Biomedical subjects
Publications and source records attributed to J J Perrenoud.
An abnormal Q wave in the ECG of the elderly calls for differential diagnosis between an old myocardial infarction and left ventricular hypertrophy. The latter may be due to hypertrophic cardiomyopathy, the prognosis of which is good in the elderly. The echocardiogram is the only method which provides the correct diagnosis and helps to avoid incorrect treatment.
In cases with a history of swallow syncope, an ECG should immediately be taken during ingestion of solid or liquid food in order to determine the rhythm disturbances responsible for the syncopes. Both esophageal passage and cardiac diagnosis are indicated, since, as shown in the literature, pathologic findings are not uncommon. The triad syncope, bradyarrhythmia while swallowing is considered to be an indication for definitive electrostimulation (pacemaker implantation) unless, exceptionally, halting digitalis medication puts an end to the syncopes.
In a dose of 5 mg three times daily, the beta-blocker pindolol (Visken Sandoz) has been shown to provide protection against both the signs and the symptoms of myocardial ischaemia. The purpose of the present study was to ascertain whether the same degree of protection is provided by a single daily dose of a slow-release formulation containing 20 mg pindolol. - Twelve patients with confirmed coronary heart disease were included in the study, which was carried out using a bicycle ergometer. The exercise tests were performed 2 hours after drug administration and again immediately before the next dose was due. These times are assumed to correspond to the maximum and minimum plasma levels of pindolol respectively. - The results show no statistically significant difference between the 20 mg form of the drug once a day and the 5 mg form 3 times daily with regard to the effect on heart rate (HR), blood pressure (BP), the product of HR and BP, and S-T segment changes (Cohn score) either at rest, during maximum effort, or 3 minutes after exercise. - It is concluded that 20 mg slow-release pindolol once daily is an effective anti-anginal therapy similar in its properties to 5 mg 3 times daily.
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Hepatic drug metabolism influenced by genetic and environmental factors is a major source of variation in the response to a number of beta-adrenoceptor antagonists. The first study described here was carried out to define the role of a genetic determinant (debrisoquine-type oxidation polymorphism) on plasma concentration of bopindolol and its pharmacological effect. Atenolol was used as a negative and metoprolol as a positive control. In a second study, the relative potency and duration of action of bopindolol were assessed in comparison to atenolol and slow-release oxprenolol. The first study was carried out using 10 healthy volunteers (6 extensive and 4 poor metabolizers), and the second study was carried out using 12 volunteers, all of whom were extensive metabolizers. Genetic polymorphism did not influence the kinetic behavior or pharmacological effects of atenolol. The elimination of bopindolol was slightly but significantly prolonged in poor metabolizers, but this did not significantly alter the cardiac effects of the drug. In the case of metoprolol poor metabolizers showed a significant prolongation of drug elimination, and this was associated with a significant prolongation of the cardiac effects of the drug. The second study revealed that, in terms of cardiac beta-adrenoceptor blockade, 1 mg bopindolol was equipotent to 100 mg atenolol or 160 mg slow-release oxprenolol and that both bopindolol and atenolol had a longer duration of action than slow-release oxprenolol. It is concluded that bopindolol is a potent beta-adrenoceptor antagonist with a very long duration of action which shows little interindividual variability.
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Digitalis still remains a source of astonishment to electrophysiologists as well as clinicians. The presently known effects on the neurovegetative system and the action potential are described, and some clinical problems which may lead to ineffective digitalization or digitalis intoxication are stressed. Clinical and ECG manifestations and some therapeutic aspects are pointed out.
Presentation of a case of disseminated intravascular coagulation with micro-angiopathic hemolytic anemia, associated with a micro-carcinoma of the prostate. In the absence of other etiology it is postulated that the carcinoma was responsible for the hematological disturbance in spite of its small size andlack of either metastases or mucin secretion. The unusual discovery in this disease of bony necroses of the vertebrae, which are attributed to ischemia following micro-thromboses, is also discussed.
The relatively rare pseudotumoral lymphoid hyperplasia (benigh lymphoid or reactive lymphoreticular hyperplasia; pseudolymphoma; Castleman's disease) arises from the lymph nodes, usually in the mediastinum. The disease assumes tow histologically and clinically different forms: the first, angiofollicular, is often symptomless, while the second, lymphoplasmocytic, is sometimes associated with a marked chronic inflammatory syndrome. The etiology is unknown, but is probably a reaction of the lymphoplasmocytic system to an antigen, possibly of viral origin. Diagnosis is based on histology. Surgical treatment is curative. A rare form of this unusual disease is reported with reference to the morphological differential diagnosis; the similarities with immunoblastic lymphadenopathy are emphasized.
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