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Biomedical subjects

J P Donzeau

Publications and source records attributed to J P Donzeau.

18 recordsLinked to original sources
PubMed1979

[Bacterial endocarditis due to Staphylococcus epidermidis. Two cases (author's transl)].

Bacterial endocarditis due to Staphylococcus epermidis is rare and severe. In a first patient, a 58-year-old-man, it developed 40 days after the insertion of a double prosthesis (mitral and aortic). Cure was obtained by medical treatment using a combination of vancomycin and gentamicin, followed by pristinamycin and tobramycin. The second patient, a 50-year-old-woman, suffering from cirrhogenic hepatitis and treated with corticosteroids. Staphylococcus epidermidis endocarditis developed without any portal of entry being discovered. After the failure of various antibiotic combinations (even though bactericidal in vitro), a mitral Starr valve was inserted which resulted in cure. None of the patients showed any sign of valvular mutilations or disinsertion of prosthesis.

Adrenal Cortex Hormones↗
PubMed1979

His bundle block and concealed His bundle premature depolarization.

His bundle electrocardiograms were recorded from a patient with previously unexplained PR prolongations or shortenings suggestive of both type I and II second degree AV block. The conduction disturbances were due to the association of concealed His bundle depolarizations (H') not propagated to atria or ventricles with first degree AV block in the His bundle. These data strongly suggest that frequent spontaneous His bundle depolarizations are another manifestation of a disease process involving the His bundle, a kind of "Sick--His bundle syndrome".

Bundle of His↗
PubMed1977

[Vasodilator treatment of left ventricular insufficiency in the acute stage of myocardial infarction].

The haemodynamic effects of two vasodilators (phentolamine and nitroprusside) have been studied in 11 patients who developed acute left ventricular failure during the acute phase of a myocardial infarction. The dose was adjusted to the highest level failing to cause tachycardia (phentolamine: 0.19 to 0.76 mg/mn; nitroprusside: 0.07 mg/mn), and the treatment was maintained for between 5 hours and 8 days. Under these conditions, after one hour a diminution in mean arterial pressure can be observed (from 94 to 82 mmHg, p less than 0.005), as can a decrease in pulmonary arterial diastolic pressure (from 21 to 14 mmHg, p less than 0.001); the cardiac index rises slightly (from 3.1 to 3.51/mn/m2(NS), and the systemic and pulmonary vascular resistance are decreased by 20% and 30% respectively. The index of systolic work does not increase to a significant degree (30.7 to 32.9 g-m-syst-m2), the same work being carried out with smaller filling pressures. Together with the lessened resistance to ventricular ejection, and also, it seems, to a dedrease in venous tone, this beneficial effect has been particularly marked in a case of posterior papillary syndrome with mitral incompetence. As the response varies from individual to individual, constant monitoring of arterial pressure and cardiac rate is vital if the maximum therapeutic effect is to be achieved, particularly in hypertensive patients, in whom tachycardia in response to lowering of the arterial pressure occurs more readily.

Acute Disease↗
PubMed1977

[Progressive external ophthalmoplegia and disorders of ventricular conduction. Apropos of 3 recent cases].

The authors report 3 cases with an association of progressive external ophthalmoplegia (OEP) and disordered intracardiac conduction. These cases, and the twenty or so similar ones reported in the literature, show that this association is important for two reasons:--there is a therapeutic importance in that the condition affects young patients, who are at risk from sudden death due to the conduction defect; for this reason electrocardiographic follow-up must be regular, and an intracavitary pacemaker must be introduced definitively at the least indication;--there is a physiopathological importance in that the effect of the myopathies on the myocardium is well known, but most information relates to the diffuse cardiomyopathies, and in only 10% of cases are there conduction defects. By contrast, the conductive tissue appears to be involved in all cases of OEP, while cardiac failure is rare. It seems likely, therefore, that cases of OEP have a pathogenesis different from that of the diffuse myopathies, whether or not these involve the external occular muscles.

Adult↗
PubMed1977

[Stenosis of the trunk of the left coronary artery. Contribution of coronary arteriography and hemodynamic correlations. Apropos of 34 cases].

From a study of 34 cases, the authors have tried to define the characteristic features of this very specialised type of coronary artery disease. From the clinical standpoint, if the common combination of uncontrolled angina and a past history of myocardial infarction are taken as representative, the basal ECG can in no way differentiate the diagnosis; on the other hand tests on the bicycle ergometer appear to have a good indicative value. Coronary arteriography shows the sharply isolated character of the stenosis of the trunk which is part of the picture of diffuse coronary disease, and the frequency (2 cases out of 3) of total coronary occlusion. The haemodynamic findings are even more variable and unpredictable, and bear no relationship to the degree of trunk stenosis, to the index of the lesion, and to the number of occlusions. However, joint analysis of the index of the lesion and of the degree to which the coronary circulation is compensated or de-compensated allows a better interpretation of the haemodynamic picture.

Adult↗
PubMed1976

[Diagnostic significance of atrial stimulation in coronary insufficiency. Correlation with the exercise test and/or coronary angiography].

140 patients underwent atrial stimulation and a triangular exercise test on the bicycle ergometer; coronary arteriography was carried out on 80 of them. Atrial stimulation is slightly more sensitive (74% compared with 68%) and significantly less specific (57% compared with 74%) than bicycle ergometry. It is valuable to combine the two tests as at least one of them is positive in 84% of subjects with a significant coronary lesion (larger than or equal 70%). "False positive" responses during the stimulation test occur especially where the ECG at rest shows evidence of the non-specific repolarisation disorders of coronary insufficiency; but these "false positives" are accompanied by angina during the test significantly less frequently than the true positives. It may be possible, on the basis of the accounts in the literature and on the present analysis, to establish a methodology for the atrial stimulation test which will increase its sensitivity slightly, but which will also increase, more importantly, its specificity. It may also be possible to reach, by progressive 2-minute steps, a rate which is slightly greater than the maximum rate according to Astrand's law, and to take less account of ST depression as a positive criterioe, and more of the appearance of pain; the fact that this pain is angina could be confirmed by a dual test using placebo and trinitrin.

Adult↗
PubMed1976

[Angiocardiographic study of obstructive cardiomyopathies. Attempt to evaluate the role of the interventricular septum and the great mitral valve in the obstructive phenomenon].

Images of the left ventricles, taken in two planes at ventriculography in 45 established cases of obstructive cardiomyopathy, were subjected to a special type of analysis which allowed certain sectional and angular measurements to be made. In particular we calculated and end-systolic index of obstruction, and two measures of the contribution of the septum and the mitral valve to the subaortic obstruction. It then proved possible to study the part played in the stenosis by the interventricular septum and the mitral valve respectively, and to classify the obstructive cardiomyopathies by these criteria. The orientation of the sigmoid floor also seems to play a vital role in determining the dominance of the septum or the mitral valve. These three factors, when examined together, allow us to conclude that there are fixed factors which determine the existance of obstructive cardiomyopathy, to calculate the degree of mitral contribution to the obstruction, and to realise that the orientation of the sigmoid floor helps us to distinguish the type of obstruction. The combination leads to an angiocardiographic classification of the obstructive cardiomyopathies, and the prognostic and surgical significance of this classification are discussed.

Angiocardiography↗