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Biomedical subjects

L Poirier

Publications and source records attributed to L Poirier.

At least 37 records · Page 2Linked to original sources
PubMed1995

Antihypertensive effects of amlodipine and hydrochlorothiazide in elderly patients with ambulatory hypertension.

Recent studies and authorities have advocated the use of low-dose thiazide diuretics as first-line treatment agents in elderly hypertensives. However, these recommendations were based solely on blood pressure (BP) measured in the clinic. The objective of the present 32-week double-blind study was to compare the effects of hydrochlorothiazide (HCTZ) and amlodipine (AML) in elderly patients with confirmed ambulatory hypertension. After a 4-week placebo washout period, 42 (25 men, 17 women) patients (mean age, 69 years) with clinic sitting diastolic BP of 95 to 114 mm Hg and daytime ambulatory diastolic BP of > or = 90 mm Hg were randomized double-blind to receive AML 5 to 10 mg (n = 21) or HCTZ 12.5 to 25 mg (n = 21) once daily. After 8 weeks of monotherapy, patients in whom clinic diastolic BP remained > or = 90 mm Hg were given combination therapy with the other agent. Amlodipine monotherapy induced significant reductions in clinic, mean 24-h, daytime and sleep systolic/diastolic BPs whereas only clinic BP decreased significantly in patients treated with HCTZ monotherapy. Moreover, 19/21 versus 8/21 patients on AML and HCTZ monotherapies achieved adequate BP control. At the end of the 32-week treatment period, combination therapy in the HCTZ group resulted in statistically significant reductions in clinic as well as in 24-h, daytime and sleep ambulatory BPs that were similar to those observed in the AML monotherapy group. In conclusion, the administration of AML monotherapy induced significant reductions in both clinic and ambulatory BPs in elderly patients whereas only clinic BP was significantly decreased by HCTZ monotherapy. Moreover, the addition of AML to HCTZ in patients inadequately controlled by monotherapy has permitted statistically significant decrements in clinic as well as in ambulatory BP. Consequently, the results of the present study suggest that the use of HCTZ in doses of up to 25 mg daily is inadequate for ambulatory BP control in the elderly despite official recommendations.

Aged↗
PubMed1995

Comparative assessment of antihypertensive efficacy of DL-nebivolol and D-nebivolol in patients with confirmed mild to moderate hypertension.

We compared the antihypertensive activity of DL- and D-nebivolol in patients with essential hypertension on clinic and 24-h ambulatory blood pressure (BP) and during dynamic exercise as well. After a 4-week placebo run-in period, 30 patients (mean age 48 years) were randomly allocated to double-blind treatment with either DL-nebivolol 5 mg or D-nebivolol 2.5 mg once daily for 4 weeks. After an interim single-blind placebo washout of 2-4 weeks, all patients crossed over double-blind to the alternative DL- or D-nebivolol treatment for 4 weeks. The results show that DL- and D-nebivolol produced similar reductions in clinic trough (delta systolic/delta diastolic BP (delta SBP/delta DBP): -10/-8 and -13/-9 mm Hg, respectively, all p < 0.0001 vs. placebo), 24-h ambulatory (-12/-11 and -13/-11 mm Hg, respectively, all p < 0.0001), and peak exercise BP (-13/-6, both p < 0.01; and -13/-7 mm Hg, both p < 0.0001, respectively) as compared with placebo (SBP/DBP clinic 147/99, ambulatory 147/94, exercise 211/103 mm Hg). Our results showing superimposable clinic and ambulatory BP profiles as well as exercise BP responses with DL- and D-nebivolol treatment do not confirm results of animal pharmacologic experiments in which the L-isomer potentiated the antihypertensive effect of the D-isomer.

Adolescent↗
PubMed1995

[Floppy eyelid syndrome. Apropos of 4 cases and review of the literature].

Often unrecognized, Floppy eyelid syndrome is an impairment of the eyelid statics with marked conjunctival signs. Over-weight middle aged men are principally concerned. Excessive eyelid laxity in the Floppy eyelid syndrome is responsible for a night ectropion of the upper lid, creating the clinical manifestations. We report four cases of Floppy eyelid syndrome to illustrate our work and discuss the clinical and therapeutic aspects.

