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Biomedical subjects

J Puel

Publications and source records attributed to J Puel.

At least 19 recordsLinked to original sources
PubMed1992

Quantitative angiographic follow-up of the coronary Wallstent in native vessels and bypass grafts (European experience--March 1986 to March 1990).

The coronary stent has been investigated as an adjunct to percutaneous transluminal coronary angioplasty to obviate the problems of early occlusion and late restenosis. From March 1986 to March 1990, 265 patients (308 lesions) were implanted with the coronary Wallstent in 6 European centers. For this study, the patients were analyzed according to date of implantation (group 1, March 1986 to January 1988; group 2, February 1988 to March 1990) and vessel type (native arteries versus bypass grafts). Quantitative angiographic follow-up was performed in 82% of the study patients. The early in-hospital occlusion rate in the overall group was 15%. Group 1 patients had a 20% rate in contrast to 12% rate in group 2 (p = not significant [NS]). The early occlusion rate in native vessels and bypass grafts was 19 and 8%, respectively (p = 0.019). Restenosis was determined by 2 criteria (criterion 1, greater than or equal to 0.72 mm loss in minimal luminal diameter from poststent to follow-up; criterion 2, greater than or equal to 50% diameter stenosis at follow-up) within the stent and in the segments immediately proximal and distal to the stent. The restenosis rate with criterion 1 was 43% in the overall group of patients, 35% in group 1 versus 49% in group 2 (p = NS), and 34% in native vessels versus 54% in bypass grafts (p = 0.016). The second criterion was met by 27% of patients in the overall group, 21% in group 1 versus 32% in group 2 (p = NS), and 18% in native vessel versus 39% in bypass grafts (p = 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1992

Comparative assessment of quantitative HIV viraemia assays.

OBJECTIVE: To compare two published methods for determining plasma viraemia in HIV-seropositive patients, with reference to a cellular viraemia assay. PATIENTS, PARTICIPANTS: Three patient groups were defined according to CD4 cell count: group I, less than 200 x 10(6)/l (23 patients); group II, 200-500 x 10(6)/l (18 patients); and group III, greater than 500 x 10(6)/l (13 patients). METHODS: The two reported methodologies were applied to all fresh samples, simultaneously and on the same day. RESULTS: The two techniques did not differ significantly in the detection of plasma viraemia: 82.3% of group I patients and 55% of group II patients were positive, while all group III patients were negative. Cellular viraemia was positive for 96% of the overall population. CONCLUSIONS: These results, obtained in a network of seven French laboratories involved in clinical trials, confirm that both plasma viraemia and cellular viraemia are useful virological markers.

AIDS Serodiagnosis↗
PubMed1992

[Myocardial beta-adrenergic receptors and left ventricular hypertrophy induced by pressure overload in man].

In experimental models, the characteristics of beta-adrenoceptors in left ventricular hypertrophy (LVH) due to pressure overload remain controversial and no data are still available in man. We investigated right auricular (RA) and left ventricular (LV) beta-adrenoceptors characteristics (125 I cyanopindolol binding) in two groups of patients undergoing valve replacement without heart failure (LV ejection fraction > 55%). Height patients with mitral stenosis (mean age: 64 +/- 4 years) and without LVH (LV mass index < 120 g/m2) constituted the control group and 13 patients with aortic stenosis (mean age: 66 +/- 4 years) and LVH (LV mass index > 150 g/m2) the study group. The results are: [table: see text] These results show that, in man, LVH due to pressure overload does not induce variation of total number beta-adrenoceptors, but is associated with a selective decrease in left ventricular beta 1-adrenoceptors.

Aged↗
PubMed1992

[Hypertensive cardiopathy and ventricular late potentials].

Ventricular arrhythmias occur with increased frequency in hypertensive patients with left ventricular hypertrophy (LVH). The aim of this work is to study the incidence of ventricular late potentials (LP) and their relation to ventricular arrhythmias in 148 hypertensive patients, 87 men and 55 women, without evidence of a coronaropathy. For each patient we carried out a signal-averaged electrocardiography, an echocardiogram to determine the LV mass index (LVMI) and the LV end-diastolic dimension (EDD), and 24 hours Holter monitoring to record ventricular arrhythmias filed according to Lown's classification. LP were considered present if the root-mean-square voltage during the last 40 ms of the QRS was: < 20 uV in absence of bundle branch block, or < or = 17 uV in presence of bundle branch block. [table: see text] The frequency of LP appears exceptional in hypertensive patients without LVH (5%) and remains uncommon in patients with concentric LVH (13%). The incidence of LP is only frequent at the end stage of hypertensive cardiopathy with eccentric LVH (48%). The severity of ventricular arrhythmias is only correlated to the presence of LP in patients with concentric LVH (p < 0.02).

