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Biomedical subjects

P Moleur

Publications and source records attributed to P Moleur.

18 recordsLinked to original sources
PubMed1996

[Right-to-left interatrial shunt with normal pulmonary pressures after pneumonectomy. Apropos of a case with severe cyanosis following left pneumonectomy].

Atrial septal defects usually give rise to left-to right in the absence of obstruction of the pulmonary outflow tract or pulmonary hypertension. The authors report a case of atrial septal defect with a right-to-left shunt despite normal pulmonary pressures at catheterisation in a 56 year-old-man who had undergone left pneumonectomy 6 months previously. The shunt was responsible for major arterial desaturation aggravated by the left lateral or dorsal decubitus position. Surgical closure of the defect resulted in cure with disappearance of cyanosis and normalisation of blood gases. The physiopathological mechanisms of these right-to-left shunts with normal pulmonary pressures are discussed with reference to previously reported cases in the literature.

Blood Gas Analysis↗
PubMed1995

A randomized comparison of the effect of four antihypertensive monotherapies on the subjective quality of life in previously untreated asymptomatic patients: field trial in general practice. The OCAPI Study Group. Optimiser le Choix d'un Anti-hypertenseur de Première Intention.

OBJECTIVE: To assess the equivalence of four antihypertensive treatments in patients with mild-to- moderate hypertension, and to compare the effects of those drugs on the subjective quality of life and clinical safety. DESIGN, SETTING AND PATIENTS: 653 patients aged > or = 18 years with untreated hypertension were randomly allocated to receive a combination of two diuretics (altizide and spironolactone), a beta-blocker (bisoprolol), a calcium antagonist (verapamil), or an angiotensin converting enzyme (ACE) inhibitor (enalapril). Follow-up lasted for 1 year. MAIN OUTCOME MEASURES: A composite outcome of the following measures was used to define success: attendance at the 12-month visit; at least nine supine DBP measurements during the study; and median supine DBP < 90 mmHg and a reduction of at least 10 mmHg compared with the baseline value. Failure was defined as one or more of those criteria not being fulfilled. Equivalence was concluded if the 95% confidence interval for the success rates differed between two groups by less than +/- 10%. Clinical safety and subjective quality of life were also assessed. RESULTS: No statistically significant differences in the change in DBP or systolic blood pressure were observed between the groups. The success rates were 43.9, 42.0, 32.5 and 43.9% in diuretic, beta-blocker, calcium antagonist and ACE inhibitor groups, respectively. Equivalence between the treatments could not be concluded, although analysis with a larger equivalence interval showed that some comparisons indicated equivalence. Significant improvement in satisfaction was observed for certain items for subjective quality of life at 1 month in the calcium antagonist treatment group, and significant differences in the responses to the clinical safety questionnaire were observed after 1-month follow-up in calcium antagonist and beta-blocker groups. Differences were no longer significant after 9 months. CONCLUSIONS: These results do not provide evidence on the basis of efficacy of blood pressure lowering or ability to increase short-term (1-year) safety and quality of life favouring any particular treatment among the studied drugs for newly diagnosed patients with mild-to-moderate hypertension.

Adolescent↗
PubMed1992

Surrogate endpoints: a basis for a rational approach.

In clinical trials, the clinical endpoint is often replaced by an intermediate endpoint, known in some instances as a "surrogate" endpoint. The reasons for the substitution are often both practical and financial. At present, no theoretical basis or practical guidelines exist to help in the choice of surrogate endpoints. An approach is proposed here, based on three provisos which can be verified using one of a series of equations, if sufficient data on the pathophysiology and epidemiology of the disease are available. It is shown that even a strong statistical correlation is not a sufficient criterion for the definition of a surrogate endpoint. It is apparent that results obtained with the commonly used "surrogate" endpoints should be cautiously considered, and that the assessment of treatments should, when possible, be based on clinical rather than intermediate endpoints.

Clinical Trials as Topic↗
PubMed1988

A comparative evaluation of the effects of propafenone and lidocaine on early ventricular arrhythmias after acute myocardial infarction.

A double-blind, placebo-controlled trial comparing the antiarrhythmic effects of lidocaine (given intravenously as a bolus injection of 100 mg followed by an infusion of 2 mg min-1) and propafenone (given as a bolus of 105 mg followed by 300 mg orally every 8 h) was conducted in the first 24 h following acute myocardial infarction. Analysis of ventricular arrhythmias was carried out by Holter recordings. The three treatment groups, propafenone (36 patients), lidocaine (28 patients), and placebo (25 patients), did not differ with respect to age, gender, prevalence of previous infarction, delay from the onset of pain to hospitalization, clinical features on entry (the patients with heart failure or malignant arrhythmias were excluded), site of acute myocardial infarction, or CPK peak. A decrease in the number of ventricular premature beats was noted with lidocaine, but was not statistically significant. The analysis of the first 8 h showed trends suggesting that only lidocaine could suppress complex arrhythmias, couplets and ventricular tachycardia. The drugs were well tolerated. Mean plasma concentrations of propafenone and lidocaine were 517 +/- 464 ng ml-1 and 3.84 +/- 1.10 mg l-1, respectively. In conclusion, this study does not favour the use of propafenone as an alternative to lidocaine therapy during the acute phase of myocardial infarction.

