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Biomedical subjects

L Ledain

Publications and source records attributed to L Ledain.

At least 19 recordsLinked to original sources
PubMed2004

[Iatrogenic syncopes and malaises].

Syncope or presyncope related to adverse drug reactions are well-known. On the other hand, little is known about the specific role of different drugs. Over one six year period, 1611 patients were referred in our hospital for syncope or presyncope, including 688 in the cardiology department. Among these patients, 420 were 70 years old or more. The search for an adverse drug reaction was systematic, with the help of the French method for causality of adverse drug reaction: knowledge of "extrinsic" criteria (bibliographical data relating to the drug involved); moreover, score on the basis of "intrinsic", chronological and symptomatic criteria. Seventy five patients (11% of the group with syncope leading to admission in cardiology department) were thus retained: score = I2, "possible adverse drug reaction", for 28 patients (37%); score = I3, "probable adverse drug reaction", for 47 patients (63%). Score I4, "definite adverse drug reaction" was not used since it required the readministration of the drug to prove the iatrogenic effect. Average age was 78 years, with a female majority of 69%. Seventy two patients (96%) had previous cardiovascular disease, 37 (50%) previously experienced syncope or presyncope. In addition to the basic assessment, a Holter recording was performed among 56 patients, finding a drug-induced arrhythmia in three cases. In the majority of the patients (59 patients, 79%), the adverse drug reaction consisted of hypotension, clinically obvious in 49 cases. In ten cases, vasovagal syndrome facilitated by the drugs was diagnosed by a tilt-test. The other side effects were eight rhythm disorders and eight severe metabolic disorders. The treatments were always multiple. The involved drug was a cardiovascular therapy in 66% of the cases. The other drug classes were primarily represented by uroselective alpha 1-adrenergic blocking drugs (12%) and psychotropic ones (22%). Among the cardiovascular treatments, ACE inhibitors and diuretics, generally in association, were involved (59%). This study confirms the role for antihypertensive drugs in iatrogenic syncope, its great frequency in elderly patients but also the responsibility of another drug class less often reported, the uroselective alpha 1-adrenergic blocking drugs.

Aged↗
PubMed2000

Unilateral pulmonary oedema complicating mitral regurgitation: diagnosis and demonstration by transoesophageal echocardiography.

One aetiology of unilateral pulmonary oedema is mitral valve disease. We report three cases of right pulmonary oedema caused by acute mitral regurgitation. These reports underline the diagnostic value of transoesophageal echocardiography, which rapidly visualised severe mitral regurgitation with retrograde jet directed toward the right pulmonary veins. Two patients underwent prompt cardiac surgery.

Aged↗
PubMed1995

[Influence of the patency of the artery responsible for myocardial infarction on the prevalence of late potentials. Apropos of a study of 80 patients].

The pejorative prognostic significance of late potentials (LP) has been clearly demonstrated over recent years. The objective of this study was to assess the influence of revascularization of the artery responsible for infarction (ARI) on the prevalence of LP. We studied 80 patients admitted to hospital for a first infarction. All patients underwent cardiac catheterization (on D8, on average) and high amplification ECG (on D9, on average). The prevalence of LP in the group with an occluded ARI (TIMI grade 0 or 1) was 54% versus 19% in the patent ARI group (TIMI grade 2 or 3) (p > 0.01). It is concluded that revascularization of the ARI (either by thrombolysis or physiological fibrinolysis) is accompanied by a lower incidence of late potentials after myocardial infarction.

Adult↗
PubMed1987

Thrombolytic treatment of acute thrombotic obstruction with disk valve prostheses: experience with 26 cases.

Twenty-eight episodes of prosthetic valve thrombosis occurred in 26 patients, and all were treated by thrombolytic drugs. The treatment consisted of UK (4500 IU/kg/hr for 12 hours) or SK (2,000,000 IU over 10 hours). The results were followed clinically and in the laboratory and by the same methods that are used for the diagnosis (echocardiography, fluoroscopy) of these problems. Immediate complete regression was seen in 23 cases. These cases did not undergo cardiac surgery. In three cases, in which clear clinical improvement was obtained while both the echocardiography and cinefluoroscopy showed persistent valve dysfunction, the patients were treated medically in two cases (second thrombolysis) and by surgery in one case. In two other cases thrombolysis was ineffective and the patients underwent emergency valve replacement. There were no significant hemorrhagic complications, but emboli from the thrombolysis occurred in five patients. Laboratory data illustrated changes in the success and improvement groups. There were no changes in the failure group.

