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Biomedical subjects

J L Cazor

Publications and source records attributed to J L Cazor.

At least 19 recordsLinked to original sources
PubMed1988

Dose-titration study of alfuzosin, a new alpha 1-adrenoceptor blocker, in essential hypertension.

An open, dose-titration study of alfuzosin, a new selective post-synaptic alpha 1-adrenoceptor antagonist with additional direct vasodilator properties has been performed. After a 3-week run-in placebo period, 12 patients with essential hypertension received alfuzosin 5 mg oral b.d., and then the dose was doubled every week, up to a maximum of 20 mg q.i.d. if the supine diastolic blood pressure was greater than 90 mm Hg. The study lasted for 4 weeks. Supine blood pressure (SBP) decreased from 160/102 (Day 0) to 148/89 mm Hg and upright blood pressure (UBP) from 151/102 (Day 0) to 137/84 mm Hg. Alfuzosin did not cause any significant change in supine or upright heart rate. In addition, after the first dose of alfuzosin, supine and upright blood pressure and heart rate (SHR and UHR) were measured every 30 min for 5 h. The fall in blood pressure was significant after 90 min and it lasted up to the 5th hour; the maximum effect was observed after 3 h: SBP decreased from 159/103 (time 0) to 137/84 mm Hg and UBP from 150/102 (time 0) to 123/79 mm Hg. SHR was increased from 72 (time 0) to 81 beats/min at the 5th hour and UHR from 87 to 101 beats/min at the 4th hour. A weak but significant correlation was observed between the hypotensive effect 12 h after drug intake and the plasma concentration of the drug at that time. A 10% decrease in supine diastolic blood pressure was found at a drug plasma concentration higher than 7 ng/ml.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic alpha-Antagonists↗
PubMed1988

[Prevention of per- and postoperative myocardial ischemia in non-cardiac surgery by intravenous diltiazem].

A controlled double-blind trial was carried out to assess the efficacy and safety of a continuous intravenous infusion of diltiazem in preventing perioperative myocardial ischaemia in patients with coronary artery disease. Sixty-six patients undergoing non cardiac surgical procedures (vascular surgery, n = 37; other, n = 29) were randomly chosen to receive either diltiazem (group D, n = 32); or placebo (group P, n = 34); there was no difference between these groups in the number of patients in each NYHA class (I: 13/16; II: 14/14; III: 5/4) or having had a previous myocardial infarct (20/22). ECG leads CM5 and CL5 were recorded continuously with an ICR 7200 Holter monitor. After starting recording, either placebo or a loading dose (0.5 mg.kg-1) of diltiazem was given, followed by an infusion of 5 micrograms.kg-1.min-1. Anaesthesia was induced by thiopentone and suxamethonium, and maintained with nitrous oxide (50%), fentanyl and either halothane or droperidol. The number of myocardial ischaemic episodes was significantly (p less than 0.05) lower in group D (2 ST depressions in two patients) than in group P (8 ST depressions in six patients, 2 myocardial infarcts and 1 pulmonary oedema). No conduction disturbance was observed; the lowest cardiac frequency was found in group P (32 b.min-1). Systolic and diastolic arterial blood pressures were lower in group D than in group P, but no difference was found in heart rate and rate-pressure product.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1988

[Hemodynamic effects at rest and exertion of a new partial beta-agonist (cicloprolol) in moderated cardiac failure].

