Biomedical subjects

K Khalife

Publications and source records attributed to K Khalife.

30 records · Page 2Linked to original sources

PubMed1985

Prophylactic effect of intravenous tiapamil on methylergometrine-induced coronary artery spasm in patients with variant angina: randomized double-blind trial.

Tiapamil is a new calcium entry blocker. The ability of its intravenous form to prevent methylergometrine-induced coronary artery spasm was studied in 11 consecutive patients with angiographically documented vasospastic angina. The study was designed as a double-blind crossover trial of tiapamil vs placebo. Each patient received, in a randomized order, either tiapamil, as a 1.5 mg/kg intravenous bolus followed by a 50 micrograms/kg/min infusion lasting 3 hours, or a matched placebo. Immediately after the infusion, methylergometrine tests were performed with up to 0.4 mg of methylergometrine or until a positive ECG was recorded. Compared to the values obtained after placebo infusion, tiapamil significantly lowered systolic and diastolic blood pressure (respective pre- and posttiapamil values: 119.9 +/- 17.7 vs 142.1 +/- 25.5 mm Hg, p less than 0.01; and 72.0 +/- 9.1 vs 82.4 +/- 9.3 mm Hg, p less than 0.02); the drug exerted no significant effect on heart rate (63.9 +/- 13.3 vs 67.6 +/- 16.5 bpm, NS), PR interval (0.180 +/- 0.020 vs 0.177 +/- 0.017 sec NS), or QTc interval (404.4 +/- 16.5 vs 396.0 +/- 26.6 msec, NS). After placebo, 10 patients had positive methylergometrine tests following single doses ranging from 0.1 to 0.4 mg. The remaining patient developed ventricular bigeminy, which resolved immediately after administration of isosorbide dinitrate; his test was therefore considered negative in the evaluation of the results. In contrast, after tiapamil, eight patients had negative tests for doses of up to 0.4 mg methylergometrine, and three had positive tests for the same methylergometrine doses as after the placebo.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1985

[Bronchial disobstruction in the treatment of cancer of the bronchi].

The progression of bronchial cancer results in death due to local complications in more than one third of cases and systemic treatment often needs to be completed by disobstruction procedures which restore the continuity of the bronchial lumen and palliate the severe complications, in particular respiratory failure and bronchial infections. The techniques are described in detail: bronchoscopy, endoscopic resection with various types of forceps, diathermy loops and, most importantly, laser. A series of 99 disobstruction procedures performed in 47 patients is presented.

Bronchi↗

PubMed1985

[Adrenal metastases of bronchial cancer: value of x-ray computed tomography].

Up until now, adrenal metastases from bronchial cancer have always been an autopsy diagnosis with a frequency as high as 45%. These metastases can now be diagnosed by means of computed tomography of the adrenal glands and most of the recent studies report an incidence of 10 to 15% of adrenal metastases independently of the histological type of bronchial cancer. The authors stress the need to perform this examination in the context of pre-treatment staging and for the follow-up of bronchial cancer. The outcome of these adrenal metastases is still poorly understood, but prospective studies could provide more information concerning their prognostic significance. In cases of operable bronchial carcinoma with an isolated adrenal metastasis, it is important to be able to detect this lesion which may be able to be excised prior to the thoracic surgery.

Adrenal Gland Neoplasms↗

PubMed1985

[Unilateral atresia of the left pulmonary veins: preoperative angiographic diagnosis in an adult].

The authors report an unusual case of unilateral obstruction of the pulmonary veins in an adult and discuss the elements of the pre-operative diagnosis. They recall the pathophysiological and therapeutic consequences of this disease.

Adult↗

PubMed1985

[The scimitar sign: a pulmonary vein or systemic artery? Apropos of a case of pure vascular sequestration].

The scimitar sign, characterised by a vertical opacity crossing the medial part of the right diaphragm, is generally attributed to abnormal pulmonary venous return draining into the inferior vena cava. This is not the only situation in which the scimitar sign is observed, which can also be seen in association with systemic anomalies, in particular sequestration. The authors report the case of a young adult in whom the chest x-ray presented the scimitar sign from childhood. This image was related to a pure pulmonary vessel sequestration by a right sub-phrenic artery. The authors stress the possibility of a purely arterial origin for the scimitar sign in the absence of any abnormality of pulmonary venous return.

Adolescent↗

PubMed1985

[Interruption of the aortic arch and malformative cardiac lesions requiring repair under extracorporeal circulation. Apropos of 3 cases].

