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Biomedical subjects

J F Kahn

Publications and source records attributed to J F Kahn.

15 recordsLinked to original sources
PubMed1992

Carotid stenosis is a powerful predictor of a positive exercise electrocardiogram in a large hyperlipidemic population.

Hypercholesterolemia is a major risk factor in coronary heart disease (CHD) and ischemic stroke. However, there is no general agreement on the usefulness of systematic screening of patients with hyperlipidemia by stress exercise electrocardiogram (ECG). The feasibility of this approach would depend on selecting patients with a high risk of CHD, since the sensitivity and specificity of the test depends on the prevalence of the disease. In view of the association of CHD and ischemic stroke, we undertook a study to determine whether the presence of atherosclerosis in the carotid arteries was predictive of a positive exercise ECG in a group of 778 asymptomatic patients referred to their hyperlipidemia. We a much higher percentage of positive exercise ECG in patients with carotid atherosclerosis in our ultrasonographic examinations. In a multiple regression analysis which included 13 parameters (age, sex, body mass index, arterial blood pressure, lipid parameters, serum level of glucose, smoking status and the severity of carotid lesions), the strongest predictors of a positive exercise ECG test were age (P = 0.014) and the degree of carotid atherosclerosis (P = 0.010). We therefore conclude that hyperlipidemic patients with atherosclerotic lesions on carotid arteries would benefit most from screening by the exercise ECG.

Adult↗
PubMed1991

[The static exercise-induced arterial hypertension test].

The exercise tests used in the detection and follow-up of hypertensive patients fall into two categories: isotonic (dynamic) and isometric (static). The isometric exercise-induced arterial hypertension test consists of an isometric contraction--usually a grip by the dominant hand--sustained for 3 minutes, with a strength that is 30 percent of maximum voluntary strength. This results in a continuous and parallel increase of systolic and diastolic blood pressures during the hand grip. The heart rate also continuously rises, though not to the level obtained by the isotonic exercise test. The increase in cardiac output observed, despite a fall in stroke volume, and the absence of decrease in peripheral vascular resistance contribute to a sometimes considerable rise in blood pressure, particularly diastolic pressure. These cardiovascular responses do not depend on the muscular mass involved but on the relative strength developed during isometric contraction. Owing to the lack of strict standardization and longitudinal studies, the isometric exercise test is of little value in the early detection of arterial hypertension. However, it is useful in the follow-up of hypertensive patients, as it provides precise information on the point of impact and mode of action of several antihypertensive drugs.

Blood Pressure↗
PubMed1991

Cardiovascular response to static handgrip in trained and untrained men.

The influence of aerobic capacity on the cardiovascular response to handgrip exercise, in relation to the muscle mass involved in the effort, was tested in 8 trained men (T) and 17 untrained men (U). The subjects performed handgrip exercises with the right-hand (RH), left-hand (LH) and both hands simultaneously (RLH) at an intensity of 25% of maximal voluntary contraction force. Maximal aerobic capacity was 4.3 l.min-1 in T and 3.21 l.min-1 in U (P less than 0.01). The endurance time for handgrip was longer in T than in U by 29% (P less than 0.05) for RH, 38% (P less than 0.001) for LH and 24% (P less than 0.001) for RLH. Heart rate (fc) was significantly lower in T than in U before handgrip exercise, and showed smaller increases (P less than 0.01) at the point of exhaustion: 89 vs 106 beats.min-1 for RH, 93 vs 100 beats.min-1 for LH and 92 vs 108 beats.min-1 for RLH. Stroke volume (SV) at rest was greater in T than in U and decreased significantly (P less than 0.05) during handgrip exercise in both groups of subjects. At the point of exhaustion SV was still greater in T than in U: 75 vs 57 ml for RH, 76 vs 54 ml for LH and 76 vs 56 ml for RLH. During the last seconds of handgrip exercise, the left ventricular ejection time was longer in T than in U. Increases in cardiac output (Qc) and systolic blood pressure did not differ substantially between T and U, nor between the handgrip exercise tests.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Absence of a direct effect of peritoneal dialysate on venous lower limb flow].

In order to verify if the presence of 21 of fluid in the peritoneum is likely to produce a slowing of the venous flow in the lower limbs, 34 patients suffering from end stage chronic renal failure and treated by continuous ambulatory peritoneal dialysis (CAPD) were followed up for two years by means of noninvasive methods. The maximum femoral venous flow velocity before and during CAPD was evaluated using Doppler effect, in 2 positions of the patients (recumbent or upright), and with or without dialysate (abdomen full or empty). The venous distensibility and the maximum venous outflow were evaluated using venous occlusion plethysmography in the recumbent position. Despite a decrease in mean arterial blood pressure (before the start of CAPD: 116.0 +/- 3.7 mm Hg; after 2 years of CAPD: 104.3 +/- 3.2 mm Hg, p less than 0.02), there was no significant slowing of the venous limb flow during the two years of treatment by CAPD, and in no case did the peritoneal fluid constitute a mechanical obstruction.

