Biomedical subjects

L Prunier

Publications and source records attributed to L Prunier.

4 recordsLinked to original sources

PubMed1996

[Return to work following myocardial infarction. Medical and socio-professional factors].

The aim of this study was to assess the influence of medical and socioprofessional factors on return to work after myocardial infarction. The authors studied a continuous series of 174 patients with an average age of 51.3 years, all of whom were active before their illness. The average follow-up period was 33 months. One hundred and thirty of the patients (75%) returned to work. The only clinical factors predictive of not returning to work were older age short exercise time and fall in blood pressure on exercise. On the other hand, nearly all socioprofessional factors, social class, type of occupation, size of company, length of employment in their company, physical stresses related to their occupation, were related to return to work. The average time before returning to work was 5.5 +/- 1 month. Though certain immediate criteria of severity of infarction such as previous myocardial infarction or anterior wall infarction were related to a more delayed return to work. The cardiac status evaluated by complementary investigations (left ventricular ejection fraction, exercise testing and Holter monitoring) was not related to the time before return to work. Of the socioprofessional factors, only difficulties related to the patients' work (modification or change of job) were associated with a more delayed return to work. Forty-four patients (33.8%) returned to work after a change in working hours (28 patients), the tasks involved (20 patients) or position (7 patients). Only the lower socioprofessional classes, independent workers and extremes of age could benefit from these measures.

Adult↗

PubMed1993

[Detection and prognostic value of silent myocardial ischemia].

Silent myocardial ischaemia (SMI) is a common manifestation of coronary artery disease. Continuous electrocardiographic recordings have shown that 75% of ischemic episodes are asymptomatic. In addition, SMI has the same consequences as symptomatic ischaemia on myocardial perfusion and ventricular function. There are many means of detecting SMI, continuous electrocardiographic monitoring, exercise stress testing with or without methods of analysis of myocardial perfusion or wall motion using radioactive tracers or echocardiography. The latter techniques seem to improve the sensitivity of exercise stress testing. More recently, pharmacological stress testing coupled with myocardial scintigraphy or echocardiography has been introduced. In coronary patients, the prevalence of SMI on Holter monitoring is about 50% in angina and 25% after myocardial infarction. The prognostic value of SMI has been the object of much research. In asymptomatic patients with documented coronary artery disease, SMI is associated with a relative risk of a cardiac event 2 to 3 times greater than that of subjects without ischaemia. In angina pectoris, the relative risk of future cardiac events is 5.3 times greater, and that of death is 2.3 times greater. These results reported with the Holter method have been confirmed by those of exercise stress testing with and without coupled imaging techniques. In unstable angina, the results are the same: the relative risk of cardiac events in patients with SMI on Holter monitoring is increased by a factor of 4.5, and that of death by a factor of 4. This increased risk is also observed after myocardial infarction whether SMI is recorded by Holter monitoring or exercise stress testing. However, these observations are not confirmed in all reports.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Disease↗

PubMed1989

Transcatheter radiofrequency ablation of atrial tissue using a suction catheter.

Closed chest ablative technique that avoid barotrauma would be attractive for ablation at thin walled cardiac structures, such as the atrial free wall or coronary sinus. Transcatheter radiofrequency (RF) currents produce tissue necrosis the size of which is dependent on the contact between the tissue and the electrode. In order to assess the effects of transvenous RF ablation of atrial free wall using a suction electrode catheter, we delivered in ten dogs, one single unmodulated RF pulse 1.2 MHz, in a unipolar mode, through the distal electrode of a lumen catheter (USCI 8F) (USCI, Billerica, MA USA) located in the right appendage. During the pulse an 80 KPa vacuum depression was applied to the lumen of the catheter. Each pulse had a 10 seconds duration and the mean delivered power was 4.3 +/- 1.4 W. Aortic pressure and electrocardiogram were monitored during the procedure. A right atrial electrophysiological study was performed at the ablated site, at control, after suction application and after RF pulse delivery. The animals were sacrificed after 14 or 21 days. Atrial pacing threshold values decreased after suction application in comparison to control values after the pulse (0.42 +/- 0.06 vs 0.60 +/- 0.23 mA, P less than O.05) but increased after the pulse delivery (2.60 +/- 1.85 mA, P less than 0.01). In contrast, the atrial effective refractory period did not significantly change after suction, nor after RF pulse delivery. Aortic pressure remained unchanged throughout the procedure. Complex arrhythmias were not observed during or after RF pulse delivery. One dog died suddenly at the first day after ablation, but this death was most probably unrelated to RF ablation. Anatomic lesions had a length of 8.8 +/- 3.3 mm, a width of 4.6 +/- 2.5 mm and a depth of 3.6 +/- 1.1 mm. They were transmural in nine of the ten dogs but without atrial wall perforation in any case. Lesions suggesting tissue volatilization were present in four dogs. These results demonstrate that low energy RF currents delivered with a suction electrode catheter can produce transmural necrosis of free wall, without risk of perforation. Such ablative technique would be of interest for ablation of right sided accessory pathways or atrial ectopic foci. Further experimental data are required in order to define the optimal energy level required to avoid tissue volatilization.

Animals↗

PubMed1988

[Recurrent myocardial abscess during Streptococcus B endocarditis].

The authors report a case of serious streptococcus B endocarditis with a myocardial abscess that recurred after surgery. Streptococcus B endocarditis is a rare disease which is characterized by a pronounced tropism of the organism for cardiac tissues, with severe cardiac valve mutilation and abscess formation in 40% of the cases. A myocardial abscess makes the prognosis worse and must be treated surgically during the acute phase of endocarditis. Modern imaging methods, notably trans-oesophageal two-dimensional echocardiography and computerized tomography should now be used to detect such abscesses.

Abscess↗