Interruption of the aortic arch is practically always associated with intracardiac malformations of variable complexity, at the least, a ventricular septal defect. Surgery is usually performed in two stages: aortic repair and pulmonary artery banding after intravenous prostaglandin administration. The second stage comprises debanding and repair of the intracardiac lesions under cardiopulmonary bypass. However, in some cases, interruption of the aortic arch is associated with intracardiac lesions which necessitate correction under cardiopulmonary bypass from the onset, this was the situation in two of the three cases described by the authors: aorto-pulmonary window, a lesion which can only be corrected under circulatory arrest and deep hypothermia. One of these two children, operated in the neonatal period, did not survive: the other, operated at 6 weeks, had an excellent result. In the third case, the association of tricuspid atresia and a restrictive ventricular septal defect necessitated enlargement of the septal defect and therefore, open heart surgery under circulatory arrest; the results were favourable.

Aorta, Thoracic↗

PubMed1984

[Significance of a supraventricular arrhythmia precipitated during an electrophysiological study].

The clinical history and 24 hour Holter monitoring of 749 patients without ECG appearances of ventricular preexcitation were compared with the results of electrophysiological investigations to determine whether supraventricular arrhythmias initiated during endocavitary electrophysiological investigations had any pathological significance. Endocavitary studies were undertaken to investigate symptoms of dizziness, syncope and/or conduction defects except in the group of paroxysmal junctional tachycardia (PJT) where the indication was investigation of a tachycardia (78 cases). In 544 patients (Group I) no arrhythmias were initiated. Thirty five patients (6.4%) had supraventricular tachycardia (SVT), atrial flutter (AFI), atrial tachycardia (PAT), atrial fibrillation (AF) or PJT. The anterograde Wenckebach point (AV) was over 200/min in 22 cases (4%). In 400 patients the Wenckebach point or the retrograde Mobitz II (VA') point was 170/min in 56 patients (14%). In 28 patients with spontaneous SVT in whom retrograde conduction was studied, 3 had a Wenckebach 200/min (17.7%) and 9 had a Wenckebach point (VA') greater than 170/min (32%). In 86 patients (Group II) paired atrial stimulation induced PJT. Seventy nine patients (91.8%) had PJT : AV was greater than 200/min in 19 cases (22%) and VA was greater than or equal to 170/min in 69 cases (80.2%). In 119 patients (Group III) a supraventricular tachycardia (other than PJT) was induced. Manipulation of the catheter in the atrium led to AF, AFI or PAT in 9 patients. Eight patients had SVT (80.8%), AV was greater than 200/min in one case (11.1%) and VA' greater than or equal to 170/min in 5 of the 7 cases in which it was measured (71.4%). Paired atrial stimulation induced atrial echos in 63 patients; 47 presented spontaneous SVT : AV was greater than 200/min in 7 cases (11.2%) and VA' greater than or equal to 170/min in 23 of the 60 patients investigated (38.3%). Paired atrial extrastimuli triggered AF or PAT in 18 cases : 16 cases (88.8%) had spontaneous SVT. AV was greater than 200/min in 3 cases (16.6%), VA' was greater than or equal to 170/min in 10 of the 17 cases investigated (58.8%) : 11 of these patients also had atrial echos. Fixed atrial stimulation (less than 200/min) triggered AF or AFI in 14 patients. Nine had spontaneous SVT (64.3%) : AV was greater than 200/min in 2 cases (14.2%) and VA' greater than or equal 170/min in 2 of the 10 cases studied (20%). Ventricular stimulation induced SVT in 15 patients, 14 of whom had SVT (92%).(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗

PubMed1984

[Retrospective study of the role of systematic coronarography in patients with heart valve diseases].

The aim of this study was to assess retrospectively the valve of routine coronary angiography in the investigation of patients with valvular heart disease. Between 1978 and 1981, 598 patients over 40 years old underwent left heart catheterisation with routine coronary angiography. In the group with a medical history of angina or infarction (N = 149), there were 49 cases (33%) of severe coronary artery disease (greater than or equal to 70%) and 17 cases of moderate coronary artery disease (11%); of the 49 patients with severe lesions, 2 died after catheterisation, 8 were considered to have too high an operative risk because of their coronary disease and 19 were operated. Valve replacement was associated with a procedure for myocardial revascularisation in 15 cases. In the group without angina (N = 449), severe coronary lesions were much less common (3.6%) and only 5.1% had moderate coronary disease. Severe coronary lesions were found more frequently in certain sub-groups: Stage IV dyspnoea (9%), patients over 65 years of age (11.5%), and coronary calcification (24%). Of the 39 patients without angina and over 50% narrowing on coronary angiography, 17 underwent isolated valve surgery, and 9 underwent combined valvular and coronary surgery (2% of catheterised patients without angina; 3.5% of patients operated without angina. These results show that routine coronary angiography is fully justified in patients with valvular heart disease and a history of angina as vital information is obtained in a high proportion of cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1984

[Supraventricular arrhythmia in newborn infants and interatrial septal aneurysm].