Anti-Arrhythmia Agents↗
PubMed1988

Bopindolol in the treatment of moderate hypertension: a dose-response study.

To determine the optimal antihypertensive dose of bopindolol, we performed a randomized double-blind study in parallel groups. After 15 days of placebo single-blind, 115 hypertensive patients received daily for 28 days one of 4 doses: 0 mg (placebo), 0.5 mg, 1.0 mg, 2.0 mg. The reduction of supine diastolic blood pressure (BP) did not exhibit the pattern of a dose-effect relationship. The effect of 0.5 mg belonged to the plateau of the dose-effect curve (P = 0.1, analysis of variance). The reduction of heart rate (HR) followed a typical dose-effect curve, with a plateau beginning with 1 mg (P = 0.02). A trend toward an increase in the incidence of side-effects with dosage was observed (P = 0.3). Thus, the optimal antihypertensive dose may be 0.5 mg or less. Previous studies not using parallel randomized groups suggested an antihypertensive dose ranging from 2 to 4 mg. This study confirms that the dose-effect curves of beta blockers on HR and BP are dissociated. The dose-effect curve of HR seems unsuitable for assessing the optimal antihypertensive dose of a beta blocker.

Adrenergic beta-Antagonists↗
PubMed1988

[Anticoagulants in the treatment of severe pulmonary embolism. A prospective study].

This prospective study was designed to obtain information on the fate of patients with severe pulmonary embolism who received anticoagulants as first-line treatment, in order to identify those in whom other treatments available might be expected to reduce mortality or sequelae. Thirty-seven patients selected as they showed evidence of acute cor pulmonale entered the study. Seven of them (18.9 p. 100) died in hospital, and these were patients whose age (p = 0.004), degree of pulmonary obstruction (p = 0.008) and serum lactate dehydrogenase level (p = 0.001) were significantly higher than those of the other patients. The mean values of these parameters (64 years, 72 p. 100 and 450 IU/l respectively) made it possible to select patients with a high risk of death. At the end of the follow-up period (25 +/- 12 months) only 2 patients complained of moderate dyspnoea, in contrast with the high incidence (17/18 patients) of paraclinical abnormalities observed 3 months after the initial accident. We conclude that clinical trials comparing other treatments with the one we used would be useful if their objective was to reduce mortality in high risk patients. On the other hand, it seems impossible to demonstrate a functional improvement: we found our treatment satisfactory and its results independent of the abnormalities observed on the 3rd month.

Adolescent↗
PubMed1986

Electrophysiologic effects of cibenzoline in humans related to dose and plasma concentration.

The electrophysiologic effects of a new antiarrhythmic agent, cibenzoline, were investigated in 25 patients with an average age of 62 years. The compound was administered intravenously, as a bolus given over 2 minutes, then as a slow infusion over 40 minutes. Each subject was randomly allocated to receive one of the following four doses: 1.55 mg/kg (six patients), 1.8 mg/kg (six patients), 2.2 mg/kg (six patients), or 2.6 mg/kg (seven patients). Plasma cibenzoline concentrations at these doses were 378 +/- 80,525 +/- 194, 618 +/- 72, and 731 +/- 196 ng/ml, respectively. Administration of 1.55 mg/kg cibenzoline significantly shortened the sinus cycle (60 msec on average; p less than 0.025) and increased intraatrial (+8 msec; p less than 0.05) and His-Purkinje conduction times (HV interval + 13 msec; p less than 0.001). At 1.80 mg/kg, prolongation occurred in the HV interval (+9 msec; p less than 0.02), the duration of the QRS complex (+20 msec; p greater than 0.05), and the QT interval (+18 msec; p less than 0.025). At the higher doses these changes became more marked (maximum increase: HV = +16 msec, p less than 0.001; QRS + 25 msec; p less than 0.001; QT + 26 msec, p less than 0.05), and additional effects on atrioventricular nodal conduction time (AH interval + 17 msec; p less than 0.05) and atrial (+20 msec; p less than 0.05) and ventricular (+10 msec; p greater than 0.05) effective refractory periods were observed. Prolongation of the QRS duration was the effect that correlated best with plasma cibenzoline levels (r = 0.47; p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Bundle branch reentrant tachycardia treated by electrical ablation of the right bundle branch.

A 66 year old man presented with multiple episodes of tachycardia. Some had QRS complexes with a right bundle branch block configuration identical to those of sinus beats. The onset of the tachycardia was preceded by premature His bundle depolarizations. There was a His potential before each QRS complex of the tachycardia. Atrial activity was dissociated. Occasionally the appearance of sinus beats with a left bundle branch block pattern announced a tachycardia with an identical configuration and atrioventricular dissociation. His bundle activity occurred before the QRS complex and was followed by a right bundle branch deflection. A reentrant mechanism within the bundle branch system was invoked. One 200 J shock was delivered through an electrode catheter to the site of the right bundle branch. The postprocedure course was uneventful (follow-up 10 months).