The haemodynamic effects of cicloprolol, a new partial beta 1-adrenoceptor agonist, were investigated at rest and during exercise in 10 patients with moderate heart failure. At rest, cicloprolol (0.10 mg/kg i.v.) increased heart rate by 8 p. 100 (80.6 +/- 5.7 vs 74.7 +/- 11.9 beats/min; p less than 0.05), cardiac index by 17 p. 100 (3.74 +/- 0.57 vs 3.20 +/- 0.41 l/min/m2; p less than 0.001) and stroke index by 6 p. 100 (46.3 +/- 8.3 vs 43.7 +/- 8.8 ml/beat/m2; p less than 0.05). Left ventricular end-diastolic pressure was reduced by 35 p. 100 (9.9 +/- 5.0 vs 15.2 +/- 7.4 mmHg; p less than 0.01). There were no significant changes in aortic pressure. Systemic vascular resistance decreased by 15 p. 100 (1,030.8 +/- 234.6 vs 1,209.6 +/- 319.7 dynes.s.cm-5; p less than 0.01). During moderate exercise (114 +/- 13 watts) in supine position, cicloprolol induced a 10 p. 100 reduction of tachycardia (99.7 +/- 10.2 vs 112.2 +/- 16.5 beats/min; p less than 0.01), a 6 p. 100 decrease of mean aortic pressure (112.4 +/- 19.7 vs 119.5 +/- 19.2 mmHg; p less than 0.01) and an 8 p. 100 decrease of cardiac index (5.42 +/- 0.63 vs 5.88 +/- 0.75 l/min/m2; p less than 0.001). There were no significant changes in left ventricular filling pressure and stroke index. When data obtained at rest and during exercise were pooled, an inverse linear relationship (p less than 0.01) was found between heart rate before treatment with cicloprolol and cicloprolol-induced variations in heart rate and cardiac index.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Agonists↗
PubMed1986

Hemodynamic effects of intravenous diltiazem in patients treated chronically with propranolol.

In the search for any deleterious hemodynamic effects of the acute administration of intravenous diltiazem (0.25 mg/kg), in patients on beta blockers, studies were performed in two comparable groups of eight patients with chronic coronary heart disease without clinical signs of heart failure. In the first group, with no previous treatment, the only significant variations observed were a decrease in systemic vascular resistance (p less than 0.01) and an increase in cardiac index (p less than 0.01), which were noted only at 5 minutes. In the second group, receiving long-term oral doses of 120 to 240 mg/day of propranolol, at 5 minutes, despite a slight decrease in peak positive first derivative of left ventricular pressure (p less than 0.05), cardiac index and systolic index increased (p less than 0.05 and p less than 0.01) with decreases in systemic vascular resistance (p less than 0.01) and mean blood pressure (p less than 0.05); at 15 minutes, systemic vascular resistance was still decreased (p less than 0.05) and cardiac index and systolic index were still increased (p less than 0.05). In conclusion, intravenous administration of diltiazem (0.25 mg/kg) to patients with chronic coronary heart disease and no evidence of congestive heart failure, who were receiving propranolol, was safe and prevented, in these patients, the potential deleterious effects of beta blockers, that is, increased peripheral vascular resistance and decreased cardiac output.

Adult↗
PubMed1984

Angina pectoris with angiographically normal coronary arteries: a clinical, hemodynamic, and metabolic study.

Seventy-six patients with anginalike chest pain (ALCP) and angiographically normal coronary arteries (NCA) had a study of the myocardial metabolism at rest and during maximal atrial pacing. The results were compared with pain characteristics, electrocardiogram, left ventricular, and coronary hemodynamic data. Coronary blood flow (CBF) was measured by continuous thermodilution. At maximal paced heart rate, the study of the myocardial metabolism distinguished two groups: (1) a first group of 50 patients whose lactate extraction coefficient was equal to or exceeded 9% and was considered as normal (Gr. I, K greater than or equal to 9%); (2) a second group of 26 patients whose lactate extraction coefficient was below 9% (Gr. II, K less than 9%), significant of myocardial ischemia. In group I (K greater than or equal to 9%), chest pain was usually atypical (typical in only 25% of cases) and rapid atrial pacing most often caused neither pain nor ECG changes. The hemodynamic and angiographic study showed minor alterations of the left ventricular cavity in 50% of cases. In group II (K less than 9%), chest pain was typical in 50% of the patients and maximal atrial pacing most often caused chest pain (85%) and ST-segment depression (80%). In almost every case, the left ventricular and the coronary angiograms were normal. Only in this group, which had clinical, electrical, and metabolic signs of myocardial ischemia, could the diagnosis of angina pectoris with angiographically normal coronary arteries be upheld.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

Coronary hemodynamic data in ischemic heart disease according to ischemic behavior during pacing.

