Acute profound thrombocytopenia after c7E3 Fab therapy.
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Abciximab↗
Biomedical subjects
M Baudouy
Publications and source records attributed to M Baudouy.
Images in cardiovascular medicine. Accessory mitral tissue in a young girl.
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Adolescent↗
[Blood levels of homocysteine in patients under 55 years of age with acute coronary insufficiency].
OBJECTIVES: High blood levels of homocysteine have been recently described as a risk factor for thromboembolic events and early development of atherosclerosis. The aim of this work was to study homocysteine blood levels in patients under 55 years of age with acute coronary artery disease. PATIENTS AND METHODS: The study included 110 patients (98 men, 12 women) with poorly controlled angina pectoris (n = 35) or in the acute phase of myocardial infarction (n = 65). Homocysteine was assayed by liquid chromatography in all patients on the day of the acute episode and 24 hours later. Homocysteine levels were also determined in 40 controls under 55 years of age with no history of coronary artery disease. RESULTS: Blood level of homocysteine was 10.6 +/- 6.2 mumol/l in the patients and 7.7 +/- 2.5 mumol/l in the controls (p < 0.01). The difference was greater in the 30-40 year age rang with 14.4 +/- 2 mumol/l in patients versus 6.4 +/- 1.5 mumol/l in controls (p < 0.001). The assays were reproducible at 24 hours (difference less than 10%). The levels were significantly higher in patients with several diseased arteries than those with single-artery disease. The difference between patients and controls was especially remarkable for non-smokers and those with high cholesterol levels. CONCLUSION: Hyperhomocysteinemia would be a factor favoring early development of coronary atherosclerosis.
Acute Disease↗
Detection of embolic signals using Doppler ultrasound: a new approach to cardiac embolism.
Cerebral embolism from cardiac, aortic or carotid cause can be detected by Doppler examination of carotid arteries or transcranial Doppler with long-duration recordings. The signals detected called HITS (high intensity transient signals), which have been described in vitro and in vivo, have specific physical characteristics. This novel technique is considered promising in establishing the relationship between the discovery of embolic heart disease and its clinical neurological manifestations. In the evaluation of a stroke, the detection of HITS could provide evidence in support of an embolic cause. The areas of application of this new technique are many: screening for asymptomatic embolism in patients with an embolic cardiac disorder, and effects of antiplatelet and anticoagulant medications or surgical treatments.
Cardiovascular Diseases↗
Clinical epidemiology of venous thromboembolic disease. Results of a French Multicentre Registry.
OBJECTIVE: Between July 1992 and December 1994, 16 French hospital centres, mainly cardiological, participated in a non-controlled observational study on venous thromboembolic disease. The objective of this survey was to collect data concerning the current status of pulmonary embolism and deep venous thrombosis. PATIENTS: During this period, 547 patients were included: 446 with deep venous thrombosis and 387 with pulmonary embolisms. RESULTS: Mean age of patients was 63 +/- 21 years. There were no significant differences between the sexes. Pulmonary embolism and deep venous thrombosis tended to occur more frequently during the autumn and winter. In 30% of cases, prior deep venous thrombosis or pulmonary embolism was noted. No cause was found for the condition in 47% of cases. Ultrasound (echocardiography and/or venous ultrasound) was the most frequently requested investigation. Intravenous heparin remains the most widely used treatment (76%). Oral anticoagulation was begun before day 3 in less than 31% of cases. Thrombolytic treatment was used in 20% of pulmonary embolism cases, but was rarely prescribed for deep venous thrombosis (2.2%). The hospital recurrence rate (12/547 cases) was fairly low. The search for occult malignancy, performed in 48% of cases, seems to remain one of the major concerns of physicians. The combined pulmonary embolism and deep venous thrombosis mortality rate was 4.4%, while the death rate for pulmonary embolism alone was 6.2%.
Adult↗
The ECG in pulmonary embolism. Predictive value of negative T waves in precordial leads--80 case reports.
