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Biomedical subjects

P Atlas

Publications and source records attributed to P Atlas.

18 recordsLinked to original sources
PubMed1995

Comparative effects of atenolol and clonidine on polygraphically recorded sleep in hypertensive men: a randomized, double-blind, crossover study.

The effects on sleep of atenolol and clonidine were compared in 8 hypertensive men (mean age 46.9 years, range 16-56 years) without prior history of sleep disturbances. Polygraphic sleep recordings were performed at baseline (NO) and after a single oral dose of atenolol (100 mg) or clonidine (0.15 mg) at 6:00 pm at a 48-hour interval in a double-blind randomized crossover protocol. Both medications lowered arterial pressure to a similar extent. The subjective quality of sleep was judged satisfactory after both medications, the number of patients reporting dreams decreased from 5 (NO) to 1 after each treatment night. Total sleep time decreased slightly but not significantly after atenolol (440 +/- 63 min vs 474 +/- 47 min at baseline). Sleep latency was not affected after atenolol but significantly decreased after clonidine (16.9 +/- 21.6 vs 28.6 +/- 16.6 at baseline, p < 0.02). Although rapid-eye movement (REM) sleep time decreased after atenolol (71 +/- 30 min vs 95 +/- 30 min at baseline, p < 0.05), the percentage of REM sleep was unchanged (22 +/- 7% vs 23 +/- 5%). In contrast, clonidine strikingly reduced both REM sleep time (54 +/- 28 min vs 95 +/- 30 min at baseline, p < 0.002) and percentage of REM sleep (14 +/- 6% vs 23 +/- 5%, p < 0.0005). Thus atenolol tends to decrease total sleep time but does not affect the normal architecture of sleep, clonidine has a marked hypnotic effect, similar to that of some sedative medications and significantly reduces REM sleep.

Adolescent↗
PubMed1986

[Value of mazindol in Gélineau's disease. Apropos of 10 cases].

Ten narcoleptic patients were treated daily with Mazindol 2-6 mg for 42.2 months (31-63 months). The response was excellent on narcoleptic attacks in 6 and on cataplexy in 7 cases. However, the nocturnal sleep disturbance persisted unchanged. The improvement was poor in 1 case and inexistant in 1 subject. Minor side effects (dry mouth) occurred in 3 cases, and urinary retention obliged to stop the medication in 2 cases.

Adolescent↗
PubMed1980

Exercise tests in patients with severe angina pectoris: an angiographic correlation.

Graded submaximal ergometric tests were peformed on 60 patients who suffered from clinically severe angina pectoris, and the results were correlated with their coronary angiograms. The test was positive in 44, negative in 9, and undetermined in 7 patients (defined as failure to reach the target heart rate without ischemic ST changes). Among patients with positive tests, 42 (95%) had obstruction of one to three coronary vessels. Among patients with negative tests, only 3 had significant coronary disease (sensitivity 93%). While all patients suffered clinically from severe "angina pectoris," 8 (15%) had insignificant CAD, and among them 6 had a negative and 2 a false-positive exercise response (specificity 75%). Although ST depression was a good indicator of CAD, its degree did not parallel the severity of the lesions. The peak heart rate on exercise of patients with ischemic ST changes was lower than their target heart rate, suggesting that the heart rate at which ST changes occur constitutes in itself a good indicator of severity. Among the 7 patients with undetermined tests, CAD was found in 6. In these patients the absence of ST changes may be ascribed to extensive myocardial fibrosis, and the only clue to CAD resides in the negative chronotropic response to exercise. Although exercise testing does not always distinguish between normal and CAD patients, it nevertheless constitutes a valuable noninvasive technique for the detection of the high-risk patients.

Adult↗
PubMed1977

"Coronary" T waves in the presence of complete left bundle-branch block: a normal variant?

The case report of a patient with an ECG pattern of intermittent left bundle-branch block, presenting inverted and symmetric ("coronary") T waves in leads V1 to V3 during periods of normal intraventricular conduction, is presented. The patient was followed up for eight years during which time no relevant symptoms appeared while extensive noninvasive investigations repeatedly failed to reveal any organic basis for the ECG changes. It is stressed that inverted, symmetric T waves in right-sided chest leads may be encountered in young, otherwise healthy subjects with intermittent left bundle-branch block during periods of normal intraventricular conduction. Knowledge of this fact is important in order to avoid iatrogenic cardiac invalidism in such cases.

Adult↗
PubMed1976

Chordal rupture: a common complication of myxomatous degeneration of the mitral valve.

In two patients with a clinical picture of acute mitral insufficiency, the presence of chordal rupture secondary to myxomatous degeneration of the mitral valve was disclosed during surgery. There was no evidence of previous rheumatic valvulitis, subacute bacterial endocarditis or other etiologies. It appears from the literature and from the cases described that ruptured chorda tendinea is a not uncommon complication of myxomatous transformation of the mitral valve. While this fact has been mentioned in anatomophological reports, clinicians are less aware of the association. In the absence of supportive evidence for a rheumatic or arteriosclerotic etiology, a clinical picture of acute mitral insufficiency should suggest ruptured chorda tendinea secondary to myxomatous degeneration of the mitral apparatus. This is particularly true in older patients, especially among those followed for a midsystolic click-late systolic murmur or an apical pansystolic murmur of pure mitral regurgitation.