In order to study the circulatory changes induced by maximal atrial pacing in coronary patients, coronary sinus blood flow (CBF) measured by continuous thermodilution, lactate extraction coefficient (K), arteriovenous difference in oxygen (AVO2 diff), and aortic blood pressure (BP) were measured at basal state and at maximal heart rate (HRmax) in 11 patients without coronary disease (group I) and in 28 patients with severe coronary lesions, divided into two groups according to the absence (group IIa) or the presence (group IIb) of chest pain and ST-segment depression at HRmax X K was inverted in group IIb (24 +/- 17% vs -23 +/- 39%, p less than 0.001), but remained unchanged in group I and group IIa. Despite similar HRmax, percent increase in CBF was significantly lower in group IIb (54 +/- 34%), than in group I (113 +/- 54%, p less than 0.01). This contrasts with the higher values of the product of heart rate times systolic blood pressure (HR X SBP) as well as of diastolic blood pressure (DBP) in group IIb. The decrease in coronary resistances was lower in group IIb than in group I (p less than 0.001), and also lower than in group IIa (p less than 0.05). The ratio MVO2 X CBF/systolic BP X HRmax was significantly lowered only in group IIb (p less than 0.001) confirming the imbalance between myocardial oxygen supply and oxygen demand. In coronary patients, myocardial ischemia induced by atrial pacing is related to an insufficient increase in CBF, well evidenced by continuous thermodilution.

Angina Pectoris↗
PubMed1983

[Angina pectoris with normal coronary arteries: clinical, hemodynamic and metabolic study].

Sixty patients without organic heart disease presenting with chest pain suggestive of angina pectoris and angiographically normal coronary arteries underwent clinical, hemodynamic and metabolic investigation. The study of myocardial lactate metabolism during atrial pacing (168 +/- 14 bpm) allowed identification of two groups: --40 patients with a normal coefficient of lactate extraction (K greater than or equal to 9 per cent); --20 patients with a pathologically low coefficient of lactate extraction (K less than 9 per cent) reflecting myocardial ischemia. In the first group, chest pain was often atypical (75 per cent of cases). Hemodynamic investigation showed minor abnormalities of the left ventricle in 48 per cent of cases. The diagnosis of angina was rejected in these patients. In the second group, the majority of patients developed chest pain (85 per cent of cases) at the maximal heart rate with significant ST depression (80 per cent of cases). The chest pain was typical of angina pectoris in 50 per cent of cases. Hemodynamic and angiographic investigation of the left ventricle was completely normal in nearly all cases. Only these patients with clinical, electrocardiographic and metabolic signs of myocardial ischemia can be considered as having angina with normal coronary arteries. Although studies of myocardial lactate metabolism and other signs of myocardial ischemia distinguish clearly between these two groups of patients, the coronary hemodynamics were similar. Resting coronary flow, its increase for the same myocardial oxygen demands and coronary resistances were comparable in both groups, and not significantly different from the values obtained in a control group of patients without coronary artery disease or chest pain. These results confirm that about 30 per cent of patients investigated for chest pain suggestive of angina pectoris who have angiographically normal coronary arteries, develop signs of myocardial ischemia during atrial pacing. The physiopathological explanation remains unclear as coronary hemodynamics have been found to be normal.

Adult↗
PubMed1983

Hemodynamic effects of diltiazem in hypertension.

Cardiac hemodynamics, diameter, blood flow velocity, and volumic flow of the brachial artery were studied before and after diltiazem administration in 11 patients with sustained essential hypertension. The study was compared with the hemodynamic effects of dihydralazine. The caliber of the brachial artery was evaluated with a pulsed Doppler velocimeter enabling the determination of the angle between the ultrasound beam and the vessel axis with a precision of 2%. After bolus administration of diltiazem, blood pressure and total peripheral resistance significantly decreased (P less than 0.001) while cardiac index and heart rate significantly increased (P less than 0.01). After 25 minutes of perfusion, cardiac output and heart rate returned toward control values, while blood pressure and total peripheral resistance remained decreased. The results contrasted with those observed after dihydralazine, which induced a sustained increase in cardiac index and heart rate. The caliber of the brachial artery decreased significantly (P less than 0.001) after dihydralazine and increased significantly after diltiazem (P less than 0.01). The study provided evidence that the antihypertensive effect of diltiazem was due to a fall in total peripheral resistance, associated with a transient baroreflex mediated tachycardia, and that--in addition to their effects on small arteries--vasodilating drugs may either increase (diltiazem) or decrease (dihydralazine) the caliber of peripheral large arteries.

