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Biomedical subjects

P Djiane

Publications and source records attributed to P Djiane.

At least 19 recordsLinked to original sources
PubMed1992

Simultaneous modelling of mexiletine and hydroxy-methyl-mexiletine data after single- and multiple-dose administration of a sustained-release mexiletine formulation.

The pharmacokinetics of mexiletine and its metabolite hydroxy-methyl-mexiletine have been investigated following single-dose and during multiple-dose administration of a sustained-release form of mexiletine to six post-myocardial infarct patients. Comparison of single-dose and washout pharmacokinetics, after short-term multiple-dose administration, showed significant (p < 0.005), but not systematic, modifications in mexiletine apparent clearance for three patients. Furthermore, for these patients, simulation with both sets of parameters indicated that the steady-state was achieved before washout experiment in two cases. The fraction of mexiletine metabolized to hydroxy-methyl-mexiletine was lower for multiple-dose administration (about 18 per cent) than for the single dose (about 42 per cent). The hydroxy-methyl-mexiletine elimination rate constant was about four times that of mexiletine. Mexiletine clearance could be accounted for by other metabolic pathways. In one patient, hydroxy-methyl-mexiletine was undetectable even during multiple-dose administration, despite a significant increase in mexiletine clearance. However, the observed changes in mexiletine disposition had no therapeutic implications and active plasma levels were achieved by the third day of administration and maintained in the therapeutic range (0.75 to 2 micrograms ml-1) in all patients after a twice daily dosage regimen.

Aged↗
PubMed1992

Evaluation of bepridil efficacy by electrophysiologic testing in patients with recurrent ventricular tachycardia: comparison of two regimens.

The purpose of the study was to evaluate this effect of different doses of intravenous and oral bepridil on the induction of ventricular tachycardia. Thirty-eight patients underwent electrophysiologic evaluation for recurrent ventricular tachycardia (VT). Sustained monomorphic VT was induced by programmed ventricular stimulation, using up to three extrastimuli in all patients. The effects of intravenous bepridil (2 mg/kg) were evaluated during the initial study. Intravenous bepridil prevented the induction of sustained VT in eight patients (21%). Electrophysiologic study was repeated after oral bepridil. In six patients the study was stopped because of adverse effects or VT recurrence. Thirty-two patients underwent repeat study 7 days later, taking oral bepridil, 500 mg/day (n = 16) or 900/day (n = 16). A dose of 500 mg/day of bepridil prevented the induction of sustained VT in only one patient. A dose of 900 mg/day of bepridil prevented the induction of sustained VT in eight patients. There were no significant clinical adverse effects, except in one patient receiving intravenous bepridil. The response to intravenous bepridil did not predict the response to oral bepridil. The response to intravenous or oral bepridil was not related to the plasma level of bepridil but was related to a higher left ventricular ejection fraction. Eight patients (21%) in whom VTs were noninducible on oral bepridil were discharged on 300 mg/day of bepridil if their initial loading dose was 500 mg/day or on 600 mg/day if their initial loading dose was 900 mg/day. They remained free of VT during a follow-up of at least 6 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1992

[Diastolic function of the left ventricle in aortic valve stenosis. Doppler echocardiography].

Doppler echocardiographic parameters of LV diastolic function (isovolumic relaxation time, E wave velocity, ratio of E/A wave velocities, mitral valve pressure half time) were compared to catheter data in 35 patients (average age 67 years) with pure or dominant aortic stenosis (mean gradient: 65 +/- 30 mmHg). The isovolumic relaxation time was prolonged in most patients (m = 103 +/- 23 ms) and seemed uninfluenced by any haemodynamic parameter. There was a positive correlation between pressure half time and ejection fraction (r = 0.41, p = 0.02) and a negative correlation with pulmonary capillary pressure (r = -0.61, p < 0.01). The E and E/A ratio were negatively correlated with the ejection fraction (r = -0.41 and -0.52) and positively correlated with pulmonary capillary pressure (r = 0.46 and 0.62). The Doppler parameters were independant of the patients' age, severity of stenosis and degree of left ventricular hypertrophy. Patients with normal pulmonary capillary pressure (< 15 mmHg, N = 19) had abnormal diastolic filling with low E wave velocities (71 +/- 28 cm/s) and E/A ratios (0.9 +/- 0.6) and prolonged half pressure times (96 +/- 37 ms). Conversely, patients with high pulmonary capillary pressures (> 15 mmHg, N = 16) had normal or high E wave velocities (107 +/- 31 cm/s) and E/A ratios (1.5 +/- 0.6) and normal or shortened isovolumic relaxation times (62 +/- 22 ms).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

[Value and limits of the tilt-test in the etiological diagnosis of transient malaise].

