PubMed Health⌕ Search

Biomedical subjects

M Desnos

Publications and source records attributed to M Desnos.

120 records · Page 7Linked to original sources
PubMed1987

[Dilated cardiomyopathy: electrocardiographic forms].

The shape of the QRS complex was analyzed in 90 cases of dilated cardiomyopathy and was divided into 6 electrocardiographic types which may be interpreted as follows: A predominant S wave in V2, V3 and V4 leads, surrounded by a reduced QRS voltage in the other leads was the most frequent characteristic pattern, being found in 31 cases (34.4%). This pattern coexisted with a lack of R wave progression from V1 to V4, with primary disorders of ST-T and with alterations in P wave. The deep S wave is probably due to a growth of vectors in the base of the left ventricle and in the septum in response to lesions in the rest of the myocardium. Second in frequency (22.2%) came left bundle branch block, with 20 cases. If to these are added the 19 cases of left anterior half-block observed, dilated cardiomyopathy appears as the major cause of the cardiac pathology that partially or completely interrupts the left branch. These cases also show that the lesions predominate in the left ventricle. The 14 cases (15.5%) of QS with elevated and convex ST-T betray extensive areas of fibrosis or necrosis. This pattern is characteristically located at the apex of the heart and associated with ventricular tachycardia. In 11 cases (12.2%) the QRS complex was normal in shape but associated with depressed ST-T and atrial disorders. This shows that the ventricular myocardium which produces QRS is neither badly damaged nor hypertrophic, but that repolarization is highly sensitive to the constant alterations of the subendocardial layers observed in dilated cardiomyopathy. Left ventricular hypertrophy was seen in 9 cases (10%).(ABSTRACT TRUNCATED AT 250 WORDS)

Arrhythmias, Cardiac↗
PubMed1986

Antithrombin III Alger: a new homozygous AT III variant.

A qualitative abnormality of antithrombin III (AT III) was found in the plasma of a 41-year old patient. The plasmatic AT III antigen concentration was 130% and the progressive anti-F IIa and anti-F Xa activities were normal (105% and 137%). The plasma heparin cofactor activity was less than 10%, when measured by F IIa or F Xa inhibition. Crossed immunoelectrophoresis of AT III in the presence of heparin revealed in the plasma an abnormal slow-moving peak. When tested by affinity chromatography on heparin Sepharose, this abnormal AT III did not bind to heparin. Among the investigated relatives, 5 subjects had normal AT III levels, whatever the test used, the nine others having reduced levels of antithrombin heparin cofactor activity (45-61%) but normal levels of immunoreactive AT III (97-122%). Consanguinity was found in the family history. We therefore considered our patient as homozygous for an AT III molecular abnormality affecting the binding site for heparin.

Adult↗
PubMed1986

[Phono-mechanographic evaluation of aortic stenoses. Contribution of the B1-maximum murmur/B1-B2 index].

The diagnostic value of phonomechanography in valvular aortic stenosis was reassessed with a rarely used index, the ratio S1-maximum intensity of the systolic murmur/S1-S2, or Thiron's index, the author of which only studied the correlations with the aortic transvalvular pressure gradient. The results obtained by the author being considered inconclusive, we decided to examine its correlations with aortic valve surface area calculated with the Gorlin's formula. The study was carried out in 38 patients with pure aortic stenosis, in whom 4 phonomechanographic parameters, the corrected left ventricular ejection time (Meiners), the carotid pulse half peak time, the S1-maximum intensity of the murmur interval and Thiron's index, were compared with the transvalvular pressure gradient and the aortic valve surface area at catheterisation. The first two parameters mentioned above were of limited value (correlations with aortic valve surface area r = 0.315, p less than 0.05 and r = 0.477, p less than 0.01 respectively). On the other hand, a good correlation was obtained with Thiron's index (r = 0.624, p less than 0.001) which was better than that found with the interval between S1 and maximum intensity of the systolic murmur (r = 0.483, p less than 0.001) in a population not excluding subjects with cardiac failure. These results indicate that: when Thiron's index less than or equal to 0.45, the aortic stenosis is probably mild (aortic surface area greater than 0.8 cm2), when Thiron's index is 0.46 greater than 0.56, the aortic stenosis is likely to be moderately severe (aortic surface area 0.8 less than 0.5 cm2), when Thiron's index is greater than 0.57, the aortic stenosis is probably severe (aortic surface area less than 0.5 cm2). In our series, Thiron's index was the best phonomechanographic parameter for the assessment of pure aortic stenosis. It could not be calculated in 10 out of 48 patients; this drawback was not encountered with the corrected left ventricular ejection time or the carotid pulse half peak time.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

[Outcome of hypertrophic and obstructive myocardiopathies treated with high doses of propranolol].