BACKGROUND AND STUDY OBJECTIVE: The value of the ECG for the diagnosis of pulmonary embolism (PE) is debatable. Once the diagnosis of PE has been established, however, the ECG could allow the massive forms to be distinguished. The purpose of our study was to analyze the ECG signs in patients hospitalized for PE in a cardiology unit. DESIGN: Taking a series of 80 consecutive patients hospitalized for PE, we analyzed the ECGs on admission and then during hospitalization. We sought to evaluate changes in ECG signs compared with angiographic and hemodynamic changes in PE. RESULTS: T-wave inversion in the precordial leads is the most common abnormality (68%), and represents the ECG sign best correlated to the severity of the PE. Among those patients with anterior T-wave inversion, 90% had a Miller index over 50% (mean, 60 +/- 8%). Eighty-one percent had a mean pulmonary arterial pressure (PAP) over 30 mm Hg (mean, 37 +/- 8%). This subepicardial ischemic pattern is an even stronger marker of severity when it appears as early as the first day (p < 0.01). Its reversibility is correlated to the changes in PE. After thrombolysis in particular, normalization of repolarization systematically indicates mean Miller and PAP indexes of < 20% and < 20 mm Hg, respectively. CONCLUSIONS: The anterior subepicardial ischemic pattern is the most frequent ECG sign of massive PE. This parameter is easy to obtain and reflects the severity of PE. Its reversibility before the sixth day points to a good outcome or high level of therapeutic efficacy.
Adult↗
Treatment of the heparin-induced thrombosis-thrombocytopenia syndrome by very low dose streptokinase.
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Aged↗
[Complete regression of cardiac non-Hodgkin's lymphoma after 23 months with chemotherapy].
The authors report the case of a non-Hodgkin malignant lymphoma (NHL) of the heart presenting with syncope. The diagnosis of a cardiac tumours was made by echocardiography. Myocardial biopsy enabled diagnosis of a highly malignant NHL in a patient with a history of low grade NHL. Chemotherapy with CNOP (Cyclophosphamide, Novantrone, Oncovin, Prednisone) induced total regression of the tumour. The patient is in total remission 23 months later. The authors emphasise the value of echocardiography in the diagnosis and follow-up of this pathology. The case is also noteworthy because of the unusual transformation of a low grade to a high grade cardiac NHL.
Antineoplastic Combined Chemotherapy Protocols↗
[Detection of cardiac embolism by transcranial Doppler].
Cerebral emboli, regardless of their nature, can be detected by transcranial Doppler by performing long-term recordings of the middle cerebral artery. The signals detected, called HITS (high intensity transient signals) described in vitro and in vivo have particular physical characteristics. These embolic signals have been identified in patients with prosthetic heart valves, in patients with atrial fibrillation, following myocardial infarction, following cerebrovascular accident, in patients with carotid stenosis or aortic plaques, during cardiac and carotid surgery and during carotid angiography. During assessment of a cerebrovascular accident, the discovery of HITS could be an argument in favour of an embolic origin. This new technique raises great hopes for establishing the relationship between the discovery of emboligenic heart disease and their neurological clinical manifestations. This new technique has many fields of application: investigation of asymptomatic emboli in patients with emboligenic heart disease, efficacy of antiaggregant, anticoagulant or surgical treatments.
Embolism↗
[Comparative data of tilt test with or without isoproterenol in investigation of unexplained unconsciousness and syncope].
The tilt test is a widely used diagnostic tool for the investigation of syncope of suspected vasovagal origin. Some workers suggest that the sensitivity should be increased at the price of the loss of some specificity. Passive (non-sensitised) or isoproterenol (sensitised) protocols have not been widely studied on a large scale. The authors report the respective results of two protocols (passive and sensitised with isoproterenol proposed by Benditt et al.) applied to the same subject at 24 hours' interval in a random order in a series of 108 patients (age 56 +/- 19.3 years, 72 men) with unexplained syncope or malaise. After 30 minutes in decubitus, an 80 degrees tilt was maintained for 45 minutes for the passive test and for 25 minutes for the sensitised test, followed by a continuous infusion of isoproterenol in 10 minutes intervals of decubitus and inclination at successive doses of 1.3 and 5 micrograms/min. One or both tests were positive in 62 patients (57.4%). The overall concordance of the two tests (both positive or both negative) was 53.7%. In a subgroup of 60 subjects with clinically suggestive vasovagal attacks, the sensitivity of the passive test was 25% compared with 73.3% with the isoproterenol test (p < 0.001). Based on this difference of sensitivity between the two protocols, and knowing the good specificity of the isoproterenol test, the authors recommended the isoproterenol test as being of great practical value.
