Biomedical subjects

P Bonet

Publications and source records attributed to P Bonet.

3 recordsLinked to original sources

PubMed1998

Recurrent brief depression successfully treated with lithium.

BACKGROUND: The diagnostic criteria for RBD requires the presence of at least five out of nine depressive symptoms analogous to the symptoms of major depression, yet a duration of less than two weeks, a recurrence of at least 12 times a year, and the evidence of impairment in occupational or other important areas of functioning. The lack of a successful treatment represents one of the main challenges of this disorder. The therapeutic value of lithium in RBD has been suggested by Montgomery, but the specific efficacy of this agent has not been tested yet in the case of patients with recurrent brief depressive disorder. METHODS: We report on a 38-year-old man who presented a 10-month history of sudden depressive episodes, with monthly recurrences lasting 2-4 days, prior to our first assessment. RESULTS: The patient was treated with clomipramine, with complete remission of the depressive episode after three days. Nevertheless, in spite of maintaining the treatment, he presented a new episode one month later and two episodes the month after. Since then, lithium therapy was added and during the last 13 months he has remained euthymic, without any recurrence of depressive symptoms. Lithium treatment has been maintained and clomipramine treatment was gradually tapered because of the complaints of impotence, dry mouth, and dizziness. CONCLUSIONS: The absence of recurrences since lithium treatment was started (during the last 13 months, and especially during the last 10 months, where lithium has been the only treatment), suggests a prophylactic effect of this agent on RBD. Lithium's mechanism of action in preventing depressive recurrences might play a major role in the therapeutic approach of RBD, especially since recurrence (but not the duration of the symptoms) is the main feature that defines the severity of this disorder.

Acute Disease↗

PubMed1985

[Bepridil in the treatment of supraventricular paroxysmal tachycardias].

Previous studies have demonstrated the efficacy of bepridil, a new calcium antagonist, in the treatment of ventricular extrasystoles and tachycardia. The electrophysiological properties of bepridil especially the lengthening of the atrial effective refractory period, would also suggest an antiarrhythmic effect at the supraventricular level. This effect was studied on 33 episodes of paroxysmal supraventricular tachycardia (SVT) occurring in 23 patients (6 men and 17 women, mean age 58.1 years; range 18 to 88 years). Bepridil was given intravenously over 5 minutes at a dose of 3 mg/kg. The duration of SVT before administration was less than 1 hour in 10 cases, between 1 and 2 hours in 8 cases and over 2 hours in 15 cases. Sinus rhythm was successfully restored in 25 cases: within 1 to 5 minutes in 19 cases, 6 to 10 minutes in 3 cases and 11 to 30 minutes in 3 cases. In 24 of the 25 cases sinus rhythm was restored without a prolonged pause (over 2 sec) after the termination of SVT; in 3 cases intermediary atrial fibrillation lasting 1, 3 and 9 minutes was observed. There were no side-effects in 26 cases; transient flushing was noted in 5 cases and vagal symptoms in 2 cases. Haemodynamic tolerance judged by blood pressure measurements excellent in all cases. The correlations between plasma concentrations of bepridil and success or failure were poor. In conclusion, bepridil is a valuable alternative to adenosine triphosphate which may induce an exaggerated vagal response and to verapamil whose negative inotropic effects may sometimes be a serious disadvantage in the reduction of paroxysmal SVT.

Adult↗

PubMed1984

[Course of ventricular arrhythmias following myocardial infarction. Results of a 2-year follow-up].

The incidence, evolution and prognostic significance of ventricular arrhythmias after myocardial infarctions were studied over a 2 year period in 144 patients (108 men, 36 women: mean age 64 +/- 2 years) by Holter monitoring on the 20th day, 6th month (104 recordings), 12th month (94 recordings), 18th month (76 recordings) and 24th month (82 recordings). A total of 500 recordings was obtained, 471 of which were of good enough quality to be interpreted. On the 20th day, the prevalence of ventricular arrhythmias was independent of the site of myocardial infarction: they were classified as follows (Lown and Wolff grading): no ventricular arrhythmias (34 patients); moderate (Grade I) arrhythmias (73 patients, 50%); severe ventricular arrhythmias (Grades 2, 3, 4, 5) (37 patients, 26%). Fourty-seven patients underwent all 5 Holter recordings, the evolution of the arrhythmias could therefore be followed in detail. Despite considerable individual variation, the overall evolution indicated a clear aggravation at 6 months compared to the recording taken on the 20th day. At the 12th month, there was a higher incidence of arrhythmias but they were of a lower grade in 72% of cases: there was a steady improvement thereafter until the 24th month with the incidences falling to those observed on the 20th day. At the end of 2 years, there were 102 survivors; 41 patients died, and one was lost to follow-up. Over half the deaths (23 cases) occurred during the first 6 months, 4 during the second, 7 during the third and 7 during the fourth 6 months. The cause of death was cardiac in 21 cases, was of other causes in 4 cases and was unknown in 16 cases. The correlation between the death rate and results of Holter monitoring on the 20th day showed: only 4 of the 41 deaths had no recorded ventricular arrhythmia, there was a moderate or severe ventricular arrhythmia in 37 cases; in these patients, the cause of death (cardiac or other) was not related to the degree of arrhythmia. These results confirm previously reported preliminary studies indicating the value of Holter monitoring on the 20th day of myocardial infarction for assessing the 2 year prognosis. Death occurred in I ou of 10 Patients without ventricular arrhythmias, in 1 out of 4 patients with a moderate ventricular arrhythmia, and in 1 out of 2 patients with severe arrhythmias (p less than 0.001). The evolution was characterised by a "critical period", the first year, during which most deaths and aggravation of ventricular arrhythmias (in survivors) were observed; during the second year, there was a progressive improvement.(ABSTRACT TRUNCATED AT 400 WORDS)

Arrhythmias, Cardiac↗