Adolescent↗
PubMed1986

[Fibrinolytic treatment of 28 thromboses of valve prostheses. A biological study].

We carried out a series of laboratory investigation in 28 patients with prosthetic valve thrombosis (17 mitral and 11 aortic). The diagnosis was confirmed by TM and bidimensional echocardiograms and by cineradiography. The treatment consisted of UK (4,500 IU/kg/hour for 12 hours) and/or SK (initial loading dose of 500,000 IU, then 150,000 IU/hour for 10 hours). We measured fibrinogen, degradation products of fibrinogen-fibrin, plasminogen and antiplasmin. Two dimensional electrophoresis against anti-fibrinogen, anti-fragment-D and anti-fragment-E were employed for some samples. After thrombolytic therapy (SK: 18; UK: 7; SK-UK: 2; UK-SK: 1) complete clot removal was obtained in 21 cases (successful: group S), partial removal in 4 cases (improvement: group A) and failure in 3 cases (failure: group E). 3 patients died. Biochemical effects can be seen in group S and in group A. There were no changes in group E.

Adult↗
PubMed1985

[Comparative effects of intracoronary fibrinolysis and conventional treatment of myocardial infarction].

57 patients with a complete coronary thrombosis were treated by intracoronary fibrinolysis during the first 6 hours of inaugural myocardial infarction. The artery was revascularised in 37 cases (65 p. 100). Eleven patients had isolated stenosis of the left anterior descending artery and 16 patients isolated stenosis of the right coronary artery. These patients were compared with 27 other patients admitted between the 6th and 18th hours of primary myocardial infarction treated conventionally, in whom coronary angiography performed between the 14th and 21st day after infarction showed isolated left anterior descending disease in 14 cases (9 thromboses and 5 stenoses) and isolated right coronary disease in 13 cases (7 thromboses and 6 stenoses). The haemodynamic data and heart rates were identical in both groups during control coronary angiography between the 14th and the 21st days. Global left ventricular function and regional wall motion were studied by 30 degrees right anterior oblique ventriculography using the Stanford method before fibrinolysis in the first group and at the end of the 3rd week in both groups. In LAD, repermeabilisation by fibrinolysis, significant improvements were observed in ejection fraction (EF p. 100 = 42 +/- 9 vs 50.6 +/- 14 p. 100, p less than 0.05); fractional shortening of the hypokinetic segment (FS p. 100 = 4.5 +/- 4.6 vs 12.4 +/- 8.8 p. 100, p less than 0.001), and in the number of hypokinetic or akinetic segments (6.0 +/- 1.1 vs 4.2 +/- 2.1, p less than 0.05). Segmental and global left ventricular function was much poorer in the group treated conventionally at the 21st day (EF p. 100 = 44 +/- 11 p. 100, p less than 0.05; FS p.t100 = 5.8 +/- 9.7 p.t100, p less than 0.05; number of diseased segments: 6.0 +/- 1.4, p less than 0.01). On the other hand, the improvement was less marked in patients with inferior wall infarction; the results in the two groups were comparable.

Adult↗
PubMed1984

[Leptospirosis with isolated cardiac manifestations].

A case of leptospirosis with isolated myocardial involvement is reported. Diagnostic problems set by this uncommon clinical picture are considered. The cause of the increase in CPK and MBCPK concentrations, reflecting myolysis, is discussed.

Adult↗
PubMed1984

Effects of contrast media used in angiocardiography on the mechanical performance and the relaxation of normal and ischaemic myocardium.