This study was undertaken to assess the usefulness of the head-up tilt test in the diagnosis of vasovagal syncope and to evaluate the indications of this investigation. The test consists in a 30 minute period in the horizontal decubitus position followed by a 60 degrees head-up tilt position for 30 minutes. In the 26 subjects in whom the diagnosis of repeated vasovagal syncope had been made on the basis of typical prodromic symptoms after exclusion of all other causes, the test induced a vasodepressive or vagal reaction in 10 cases (38%) 20 +/- 4 minutes after tilting. In 8 patients in whom the test was performed within 48 hours of their syncopal episode, a similar malaise was induced in 7 cases. Twenty patients with repeated malaise without loss of consciousness had no symptoms during the test which was also negative in 10 normal control subjects. In a group of 27 subjects with unexplained syncope after clinical and paraclinical investigations, the test was accompanied by a malaise on five occasions (19%). Using this protocol, the tilt test had good specificity but moderate sensitivity in the diagnosis of vasovagal syncope. Its sensitivity increased when performed within 48 hours of syncope. It is of no value in the diagnosis of recurrent malaise without loss of consciousness.

Blood Pressure↗
PubMed1991

[Late coronary reperfusion. A possible etiology of post-infarction angina].

Late recanalisation of the infarct Related Artery is possible and may cause post-infarction angina. This was observed in 7 male patients who had complete occlusions of an artery with collateral circulation in the immediate post-infarction period. After a symptom-free period of 17 months, angina recurred and repeat angiography showed recanalisation of the occluded artery with regression of the collateral circulation resulting in myocardial ischemia. Myocardial revascularisation was then required.

Adult↗
PubMed1991

[Study of early myocardial infarction by nuclear magnetic resonance imaging with gadolinium Dota injection].

Ten patients with acute myocardial infarction were studied by magnetic resonance imaging (MRI) with injection of a paramagnetic contrast agent: Gadolinium-DOTA (Gd-DOTA). The time interval between the onset of symptoms and MRI was 8 to 12 days. The site of infarction was determined in all cases by Thallium 201 scintigraphy (hypofixation) and selective ventriculography (segmental wall anomalies): anterior (6 cases), inferior (4 cases). MRI was performed with a 0.5 Tesla CGR Magniscan by the multiple spin technique. A series of tomographic sections was recorded immediately after intravenous injection of 0.4 mmol/Kg of Gd-DOTA. Recent myocardial infarction with parenchymal oedema gives an enhanced transmural signal: only 3 patients had a sufficiently contrasted image on the 1st spin echo. After Gd-DOTA, 7 patients had significantly increased contrast on this echo and in all excellent contrast between infarcted and healthy myocardium was obtained in 9 of the 10 patients. There was excellent correlation concerning the site of infarction between Thallium scintigraphy and left ventriculography. The intensity of signal and T2 relaxation time of different myocardial segments was studied by the regions of interest technique: the ratio of signal intensity of infarcted/healthy myocardium was 1.3 before and 1.7 after Gd-DOTA on first spin echo images. The mean T2 was 54.1 +/- 9 ms in healthy and 82 +/- 28 ms in infarcted myocardium. After Gd-DOTA, both values decreased and tended to equalize.(ABSTRACT TRUNCATED AT 250 WORDS)

Diastole↗
PubMed1991

[Comparative study of effects of diltiazem, nifedipine and their combination on exercise stable angina].

Diltiazem and Nifedipine could be synergic. The aim of this study was to investigate the benefits of their association. Eighteen patients, 15 men and 3 women, average age 61 +/- 6 years, with stable angina on effort, were studied. Eight patients had single vessel disease and 10 patients had multivessel disease. The patients underwent a randomised double-blind trial with 4 successive treatment periods each lasting one week: placebo; 360 mg/day of Diltiazem; 60 mg/day of Nifedipine; 180 mg/day of Diltiazem with 30 mg/day of Nifedipine. The benefits were evaluated clinically, by exercise stress testing and with drug plasma concentrations at the end of each sequence. The results at the end of the 3 treatment periods were significantly better than with placebo. Diltiazem was significantly better than Nifedipine with respect to the development of angina during exercise testing (1 patient compared with 7 patients) and to maximum load (118.3 +/- 33.3 watts compared with 105.9 +/- 35.4 watts) (p less than 0.05). The association of the two drugs did not give better results than Diltiazem alone. Compared with placebo, the total duration of exercise testing and the duration of 1 mm ST depression were significantly longer during the 3 treatment sequences but there were no significant differences between each of them. Secondary effects were significantly more common with Nifedipine (7 patients) and with the drug association (9 patients) than with Diltiazem alone (3 patients) or placebo (1 patient). Plasma concentrations of Diltiazem were 328 +/- 35 ng/l with the 360 mg/day dosage and 137 +/- 52 ng/l with the 180 mg/day dosage.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

[Value of magnetic resonance imaging in 2 cases of annular constriction of the ventricles].

