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Biomedical subjects

J P Colle

Publications and source records attributed to J P Colle.

At least 19 recordsLinked to original sources
PubMed1999

Abnormal fibrin clot architecture in nephrotic patients is related to hypofibrinolysis: influence of plasma biochemical modifications: a possible mechanism for the high thrombotic tendency?

Porosity, viscoelasticity and morphological properties of plasma fibrin from 16 nephrotic patients and 16 healthy volunteers were compared. Nephrotic patients were characterized by formation of tight and rigid plasma fibrin gels which resulted in a slower rate of fibrin lysis studied either under pressure-driven permeation or diffusional transport of fibrinolytic agents. These latter findings indicated that both abnormal fibrin network conformation and abnormal fibrin fiber structure were involved in hypofibrinolysis. Albumin supplementation up to 40 mg/ml partially restored normal fibrin architecture and increased the rate of fibrinolysis in these patients. Multiparametric analysis showed that nephrotic patients were mainly characterized by a low plasma albumin level (R = -0.85), a low albumin to fibrinogen ratio (R = -0.89) and a high resistance to lysis (R = -0.82). High triglycerides level was the only plasma modification related to the slower fibrin lysis rate (R = -0.54). High fibrin rigidity (G') was the only fibrin parameter simultaneously related to the nephrotic state (R = 0.75) and the lysis resistance (R = -0.71). After eliminating the effects of age, albumin and fibrinogen levels, low fibrin porosity (Ks) and low fiber mass-length ratio (mu) were the main features of the nephrotic state. These findings are discussed in relation to both the pathophysiology of thrombotic complications in nephrotic syndrome and their pharmacological prevention.

Adolescent↗
PubMed1993

[Multiple left coronary-ventricular microfistula and apical hypertrophy].

Coronary arterio-systemic fistula is a rare condition, especially when multiple fistulae communicate with the left ventricule. The association of multiple congenital coronary artery-left ventricular fistulae and apical hypertrophy has not been previously reported. The authors report three cases, all in women, with multiple coronary artery-left ventricular fistulae and apical hypertrophy diagnosed by angiography. The association may not be coincidental as multiple microfistulae could cause abnormalities of the microcirculation and result in reactional myocardial hypertrophy.

Aged↗
PubMed1992

PTCA with side-by-side balloon using fixed guide wire systems: a potential alternative autoperfusion device--an in vitro study.

The use of "hugging balloons" for the implementation of a coronary angioplasty is a well-known and much-written-about technique. It has not, on the other hand, ever been stressed that two inflated hugging balloons are not totally obstructive, leaving enough space, between the balloons and the arterial wall, for perfusion. The cross section of this free area can be as much as 12% of the total arterial cross section, when the side-by-side balloons are of a relatively similar size. Calculations show that similar total conduit cross sections are achieved when inflating either a 3.0 balloon or two 2.0 side-by-side balloons. An in vitro experiment compares how systems using 2.0 double balloons and a 3.0 autoperfusion balloon affect the distal flow of a 3 mm internal diameter conduit. A semi-rigid silastic tubing is perfused with a 5% glucose isotonic solution at various predetermined proximal pressure levels. Distal pressures and flows are measured at different stages: with no balloon, with deflated balloons, and with inflated balloons. Comparison shows that 1) the double balloon system offers little resistance to flow compared to the autoperfusion balloon; 2) this system's rate of perfusion run-off is hardly affected and is constantly better than with the autoperfusion balloon; 3) this difference is all the more marked, the lower the proximal perfusion. These results suggest that the use of a double balloon could, in some cases, provide an alternative solution to autoperfusion equipment. Further clinical studies are needed to test this hypothesis.

Angioplasty, Balloon, Coronary↗
PubMed1991

Nondiagnosed left main ostial stenosis partly due to the use of 5 French coronary angiographic catheters.

Two cases have been reported in which the use of 5 F angiographic catheters is associated with a failure to diagnose an ostial stenosis of the left main coronary artery (LMCA). In both cases, the erroneous diagnosis led to an inappropriate indication for percutaneous transluminal coronary angioplasty (PTCA) on other stenosed vessels, and the ostial left main lesion was unexpectedly discovered when using 8F guiding catheters. It is supposed that the ability of performed 5F catheters to pass easily through an ostial lesion makes detection of such proximal stenosis much more difficult. We suggest that the choice of 5F catheters must be approached with caution when left main disease is potentially expected from the clinical features.