Aged↗
PubMed1984

Premature atrial stimulation during regular atrial pacing: a new approach to the study of the sinus node.

Using an induced premature atrial depolarization after atrial pacing for 8 beats to scan the postpacing cycle, sinus node (SN) response was studied in 23 patients and the results were compared with those obtained using the Strauss method. Late extrastimuli resulted in compensatory return cycles (zone I), increasing prematurity gave rise to less-than-compensatory return cycles (zone II or "plateau") and interpolation or echo responses occurred at shorter coupling intervals (zone III). The sinoatrial (SA) conduction time was defined as the difference between return cycle and postreturn cycle lengths that fell in the latter portion of zone II. The SA conduction time was similar to those derived from the Strauss method (r = 0.91, n = 17, p less than 0.01) and remained similar at the 2 pacing cycles, 172 +/- 52 ms (mean +/- standard deviation) at 739 +/- 71 ms (cycle 1) and 170 +/- 60 ms at 596 +/- 57 ms (cycle 2). In 4 patients, the atrial pacing method could unmask zone II. The SN refractory period was defined as the longest coupling interval at which zone III was apparent. It was compared at cycles 1 and 2 in 14 patients. There was a significant increase in the SN refractory period with faster pacing rates, from 406 +/- 104 ms (cycle 1) to 462 +/- 112 ms (cycle 2) (p less than 0.05). The atrial pacing method provides an alternative evaluation of SA conduction and may permit the study of drug effects at identical basic rates.

Adult↗
PubMed1984

Clinical electrophysiology of intravenous sotalol, a beta-blocking drug with class III antiarrhythmic properties.

The electrophysiologic changes produced by the intravenous administration of 0.6 mg/kg of sotalol were studied in 12 patients aged 45 to 85 years (mean 68 years). Effects upon atrioventricular (AV) nodal conduction time (AH interval) and His-Purkinje conduction time (HV interval) were assessed at identical rates. The Wenckebach cycle length was determined by rapid atrial stimulation. Refractory periods before and after the drug were compared at the same cycle length. Retrograde conduction was studied, with special reference to reentry phenomena within the His-Purkinje system. Sinoatrial function was evaluated using sinus node recovery time and sinoatrial conduction time. The following changes were noted: (1) decrease in sinus rate, (2) prolongation of QT interval, (3) depression of AV nodal conduction (prolonged AH interval) and increase in effective and functional refractory periods of the AV node, (4) increase in relative refractory period of the His-Purkinje system with no associated change in HV interval, (5) prolongation of effective refractory period in the atrium and ventricle, and (6) increase in retrograde refractory period of specialized ventricular tissue and depressed conduction of premature ventricular responses. Reentry phenomena in the His-Purkinje system were not significantly affected by the drug. Thus certain of the electrophysiologic effects of sotalol in humans were found to be in favor of a class III antiarrhythmic mechanism of action. These results justify further studies to evaluate the usefulness of this drug as an antiarrhythmic agent.

Aged↗
PubMed1983

Bundle branch reentry: a possible mechanism of ventricular tachycardia.

Electrophysiologic studies were performed in three patients suffering from attacks of paroxysmal tachycardia with wide QRS complexes. Two patients had atrioventricular dissociation. The arrhythmia could be initiated and terminated by premature ventricular stimulation in all three patients. One patient developed the arrhythmia after rapid atrial stimulation. In each subject, the QRS complexes during tachycardia were identical to recorded supraventricular beats (left bundle branch block pattern in two cases and right bundle branch block pattern in one). A His bundle potential was noted before the QRS complex; the HV interval was equal to or longer than that of the sinus beats. The following observations suggested the presence of a bundle branch reentry mechanism: (1) the relationship between bundle branch block development and tachycardia initiation; (2) the occurrence of tachycardia after electrically induced His-Purkinje reentry; (3) the ability of premature ventricular stimulation during tachycardia to advance the timing of the His deflection and QRS complex, with an unchanged or slightly increased HV interval; and (4) the termination of arrhythmia by premature ventricular depolarization blocked within the bundle branch system. Our results support the idea that bundle branch reentry can play a role in the genesis of ventricular tachycardia.

Aged↗
PubMedDate not supplied

[Quality of life assessment in therapeutic trials. Conceptual aspects and presentation of a questionnaire].

The importance of assessing the quality of life is more and more emphasized when therapeutic effects are to be studied. However, if its theoretical bases appeared as rather well established, they are not yet effectively translated into the presently available instruments: there is not yet any "gold exchange standard" in this field. This fact is the result of the difficulty of this translation and of the medical tendency to reduce the assessment of the quality of life to the assessment of the health. The second part of this paper is thus devoted to the presentation of a new instrument ("PQVS" in french, or "QLPI" for "Quality of Life Profile Inventory"). It was devised for applying the theoretical bases of the study of the quality of life. It thus allows for the assessment: 1) of the quality of the global life, 2) of the quality of what is experienced in several dimensions of the life, and 3) of the individual structure of the quality of life.

Activities of Daily Living↗