Aged↗
PubMed1976

Left ventricular aneurysmectomy for refractory tachyarrhythmias: report in 11 postinfarction patients.

Between January 1970 and August 1974, eleven postinfarction patients underwent left ventricular aneurysmectomy for refractory tachyarrhythmias. Ten suffered from ventricular tachycardias and one from supraventricular tachycardia. All had localized aneurysms and normal contractions of the surrounding myocardium on angiocardiography. None suffered from significant angina, congestive heart failure or papillary muscle dysfunction. The diagnosis was first suspected at fluoroscopy, the latter being in our opinion a most reliable screening method for the recognition of these cases. There was one hospital death after surgery. The remaining ten patients are now free from further arrhythmic attacks for a follow-up period between fourteen months to five and a half years. These results confirm that in some carefully selected postinfarction patients, left ventricular aneurysmectomy without concomittant aortocoronary bypass may result in the elimination of medically intractable tachyarrhythmias.

Aged↗
PubMed1975

Telangiectatic fistula between the conal branch of the left coronary artery and the pulmonary trunk.

A rare case of telangiectatic communication between the conal branch of the left coronary artery and the pulmonary trunk in a 50-year-old woman is reported. Unusual features included the presence of clear-cut angina on effort, unstable auscultatory findings and a RSR' pattern in lead V1, probably related to concommitant diffuse coronary atherosclerosis. Ten previously reported cases of the condition are briefly reviewed.

Angina Pectoris↗
PubMed1975

Nonrheumatic mitral incompetence.

This review clearly indicates that a clinical picture of pure, isolated mitral insufficiency constitutes an interesting diagnostic challenge. In adult patients especially, this common valvular lesion is often nonrheumatic and may be found in a variety of cardiac conditions. The following provides a general orientation for their differential diagnosis. The first clue to the presence of papillary muscle dysfunction, a "spontaneous" chordal rupture, or a congenital or traumatic lesion which may account for the mitral insufficiency, may be derived from the patient's case history. A history suggesting systemic manifestations raises the possibility of atrial myxoma. When a familial incidence is reported, various syndromes or a cardiomyopathy should be considered as the etiology of the mitral incompetence. The auscultatory findings are typical in the mid-late systolic click and murmur syndrome, but recognition of this condition may require careful examination of the patient in different postures. The possibility of obstructive cardiomyopathy may be confirmed by the characteristic carotid pressure tracing. ECG findings of acute or chronic coronary heart disease favor the possibility of papillary muscle dysfunction. In addition, the ECG may support the clinical impression of a cardiomyopathy. Fluoroscopy may show calcification of the coronary arteries and/or dyskinetic left ventricular contractions in papillary muscle dysfunction, intracardiac calcifications in atrial space-occupying lesions, or calcification of a mitral annulus. Chest X-rays may contribute to the diagnosis of acute mitral insufficiency by showing a relatively small left atrium and ventricle in the presence of severe congestive failure. While echocardiography is invaluable as a noninvasive procedure and readily demonstrates the presence of a flail mitral leaflet from chordal rupture, or aids in the recognition of obstructive cardiomyopathy, an atrial space-occupying lesion, or of a billowing mitral leaflet, left ventriculography and coronary angiography constitute the procedure of choice for the fine anatomic diagnosis and functional evaluation of most cases. The accurate diagnosis of the anatomic disruption of the mitral valvular apparatus, as well as of the state of the myocardium and of the coronary arteries, is of particular importance in symptomatic patients, in order to determine the prognosis and to plan the surgical approach.

Calcinosis↗
PubMed1974

Multiple anomalous venous systemic connections in a case of atrial septal defect associated with right aortic arch and spine defromities.

Multiple anomalies of persistent left superior vena cava and left hepatic vein emptying into the left atrium associated with atrial septal defect, right aortic arch and multiple skeletal malformations are presented. The anatomy and the embryology of these anomalous venous connections are briefly reviewed. Clinical, hemodynamic and surgical implications of these anomalies are discussed.

Abnormalities, Multiple↗
PubMedDate not supplied

False aneurysm of the left atrium after closed mitral commissurotomy: diagnosis by cineangiocardiogrpahy. Report of one case treated surgically.

A case of false aneurysm of the left atrium after closed mitral commissurotomy which was demonstrated by cineangiography is here reported. It is believed that the false aneurysm resulted from a tear of the left appendage which accidentally occurred during the surgical procedure. The diagnosis was suspected in plain chest X-ray and fluoroscopy. Angiography demonstrated the presence of a false aneurysm of the left atrium which was confirmed at surgery.

Angiocardiography↗