Chronic pericarditis can take the form of localised annular bands constricting the atrioventricular grooves, the pulmonary infundibulum and, rarely, the atria. The authors report two cases of pericardial bands surrounding the ventricles and involving the atrioventricular groove resulting in a biloculation of the left ventricle. One case was complicated by adiastole and one by mitral regurgitation due to involvement of the posterior mitral leaflet. Magnetic resonance imaging gave precise definition of these bands and of their extension into the myocardium. This investigation was a valuable complement before surgery of the localised constriction.

Calcinosis↗
PubMed1990

Double thoracic drainage of a left inferior vena cava. Case report.

The authors report a case of left IVC with a preferential hemiazygos-azygos drainage associated with an accessory left superior intercostal vein drainage. This exceptional congenital malformation which finds its place in polysplenia was studied by cavography, CT and MR imaging.

Azygos Vein↗
PubMed1990

[Contribution of Doppler echocardiography to the evaluation and monitoring of normal and pathologic mitral valve prostheses].

Doppler echocardiographic examinations were performed in 146 patients with normal and 42 patients with pathological (31 regurgitations and 11 obstructions) mitral valve prostheses confirmed by catheterisation and/or surgery. The maximum and mean transprosthetic gradients and pressure half times (PHT) were calculated from continuous wave Doppler recordings and regurgitant signals were searched for by continuous and pulsed wave Doppler. In the group of normal mitral valve prostheses, the mean gradients and PHT were very variable even within the subgroups of the same type and size of prosthesis. The best haemodynamic profile was observed with the St Jude prosthesis (mean gradient = 5 +/- 2 mmHg, PHT = 90 +/- 22 ms, p less than 0.05 vs other prostheses). Minimal mitral regurgitation was detected in 12 per cent of bioprostheses and 20 per cent of mechanical prostheses. No correlations were found between the mean pressure gradient or PHT and the size of the prostheses. Regular Doppler echocardiographic follow-up over 2.4 years was obtained in 25 patients and showed a remarkable stability of the Doppler parameters in 17 patients whereas prosthetic valve dysfunction was diagnosed in the other 8 cases. In the group of pathological mitral valve prostheses, regurgitation (N = 31) was associated with a high early diastolic pressure gradient (20.2 +/- 8 mmHg) and a normal or shortened PHT (84 +/- 28 ms). Obstructed prostheses (N = 11) had high mean pressure gradients (17 +/- 5 mmHg) and increased PHT (195 +/- 53 ms). All cases of obstruction were correctly identified by the Doppler but 4 prosthetic valve regurgitations were missed or underestimated (4 mechanical prostheses).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

[Contribution of Doppler echocardiography in the evaluation of normal and pathologic aortic valve prosthesis].

Doppler echocardiography was performed in 112 patients with normal aortic valve prostheses and 13 patients with dysfunction (3 obstructions, 10 regurgitations) confirmed at catheterisation and/or surgery. The maximum and mean transprosthetic pressure gradients were measured in all patients by continuous wave Doppler. The prosthetic valve surface area was calculated by applying the continuity equation in the last 67 patients and compared with the effective surface area deduced from hemodynamic studies in the literature: --There was a great variability in the values of mean pressure gradient and prosthetic valve area within each group and with each size of prosthesis in patients with normal valves. No significant difference was observed between the gradients of different prostheses. However, for a given size, the St Jude Medical prosthesis had larger calculated surface areas than the other prostheses. The Doppler valve surface area did not differ significantly from the area measured invasively for the different categories of prostheses, and it increased with the size of the prosthesis. Mild aortic regurgitation was observed in 16 per cent of bioprostheses and 30 per cent of mechanical prostheses. The three cases of obstruction were characterised by a high mean pressure gradient (59 +/- 16 mmHg, p less than 0.01 vs normal prostheses) and a reduced Doppler surface area (0.7 +/- 0.2 cm2, p less than 0.005 vs normal prostheses) and were correctly diagnosed by Doppler echocardiography. Eight of the ten prosthetic regurgitations were correctly quantified by Doppler. Cardiac Doppler coupled with echocardiography is a very valuable method of non-invasive assessment of aortic valve prostheses.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

[Late potentials in patients with hypertension].