Aged↗
PubMed1991

Clinical factors affecting the immediate outcome of PTCA in patients with unstable angina and poor candidates for surgery.

Percutaneous Transluminal Coronary Angioplasty (PTCA) has been successfully applied in unstable angina to carefully selected patients. In this study, PTCA was performed in 277 consecutive patients suffering from unstable angina and for whom bypass surgery was not a valid alternative because either of inoperable conditions or of emergency, or because surgery was not the best option. All patients were admitted first to the intensive care unit where an attempt was made to control unstable angina under conventional medical therapy using at least iv nitroderivative, heparin, and calcium blockers. After a standardized preparation PTCA was performed either as an emergency procedure in medically refractory unstable angina (107 cases) or as an elective procedure in controlled situations after a 7 to 10 days symptom-free period. Three hundred fifty-three coronary vessels were attempted. Results of this group are compared with those of a control group made of 670 consecutive stable patients recruited during the same period, and clinical characteristics are envisaged as potential predictive factors. Unstable angina is undoubtedly associated with a higher overall complication rate, but the immediate outcome is strongly affected by the clinical context. As an example, respective success and mortality rates are: 93% and 0% when a full revascularization is attempted; 91% and 0% in elective procedures in patients under 60; 87% and 1.2% in elective PTCA for multiple vessel disease; 80% and 6.5% in emergency PTCA; 80% and 11% in the overall triple vessel disease; 84% and 16% in patients with deeply altered ejection fraction; and 58% and 26% in triple vessel disease with 2 previously occluded coronary arteries.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1990

Clinical characteristics affecting success or failure of PTCA in patients with multiple vessel disease and poor candidates for surgery.

A special form of complex coronary angioplasty is represented by the extension of indications for percutaneous transluminal coronary angioplasty (PTCA) to patients with multivessel disease (MVD) for whom surgery is not indicated, and thus for whom surgical standby is not available. Over a two-year period, 254 consecutive coronary patients with multivessel disease underwent PTCA under such conditions. These patients could not benefit from surgery for various reasons. Of the 612 arteries involved, 155 were occluded, 47 had been previously bypassed. A distal nonbypassable lesion in one of the three major arteries was found in 244 patients, 61 had suffered from a previous infarct, 24 demonstrated an ejection fraction below 0.40, and in 19 a single patent vessel was found. Fifteen patients were in cardiogenic shock and 69 procedures were undertaken for unstable angina. Of this latter group, 25 emergency PTCA were attempted for refractory unstable angina, and 44 additional emergency procedures were directed to the treatment of acute infarct. A total of 40 intra-aortic counterpulsations were needed. As far as possible the procedure aimed at full revascularization. Immediate outcome is strongly affected by the clinical context, and despite a rather constant initial success rate (88-95%), the procedural mortality (directly related or not) can change dramatically with clinical factors.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

The vascular resistance of arterial stenoses in series.

The vascular resistance of stenoses in series has been studied in vitro by use of fiber optic laser Doppler anemometry to measure the cross-sectional areas of the stenoses. Pressure gradients across each of the stenoses were measured while both the severity and the separation of the stenoses were altered. The individual resistances were compared with the combined resistance. Resistance at a stenosis is a nonlinear function of the severity of the stenosis. The resistance is a complex function of the perfusion pressure and the cross-sectional area of the stenosis and cannot be accurately predicted from a single plane angiographic image. With multiple stenoses an approximate assessment of the combined effect can be obtained by summing the value of the resistance for each stenosis but not the degree of the stenoses. The nonlinear relationship of resistance to stenosis severity means that if one stenosis is more severe than the other, the combined effect can be regarded as the same as the effect of the more severe stenosis acting by itself. The distance between the stenoses does not change their combined effect.

Arteries↗
PubMed1989

Hemodynamic effects of continuous infusion of AR-C 239 in left ventricular failure.

AR-C 239 is a new specific alpha 1 antagonist drug with an action similar to that of prazosin. In dogs it appears to be specific for the alpha 1 adrenoreceptor. AR-C 239 was tested in 11 patients (49 +/- 11 years old) with left heart failure, who had not received any previous treatment. The drug was infused intravenously with a stepwise increase in dose, producing three stable plasma concentration plateaus: 10 +/- 2, 51 +/- 3, and 138 +/- 55 ng/ml. Hemodynamic data were collected at time T0 before drug infusion, and half-way through each infusion. Blood pressures and cardiac output were recorded using a Millar microtip manometer (left ventricle), a Swan-Ganz catheter (pulmonary artery), and a femoral catheter, connected to a Syscomoram computer system which calculated the following parameters: work, resistances, tension-time index and contractility indices. Left ventricular ejection fraction and volumes were obtained from cineangiograms performed 30 min before drug infusion and at the end of the third infusion plateau. AR-C 239 produces a dose-dependent fall in systemic blood pressure (r = 0.539, n = 33, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic alpha-Antagonists↗
PubMed1988

Intravenous and intrapulmonary recombinant tissue-type plasminogen activator in the treatment of acute massive pulmonary embolism.