Blood Flow Velocity↗
PubMed1989

Cardiovascular and sympatho-adrenal responses to static handgrip performed with one and two hands.

12 healthy men aged 21-25 years performed, in the sitting position, a sustained handgrip at 25% of their maximum voluntary contraction, first with each hand separately and then with both hands simultaneously. Heart rate (HR), systolic blood pressure (SBP), stroke volume (determined reographically) and plasma catecholamine concentration were measured during each handgrip test. The HR and SBP increased consistently during each handgrip test while stroke volume decreased by approximately 20% of the initial value. Cardiac output did not change significantly. There were no significant differences in the magnitude and dynamics of the cardiovascular responses between the tests with one and with both hands. Plasma noradrenaline and adrenaline levels showed similar elevations in response to handgrip performed with the right hand and with both hands, while during the exercise performed with the left hand the increase in the plasma catecholamine concentration was less pronounced. It was concluded that: (1) during sustained handgrip, performed in the sitting position by young healthy subjects, the stroke volume markedly decreases and cardiac output does not change significantly in spite of the increased HR; (2) the cardiovascular and sympatho-adrenal responses to static handgrip do not depend on the mass of contracting muscle when the same relative tension is developed.

Adult↗
PubMed1989

Fatigue induced by static work.

Despite its low energy cost, isometric contraction can result in the onset of local muscle fatigue. The onset of fatigue occurs more rapidly when the relative force exerted is greater than 15-20% of the maximum voluntary contraction (MVC) of the muscle considered, and when the contraction time is increased. The maximum maintenance time (limit-time) and the corresponding relative force are linked by a hyperbolic relation. Ischaemia promotes accumulation of acid metabolites produced during contraction, and hinders their elimination, thus constituting the main causal factor in the onset of local muscle fatigue. The introduction of rest periods of sufficient duration to ensure restoration of normal blood flow through the muscle is an effective way of delaying, or even preventing, the onset of muscle fatigue. Other factors may also be taken into account, such as the position in which the static work is performed, and the nature and number of muscles used simultaneously, etc. Numerous laboratory and field studies have allowed the development of various models that take into account the conditions relating to isometric contractions during static work.

Fatigue↗
PubMed1989

[Changes in blood pressure during static work. Practical implication].

while the cardiocirculatory response to dynamic exercises (e.g. running, cycling, swimming) is the object of the physician's full attention, the cardiovascular repercussions of static exercises, such as weight-lifting, sustained postures in gymnastics or immobilization in judo, are often ignored. Yet any sustained isometric contraction is associated from the art with an increase in blood pressure which may be major and involves about equally the systolic and diastolic pressures. As soon as the strength developed by the muscle exceeds 20 p. 100 of its maximum voluntary strength (MVS) the increase of blood pressure continues until the contraction comes to an end. Whatever the muscle used, the intensity of a cardiovascular response is independent of the muscular mass in action, but it mostly depends on the MVS percentage This rise in blood pressure is mainly due to an increase in heart and cardiac output. The reactions are such that relatively moderate and localized static effort may result in a rapid and important increase in myocardial work, and this may cause serious accidents in subject with a cardiovascular weakness, either isolated or associated with such risk factors as age or arterial hypertension. In consequence, adults who are insufficiently trained and present with one or several risk factors should avoid sports which required frequent respiratory arrests and/or sustained postures. If such sports are nevertheless chosen, it would seem that practising also a dynamic sport relying on aerobic metabolism might lin , at least in part, the effects of increased blood pressure due to static activities.

Adult↗
PubMed1988

[Clinical aspects of continuous ambulatory peritoneal dialysis in diabetics].