Aged↗
PubMed1995

[Corneal ulcer and Behçet disease. Apropos of a case].

We report a case of a peripheral corneal ulcer that occurred to a 33 years old female with a Behçet's disease. This patient had a previous history of viral keratoconjunctivitis with subepithelial nodules one year ago. The type, aspect and localization of the ulcer suggested an immunologic origin. The evolution was favourable after systemic and local steroid therapy. The other aetiologies of such ulcer are discussed by the authors.

Adult↗
PubMed1995

[Trabeculectomy with mitomycin C. Study apropos of 30 cases].

UNLABELLED: Standard trabeculectomy with adjunct Mitomycin C application was performed in 30 eyes of 26 patients with refractory glaucoma to study the efficacy and safety of this technique. The results were analyzed for each aetiology and number of ocular risk factors for failure of filtering procedure and compared with those of other series, including those using 5-fluorouracil. METHODS: The surgical procedure was similar to that described by Cairns, except that a fornix-based conjunctival flap was used. A 0.4 mg/ml solution of Mitomycin C was applied at the filtration site for three minutes. The mean follow-up was 6.4 months; the thirty eyes were followed for 4 to 11 months. RESULTS: At 6 months, the intraocular pressure was less than 21 mmHg in 65.2% of cases without postoperative glaucoma medication, and the overall success rate was 86.9%. No remarkable complications occurred. CONCLUSION: Intraoperative Mitomycin C may be a helpful adjunct in achieving low final intraocular pressure after trabeculectomy in high-risk glaucoma filtering surgery, and Mitomycin C may be a viable alternative to postoperative 5-Fluorouracil. But further studies regarding late complications due to mitomycin are required.

Adolescent↗
PubMed1995

[Complication of keratoprosthesis of posterior fixation: retroprosthetic membranes. Apropos of 4 cases].

Keratoprosthesis represents the last solution for patients with bilateral corneal blindness or for monophthalm patients who cannot benefit from corneal grafts. Complications related to this technique are recalled together with an in-depth analysis of the problem of retroprosthesis membranes. The frequency of retroprosthesis membranes varies depending on the series reported, although it appears to be a more agreement on treatment and causes. Among 8 patients who underwent a KPF operation using the E. Lacombes technique, 50% of the cases had retroprosthesis membranes with an unusual thickness, vascularization and recurrent character. Emphasis was placed on early and intense intraocular inflammation.

Adult↗
PubMed1995

[Orbital dermoid cysts. Apropos of a case].

We report the case of a 53 year-old female patient with an orbital dermoid cyst. A mass effect with proptosis, hypotropia and choroidal folds was noted. Imaging aspects (radiography, ultrasonography and computed tomography) were highly suggestive of a deep orbital dermoid cyst. A fronto-temporal neuro-surgical approach allowed complete removal of the tumour. Histopathology confirmed the diagnosis of dermoid cyst. The incidence of orbital dermoid cyst falls significantly after the second decade of life thus making our clinical case original.

Dermoid Cyst↗
PubMed1995

[Lacrimal IgE levels in chlamydia infections].

Dosage of tear IgE was performed in lacrimal fluid of 110 patients with chlamydioses (12 were trachomatous and 98 had a chlamydiosis serovar D through K). Simultaneously skinpatch testing and RASTS were evaluated. In half of cases, we found a rise of tear IgE. All these patients had documented allergy. We conclude that allergic treatment could be added.

Adolescent↗
PubMed1994

Treatment of ambulatory hypertensives with nebivolol or hydrochlorothiazide alone and in combination. A randomized, double-blind, placebo-controlled, factorial-design trial.