Eight centers participated in a study in which intrapulmonary and intravenous administration of recombinant tissue-type plasminogen activator (rt-PA) were compared in 34 patients with acute massive pulmonary embolism. All patients received intravenous heparin in a bolus of 5,000 IU followed by 1,000 IU/hr. After 50 mg rt-PA given over 2 hr the severity of embolism, determined from pulmonary angiograms, declined by 12% in the intrapulmonary drug group (p less than .005) and 15% in the intravenous drug group (p less than .005); mean pulmonary arterial pressure fell from 31 +/- 7 to 22 +/- 6 mm Hg (p less than .005) and from 31 +/- 12 to 21 +/- 9 mm Hg (p less than .005) in the respective groups. After a further 50 mg given over 5 hr (22 patients), the angiographically determined severity of embolism had decreased by 38% from baseline in the intrapulmonary drug group and by 38% in the intravenous drug group. The mean pulmonary arterial pressure further declined to 18 +/- 7 and 12 +/- 5 mm Hg in the respective groups. Fibrinogen levels dropped to 48% of baseline after 50 mg and to 36% of baseline after 100 mg rt-PA. Some degree of bleeding at puncture and/or operation sites was noted in 16 patients, including four who required a transfusion of two or more units of blood and had been operated on an average of 7.5 days (range 2 to 13) before thrombolytic treatment was started.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1988

Long-term beneficial effects of PTCA on segmental early relaxation in disease of the left anterior descending coronary artery.

The relationship between regional left ventricular (LV) motion and global pressure relaxation of the left ventricle remains unclear. To clarify the recent concept of segmental early relaxation in coronary artery disease, the authors investigated two groups of patients. In group I, all 12 patients (mean age 47 +/- 7 years) exhibited evidence of a normal heart after an extensive investigation. In group II, 25 patients (55 +/- 7 years) presented an isolated stenosis of the left anterior descending coronary artery, and they underwent a hemodynamic investigation before and after (six to nine months) a durable successful percutaneous transluminal coronary angioplasty (PTCA). After all conventional hemodynamic measurements had been done, a quantitative frame-by-frame analysis of left ventricular wall motion was conducted. The authors' method is derived from that of Ingels, applying to LV cineangiograms filmed in 30 degrees right anterior oblique view at a 50 frames/second rate. Thus segmental wall motion is analyzed in terms of amplitudes (%), velocities of shortening and lengthening in circumferences/second (circ/sec), and times of events (%). Statistical results took into account the reproducibility of the method. Main results regarding the control state of group II consisted of an asynergic motion of the anterior region taking place from end systole to early diastole: 1. Early end of contraction in anterior segments (% of systolic time interval: 88 +/- 14% vs 96 +/- 6% in group I, p less than 0.001) 2. Asynchronism at end systole (maximal velocity of shortening - 0.4 +/- 2.3 circ/sec in anterior segments vs 0.05 +/- 1.9 in inferior segments, p less than 0.02) 3. An early but poor outward anterior wall motion (anterior lengthening at 0.04 sec after the end of ejection 2.9 +/- 10% in group II versus 5.4 +/- 7.2% in group I, p less than 0.05) These abnormalities are strongly correlated with a significant impairment of peak negative diastolic pressure/diastolic time (dP/dt) (1500 +/- 400 mmHg. sec-1 vs 1850 +/- 410 in group I, p less than 0.02). Long-term beneficial effects of PTCA in group II were characterized by an almost complete normalization, both asynergy and relaxation taking place back within the normal range. The authors conclude that in this kind of patient, peak negative dP/dt could be an index of an asynergic segmental motion, this one being correctly analyzed and quantified on LV cineangiograms with our method.

Angioplasty, Balloon↗
PubMed1988

[Myocardial infarction caused by the thrombosis of the common trunk of the left coronary artery. Fatal outcome despite an early obstruction removal by angioplasty. Apropos of a case].

