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Biomedical subjects

L Pierard

Publications and source records attributed to L Pierard.

18 recordsLinked to original sources
PubMed2006

[Post-radiotherapy and atherosclerotic stenosis of the internal carotid artery treated by angioplasty and stenting].

We report the case of a 70-year old man treated by surgery and radiotherapy for a neoplasic lesion of the tongue in whom severe symptomatic stenosis of the left internal carotid artery occurred a few years later. This lesion was successfully treated by percutaneous carotid angioplasty and stenting with distal embolic protection (PCAS). After a period of experimenting with angioplasty and stenting, PCAS is becoming a serious alternative for carotid thrombo-endarterectomy (TEA). Indications for PCAS are currently patients who, due to several reasons, are no good candidates for surgery. Several of large PCAS versus TEA randomized trials are underway and final results will help us determine the best indication for TEA or PCAS for both low and high risk patients with symptomatic or asymptomatic carotid stenosis.

Aged↗
PubMed2005

Atropine reduces dobutamine-induced side effects in ponies undergoing a pharmacological stress protocol.

REASONS FOR PERFORMING STUDY: High-dose dobutamine stress echocardiography has been shown to be cardiotoxic and arrhythmogenic in horses. However, the test may have benefit in practice as a pharmacological challenge of exercise without the treadmill being required. OBJECTIVES: To investigate the effect of low-dose dobutamine on cardiac performance in ponies previously treated with atropine, in order to develop a pharmacological protocol that allows examination of the equine heart under stimulation. METHODS: In 13 healthy Shetland ponies, heart rate (HR), stroke index (SI) and cardiac index (CI) were calculated from pulsed-wave Doppler ultrasound measurements performed at rest and during incremental steps of dobutamine infusion. Group 1 (n = 7) received dobutamine infusion at 2 microg/kg bwt/min for 5 mins followed by incremental rates of 5 microg/kg bwt/min every 5 mins, from 5 to 40 microg/kg bwt/min. Group 2 (n = 6) received dobutamine infusion in incremental rates of 1 microg/kg bwt/min, every 5 mins, from 2 microg/kg bwt/min to 5 microg/kg bwt/min, after premedication with 2 injections of 25 microg/kg bwt of atropine 5 mins apart. RESULTS: The increase in CI during the pharmacological challenge was higher in Group 2 and reached about 2.5 times the resting value. This increase in CI was mediated by a significant increase in HR in both groups, while SI significantly decreased in Group 1 and did not change significantly in Group 2. Ponies of Group 1, but not those of Group 2, showed excessive restlessness and cardiac arrhythmias during the pharmacological challenge and a high intragroup variability in cardiac response. CONCLUSIONS: The results of this study suggest that a low dose of dobutamine in ponies previously given atropine could be a helpful pharmacological protocol to perform stress echocardiography in equids. POTENTIAL RELEVANCE: Further studies should evaluate left ventricular wall motion in horses undergoing low-dose dobutamine protocol after pretreatment with atropine.

Animals↗
PubMed1999

[Clinical case of the month. Prolapse due to fibro-elastic degeneration. The aging of the mitral valve].

We report the case of a 73-year-old woman who presents an acute mitral regurgitation secondary to fibro-elastic degenerescence. A mitral valvuloplasty is rapidly performed with complete disappearance of valvular insufficiency and the patient leaves the hospital ten days later. Degenerative mitral regurgitation is commonly seen in elderly patients. This constitutes an excellent indication for mitral valvuloplasty, rather than valve replacement. In our experience, mitral valvuloplasty leads to a complete correction of valvular regurgitation without neither stenosis, nor subvalvular obstruction. Left ventricular function is preserved, as subvalvular apparatus is conserved. This approach allows, in the absence of specific indication, anticoagulation withdrawn two to three months later.

Aged↗
PubMed1998

Evaluation of a weight-adjusted single-bolus plasminogen activator in patients with myocardial infarction: a double-blind, randomized angiographic trial of lanoteplase versus alteplase.

BACKGROUND: Lanoteplase (nPA) is a rationally designed variant of tissue plasminogen activator with greater fibrinolytic potency and slower plasma clearance than alteplase. METHODS AND RESULTS: InTIME (Intravenous nPA for Treatment of Infarcting Myocardium Early), a multicenter, double-blind, randomized, double-placebo angiographic trial, evaluated the dose-response relationship and safety of single-bolus, weight-adjusted lanoteplase. Patients (n=602) presenting within 6 hours of acute myocardial infarction were randomized and treated with either a single-bolus injection of lanoteplase (15, 30, 60, or 120 kU/kg) or accelerated alteplase. The primary objective was to determine TIMI grade flow at 60 minutes. Angiographic assessments were also performed at 90 minutes and on days 3 to 5. Follow-up was continued for 30 days. Lanoteplase achieved its primary objective, demonstrating a dose-response in TIMI grade 3 flow at 60 minutes (23.6% to 47.1% of subjects, P<0. 001). Similar results were observed at 90 minutes (26.1% to 57.1%, P<0.001). At 90 minutes, coronary patency (TIMI 2 or 3) increased across the dose range up to 83% of subjects at 120 kU/kg lanoteplase compared with 71.4% with alteplase. Thus, at this dose, lanoteplase was superior to alteplase in restoring coronary patency (difference, 12%; 95% CI, 1% to 23%). The early safety experience in this study suggests that lanoteplase was well tolerated at all doses with safety comparable to that of alteplase. CONCLUSIONS: Lanoteplase, a single-bolus, weight-adjusted agent, increased coronary patency at 60 and 90 minutes in a dose-dependent fashion. Coronary patency at 90 minutes was achieved more frequently with 120 kU/kg lanoteplase than alteplase. In this study, safety with lanoteplase and alteplase was comparable. InTIME-II, a worldwide mortality trial, will evaluate efficacy and safety with this promising new agent.