This placebo-controlled multifactorial design trial assessed the antihypertensive efficacy of nebivolol, a novel cardioselective beta 1-blocker with vasodilating properties, and hydrochlorothiazide monotherapy and in combination. After a 4-week placebo period, 240 white patients with a mean daytime ambulatory blood pressure of > or = 90 mm Hg were randomized to receive either placebo, nebivolol (1, 5, or 10 mg), hydrochlorothiazide (12.5 or 25 mg), or one of the six possible combinations of nebivolol and hydrochlorothiazide for 12 weeks. A dose-related reduction in clinic and ambulatory blood pressure was demonstrated for each drug as monotherapy and for the two drugs in combination. Nebivolol, 5- and 10-mg doses, showed a larger effect than hydrochlorothiazide doses on clinic blood pressure and over the 24-h interval. Moreover, the combination doses had substantial antihypertensive effects that were sustained over the entire 24-h profile with a greater effect observed with the higher dose combinations. The reduction in ambulatory blood pressure was further substantiated by the reduction of blood pressure loads (% of BP > 140/90 mm Hg awake and > 120/80 mm Hg asleep) to as low as 11.5% with 10 mg of nebivolol combined with 25 mg of hydrochlorothiazide. Nebivolol and hydrochlorothiazide were well tolerated. We provided evidence that nebivolol, given as monotherapy or in combination with low dose of hydrochlorothiazide, is effective in reducing clinic and 24-h ambulatory blood pressure in patients with ambulatory hypertension. The results provided further evidence for the use of ambulatory blood pressure monitoring and factorial designs when investigating new antihypertensive agents.

Adolescent↗
PubMed1994

Compared optical performances of multifocal and monofocal intraocular lenses (contrast sensitivity and dynamic visual acuity)

The functional results (contrast sensitivity and dynamic visual acuity) of 19 multifocal (3M design) and 14 all polymethylmethacrylate biconvex monofocal intraocular lenses (IOLs), 6 mm in optical diameter were compared. Best corrected visual acuity was > or = 8/10 (Monoyer chart) Parinaud 2 in all cases. Major differences of functional performance in favour of monofocal IOLs were found outside standard conditions of vision (low contrast and illumination levels). A significant difference in contrast sensitivity was found for each spatial frequency in favour of multifocal IOLs (0.0016 < p < 0.05). Mesopic vision was statistically higher in the monofocal IOL group (p = 0.0015). Moreover, dynamic visual acuity allowed accurate evaluation of the difference in performance between these two models of implant. In view of these results multifocal IOLs should be reserved for patients with normal psychosensitive adaptation; an ocular pathology that could alter contrast sensitivity or mesopic vision is a contraindication for multifocal IOLs.

Aged↗
PubMed1994

[Results of therapeutic photo-keratectomy using the Excimer laser. Apropos of 12 cases].

We report a series of 12 eyes which underwent phototherapeutic keratectomy with the Excimer laser Aesculap Meditec (model Mel 60). Mean follow up was 11 months (range 3 to 19 months). Six types of corneal pathologic lesions were treated: recurrent corneal erosions, corneal scars after herpetic keratitis, anterior stromal dystrophy, band keratopathy, mucous plaque, and scar after viral infection. Epithelium healed within the first post-operative week in 83.3% of cases. The goal of treatment was achieved in 75% of cases (100% of therapeutic success for recurrent corneal erosions and 66.6% for superficial corneal opacities). The main undesirable effects were postoperative pain, delayed reepithelialization (16.6%). One patient (8.3%) lost more than two lines of visual acuity. The results, the limits and the undesirable effects of phototherapeutic keratectomy are discussed from our experience and data found in the literature.

Adolescent↗
PubMed1994

[Vitreous hemorrhage associated with persistent hyaloid artery. Apropos of a case].

We report a case of vitreous haemorrhage from a persistent hyaloid artery that occurred to a 50 year-old patient. The case report is followed by a review of the embryologic development and a physiopathologic discussion about the origin of vitreous haemorrhage. The authors emphasize the distinction between persistent hyaloid artery and persistent hyperplastic primary vitreous.

Humans↗
PubMed1993

Once-daily trandolapril compared with the twice-daily formulation in the treatment of mild to moderate essential hypertension: assessment by conventional and ambulatory blood pressures.