Twenty-five patients with hypertrophic obstructive cardiomyopathy confirmed by clinical, echocardiographic and haemodynamic investigations were treated with high dose propranolol (320 to 800 mg/day, average 420 mg/day) and assessed after an average follow-up period of 25 months. The effects of treatment were assessed by interrogation in all patients and by exercise testing before and after propranolol in 19 cases. Comparative echocardiographic (21 patients) Holter (20 patients) and catheter studies (14 patients) were also performed. The cardiovascular mortality rate during the study period was nil. All patients were symptomatic before treatment; 9 became asymptomatic and 13 patients were improved, the average functional score decreasing from 5.16 +/- 2.15 to 2.28 +/- 1.49 (p less than 0.001). The persistence of severe symptoms led to withdrawal of the beta-blocker in 2 cases. There was a parallel improvement in maximal work capacity during exercise stress testing (96 +/- 27 watts vs 117 +/- 30 watts, p less than 0.01). A resting intraventricular pressure gradient was recorded in 12 of the 14 patients undergoing repeat catheter study which decreased after propranolol from an average of 66.75 +/- 32.72 mmHg to 42.75 +/- 37.6 mmHg (p less than 0.05). Left ventricular end diastolic pressures remained unchanged. The change in pressure gradient did not correlate with the symptomatology and there were no associated echocardiographic changes. The Holter monitoring did not show any improvement of ventricular hyperexcitability under propranolol: the number of patients with complex ventricular arrhythmias remained unchanged (7 patients).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

[Myocardial infarction in the young subject: a medium-term clinical and coronary angiographic study in 40 patients under 36 years of age. Comparison with coronary angiographic data of myocardial infarction in patients after 50 years of age].

A series of 40 myocardial infarctions, occurring in patients under 36 years of age was studied retrospectively (Group I: mean age 31.3 years). The medium term results of coronary angiography in this group were compared with those of 60 myocardial infarctions after 50 years of age (Group II: mean age 56.6 years). Group I had a clear male predominance (92.5%), a high incidence of smoking (69%), hypercholesterolaemia (69%); myocardial infarction was the first manifestation of their disease in 54% and it was often extensive (42%). A comparative angiographic study between the two groups showed: 1) Less widespread lesions in Group I, as assessed by the number of main arteries stenosed (p less than 0.001), the coronary index (p less than 0.01) and the mean coronary score using Friesinger's method (p less than 0.01). 2) A higher incidence of subnormal coronary angiogrammes in Group I (absence of 50% stenosis) (15%) and of single vessel disease (40%): compared with Group II in which multivessel disease was observed in 86.5% of cases. 3) Collateral circulation was less common in Group I (p less than 0.01). On the other hand, a comparative study of regional and global left ventricular function showed no difference between the two groups. Two subgroups were distinguished in Group I: in one subgroup, multiple lesions similar to those found in Group II, suggestive of premature coronary atherosclerosis (52.5%); the other group (47.5%) presented unilocular lesions i.e. focal mono-arterial lesions compatible with other causes of infarction (thrombosis and/or spasm). These patients were younger (p less than 0.05) and had significantly fewer cardiovascular risk factors (p less than 0.01). Despite the fact that the coronary lesions were limited, the myocardial damage was comparable with the other groups as the collateral circulation was much less developed (p less than 0.02). These appearances were only observed in 3.5% of patients in Group II. The study of the angiographic outcomes of these two types of lesions should show a difference and could contribute to the understanding of their mechanisms.

Adult↗
PubMed1983

[Ventricular arrhythmias in obstructive hypertrophic cardiomyopathy. Continuous electrocardiographic study].

Ventricular arrhythmias are thought to be responsible for the high incidence of sudden death among patients with hypertrophic obstructive cardiomyopathy (HOC). 24-h ECG recording was applied to 27 HOC patients before any treatment and repeated under beta-blockade with propranolol in doses not lower than 320 mg/day (mean dose : 354 mg/day). ECG tracings showed that 26/27 patients (96%) had ventricular arrhythmia; the arrhythmia was repetitive in 15 patients (55%), 3 of whom (11%) had bouts of ventricular tachycardia. These figures are very different from those found in normal subjects, i.e. : 40-50% ventricular arrhythmia and less than 5% repetitive arrhythmia. The most severe forms of ventricular arrhythmia (categories IVA and IVB in the Ryan, Lown and Horn classification) were exclusively seen in patients who had one or several syncopes. Statistically, the only positive correlations of arrhythmias were with age and left ventricular end-diastolic pressure on the one hand, and age and left ventricular systolic pressure gradient on the other hand. Propranolol had no effect on arrhythmia, which seems to contradict studies suggesting that high doses of propranolol play a substantial role in the prevention of sudden death among patients with HOC. Beta-blockers might act by preventing the transformation of arrhythmia into ventricular fibrillation.