Three neonates with relapsing supraventricular arrhythmia, diagnosed in utero in one case, presented with aneurysm of the atrial septum (AAS) found at TM and bidimensional echocardiographic examination. Arrhythmia consisted of atrial flutter 1/1 or 2/1 (1 case) or supraventricular extrasystoles with episodes of supraventricular tachycardia (2 cases). Although AAS not associated with congenital heart disease related with a downstream obstacle on the right or left heart is considered a rare condition, it is likely that echocardiography will disclose it more frequently. Anyhow, it seems worthwhile searching for it in cases with apparently primary supraventricular arrhythmias. Although the precise relationships between arrhythmia and AAS are not yet known, one could suggest that this organic anomaly is susceptible of originating and of maintaining the arrhythmia longer, if not in a more sever fashion, than in neonatal isolated arrhythmia, especially without any preexcitation syndrome. Further studies are necessary for a better understanding of the meaning and mechanism of such an association.

Arrhythmias, Cardiac↗

PubMed1983

[Return to work after myocardial infarction].

The working status of 41 men under the age of 60, who developed myocardial infarction while in vocational activity was investigated by means of a questionnaire, 3 years on average after the infarction: 63% had resumed work some time after the disease and 59% were working when the enquiry was made. The ability to resume work cannot be predicted from the patient's medical condition at the time of infarction (location of the infarct, complications during the acute stage, left ventricular ejection fraction). The only unfavourable factors are age and the presence of residual angina or marked post-infarction dyspnoea, although most patients who had not resumed work were fit for employment. Clinicians should be fully aware of the occupational future of patients with coronary artery disease--a future that is particularly at stake in this period of economic crisis in industrial countries.

Disability Evaluation↗

PubMed1983

[Use of emergency 2-dimensional echocardiography in the diagnosis and maintenance of newborn and nursing infants hospitalized because of poorly tolerated cardiopathy. A prospective study of 82 cases].

The value of 2D echocardiography was assessed prospectively in 82 patients (average age 2.6 months) including 41 newborn babies, in the emergency investigation of cardiac distress. The recording was made before any other investigations or treatment and associated subcostal and supra sternal views, and the results were compared with angiography (64 cases) or anatomical findings (44 cases). A cardiac abnormality was excluded in 5 cyanotic newborn children (persistent foetal circulation) and a precise diagnosis was made in 74 of the remaining 77 patients (94 p. 100). All cases of malposition of the great vessels were recognised (17 cases). The diagnosis was based on the simultaneous recording of the vessels, proximal branches and their ventricular connections. In conditions with severe obstruction of the pulmonary outflow tract (26 cases), 2D echo enabled an exact evaluation of ventriculo arterial concordance, pulmonary confluence and a quantitative assessment of the diameter of the pulmonary artery in 25 patients. Angiography provided little further information, mainly concerning associated lesions (anterior muscular VSDs, abnormalities of the supra aortic vessels). On the other hand, 2D echocardiography was superior to angiocardiography for the study of the atrioventricular values and intracavitary and subvalvular obstruction. 2D echo is a reliable method for emergency assessment of the indication for therapeutic catheterisation (atrioseptostomy). In other cases it allows it to be deferred and guided. The comparison of the results of 2D echo and angiocardiography in this series suggests the possibility of reducing the number of endocavitary investigations in the newborn and infant in the future, even in cases where surgery is being considered.

Angiocardiography↗

PubMedDate not supplied

[Two-dimensional echocardiography and left heart obstruction in the newborn infant. Diagnostic contribution and impact on therapy].

Thirty-nine neonates with left heart obstructions (LHO) were investigated by two-dimensional echocardiography (2 D echo). Results of 37 investigations were compared with angiographic data (15 cases) and/or anatomic data (surgery: 20 cases; post-mortem examination: 20 cases). 2 D echo was always performed as an emergency procedure and was interpreted before further hemodynamic investigation. Accurate investigation of the left ventricle and of the aorta (arch and proximal branches) was possible in 38 patients (97%) by combining the supra-sternal and subcostal approaches. The existence of LHO and its localization were correctly predicted by 2 D echo in 37 of 39 cases including: aortic coarctation (Ao co) (23 cases), isolated aortic stenosis (iAo S) (5 cases), interruption of the aortic arch (IAA) (3 cases), hypoplastic left ventricle (6 cases), and ranged LHO (2 cases). In 2 patients, one of whom presented with transposition of the great arteries, a coarctation was overlooked and a false positive (Ao co) was found during the same period in a prospective study of 100 neonates by 2 D echo (sensibility 95%, specificity 99%, predictive value 97%). In all patients, 2 D echo made it possible to establish the associated lesions that could modify therapeutics. In no case was emergency diagnostic surgery necessary and the last 9 patients of this series underwent successful therapeutic surgery only on the basis of echographic data.

Aortic Coarctation↗