Adolescent↗
Effect of pacing rate on regional left ventricular wall motion. Assessment by quantitative analysis of equilibrium radionuclide angiography.
We evaluated the hemodynamic impact of right ventricular pacing at different stimulation frequencies. Fourteen patients with a right ventricular pacemaker (VVI pacing with retrograde P wave) but without clinical and electrocardiographic evidence of coronary artery disease underwent two equilibrium radionuclide angiographies: one under low heart rate (50/60 beats per minute) and the other under fast heart rate (90/100 beats per minute). Left ventricular global and sectorial ejection fractions, amplitude and phase images of first harmonic, and sectorial phases of left ventricle were analyzed. In twelve patients (84.7%), sectorial ejection fraction abnormalities in the left ventricular apicoseptal and inferoapical regions were observed under low heart rate, and worsened under fast heart rate, while new onset sectorial ejection fraction abnormalities under fast heart rate were observed in the other two patients with normal sectorial ejection fraction under low heart rate. Sectorial ejection fractions of left ventricular apicoseptal and inferoapical regions significantly changed between low and high heart rate (- 14.1 +/- 3.8%, p < 0.005; - 7.5 +/- 2.4%, p < 0.01 respectively). Left ventricular sectorial phases were abnormal in only two patients (14.3%) under low heart rate, and in twelve patients (84.7%) under fast heart rate. Our study confirms that left ventricular regional wall motion abnormalities during VVI pacing significantly worsen under fast heart rate in comparison to those under low heart rate.
Aged↗
Spontaneous echo contrast and Chiari's network.
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Adult↗
Relationship between interatrial conduction times and left atrial dimension in patients undergoing atrioventricular stimulation.
Interatrial conduction time (IACT) and left atrial dimension (LAD) were determined in 75 patients (41 males, 34 females, mean age 78.2 +/- 7.9 years) undergoing atrioventricular (AV) stimulation. The LAD was measured by M mode echocardiography as the distance between the posterior aortic wall and the posterior left atrial wall. The IACT was determined during a transvenous dual chamber pacemaker implant done under local anesthesia (lidocaine). The spontaneous interatrial conduction time (SIACT) was measured from the intrinsic deflection (ID) of the right atrium recorded in a unipolar mode (unipolar J-shaped lead positioned in the right appendage) to the ID of the left atrium (bipolar esophageal lead, left atrial positive deflection equal to the negative one) during sinus rhythm. The right atrium then was paced at a rate slightly greater than the spontaneous one. The paced interatrial conduction time (PIACT) was measured from the stimulus artifact to the left atrial ID. The PIACT was also measured during incremental right atrial pacing (10 beats/min step increase to 180 beats/min) and, from these measurements, the maximum increase of PIACT (MIPIACT) was deduced. The LAD was measured at 39.5 +/- 8.7 mm, SIACT at 70.3 +/- 24.8 msec, PIACT at 118.8 +/- 27.9 msec, and MIPIACT at 16.5 +/- 16.4 msec. We found highly significant relationships between SIACT and LAD (P = 0.0006, r = 0.39), PIACT and LAD (P = 0.0001, r = 0.45), and MIPIACT and LAD (P = 0.0006, r = 0.38). We also noted that the LAD was greater in patients in whom MIPIACT was > 10 msec than in patients in whom the MIPIACT was negligible (P < 0.002).(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
[Refractory sinus tachycardia: late complication of radiotherapy].
The authors describe a case of sinus tachycardia, an unusual cardiac complication of mediastinal radiotherapy; occurring in two patients by the first days of treatment and persisting for several years. No other cause for this tachycardia could be detected in either case. Electrophysiological investigation of one of the two patients was normal. Despite the risk of a high-degree conduction disorder, "symptomatic" beta-blocker treatment was prescribed, but only induced a limited effect.
Adult↗
[Severe arrhythmia in the elderly: a prospective hospital study].
