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Biomedical subjects

M Bory

Publications and source records attributed to M Bory.

At least 19 recordsLinked to original sources
PubMed1995

[Vagal syncope in young adults: specificity of the tilt-table test].

OBJECTIVE: The head-up tilt test has been used for more than 10 years to reproduce vagal lipothymia. The criteria for a positive test and specificity are however still lacking. METHOD: Thirty male volunteers, age 18 to 35 years, with no past history of lipothymia nor any signs of hypervagotonicity at physical examination, on fasting blood samples or on exercise tests with sudden interruption and Holter recording were selected for the study. Two head-up tilt tests at 60 degrees for 45 minutes were conducted, one with no presensitivisation and the other with a bolus of isoproterenol (2, 4, 6 and 8 micrograms) starting 30 minutes after the beginning of the test. Blood pressure was measured throughout the test. RESULTS: The systolic blood pressure curves showed drops of more than 30 mmHg accompanied by spontaneously resolving clinical signs in 6 of the 30 subjects during the non-sensitized tests and in 14 out of 30 during the sensitized tests. A symptomatic drop in systolic blood pressure of more than 30 mmHg compared to the moment before the malaise accompanied by clinical signs which did not resolve within 1 minute and required returning to the supine position occurred in one volunteer during a non-sensibilized test. This same type of reaction was observed in 4 volunteers during sensitized tests, three times after an isoproterenol bolus. CONCLUSION: Taking this later manifestation as the criteria for a positive head-up tilt test, the specificity of the non-sensitized and isoproterenol-sensitized tests in the young adult are 96.7 and 86.7% respectively. These findings must be considered with caution since there is no proof that these young men with no past history of hypervagotonicity but a positive head-up tilt test may be one day confronted with a situation generating a vagal reaction.

Adolescent↗
PubMed1995

Assessment of aortic regurgitation severity by magnetic resonance imaging of the thoracic aorta.

A new method of assessing the severity of aortic regurgitation severity by magnetic resonance imaging has been developed. Two groups were studied: 20 controls (age = 58 +/- 19 years) without valvular aortic disease, and 24 patients (age = 62 +/- 13 years) with chronic aortic insufficiency evaluated by magnetic resonance and aortic root cineangiography within 1 week of each other. A magnetic resonance sequence (TR = 35 ms/TE = 12 ms/flip angle = 20 degrees/magnet = 1.5 T) was acquired in a plane containing the thoracic aorta. A transverse saturation band 30 mm wide was positioned 30-40 mm above the aortic valve. Aortic insufficiency was graded; the importance of end-diastolic retrograde movement in the saturation band in the descending aorta was noted. Magnetic resonance was also compared to Doppler echocardiography in 20 patients. In the controls, we found that retrograde blood flow was absent (18/20) or mild (2/20). In contrast, the presence of marked retrograde movement in a saturation band across the thoracic aorta was always associated with severe aortic regurgitation (angiographic grade III or IV). This rapid method (imaging time less than 20 min) can be applied in most patients with aortic regurgitation and is likely to be helpful when echocardiography is not possible or gives inconclusive results.

Adult↗
PubMed1994

[Ambulatory venous thromboembolitic disease. Clinical, etiological and evolutive data].