Adult↗
PubMed1981

Hemodynamic and angiographic evaluation of aortic regurgitation 8 and 27 months after aortic valve replacement.

Eighteen patients with chronic aortic insufficiency were evaluated hemodynamically and angiographically 8 months after aortic valve replacement. Both the pulmonary artery diastolic pressure and the left ventricular end-diastolic volume decreased significantly (p less than 0.001), but the mean ejection fraction and the cardiac output remained identically lowered, though some individual cases showed improvement. The relative reduction in end-diastolic volume correlated only with the preoperative ejection (p less than 0.05) and regurgitation fractions (p less than 0.02). In the 10 patients whose left ventricular volume remained high or ejection fraction low, a second evaluation was performed 27 months after surgery. The left ventricular end-diastolic volume was significantly lowered (from 151 to 120 ml/m2, p less than 0.05) back to normal in five cases. The systolic and diastolic ventricular shape returned to normal. Cardiac index and ejection fraction were unchanged. These results show a marked improvement a few months after aortic valve replacement, with a further improvement several months later, as shown mainly by the decrease of left ventricular end-diastolic volume and the return to normal of left ventricular cavity shape. However, in most cases, the ejection fraction remained at its preoperative valve, suggesting that surgery should be performed early, before myocardial deterioration appears.

Adolescent↗
PubMed1981

Some haemodynamic effects of nicergoline, a new alpha-blocking agent, in the closed-chest anaesthetized dog as compared with nitroprusside and nitroglycerin.

Considering the recent rediscovery of the use of alpha-blocking agents in the treatment of hypertension and heart failure, we have studied the haemodynamic effects of 10-methyl-1,6-dimethyl-ergoline-8 beta-methanol-(5-bromonicotinate (nicergoline, Sermion), a new alpha-blocking ergot derivative, on the closed-chest anesthetized dog. For comparative reasons, the effects of nitroglycerin and nitroprusside were studied on the same model. The doses were adjusted to give an identical decrease in blood pressure after 30 min infusion (nearly 30%). Nicergoline did not change the heart rate, decreased total and femoral arterial resistance, did not change the cardiac output or the femoral flow, as opposed to nitroglycerin which decreased the cardiac output and systolic volume, causing a reflex tachycardia and femoral constriction, confirming its predominantly venous effect. Nitroprusside did not cause tachycardia, and the femoral resistances were increased, though less so than with nitroglycerin. Both nitroglycerin and nitroprusside apparently had no direct effect on myocardial performance, whilst nicergoline seemed to increase the myocardial compliance (by a decrease of the sympathetic tone). This drug merits further attention in that it is readily soluble and can easily be administered i.v., for treatment of acute heart failure, for example.

Anesthesia↗
PubMed1980

Large multiple coronary artery aneurysm in adult patients: a report on three patients and a review of the literature.

Three cases of large multiple coronary aneurysms, situated on both right and left coronary arteries, were seen in three middle-aged adult patients. These patients were hospitalized for myocardial infarction in two cases and for angina pectoris in the third case. On the coronary angiogram, the coronary lesions were quite unusual as there were multiple voluminous aneurysms on both coronary arteries without evidence of atherosclerotic lesions of the remainder of the coronary tree. These lesions did not seem to be congenital or atherosclerotic, and it was postulated that these lesions might have been the sequelae of a mucocutaneous lymph node syndrome although no previous history of this condition could be found in these three patients.

Adult↗
PubMed1980

Variations in height of jugular "a" wave in relation to heart rate in normal subjects and in patients with atrial septal defect.

Analysis of jugular tracings in seven normal subjects in sinus rhythm whose heart rate varied spontaneously from one moment to another during expiratory apnoea, showed that a pronounced variation occurred in the size of the "a" waves in relation to that of the "v" waves and in accordance with the corresponding RR interval. In the 53 measurements which were carried out, the "a/v" ratio had a mean value of 0.9 for a heart rate above 87, 1.4 for a heart rate between 87 and 68, and 1.1 for a heart rate less than 68. The variations in the size of the "a" waves in relation to heart rate are explained by the place of atrial systole during the different phases of ventricular filling. This variation in the height of the "a" wave has also been found in patients with an atrial septal defect for heart rates between 62 and 86, and this could lead to misdiagnosis, either dismissing the diagnosis of atrial septal defect when the heart rate is around these values, or suspecting it wrongly when the heart rate is either slower or faster. When examining jugular tracings, one should therefore be cautious about interpreting the size of the "a" wave which should be evaluated as a function of heart rate.