We report an exceptional case of acute myocardial infarction due to thrombosis of the left main coronary artery in a 39-year old male patient. After failure of recanalization by systemic fibrinolysis, percutaneous angioplasty under circulatory assistance was successfully performed pending a possible transplantation. The patient unfortunately died of haemodynamic disturbances 48 hours after the infarction.

Adult↗
PubMed1987

[Refractory unstable angina. Emergency treatment by coronary artery angioplasty under aortic counterpulsion].

We report our experience of 15 transluminal coronary angioplasties performed in an emergency in 13 patients (mean age 67 +/- 8 years) with refractory unstable angina. The procedures were conducted under diastolic counterpulsation effected by means of an intra-aortic balloon. The angina was of the threatening infarction type on 11 occasions and of the threatening extended infarction on 4 occasions. Electrocardiographic abnormalities were recorded in the anterior (11 cases) or in the inferior (4 cases) territory. Three patients had a very alarming haemodynamic status, with acute pulmonary oedema in two and cardiogenic shock in one. After intra-aortic counterpulsation was installed and the clinical signs were stabilized, coronaro-ventriculography was performed, leading to a decision of immediate angioplasty since age, underlying diseases, myocardial function and diffused lesions made most of the patients unsuitable for surgery. In multiple vessel patients electric and angiographic data were used to locate the tight stenosis (92% in all cases) responsible for the acute coronary ischaemia. The stenosis was found to affect the anterior interventricular artery in 9 cases, the circumflex artery in 2 cases, the right coronary artery in 2 cases and a saphenous shunt on the anterior interventricular artery in 2 cases. Immediate arteriographic and clinical success was obtained in 12 out of 15 cases (80%); there were 3 failures with 2 transmural infarctions. Later on, 2 patients underwent aorto-coronary bypass and 1 died of myocardial failure and pulmonary superinfection 3 weeks after the procedure. Ten of our 13 patients were stabilized and were discharged under medical treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1987

[Hemodynamic effects of a new alpha-1 antagonist, AR-C 239 administrated in intravenous bolus, in patients with cardiac insufficiency].

A new specific alpha-1 antagonist was studied in 16 patients with left ventricular failure. In Group I (8 patients) the drug was given as a 40 micrograms/kg intravenous bolus, and in Group II (8 patients) at the dose of 80 micrograms/kg. A thermodilution Swan-Ganz catheter, a Millar microtransducer introduced via the femoral artery were relayed to a SYSCOMORAM system to record the systemic artery pressures (SAP), pulmonary artery pressures (PAP), left ventricular pressures, and to calculate cardiac output and systemic and pulmonary arterial resistances (SAR, PAR) over a 30 minute period. In Group I (40 micrograms/kg), administration of AR-C 239 led to a significant decrease in PAP and SAP (-24 +/- 17 p. 100, p less than 0.02) with a fall in time-tension index (-20 +/- 19 p. 100, p less than 0.05) and a significant increase in LV stroke volume (+23 +/- 12 p. 100, p less than 0.01). At 80 micrograms/kg there was also a fall in LV filling pressures (-29 +/- 25 p. 100, p less than 0.05) and PAP (-38 +/- 28 p. 100, p less than 0.02) and an improvement in LV compliance (Gaaschisk -43 +/- 19 p. 100, p less than 0.01). These results show that AR-C 239 is a powerful vasodilator without secondary beta mimetic effects or influence on LV contractility; it may provide an effective means of treating cardiac failure.

Adult↗
PubMed1987

[Obstruction of the left coronary branch. Ergometric, hemodynamic and angiographic findings].

The authors present 6 personal cases of complete obstruction of the left main stem coronary artery and review the main epidemiological, clinical, ergometric, haemodynamic, angiographic and therapeutic data concerning this condition which is uncommon (0.66% of patients who underwent coronary angiography for angina in this series). This series had a number of special features. Clinical symptoms were moderate, consisting of exercise-induced aggravated angina, except in one patient with a history of anterior infarction complicated by regressive initial heart failure with residual angina. For this reason, all patients were able to perform a standard exercise-test on an ergometric bicycle without any problem. As the exercise test revealed major abnormalities, extreme precautions were observed when coronary angiography was performed, but no incident occurred in any of the 6 patients. Haemodynamic data were normal in 4 cases and altered in 2 cases. The important role played by collateral circulation must be stressed; it is probably under evaluated at arteriography. The absence of lesion of the right coronary artery is thought to facilitate the development of a collateral vascular network. Five patients were operated upon, made an uneventful recovery and were followed up for 19, 42, 17, 5 and 2 months respectively: all were symptom-free under medical treatment. In 3 out of these 5 patients who underwent a post-operative exercise-test all parameters showed excellent results; however, the 4th patient proved unadaptable to exercise, and ECG showed persistent ischaemia due to a very poor distal coronary bed; in the 5th patient, under diltiazem, the results on ischaemia and on the circulatory signs of heart failure were very good.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1987

[Effectiveness of double fibrinolytic treatments in subacute deep vein thrombosis of the lower limbs].