OBJECTIVES: Venous stasis in bedridden patients is recognized as one of the risk factors for venous thromboembolism but the phenomena is known to occur in ambulatory subjects and another cause must be involved. We investigated a series of consecutive ambulatory patients with venous thromboembolism in order to distinguish the particular clinical manifestations and possible aetiologies. METHODS: We compared a retrospective series of 120 consecutive patients with deep vein thromboembolism of the lower limbs and 127 patients with the same disease who had been bedridden at onset. In addition to the physical examination, the aetiological work-up included echography (n = 14), abdominal computed tomography (n = 38) and/or haemostasis studies (n = 61). Mean follow up was 23 +/- 13 months (range 1-45 months). RESULTS: Family history of deep venous thromboembolism was found in 17 patients and recurrence was observed in 50 patients. Phlebitis was on the right in 52 cases, on the left in 47 and bilateral in 17. Proximal locations were more frequent (74%) and pulmonary embolism occurred in one-half of the patients (n = 58). A cause was identified in 61 cases (50.8%): cancer (n = 24, 17 known, 7 previously unknown), dyscrasia (n = 17, protein S or C deficiency (5), increased plasminogen activator inhibitor I (8), circulating anticoagulants (3), hypofibrinogen (1), idiopathic varicose veins (n = 7), pregnancy (n = 5), oral contraceptives (n = 4) and other causes (n = 4). No cause was identified in 59 patients. Pulmonary embolism led to death in 4 cases. Seven patients were lost to follow-up and anticoagulation therapy was taken by 79 (72%) then interrupted in the others 3 to 6 months later. Eighteen patients died, 14 due to the underlying disease, 2 from new cancers and 12 after recurrent thromboembolism. CONCLUSION: Ambulatory venous embolism is as frequent as embolism in bedridden patients and the cause can be observed in 50% of the cases.

Adolescent↗
PubMed1994

[Myocardial infarction after 80 years of age. Apropos of 157 cases].

The authors evaluated the features of myocardial infarctions in a population of 157 subjects aged 80 years or more out of a total of 1,610 patients admitted for myocardial infarction. It was a common condition in this age group (9.8% of the population) with a female predominance (61.8%), the main risk factor begin hypertension. A previous history of angina or infarctions, silent ischaemia, atypical electrocardiographic forms and anterior infarction were significantly more common. The outcome was characterised by a higher prevalence of haemodynamic complications with cardiac failure in 60% of cases and cardiogenic shock in 10% of cases. Atrial fibrillation was also more common though severe ventricular arrythmias were more infrequent. From the therapeutic point of view, 95.7% of octogenarians were given intravenous heparin but thrombolysis was undertaken in only one case. Coronary angiography, angioplasty and cardiac surgery were exceptional. Hospital mortality was 26.7%, seven times higher than that observed in patients under 65 years of age and nearly twice that of patients 65 to 79 years of age. After hospital admission, 45% of octogenarians were prescribed a calcium inhibitor, 37.2% a platelet anti-aggregant agent, 17.2% long-term oral anticoagulants and 1.9% a betablocker. These results show that myocardial infarction after 80 years of age is common, serious, but treated conventionally.

Age Factors↗
PubMed1994

[Does syndrome X exist?].

The syndrome X is an entity characterised by the association of chest pain on exercise and a positive exercise stress test in patients with normal coronary angiography. However, this diagnosis can only be admitted when all other causes of angina with normal coronary arteries have been excluded. They include angina secondary to coronary artery spasm and myocardial hypertrophy. A review of the literature based on 26 publications recensing 822 patients shows that these criteria are not always respected: a really positive exercise stress test is an inclusion criterion in only 13 studies and concerns only 313 patients (38.1%); myocardial hypertrophy and coronary spasm were formally excluded in only 278 (33.3%) and 228 patients (27.7%) respectively. Taking into consideration only the patients of these 26 series with a positive exercise stress test after exclusion of coronary spasm and myocardial hypertrophy, 143 (17.4%) may be considered to be due to syndrome X. Syndrome X is a real entity but its incidence is usually overestimated. It is appropriate to distinguish it from other conditions associating, though the exercise stress test is negative, chest pain on effort and the positivity of a test considered to be indicative of myocardial ischaemia.

Exercise Test↗
PubMed1994

[Contribution of myocardial biopsy and immunohistochemistry to the prognostic evaluation of cardiac amyloidosis].

The authors report four cases of cardiac amyloidosis, the diagnosis of which was confirmed by endomyocardial biopsy. They underline the value of immuno-histological studies with labelling of the biopsy fragments with anti-transthyretin and anti-light chain immunoglobulin antibodies. This approach provides a more precise typing of amyloidosis and a more accurate evaluation of the prognosis.