Action Potentials↗
PubMed1991

Angiographic follow-up after placement of a self-expanding coronary-artery stent.

BACKGROUND: The placement of stents in coronary arteries after coronary angioplasty has been investigated as a way of treating abrupt coronary-artery occlusion related to the angioplasty and of reducing the late intimal hyperplasia responsible for gradual restenosis of the dilated lesion. METHODS: From March 1986 to January 1988, we implanted 117 self-expanding, stainless-steel endovascular stents (Wallstent) in the native coronary arteries (94 stents) or saphenous-vein bypass grafts (23 stents) of 105 patients. Angiograms were obtained immediately before and after placement of the stent and at follow-up at least one month later (unless symptoms required angiography sooner). The mortality after one year was 7.6 percent (8 patients). Follow-up angiograms (after a mean [+/- SD] of 5.7 +/- 4.4 months) were obtained in 95 patients with 105 stents and were analyzed quantitatively by a computer-assisted system of cardiovascular angiographic analysis. The 10 patients without follow-up angiograms included 4 who died. RESULTS: Complete occlusion occurred in 27 stents in 25 patients (24 percent); 21 occlusions were documented within the first 14 days after implantation. Overall, immediately after placement of the stent there was a significant increase in the minimal luminal diameter and a significant decrease in the percentage of the diameter with stenosis (changing from a mean [+/- SD] of 1.88 +/- 0.43 to 2.48 +/- 0.51 mm and from 37 +/- 12 to 21 +/- 10 percent, respectively; P less than 0.0001). Later, however, there was a significant decrease in the minimal luminal diameter and a significant increase in the stenosis of the segment with the stent (1.68 +/- 1.78 mm and 48 +/- 34 percent at follow-up). Significant restenosis, as indicated by a reduction of 0.72 mm in the minimal luminal diameter or by an increase in the percentage of stenosis to greater than or equal to 50 percent, occurred in 32 percent and 14 percent of patent stents, respectively. CONCLUSIONS: Early occlusion remains an important limitation of this coronary-artery stent. Even when the early effects are beneficial, there are frequently late occlusions or restenosis. The place of this form of treatment for coronary artery disease remains to be determined.

Angiography↗
PubMed1991

Viral antibody titers, immunogenetic markers, and their interrelations in multiple sclerosis patients and controls.

Our purpose was to investigate possible interrelations between antibody titers against seven viruses (measles, rubella, herpes simplex, mumps, varicella-zoster, coronavirus, cytomegalovirus), HLA-class II antigens, and immunoglobulin Gm allotypes in multiple sclerosis (MS). We studied 57 MS patients and 59 controls with similar age and sex distributions. In MS patients, we found the classical increased frequency of HLA-DR2, HLA-DQw1 and also an excess of Gm (3; +/- 23; 5*). Mumps antibody levels were higher in MS patients than in controls; elevation was not significant for measles antibodies. Analysis suggests that an association between HLA-DQw1 and antibody titers against various viruses exists in controls but is absent in MS patients. In particular, we found that mumps antibody titers were higher in DQw1-positive than in DQw1-negative controls, while there was no significant difference among MS cases. Accordingly, we found that the overall difference between patients and controls was due to the fact that DQw1-positive patients had higher titers than controls, while DQw1-negative cases had similar titers as controls. These findings suggest that biological and molecular characteristics of DQw1 might differ in MS patients.

Adult↗
PubMed1991

Relative risk analysis of angiographic predictors of restenosis within the coronary Wallstent.