The aim of this study was to investigate the mechanisms of the cardiodepressive action of ionic and non-ionic contrast media currently used in coronary arteriography. Experiments carried out on isolated preparations of cat papillary muscle, treated with increasing concentrations of Telebrix 39, Radioselectan, Hexabrix and Iopamidol 370 and 300, on the one hand and, on the other hand, a pre-determined dose of Telebrix and Iopamidol 300 during hypoxia and subsequent reoxygenation, showed that, at constant Ca2+ concentrations: (1) The cardiodepressive effects of contrast media are correlated with the hyperosmolality that they induce. When osmolality was higher than 400 mOsm, all the products caused a reduction of the peak force (PF: 40.49 +/- 5.15%), the maximum velocity of contraction (Vmax: 39.85 +/- 3.66%) and of the peak velocity of relaxation (Vrelax: 23.30 +/- 2.20%) (P less than 0.01). The time to peak force (TPF), on the other hand, remained constant, whereas the half-relaxation time (THR) was increased. No significant differences were observed between these effects and those induced by control iso-osmolar solutions when the same osmolality was induced. In practice, however, the critical hyperosmolality value of 400 mOsm is never reached when using non-ionic contrast media such as Hexabrix and Iopamidol 300. This could explain the excellent tolerance to these substances. (2) During hypoxia and reoxygenation, the effect of hyperosmolality is more marked. Thus, the non-ionic contrast medium, Iopamidol 300 (340 mOsm), reduces the hypoxic contractility depression (PF: 53.10 +/- 2.60% compared to the control values of 47.60 +/- 5.00%, P less than 0.01), whereas, at the same dose, the ionic medium Telebrix is hyperosmolar (440 mOsm) and induces a more pronounced hypoxic depression of contractility (P less than 0.01). The critical hyperosmolality is never reached during ventriculography (320 mOsm), whatever the medium used, but it can be observed during coronary arteriography. It is, therefore, important to use non-ionic contrast media in the investigation of unstable angina and of acute myocardium infarction.

Angiocardiography↗
PubMed1984

[Hemodynamic effects of a new positive inotropic agent (AR-L 115 BS) in ischemic and nonischemic myocardiopathies].

AR-L 115 BS is an imidazo-pyridine derivative with a positive inotropic action associated with peripheral and coronary vasodilatory properties. The effects of intravenous administration (a bolus of 0,45 mg/kg/min) were studied in 19 patients in functional class III of the NYHA classification in the absence of any previous drug therapy. Twelve patients had a primary myocardiopathy and the other 7 had coronary artery disease with akinetic anterior walls. A Swan-Ganz thermodilution catheter and a Millar microtransducer were used to measure pressures (pulmonary artery, left ventricular, aorta) and cardiac output under basal conditions and then every 2 minutes during intravenous administration of AR-L 115 BS. Left ventriculography in the 30 degrees RAO plane was performed under basal conditions and at the end of the investigation to measure volumes, ejection fraction, volumic compliance and segmental wall motion by the Stanford method. A stable concentration of circulating AR-L 115 BS was obtained (1 500 ng/ml). The positive inotropic action of the drug was responsible for a significant increase of all ejectional indices (cardiac and systolic index X 24 p. 100, p less than 0.01; ejection fraction +14 p. 100, p less than 0.01), of all indices of isometric contractility (dP/dt max +25 p. 100, velocity of contractile elements +35 p. 100, V max +30 p. 100 (p less than 0.01) and of the velocity of circumferential fibre shortening (+65 p. 100, p less than 0.001). All segmental shortening was improved.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

[Fibrinolytic treatment of valve thrombosis. Apropos of 16 cases].

Sixteen cases of prosthetic valve thrombosis (9 mitral, 5 aortic), occurring in 14 patients, were treated by fibrinolysis. All were disc prostheses. The clinical state of the patients was very poor in 11 of the 16 cases with pulmonary oedema, low output and arrhythmias, but less dramatic in the 5 others who presented with thromboembolism and left ventricular failure. The diagnosis was made by echocardiography (9 cases), radio-cinema of the valve (9 cases) and/or angiography (4 cases). The therapy comprised Urokinase (UK) 4,500 U/kg/hour (6 cases) of Streptokinase (SK) 2,000,000 U in 10 hours (7 cases) or SK and UK at equal doses (3 cases). The outcome was assessed clinically, echocardiographically and radiologically. There were 11 definite successes, 2 partial improvements requiring surgical revision, 2 apparent successes but with massive recurrence at the 7th and 10th days, and 1 failure. Although the biological activity of SK is greater than that of UK, the clinical results were comparable with both fibrinolytic agents. Four patients had regressive embolic episodes during lysis of the valvular thrombosis. As fibrinolytic therapy was effective in 70 p. 100 of patients in this series, it could provide an acceptable alternative to surgery, especially in patients who would be poor operative risks. The management of patients after successful fibrinolysis remains divided between intensive medical follow-up or prosthetic valve replacement.

Adult↗