Adult↗
PubMed1994

[Flecainide exercise induced left bundle branch with chest pain].

Ischaemia has been the suggested mechanism of simultaneous left bundle branch block and chest pain on effort with normal coronary angiography. This hypothesis is very controversial and was not the mechanism in the two new cases of this syndrome. The two patients in whom effort pain and left bundle branch block were observed had been treated for paroxysmal supraventricular tachycardia with flecaine. Withdrawal of the anti-arrhtymic resulted in the disappearance of this syndrome. In these cases, the ischaemic mechanism could be excluded without ambiguity. The flecaine was the only cause of rate-related LBBB by slowing conduction in the left bundle branch with no effects on coronary reserve. It would seem that LBBB alone was the cause of chest pain. The absence of coronary artery disease was confirmed in the first patient and the diagnosis was highly improbable in the second.

Aged↗
PubMed1994

[Evaluation of amlodipine in stable effort angina in office cardiologic practice].

A multicentre trial was undertaken in order to evaluate the therapeutic efficacy and ease of use of amlopidine in 1890 patients with stable effort angina. Involving prescribing conditions close to those of everyday practice, it revealed an improvement in angina symptomatology with one daily dose of amlopidine. After one month's treatment, 49.8% of patients were able to reduce or stop their use of fast-acting nitrites. After three months' treatment with amlopidine, 51% of patients had become asymptomatic. This study also revealed a decrease in the duration and severity of angina attacks. Safety/acceptability of amlopidine, assessed by clinical and laboratory parameters, was good, adverse events (22.7%), most often benign, improving or disappearing in more than half of all cases.

Adult↗
PubMed1994

[False pseudoaneurysm of the left ventricle after myocardial infarction. Recognition by transesophageal echocardiography].

Left ventricular pseudo-false aneurysm is caused by a discrete rupture of the myocardial wall which remains circumscribed within the wall itself, realising a cavity joined to the left ventricle by a narrow neck. It is an extremely rare complication of myocardial infarction. Two cases diagnosed in vivo by left ventriculography are reported. Their diagnosis and precise locations were confirmed by transoesophageal echocardiography. In the first case, the pseudo-false aneurysm was situated in the interventricular septum and, in the second, in the antero-lateral wall. The natural history of asymptomatic pseudo-false aneurysms is unknown. The advanced age of the patients and the possibility of regular follow-up by transoesophageal echocardiography were the main reasons for surgical abstention in these particular cases.

Aged↗
PubMed1994

[Comparison of continuous and intermittent treatment with glyceryl trinitrate by the transdermal route in stable effort angina].

The anti-angina efficacy of the continuous (C) transdermal application of nitroglycerin may lessen or disappear over the course of time. Pharmacological tolerance, which is probably responsible, might be prevented by intermittent (I) application. However few studies have compared the C and I methods. The effects of transdermal patches containing 10 mg, applied for 24 hours/day and for 15 hours/day for one week were evaluated in twelve patients. Exercise tests were performed before and 4 hours after the initial application and after one week of each type of treatment prescribed in random order with a 7 day wash-out between each treatment phase. Plasma nitroglycerin concentrations were measured at the same time. Total work and ischemia and angina thresholds after 4 hours application all increased significantly in comparison with baseline values. All these values persisted after one week of I treatment. With C treatment they decreased though remained significantly above baseline values with the exception of angina thresholds. I treatment appeared significantly better than C treatment regarding ischemia threshold (3,974.7 kpm v. 3,037.5-p < 0.01). Plasma nitroglycerin levels were the same during each treatment phase. These results suggest that the anti-ischemic efficacy of transdermal patches persists after one week of treatment, though with superiority of intermittent treatment. Continuous treatment tends to induce pharmacodynamic tolerance since there was no difference in plasma nitroglycerin levels.

Administration, Cutaneous↗
PubMed1994

[Comparative study of the efficacy and tolerability of bepridil and diltiazem in unstable angina. 277 patients].