UNLABELLED: The presence of late potentials (LP) is considered as the evidence of an anatomical and electrophysiological condition which can give rise to life threatening ventricular arrhythmias. The aim of this work has been to study the incidence of LP in the setting of hypertension and to study their relation to ventricular hypertrophy on one hand and to ventricular arrhythmias on the other. Our study was conducted in 45 hypertensive patients (mean age +/- SD = 53 +/- 12). None of them had clinical evidences of a coronaropathy and only 5 had never been treated. For every patient we carried out a signal averaged electrocardiogram to detect LP, an echocardiogram to determine the myocardial mass index and 48 hours Holter monitoring to record ventricular arrhythmias filed according to the Lown classification. RESULTS: LP have been found in 13 patients. The following table summaries relations between LP, ventricular arrhythmias and myocardial hypertrophy: [table: see text] CONCLUSION: LP are frequently found in hypertensive patients (29%); their incidence is not higher in patients with left ventricular hypertrophy although they more frequently have serious ventricular arrhythmias; the severity of ventricular arrhythmias is not correlated with the presence of LP.

Adult↗
PubMed1989

[Detection of acute rejection by Doppler echocardiography in orthotopic cardiac transplantation. Prospective comparative study with endomyocardial biopsy].

In a prospective study of 23 patients who had undergone orthotopic heart transplantation we tried to assess the value of doppler-echocardiography in the detection of acute graft rejection. For this purpose, 220 echocardiographic records were compared with the results of endomyocardial biopsies performed at an interval of less than 12 hours. The parameters investigated by TM and two-dimensional echocardiography were: morphological parameters (including septal echodensity), left ventricular mass and systolic function parameters. Diastolic parameters (isovolumetric relaxation time [IVR], transmitral gradient half-decrease time [T 1/2] and proto-end-diastolic mitral velocity ratio [E/A] were measured by TM echocardiography and pulsed doppler velocimetry. The best doppler-echocardiographic criteria for graft rejection were a more than 15 ms reduction of IVR, a more than 15 p. 100 increase of myocardial mass, and a more than 30 p. 100 increase of teh E/A ratio, the corresponding sensitivities for histological rejection being 82, 76 and 74 p. 100 respectively. In contrast, T 1/2 and systolic function studies seemed to be disappointing. Finally, the increase of septal echodensity enabled rejection to be diagnosed with an excellent (92 p. 100) specificity but an insufficient sensitivity. Thus, none of the parameters measured were sensitive enough, taken separetely, to replace endomyocardial biopsy. However, the combined use of the most sensitive of them should make it possible to reduce the frequency of systematic biopsies.

Acute Disease↗
PubMed1986

[Infectious endocarditis, complication of mitral valve prolapse].

Among 77 patients with bacterial endocarditis on native valves explored by echocardiography, 12 (7 male, 5 female, mean age: 50 years) presented with mitral valve prolapse. This condition is relatively common, being found in 15.5% of patients with bacterial endocarditis and in 32% of those with mitral valve endocarditis. Two-dimensional TM echocardiography showed the mitral valve prolapse in every case and, in 11/12 cases, a vegetation associated with a varying degree of thickening of the valve due to myxoid degeneration. Although cardiac signs were sometimes minimal. Ten hemocultures were positive: 7 for streptococci, 2 for staphylococci and 1 for Hemophilus para-aphrophilus. Two patients died of cerebral haemorrhage, and there were 2 cases of hemiplegia, 4 cases of transient left ventricular failure and 2 cases of spleen embolism. These findings suggest that prophylactic treatment of bacterial endocarditis should be undertaken in patients with mitral valve prolapse and signs of myxoid degeneration at echocardiography.

Adult↗
PubMed1979

[Value of continous electrocardiography (Holter monitoring) in mitral valve prolapse].

Twenty three patients with mitral valve prolapse underwent ambulatory 20 to 24 hour electrocardiography to study the incidence and severity of ventricular arrhythmias. These arrhythmias were found in 20 cases (87 p. 100). Ventricular extrasystoles were usually grouped (14 cases) causing doublets in 8 cases and bursts of ventricular tachycardia in the 6 others. The importance of the information obtained by Holter monitoring should not detract from the value of the standard resting electrocardiogramme. In fact, there appears to be a good correlation between the severity of the ventricular arrhythmia and the presence of ST changes over the postero-inferior zones. These abnormalities were never present in patients without ventricular extrasystoles but on the other hand they were observed in 5 of the 6 patients with ventricular tachycardia. From a practical point of view this may represent a simple means of identifying patients at high risk of dangerous arrhythmias.

Adolescent↗
PubMed1979

[Painless ST elevation with syncope. Diagnosis by continuous electrocardiography].

The aetiology of syncope in a 53 year old man was discovered on continuous ambulatory electrocardiography. A ventricular arrhythmia associated with ST elevation was recorded. It proved resistant to medical therapy and a double aorto-coronary bypass graft was performed. Post-operative Holter monitoring showed surgery to have been effective.

Arrhythmias, Cardiac↗