Adolescent↗
PubMed1998

Accuracy and feasibility of contrast echocardiography for detection of perfusion defects in routine practice: comparison with wall motion and technetium-99m sestamibi single-photon emission computed tomography. The Nycomed NC100100 Investigators.

OBJECTIVES: We sought to assess the feasibility and accuracy of myocardial contrast echocardiography (MCE) using standard imaging approaches for the detection of perfusion defects in patients who had a myocardial infarction (MI). BACKGROUND: Myocardial contrast echocardiography may be more versatile than perfusion scintigraphy for identifying the presence and extent of perfusion defects after MI. However, its reliability in routine practice is unclear. METHODS: Fundamental or harmonic MCE was performed with continuous or triggered imaging in 203 patients with a previous MI using bolus doses of a perfluorocarbon-filled contrast agent (NC100100). All patients underwent single-photon emission computed tomography (SPECT) after the injection of technetium-99m (Tc-99m) sestamibi at rest. Quantitative and semiquantitative SPECT, wall motion and digitized echocardiographic data were interpreted independently. The accuracy of MCE was assessed for detection of segments and patients with moderate and severe sestamibi-SPECT defects, as well as for detection of patients with extensive perfusion defects (>12% of left ventricle). RESULTS: In segments with diagnostic MCE, the segmental sensitivity ranged from 14% to 65%, and the specificity varied from 78% to 95%, depending on the dose of contrast agent. Using both segment- and patient-based analysis, the greatest accuracy and proportion of interpretable images were obtained using harmonic imaging in the triggered mode. For the detection of extensive defects, the sensitivity varied from 13% to 48%, with specificity from 63% to 100%. Harmonic imaging remained the most accurate approach. Time since MI and SPECT defect location and intensity were all determinants of the MCE response. The extent of defects on MCE was less than the extent of either abnormal wall motion or SPECT abnormalities. The combination of wall motion and MCE assessment gave the best balance of sensitivity (46% to 55%) and specificity (82% to 83%). CONCLUSIONS: Although MCE is specific, it has limited sensitivity for detection of moderate or severe perfusion defects, and it underestimates the extent of SPECT defects. The best results are obtained by integration with wall motion. More sophisticated methods of acquisition and interpretation are needed to enhance the feasibility of this technique in routine practice.

Contrast Media↗
PubMed1997

[Cerebrovascular accident and aortic thrombosis in a patient with protein S deficiency].

The authors report the case of a 50 year old man admitted to hospital with a right hemiplegia and aphasia of sudden onset in whom embolic fragments were found in the left mid and anterior cerebral artery territories at left carotid angiography : transoesophageal echocardiography demonstrated a protrusive plaque of atherosclerosis in the ascending aorta and a pediculated thrombosis in the descending aorta. Biological investigations revealed a protein S level of 3% (normal : 70-140%). This case illustrates the acute development of a thromboembolic phenomenon originating from the aortic arch in a patient with a coagulation defect.

Anticoagulants↗
PubMed1986

Cardiac tamponade as the first manifestation of cardiothoracic malignancy: a study of 10 cases.

Ten patients with cardiac tamponade as the first presentation of cardiothoracic malignancy were evaluated from May, 1976 to June, 1982. The best treatment of this particularly rare neoplastic manifestation is still being debated. The clinical data of our ten patients were compared to those previously described in the literature. They were first treated by pericardiocentesis and creation of a pericardial window, without recurrence of significant pericardial effusion. Our data suggest that the addition of radiotherapy to the other therapeutic methods (surgery and chemotherapy) may improve survival.

Adult↗
PubMed1985

Frequency and clinical significance of pericardial friction rubs in the acute phase of myocardial infarction.

An early pericardial friction rub was noted in 23.4% of a population of 1264 consecutive patients admitted with acute myocardial infarction. The incidence of the rub did not vary with age, sex or past cardiac history. The pericardial rub, however, was more often a complication of Q- than non-Q-wave infarcts (25.5% vs 10.5%, P greater than 0.001) and of anterior than inferior infarcts (35.3% vs 20.8%, P greater than 0.001). In comparing the 297 patients with a pericardial rub to the 967 others, we noted that the former group had a higher CK peak (1706 +/- 1110 UI l-1 vs 1189 +/- 1038 UI l-1, P greater than 0.001) and a higher incidence of Killip class greater than 1 (47.5% vs 33.2%, P greater than 0.001), atrial flutter or fibrillation (22.2% vs 9.3%, P greater than 0.001), second or third degree atrioventricular blocks (16.8% vs 9.4%, P greater than 0.001) and complete bundle branch block (14.5% vs 7.1%, P greater than 0.001). In spite of this, the development of a pericardial rub did not increase the in-hospital mortality (10.8% in patients with pericardial rub; 11.3% in those without).

Aged↗
PubMed1982

[Treatment of Prinzmetal's angina with normal coronary vessels by thoracic sympathectomy].

Two cases of Prinzmetal angina with normal coronary arteries are reported: coronary spasm was demonstrated in the left anterior descending artery in the first, and in the right coronary artery in the second case. Invalidating angina persisted despite maximal medical treatment with nitrite derivatives, nifedipine, verapamil and amiodarone. Homolateral thoracic sympathectomy led to long term remission of symptoms in one case and a short remission in the other, who then had to undergo complete denervation by plexectomy. Two hours after reoperation a refractory spasm of the right coronary artery led to the death of the patient. The possible causes of refractory coronary spasm and possible therapeutic approaches are discussed with reference to these cases.

Adult↗