Bepridil has been used only rarely in unstable angina since its long half-life could imply a delayed action. A loading dose could deal with this disadvantage. In order to confirm this hypothesis, a randomised trial was undertaken involving a 5 day comparison of bepridil at the dose of 300 mg/day after a loading dose (900 mg on D1, 500 mg on D2 and D3) with diltiazem 360 mg/day in 277 patients: 210 men and 67 women, with a mean age of 62.1 +/- 9.5, suffering from unstable angina confirmed by an ECG during symptomatic events showing reversible ST depression. A continuous 72 hour ECG record was obtained in 82 patients. Because of 69 inclusion errors, only 208 patients provided evaluable data (110 with bepridil and 98 with diltiazem), including 55 with continuous ECGs. Mortality (4.5% bepridil v. 3.1% diltiazem) and premature treatment terminations for therapeutic inefficacy (4.5% bepridil v. 7.1% diltiazem), myocardial infarction (3.6% bepridil v. 3% diltiazem), adverse events (3.6% bepridil v. 3% diltiazem) or at the patient's request (0.9% bepridil) were similar between the 2 groups. Efficacy regarding angina was similar, with 18.2% recurrences with bepridil and 21.4% with diltiazem during the first 72 hours, persisting without any difference beyond 72 hours. Resulting treatment adjustments concerning nitrates were identical in the 2 groups. Among the 55 patients with an evaluable continuous ECG (27 bepridil and 28 diltiazem, NS), 18 had recurrent ischemic episodes (9 bepridil and 9 diltiazem), 72.2% of which were clinically silent. Their total number, total duration and maximum amplitude of ST depression were similar in the 2 groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

Cardioprotective effect of intracoronary nifedipine during percutaneous transluminal coronary angioplasty. A French double-blind cross-over multicentre study.

The aim of this double-blind, placebo-controlled, cross-over study was to assess the cardioprotective effect of intracoronary nifedipine during percutaneous transluminal coronary angioplasty balloon occlusion. A balloon inflation without drug injection was initially made to ascertain that a shift of the ST segment (> or = 2 mm, 0.08 s after the J point) appeared (inclusion criterion). Two other balloon inflations were preceded by intracoronary injection of either 0.2 mg nifedipine or placebo, distal to the stenosis through the balloon catheter. The evaluation criteria were (1) time to ST segment shift, and (2) maximal amplitude of ST segment shift caused by balloon occlusion. Comparison of the data used an analysis of variance. Sixty-seven patients (mean age 54 +/- 8 years; 54 male, 13 female) were studied; 50 patients had 1-, 16 patients 2- and 1 patient 3-vessel disease. The dilated vessel was the left anterior descending coronary artery (n = 51), the right coronary artery (n = 12) and the left circumflex coronary artery (n = 4). Balloon inflation time was 100 +/- 31 s in the nifedipine group and 93 +/- 29 s in the placebo group. Five patients were excluded (procedure stopped after the first inflation in 1 and ST segment shift < 2 mm during the first inflation in 4). The time to 2-mm ST segment shift was longer in the nifedipine group than in the placebo group (62 +/- 40 s versus 51 +/- 40 s, P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Indapamide reduces hypertensive left ventricular hypertrophy: an international multicenter study.