BACKGROUND: Late angiographic narrowing has been observed following coronary implantation of the Wallstent. To identify the angiographic variables that predict restenosis within the stented segment, a retrospective study of data from the European Wallstent core laboratory was performed. METHODS AND RESULTS: Follow-up angiograms (excluding patients with in-hospital occlusions) were analyzed for 214 lesions in 176 patients (78% restudy rate). The incidence of restenosis within the stented segment was 35% by lesion and 35% by patient for criterion 1 (greater than or equal to 0.72 mm loss in minimal luminal diameter) and 24% by lesion and 24% by patient for criterion 2 (diameter stenosis greater than or equal to 50% at follow-up). The association between 16 variables and restenosis was determined by a relative risk ratio assessment. Variables with significant risk ratios for restenosis with criterion 1 were use of multiple stents/lesion (relative risk, 1.56; 95% confidence interval [CI], 1.08-2.25) and oversized (unconstrained stent diameter exceeding reference diameter greater than 0.7 mm) stents (relative risk, 1.64; 95% CI, 1.10-2.45), and for criterion 2, oversizing by more than 0.70 mm (relative risk, 1.93; 95% CI, 1.13-3.31), bypass grafts (relative risk, 1.62; 95% CI, 0.98-2.66), use of multiple stents/lesion (relative risk, 1.61; 95% CI, 0.97-2.67) and residual diameter stenosis more than 20% post stenting (relative risk, 1.51; 95% CI, 0.91-2.50). CONCLUSIONS: It is concluded that several angiographic variables are significantly associated with late angiographic narrowing after stenting in the coronary arteries. We suggest that stent operators avoid excessive oversizing in the selection of stent diameter and the use of multiple stents per lesion to lessen the risk of late restenosis.

Blood Vessel Prosthesis↗
PubMed1991

[In which type of hypertension should ventricular hyperexcitability be suspected?].

The aim of the present study was to determine when a search for ventricular arrhythmias, by ambulatory electrocardiographic monitoring, is necessary in hypertensive patients. An electrocardiogram, an echocardiogram and a 24 hour Holter monitoring were recorded in 88 patients with essential hypertension. According to the results of electrocardiogram patients were subdivided into 4 groups: normal electrocardiogram, isolated left auricular hypertrophy (LAH), isolated left ventricular hypertrophy (LVH) and major ST-T wave changes. According to the degree of septal thickness (ST), patients were classed in 4 groups. [table; see text] For hypertensive patients with normal electrocardiogram, Holter monitoring is not necessary; in fact practically no complex arrhythmias is found in this group. On the contrary, for hypertensive subjects with ST-T waves changes, this investigation seems very interesting, nearly 75% of them present high-grade ventricular arrhythmias. For the patients with electrocardiographic isolated LAH or LVH, the realisation of an echocardiography permits to separate the subjects with mild LVH (ST less than 12 mm) where Holter monitoring is not necessary (81% Lown O-I) and the patients with mean or severe LVH (ST greater than or equal to 12 mm) where this investigation seems very interesting, nearly 65% of them present high-grade ventricular arrhythmias.

Adult↗
PubMed1991

[Coronary endoprosthesis. Short- and mid-term results].

Mechanical stenting of the coronary wall by an endoprosthesis is a method of treating and preventing the 2 major complications of balloon angioplasty: acute occlusion by dissection and secondary restenosis. Forty-four self expanding stents were implanted in 42 patients presenting with post-angioplasty restenosis (35 cases), stenosis of an aortocoronary bypass graft (4 cases) or symptomatic post-angioplasty coronary dissection (3 cases). The primary results featured a high early occlusion rate of the endoprosthesis (28.5%, 12 cases). Better patient selection to include patients with stable angina and coronary arteries with a diameter greater than 3 millimeters, and the administration of an association of platelet antiaggregant therapy with heparin and oral anticoagulants has led to an improvement in these results. The early occlusion rate in the first 23 patients implanted without these selection criteria was 43% (10 cases) whereas it was only 10.5% (2 cases) in the last 19 selected patients who were prescribed effective medical therapy. The medium term results of the 27 patients implanted without complications at 6 months showed restenosis in 5 cases and reocclusion (asymptomatic) in 1 case (22.2% at control angiography at the 6th month). Restenosis was only observed in cases in which the endoprosthesis did not completely cover the coronary lesion (3 out of 3 cases) or when the endoprosthesis was implanted in a saphenous vein graft (2 out of 4 cases) and the only case of reocclusion occurred on a stent implanted in a coronary artery responsible for previous myocardial infarction. In the 21 patients in whom the stenosis had been totally covered by the stent there were no cases of restenosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