the current literature forms the basis for an assessment of the potential importance of dynamic and quantitative NMRI of flow patterns in the cardiovascular area.

Aorta↗
PubMed1993

[Acute myocardial infarction in patients over 70 years of age treated by immediate primary angioplasty].

Twenty consecutive patients aged over 70, admitted for acute myocardial infarction, underwent coronary arteriography within less than 6 hours after the onset of pain to confirm the diagnosis and determine the indications for other than thrombolytic reperfusion treatment, the risk of thrombolysis seeming theoretically prohibitive. In all cases, the artery responsible was found to be obstructed and, based upon this criterion, primary reperfusion angioplasty was performed. The criterion for success of angioplasty was the reappearance of distal flow (grade > 1 of the TIMI classification--Thrombolysis in Myocardial Infarction). The reperfusion rate obtained by angioplasty was 85%. Follow-up coronary arteriography during hospitalisation (between D10 and D15) in 17 patients revealed neither restenosis nor re-occlusion. In case of successful reperfusion, left ventricular ejection fraction improved by 16% (in absolute values). Hospital mortality was 15% (6 patients were in cardiogenic shock from the time of admission). Mortality (after a follow-up of 27.3 +/- 17.5 months) was 20%. Complications of the procedure during the acute phase included one femoral hematoma and one moderate coronary dissection, with an uncomplicated outcome. Angioplasty is an effective reperfusion method in patients aged over 70, and is an alternative to thrombolysis which, in this age group, is accompanied by a risk of hemorrhagic complications, cerebral in particular. Thus angioplasty can be suggested as first line treatment in elderly patients provided they have been admitted to a unit where operational cardiology is available on a continuous basis.

Aged↗
PubMed1992

Inter-study variability in left ventricular mass measurement. Comparison between M-mode echography and MRI.

In order to compare variability in M-mode echography and MRI in the assessment of left ventricular mass, 20 echogenic patients without evidence of coronary artery disease were investigated. Two MR and two M-echo examinations were performed within 4 days by different trained operators, each unaware of the other's results. M-mode echo was carried out according to Devereux's method, using the 'Penn-Cube' formula. MR protocol included multislice (8 to 12) true, short-axis spin-echo imaging (10 mm thick with a 1 to 3 mm gap) encompassing the entire left ventricle. Planimetry was manually traced with standardized window settings. Correlations between both echographic and both MR measurements showed r = 0.89, SEE = 22.7 g and r = 0.96, SEE = 11.2 g, respectively. Mean inter-study variability was 11 +/- 6.4% and 6.75 +/- 3.8% (P = 0.0021). The threshold value corresponding to the 95th percentile of the variability data was 21.5% for echography and 13.5% for MR. In conclusion, MR appeared to be a significantly more reproducible examination tool, when compared with M-mode echo, for the evaluation of left ventricular mass (variability, 63% higher with echo than with MR). The main practical consequence of this result lies in the reduced number of patients required to demonstrate a significant change in the LVM with MR as compared with echography.

Adult↗
PubMed1992

Increase in radionuclide left ventricular ejection fraction after cardioversion of chronic atrial fibrillation in idiopathic dilated cardiomyopathy.

To assess the potential improvement in left ventricular ejection fraction after cardioversion of chronic atrial fibrillation to sinus rhythm in idiopathic dilated cardiomyopathy, we studied prospectively 17 patients, aged 58 +/- 6 years, by radionuclide angiocardiography at rest. Left ventricular ejection fraction was determined before treatment and at a mean delay of 4.7 months after cardioversion. Return to sinus rhythm was obtained in 12 patients, pharmacologically or by electrical cardioversion. Five patients remained in atrial fibrillation. No clinical, echocardiographic or haemodynamic finding could predict the success of cardioversion. In chronic atrial fibrillation, the ejection fraction did not change significantly: 30.0 +/- 9.1% (19 to 44%) at the first evaluation and 29.5 +/- 8.3% (22 to 41%) after 4.7 months. After successful cardioversion, left ventricular ejection fraction improved from 32.1 +/- 5.3% (24 to 41%) to 52.9 +/- 9.7% (37 to 71%) (P less than 0.001). The difference was 20.8 +/- 11.3% and left ventricular ejection fraction was normalized in 50% (6/12) of the patients. There was a significant reduction in the cardiothoracic ratio on chest X-rays and of the left ventricular end-diastolic diameter on echocardiography; fractional shortening increased (27.7 +/- 4.3% vs 20.3 +/- 2.7%, P less than 0.01). A third evaluation was realized after a mean delay of 11.7 months in the patients with successful cardioversion. Sinus rhythm was present in 83% (10/12) of the patients: seven patients were reevaluated by radionuclide angiography. The improvement in left ventricular function observed at the 4.7 months evaluation was still present. In two patients with recurrence of atrial fibrillation, there was a severe deterioration of left ventricular systolic function.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

[Familial polymorph ventricular extrasystole associated with Pierre Robin syndrome].

In a family of 9 persons over 3 generations, 6 had incessant polymorphic ventricular extrasystoles, often in salves, resembling unsustained bidirectional ventricular tachycardia. Ventricular repolarisation was abnormal with giant U waves. Five persons had suffered syncopes. All had a facial abnormality: one woman had a complete Pierre Robin syndrome with mandibular hypoplasia, glossoptos and cleft palate; in the other cases, minor forms were observed, with micrognathia and ogival palate. Two patients had bone abnormalities of the feet with total agenesis of the last 2 phalanges of several toes. This familial polymorphic ventricular extrasystole with repolarisation abnormalities has many features in common with the congenital long QT syndrome; associated with the Pierre Robin syndrome and bone abnormalities of the extremities it would seem to be a new multiple congenital abnormalities syndrome.

Adolescent↗
PubMed1992

[Drug therapy of acute myocardial infarction without cardiogenic shock and thrombolytic therapy excluded].

Myocardial infarction is responsible for 25,000 deaths per year in France and is a real problem of public health. The management of patients victims of this condition is an important feature of medical practice. Thrombolytic therapy has resulted in significant improvements in the reduction of the size of the infarct, in the conservation of left ventricular function and in the reduction of mortality. Treatment of the acute phase of myocardial infarction, especially when there are contra-indications to thrombolysis, comprises other approaches, some of which are old, which are reviewed in the light of the results of the latest large scale therapeutic trials.

Adrenergic beta-Antagonists↗