The prevalence of arrhythmia increases with age. Considered as an "ordinary" event in elderly patients, these arrhythmias may nevertheless have serious consequences. This study was undertaken to determine the clinical, aetiological and prognostic features of serious arrhythmias in a population of elderly subjects (> or = 70 years) hospitalised over a 20 months period and comprising 202 patients (103 women, 99 men, mean age 79.6 +/- 5.9 years). Supraventricular arrhythmias are the most common by far (84.2%): 51.4% of patients had atrial fibrillation, 15.3% had atrial flutter; 12.9% had focal atrial tachycardia, 4.5% had junctional tachycardia. Of the ventricular arrhythmias (15.8%), there were 12 sustained ventricular tachycardias, 4 torsades de pointes and 1 ventricular fibrillation. The increased duration of hospital stay (10 +/- 6 days on average) is related not to age but to the type of arrhythmia (longer for ventricular arrhythmias) and to left ventricular dysfunction. The main complications of arrhythmias were cardiac failure (52.4%), neurological deficits (37.4%) and angina (18.6%). Electrocardiographic signs of atrioventricular block were present in 62% of cases and QRS changes in 47.3% of cases. Ventricular arrhythmias were more commonly associated with intraventricular conduction defects, signs of myocardial necrosis and prolongation of the QT interval; they were also common in patients with left ventricular dysfunction and when the left ventricle was dilated. The aetiology of ventricular arrhythmias was mainly iatrogenic (50%) and ischaemic (21.8%), whereas the aetiologies of the supraventricular arrhythmias were varied, 14.7% of cases being idiopathic. Conversion to stable sinus rhythm was obtained in half the patients. A pacemaker was implanted in 10.8% of cases. The hospital mortality was 4.9%.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
[Pulmonary hypertension caused by talcoma in a couple of drug addicts].
The authors report a case of severe pulmonary hypertension (PHT) in a couple of HIV seropositive heroin addicts. The parallel clinical course in these two patients with only mild immunodeficiency and the fact that they both had the same supplier were in favour of PHT secondary to talcoma. In the light of these cases, one wonders whether, as suggested by certain epidemiological studies currently underway, drug addiction should be considered to be a cause of PHT in its own right. According to the authors, this approach would underestimate the incidence of this disease in this particular population and would therefore bias the epidemiological data.
Adult↗
[Duration of antivitamin K therapy in venous thromboembolic disease].
The necessity for anticoagulant treatment after pulmonary embolism or deep vein thrombosis has been demonstrated. The modalities of this treatment have been established, especially the value of initial heparin relayed by oral antivitamin K therapy with a target INR value between 2 and 3. The last question remaining in this protocol is that of the duration of anticoagulant treatment. The choice of duration of anticoagulation should take into consideration two potential complications: haemorrhage due to over-anticoagulation and excessive duration of therapy, and recurrent thromboembolism which could result from an inadequate duration of therapy. Several trials have addressed this question and have led to a consensus of opinion: therefore, secondary venous thrombo-embolic disease, occurring under known, special circumstances, the cause of which has been treated, should be given 4 to 6 weeks anticoagulant therapy. In the other cases, so-called idiopathic venous thromboembolism (the proportion of which is on the increase), recent studies are inadequate to reach a consensus. These "idiopathic" forms are characterised by a higher incidence of recurrent thromboembolism of "secondary" cancer and coagulation abnormalities. The search for the optimal duration of anticoagulant therapy in these forms requires prospective trials taking their features into account and should lead to further therapeutic options. The evaluation of longer treatment protocols with less intensive degrees of anticoagulation and of alternatives to oral vitamin K antagonists is justified.
Anticoagulants↗
[Epidemiology of pulmonary embolism].
There are few conditions in medicine as difficult to diagnose as pulmonary embolism. This is certainly not due to the rarity of the disease which is probably as common as myocardial infarction in France. The circumstances surrounding pulmonary embolism and the risk factors of deep venous thrombosis have been well identified. The risk of thromboembolic venous disease has been assessed for each type of surgery. The methods of treatment and prevention have progressed over a number of years. However, in practice, these advances have not "transformed" the frequency of the disease or reduced its mortality. Further progress could come from improved identification of patients at risk, especially by biological tests and new abnormalities of blood coagulation.
Adult↗