Adolescent↗
PubMed1980

Quantitative angiographic evaluation in left ventricular aneurysm.

A new method was used for the quantitative analysis of left ventricular angiography in 22 patients with an anterior aneurysm. The line of demarcation between the aneurysm (A) and the remaining myocardium (RM) was determined accurately by looking at a sudden change in the percentage of shortening of two contiguous half-axes, the left ventricular cavity being divided by 19 parallel and equidistant axes. The total volume of the left ventricle, the volume of the A and that of the RM were calculated using a method derived from Chapman's method. Total ejection fraction, ejection fraction and VCF of the RM were also calculated. A comparison was made between patients with heart failure (Group I) and those without (Group II). In Group I, the A was much larger (P less than 0.01) but volume, ejection fraction and VCF of the RM, were not significantly different, indicating that the surgical resection should give a favorable result. The validity of this method of quantitative analysis was confirmed by a comparison of the calculated preoperative remaining left ventricular volume with the volume of the postoperative cavity in 8 patients. These measurements lead to a better evaluation of patients with ventricular aneurysm in view of selection for surgery.

Adult↗
PubMed1978

[An indication for a permanent pacemaker : digitialis therapy for cardiac failure with disturbed atrioventricular conduction (author's transl)].

In twenty patients with advanced heart disease with severe cardiac failure and the presence of conduction disturbances before digitalis therapy, but in whom such disturbances were worsened or revealed by the treatment, it was necessary to insert a permanent pacemaker in order to make effective long term digitalisation possible without the risk of excessive bradycardia or pauses due to worsening of atrioventricular block. Six patients died within a period of 9 days to 34 months after insertion of the pacemaker, two were lost from sight, and the other 12 were followed-up regularly for an average period of 20 months, their condition remaining stationary and, in general, satisfactory.

Aged↗
PubMed1978

[Analysis of factors which can influence results of aortocoronary bypass surgery].

The various factors influencing the result of treatment have been studied in a series of 100 consecutive patients undergoing aorto-coronary bypass graft surgery. There were three operative deaths and twelve cases of post-operative infarction. Longterm, 85% of them were three year survivors, clinical improvement being maintained in 84% of them. Post-operative tests showed that 70% of patients have no pain on the maximal exercise test, but 48% had ischaemic depression of the ST segment. From among the 47 patients who had follow-up arteriography, 78% of the grafts were patent, but no improvement of the contractility of the left ventricle could be demonstrated (pre-operative ejection fraction 47 +/- 3%, post-operative 49+/- 3%). The pre-operative clinical features rarely give any indication of the prognosis. The same is true in the present series of the condition of the left ventricle, bearing in mind the fact that patients with grossly impaired ventricular contractility (ejection fraction below 30%) were routinely excluded from surgery. It is essentially the state of the coronary arterial network, as assessed by a score made up from the degree and number of stenoses, the quality of the distal bed, and the anatomical distribution, which will pick out those patients more at risk both from the surgery and from post-operative death and in whom the longterm result is likely to be disappointing with no improvement in function, with obstruction of the grafts, or with secondary death.

Adult↗
PubMed1976

Effect of salmon calcitonin on renal excretion of adenosine 3', 5' monophosphate in man.

Intravenous infusion of salmon calcitonin in six healthy subjects produced an increase in the plasma levels and urinary excretion of cyclic AMP. Cyclic AMP clearance diminished but remained higher than inulin clearance. Salmon calcitonin was also infused in six hypertensive patients with normal glomerular filtration rate. Arterial and renal venous plasma concentration of cyclic AMP were clearly raised. The difference between both these concentrations was not significant in the control periods but became marked during the treatment and post treatment periods demonstrating a net extraction of cyclic AMP from plasma by the kidneys. Renal extraction of cyclic AMP was lower than its urinary excretion in the control periods whereas it was clearly higher after salmon calcitonin was given. This shows that salmon calcitonin stimulates the production of cyclic AMP in extra-renal tissues and that the excess of cyclic AMP formed is catabolized by the kidneys.

Adult↗