The effect of 6 months of treatment with indapamide (IND, 2.5 mg/day) on regression of left ventricular hypertrophy (LVH), an independent predictor of poor prognosis in hypertension, was compared by echocardiography to that of nifedipine (NFD, 40 mg/day), enalapril (ENL, 20 mg/day), atenolol (ATL, 100 mg/day), and hydrochlorothiazide (HCTZ, 25 mg/day) in four parallel double-blind studies in 151 hypertensive patients with a diastolic blood pressure between 95 and 120 mm Hg and a raised left ventricular mass index (LVMI) (mg/m2) (Devereux). Patients were randomized to IND or comparator following a 2-week washout (1 month in the IND vs. ATL study). Respective baseline and 6-month LVMI values (mg/m2) were: IND (n = 20) vs. HCTZ (n = 20): 151.4 +/- 6.3 and 125.70 +/- 4.6 (p < 0.001) vs. 141.3 +/- 6.6 and 135.6 +/- 8.3 (p = N.S.); IND (n = 22) vs NFD (n = 19): 144.1 +/- 5.3 and 125.1 +/- 4.3 (p < 0.001) vs. 170.4 +/- 6.6 and 148.2 +/- 6.2 (p < 0.001); IND (n = 9) vs. ENL (n = 9): 155.1 +/- 6.3 and 143.4 +/- 5.2 (p < 0.001) vs. 142.0 +/- 6.7 and 130.0 +/- 5.9 (p < 0.001); IND (n = 17) vs. ATL (n = 12): 146.2 +/- 5.1 and 130.8 +/- 6.5 (p < 0.001) vs. 156.7 +/- 8.4 and 142.9 +/- 10.3 (p < 0.01). All drugs significantly reduced diastolic blood pressure, and all except HCTZ induced a significant and similar reduction in left ventricular mass.

Adult↗
PubMed1993

[Pulmonary perfusion tomoscintigraphy in pulmonary embolism. Preliminary study].

Tomoscintigraphy, a method developed over 10 years ago, is little used nowadays for the evaluation of suspected pulmonary embolism. The authors report the results of a preliminary study of 10 patients hospitalised for this condition. Tomoscintigraphy was normal in 2 cases and abnormal in 8 cases. Seven of these 8 patients underwent pulmonary angiography which confirmed the diagnosis of pulmonary embolism in 6 cases. The small number of patients, however, did not allow measurement of the sensitivity and specificity. Tomoscintigraphy, repeated at the 8th day and at the first month, provides an assessment of therapeutic efficacy. Some improvement is observed in all cases from the first control but the amount varies from one subject to another. At one month, 3 of the 6 patients undergoing control tomoscintigraphy had hypoperfusion sequellae. The simplicity of pulmonary tomoscintigraphy makes it a useful investigation for emergency diagnosis and follow-up pulmonary embolism.

Aged↗
PubMed1993

[Importance of venous angioplasty in the treatment of subclavian venous thrombosis due to thoraco-brachial outlet syndrome].

A patient with subclavian vein thrombosis was treated successfully by transluminal angioplasty after initial inefficacy of thrombolytic agents. Although employed previously in the treatment of intrinsic and extrinsic subclavian vein stenosis with variable results, this technique has not been used up to the present for the acute phase of thrombosis. Because of the presence of a thoraco-brachial outlet syndrome, the procedure was completed by a first rib resection. A control phlebography in forced abduction at two month follow up showed excellent permeability of the subclavian vein.

Adult↗
PubMed1993

[Efficacy of intravenous milrinone in the treatment of acute congestive cardiac failure. Results of a French multicenter study].

The hemodynamic effects and safety of milrinone, a phosphodiesterase inhibitor, were studied in 57 patients in the acute phase of cardiac failure. The drug was given intravenously as an initial push dose of 50 micrograms/kg in 10 min followed by a 24 hour infusion at the dose of 0.5 micrograms/kg/min. Maximal response was obtained after 15 min and persisted throughout the infusion. Cardiac index rose by 40%, while pulmonary capillary pressure fell from 25 mmHg to 17 mmHg (-30%) by the fifth minute of treatment. Mean pulmonary artery pressure fell by 20% by the 15th minute. Systemic resistance decreased by 26% and pulmonary vascular resistance by 22%. All these variations were significant. Heart rate and systemic blood pressure remained stable. Study of three sub-groups: digoxin vs non-digoxin, sinus rhythm vs atrial fibrillation, and coronary patients vs non-coronary patients, revealed no significant difference. Safety of the drug was good, no extra-cardiac actions having required interruption of the infusion. Stoppage was made necessary by two instances of ventricular tachycardia. Improved hemodynamic effects and the good safety/acceptability of the drug indicate that milrinone is a treatment of choice in cardiac failure.

Acute Disease↗