The purpose of this study was to evaluate the effectiveness and desirability of a double fibrinolytic treatment in subacute venous thrombosis of the lower limbs. Thirty-four patients (mean age 55.2 +/- 15.4 years) hospitalized for thrombosis of deep lower limb veins were treated with two different fibrinolytic drugs administered successively: 23 patients received streptokinase first followed urokinase, and 11 patients received urokinase first followed by streptokinase. The overall results that improvement of the phlebographic score (Ph.s) was significantly greater in double fibrinolytic treatment (delta Ph.s. = 4.41 +/- 6.45, p less than 0.001) than after a single fibrinolytic treatment (delta Ph.s. = 3.14 +/- 4.76, p less than 0.001). Individual analysis of the results showed that 28% of the patients were improved by a second fibrinolytic treatment. It would appear that two fibrinolytic treatments are truly effective, albeit inconstantly and in most cases partially. We were unable in this study to determine the characteristics of patients likely to benefit from a double treatment.

Adult↗
PubMed1986

Quantitative frame by frame analysis of regional contraction and lengthening on left ventricular cineangiograms: application to the study of normal left ventricles and left ventricles with mitral valve prolapse.

This work attempted to study the segmental wall motion on left ventriculograms, in terms of segmental shortening, velocity of segmental shortening, and temporal sequences of various events in systole as well as in diastole. The ability of such a method to characterize patterns of normal regional wall motion and to detect mild abnormalities such as isolated asynchronisms, was tested on two groups of patients. Group I included 25 patients presenting evidence of a normal left ventricle (LV) after left heart catheterization. Group II consisted of 21 patients suffering from an isolated pure idiopathic mitral valve prolapse (MVP), with no mitral insufficiency and with an unaffected global LV function. In all patients left ventriculography was filmed in the right anterior oblique view at a rate of 50 frames/s. For each patient a cycle was chosen, distant from any premature beat, with acceptably contrasted outlines, and a quantitative frame by frame study of the motion of 10 segments was performed using a semiautomated method derived from the Stanford method. In the control group (Group I), analysis of the segmental motion by means of this method demonstrates a mild nonuniformity of the normal wall motion. This is principally marked by a stronger and faster contraction in anterolateral segments (segments 7, 8, 9) and by a shorter duration of the contraction in this region. In contrast the MVP group (Group II), exhibited a frank asynergy of the anterolateral region occurring from end systole to early diastole.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Acute thrombotic obstruction with disc valve prostheses: diagnostic considerations and fibrinolytic treatment.

Twenty-six patients presenting with 28 instances of massive acute thrombotic obstruction of a prosthetic valve (16 mitral, 12 aortic) were treated with fibrinolytic agents. In 15 cases the patient presented with acute pulmonary edema and low cardiac output, in 10 with congestive heart failure and embolism and in 3 with peripheral embolism only. The diagnosis of thrombotic obstruction was made by echocardiography or cineradiography, in patients in whom the disc was immobile or barely moving; cineangiography was necessary in only four patients. The fibrinolytic agents administered were streptokinase, 2,000,000 U for 10 hours (14 cases), urokinase, 4,500 U/kg per h for 12 hours (7 cases), or the two agents successively (7 cases). Fibrinolysis was entirely successful in 19 patients: 18 are alive and well without surgical intervention after follow-up of 6 to 64 months and 1 patient had surgical revision after fibrinolysis. In two patients, fibrinolytic treatment was apparently successful but obstruction recurred 4 and 19 months later, respectively, and the patients were again treated by fibrinolysis. In two patients complete failure of fibrinolytic treatment led to emergency surgery, and in three patients improvement was incomplete and death occurred shortly after treatment. No hemorrhagic complications were observed, but there were five cases of embolism during the fibrinolytic treatment. Fibrinolytic treatment would seem to be an attractive, nonsurgical alternative for the thrombosis of a valve prosthesis but, because of the risk of embolism with possible permanent damage, its use should be reserved for critically ill patients who are too sick to undergo immediate surgery.

Adolescent↗