A double-blind, crossover study was carried out to compare the antihypertensive efficacy of the long-acting ACE inhibitor trandolapril 1 mg administered once daily and 0.5 mg twice daily in 31 patients with mild to moderate essential hypertension. After randomization, patients entered a single-blind placebo period of 4 weeks. After a double-blind treatment of 4 weeks with either of the dosage regimens, patients were then crossed over to the alternate regimen for the last 4 weeks of the study. Conventional BP and heart rate were measured on each visit and ambulatory BP monitoring was done at baseline and at the end of each treatment phase. Conventional as well as 24-hour and awake ambulatory systolic and diastolic BPs were significantly (P < 0.001) and almost identically decreased by both once- and twice-daily formulations. Moreover, the clinical response rates (reduction in seated diastolic BP > or = 10% or diastolic BP < or = 90 mm Hg) were similar with both treatment regimens (42% vs. 45% with the once- and twice-daily formulations, respectively). However, trandolapril twice daily exerted a significantly (P = 0.03) greater antihypertensive effect on systolic BP during sleep as compared with the once-daily formulation. Due to the fact that the minimal effective dose was used in this trial, further studies with higher doses should demonstrate effective 24-hour control of BP as described with other long-acting ACE inhibitors. In addition, our results suggest that ambulatory BP measurements should be done in dose-response studies.

Adolescent↗
PubMed1993

Comparison of quinapril and atenolol as single drugs or in combination with hydrochlorothiazide in moderate to severe hypertensives, using automated ambulatory monitoring.

1. Forty patients with moderate to severe hypertension and daytime ambulatory diastolic blood pressure > or = 90 mm Hg were randomized double-blind to once-daily treatment with either quinapril up to 20 mg (n = 20) or atenolol up to 100 mg (n = 20) as single drugs or in combination with hydrochlorothiazide 25 mg over a period of 12 weeks. 2. Conventional and ambulatory blood pressure, heart rate, side effects and metabolic changes were compared at the end of the run-in period on placebo, after 4 weeks on monotherapy and at the end of the 12-week period of active treatment. 3. Quinapril and atenolol reduced conventional blood pressure equally with substantial additional effect seen on combination therapy. The two regimens induced a significant decrease in ambulatory BP. However, the atenolol treated ambulatory hypertensive group experienced significantly greater decreases in diastolic blood pressure during 24 h, awake and sleep periods than did the quinapril group. 4. Adverse reactions were mild with both drugs except for severe Raynaud phenomenon in one patient in the atenolol group. Triglyceride levels were significantly increased with atenolol alone and in combination with hydrochlorothiazide. 5. Thus, within the limits of the dose ranges tested, quinapril and atenolol as single drugs or in combination with hydrochlorothiazide reduce significantly conventional and ambulatory blood pressure in moderate to severe hypertensives, but atenolol is more effective in reducing ambulatory diastolic blood pressure.

Adolescent↗
PubMed1993

Detection of Toxoplasma gondii in aqueous humour by the polymerase chain reaction.

Ocular toxoplasmosis is the most frequent infectious cause of chorioretinal inflammation in immunocompetent patients. Nowadays, the biological diagnosis of ocular toxoplasmosis requires serological tests and anterior chamber puncture to detect the local production of specific antibodies. A new technique is described to detect Toxoplasma in aqueous humour by a polymerase chain reaction in which the target is a specific ribosomal DNA segment. Sixty eight patients (71 eyes) were included; 59 (83%) eyes were suspected of having ocular toxoplasmosis. Of these 59 eyes, 15 (25.4%) had characteristic fundus lesions with obvious intraocular inflammation signs and 44 (75%) had retinal scar of ocular toxoplasmosis without clinically detectable inflammation. Twelve (17%) eyes had uveitis of non-Toxoplasma origin and constituted the control group. The parasite was present in aqueous humour in 20 (33.8%) cases. No false positives were detected. The sensitivity of the test is reduced by the low numbers of the sample. The combination of this technique with Witmer-Desmonts coefficient increases the probability of making a biological diagnosis of ocular toxoplasmosis. The physiopathological value of this technique is emphasised and the presence of tachyzoites in the anterior chamber is suggested. This should be a very promising technique for the diagnosis of ocular toxoplasmosis.

Adolescent↗