The treatment of end stage renal diabetic nephropathy remains a challenge. A large experience allows us to clearly outline the advantages and the drawbacks of continuous ambulatory peritoneal dialysis (CAPD). 81 patients, mean age 51.3 years, were treated over the past nine years by CAPD-CCPD. Extrarenal complications, mainly vascular lesions, account for qualifying these patients as a high risk population. The technique was modified in order to inject insulin intraperitoneally, four times per day, to control blood glucose level. Peripheral vascular disease was prospectively studied in 19 patients. Actuarial survival was 92% at one year, 50% at four years mainly influenced by age: 85% survival at two years in 35 patients aged less than 50 years and 62% at two years in 46 patients aged more than 50 years. The main causes of death were of cardiovascular origin: arteritis, myocardial infarction, stroke. The main causes for transfer to an alternative method of treatment were technical complications. Peritonitis rate was one episode ever 14 months. Satisfactory control of blood pressure, blood glucose levels, main biological parameters, visual status were the clear advantages of the method. Peripheral vascular disease is not influenced by the technique. CAPD can be the technique of first choice in young diabetics awaiting a kidney transplant and the reference technique for home dialysis.

Adult↗
PubMed1986

Effect of arm position on cardiovascular responses during isometric handgrips.

Sixteen subjects (eight women and eight men, age 20-25 years) carried out in the seated position, isometric contractions sustained until exhaustion of the digital flexors. The subject's arm was placed in two positions, high and low. The muscle tensions used were 30, 40 and 50% of maximum voluntary contraction (MVC). Under these conditions, for a given relative force, the duration of contraction (limit-time) was not modified by the arm position. In the male subjects, increases in heart rate (HR) and systolic blood pressure (SBP) were slightly more pronounced in the low than the high position, but the differences were not significant. Limit times in the high position were similar to those in the low position, and, in the absence of an increase in HR and SBP, this seemed to be due to an increase in cardiac output consequent upon a transient improvement in venous return together with an increase in the coefficient of oxygen utilization.

Adult↗
PubMed1986

Physiological modifications of local haemodynamic conditions during bilateral isometric contractions.

Nine subjects (five women and four men) simultaneously performed two isometric contractions sustained until exhaustion at different relative forces: 40% of maximum voluntary contraction (MVC) for the right elbow flexors; 50% MVC for the left elbow flexors. Contraction of the left elbow flexors commenced at 50% of the limit time (maximum maintenance time) of isometric contraction of the right elbow flexors. Increase in heart rate during concomitant contraction of the left elbow flexors led to an increase in blood flow to the right elbow flexors. Under these conditions, the limit time of isometric contraction of the right elbow flexors was prolonged with respect to the limit time obtained for an isolated isometric contraction at the same relative tension. The difference was more significant in the female (+40%, P less than 0.05) than in the male subjects (+20%, P greater than 0.05).

Adult↗
PubMed1985

Comparison of two modalities when exerting isometric contractions.

In order to verify whether the method employed to obtain an isometric contraction has any effects on the time for which the contraction can be sustained as well as the consequent cardiocirculatory responses, nine male subjects, from 23 to 42 years of age, carried out isometric contractions of the elbow flexor muscles against either a suspended weight (W) or a fixed strain gauge (SG). The maximum voluntary contraction (MVC) appears to be identical in both instances; and, for a given percentage of MVC, the limit-time of the isometric contraction and its accompanying heart rate changes reveal no significant differences in the two cases.

Adult↗
PubMedDate not supplied

Complementary roles of central command and muscular reflex in the regulation of heart rate during submaximal isometric contraction.

During submaximal isometric contraction, the heart rate (HR) and the electromyographic activity (EMG) increase continuously. Although activation of the muscle and the cardiovascular center is placed partly under the common control of the central command, the nature of the relationship that may exist between HR and the integrated electromyogram (iEMG) is seldom studied. Seventeen healthy men, 22.4 +/- 0.5 years of age (M +/- SE), performed isometric contractions with the right elbow flexors. Forces of 25, 40, 50 and 65% of the maximum voluntary contraction (MVC) were used, and the contractions were sustained until (isotonic isometric contraction: IIC) and beyond exhaustion (anisotonic isometric contraction: AIC). During IIC, a linear relationship exists between HR and iEMG; the slope of this relationship is independent of the relative force developed, which is in favor of a predominant role played by the central command in HR increase. The increase in the ratio iEMG/HR at the approach of local muscular exhaustion would indicate that at the end of IIC there is an increase in the relative part furnished by the information of peripheral origin in HR regulation. During AIC, the force (F) decreases in an exponential manner and stabilizes at around 25% MVC from tAIC = 70 s on. The iEMG and HR change independently: iEMG decreases like F such that iEMG/F remains constant; HR continues to increase in the first phase corresponding to the rapid decrease in F and iEMG, then in a second phase, it decreases linearly with respect to time. Our results suggest that the action of the central command is dominant during stage 1 of AIC, while during stage 2 the relative part furnished by the muscle reflexes increases. Beyond tAIC = 70 s, there seems to be a certain degree of central fatigue.

Adolescent↗