Adult↗
PubMed1983

[Indication for and the future of valvular bioprosthesis].

Two fundamental characteristics distinguish bioprostheses from mechanical prostheses: disadvantage: reoperation inevitable after a variable delay; advantage: the problems of anticoagulation are avoided in the majority of cases and, above all, thromboembolic complications are reduced, thus improving the quality of life even if anticoagulation proves necessary. Before weighing up these considerations and making the difficult choice of the best prosthesis, two factors must be taken into account: the advances in cardiac surgery have enabled surgical therapy to be considered even in asymptomatic patients with the object of ensuring longer and better quality life; the concept of reoperation is still too often synonymous with surgical failure whilst thromboembolic complications are referred to fatality. To delay reoperation is to significantly increase the risks, so falsifying the statistical mortality rate and making it impossible to answer the fundamental question: "does the use of bioprostheses prolong life expectancy compared to mechanical prosthesis?".

Adult↗
PubMed1981

[Haemorrhagic necrosis of the digestive tract consecutive to massive digitalis intoxication (author's transl)].

A 60-year-old man under digitalis treatment for hypertensive heart tried to commit suicide by absorbing a 15 mg dose of digitoxin. Severe intestinal bleeding occurred 12 hours later, followed by pseudo-occlusive syndrome and ischaemia of the distal lower limbs. On abdominal incision the whole gut was found to be invaded by haemorrhagic necrosis and perforated on three points. The patients subsequently died of peritonitis. The responsibility of digitoxin in these events was demonstrated by the absence of any other cause of ischaemia, such as heart failure, shock, arrhythmia, consumption coagulopathy or use of sympathomimetic drugs. This case shows that the vasoconstrictor effect of digitalis, experimentally demonstrated but clinically controversial, is a reality, and that digitalis compounds are contra-indicated in patients with haemorrhagic necrosis of the digestive tract.

Digitalis Glycosides↗
PubMed1980

[Valvular insufficiency in Lobstein's disease. A review of the literature apropos of a patient operated on for aortic insufficiency].

Lobstein's disease, a hereditary disorder of connective tissue, may rarely be accompanied by aortic or mitral regurgitation due to valvular dystrophy. The case reported is that of a patient with severe aortic incompetence with dilatation of the ascending aorta, complicated by angina pectoris and left ventricular failure; the patient also had Lobstein's disease with numerous spontaneous fractures, transverse lines of ossification, blue sclera skeletal deformities, and a positive family history of blue sclera. At surgery, valvular dystrophy was confirmed and corrected by aortic valve replacement. The patient's brother died recently with the same pathological association of Lobstein's disease and aortic incompetence. 28 cases of valvular disease and Lobstein's disease have been reported 12 with pathological evidence (at operation) on the purely dystrophic origin of the valvular regurgitation, and 2 with histological diagnoses alone in two newly born children. Aortic incompetence with dilatation of the ascending aorta is commoner than mitral incompetence. The macroscopical and histological appearances are similar to Marfan's syndrome and account for the operative risk of valvular replacement and for the incidence of postoperative haemorrhage. The rarity of valvular dysfunction in Lobstein disease contrasts with its relatively common occurrence in Marfan's syndrome.

Adult↗
PubMedDate not supplied

[Myocardiopathy and Takayasu's disease. Apropos of a case].

The possibility of cardiac involvement in Takayasu's disease is well known, but this involvement generally appears to be secondary to reno-vascular hypertension or to pulmonary arteritis and, exceptionally, as a result of coronary disease. In the case reported here, the inflammatory myocardial lesion localised to the left ventricle was demonstrated while the patient was still alive. It was responsible for an episode of severe heart failure which finally resolved after 2 years. The inflammatory involvement of the myocardium was associated with laboratory signs of inflammation and with inflammatory arterial lesions. Several haemodynamic investigations were performed to follow the course of the disease. The diagnosis was confirmed by myocardial biopsies and by the pulmonary arterial and renal arterial involvement. A review of the literature revealed that this condition was extremely rare and has only been proven in a few autopsy cases.

Adolescent↗