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Biomedical subjects

P Raynaud

Publications and source records attributed to P Raynaud.

At least 19 recordsLinked to original sources
PubMed1992

Thrombolysis in patients with unstable angina improves the angiographic but not the clinical outcome. Results of UNASEM, a multicenter, randomized, placebo-controlled, clinical trial with anistreplase.

BACKGROUND: The value of thrombolytic therapy in unstable angina is unclear. METHODS AND RESULTS: To study this problem, 159 patients were studied in a double-blind, placebo-controlled multicenter trial. Patients without a previous myocardial infarction, with a typical history of unstable angina, and ECG abnormalities indicative of ischemia were included. After baseline angiography, study medication (anistreplase or placebo) was given. Angiography was repeated after 12-28 hours. A significant decrease occurred in diameter stenosis between the first and second angiogram in the anistreplase group compared with the placebo group (11% versus 3%, p = 0.008). This difference was caused by reopening of occluded vessels in the thrombolytic group. However, no beneficial clinical effects of thrombolytic treatment were found. Bleeding complications were significantly higher in patients who received thrombolytic therapy (21 versus seven patients, p = 0.001). CONCLUSIONS: Thus, angiographic but no clinical improvement after thrombolytic treatment with anistreplase was found in patients with unstable angina with an excess of bleeding complications. Therefore, thrombolytic treatment cannot be recommended in patients diagnosed as having unstable angina until proven otherwise.

Adult↗
PubMed1992

[Angioplasty after failure of thrombolysis in myocardial infarction. Hospital results apropos of 40 consecutive patients].

Intravenous thrombolysis during the acute phase of myocardial infarction is successful in restoring perfusion in 60 to 80% of cases. When it is unsuccessful, there is disagreement about the best approach to adopt. The article reports the results obtained in 40 consecutive patients treated by angioplasty after thrombolysis had been unsuccessful. Reperfusion was achieved in 92.5% of cases, with a hospital mortality rate of 7.5% (2.5% if patients admitted in a stage of cardiogenic shock are excluded). There was no mortality related to the procedure itself and an emergency aorto-coronary by-pass was not required in any case. Since it is accepted that the subsequent prognosis depends on coronary patency, coronary artery assessment after thrombolysis, followed by angioplasty if the occlusion persists seems to be a logical strategy if the myocardial territory is compromised.

Adult↗
PubMed1991

Thrombosis and thrombolysis in unstable angina.

Pathophysiology of unstable angina involves spasm, plaque rupture, activation of platelets, and coagulation. The incidence and frequency of intracoronary thrombus formation are presently under active assessment in order to establish the potential benefit of thrombolytic therapy. A preliminary study was conducted in patients admitted in our coronary care unit for unstable angina with typical clinical and electrocardiographic criteria and with early coronary angiogram. After exclusion of 4 patients with left main coronary stenosis or contraindications for thrombolysis, 16 patients received thrombolytic infusion and 14 underwent a second coronary angiogram. Seven patients had an intracoronary thrombus (6 nonocclusive, 1 occlusive) and at the second angiogram only 3 nonocclusive thrombi were modified (1 disappeared, 2 were reduced). Moreover, the quantitative Coronary Angiography Analysis System (CAAS) in the 11 cases suitable for analysis did not show any significant changes, especially in the Ambrose type IIB lesions. In-hospital clinical outcome was not influenced by thrombolytic therapy (5 ischemic recurrences, 1 fatal myocardial infarction, 4 emergency and 4 elective revascularization procedures). This short series is in agreement with the literature data. Only one third of patients with active unstable angina remains refractory to conventional therapy. The transient benefit of thrombolysis is limited to patients with demonstrated intracoronary thrombi. Clinical or angiographic improvement are not always in correlation and until now do not seem able to prevent short-term recurrences or the need for revascularization procedures.

Adult↗
PubMed1991

[Partial abnormal pulmonary venous return. An underestimated and unknown association in Turner-Ullrich syndrome. Presentation of an original case].

The authors report the case of a 59-year-old woman with a complex cardiac lesion consisting of degenerative major mitral insufficiency masking partial abnormal pulmonary venous return. These cardiac abnormalities fell within a context of genetic disease since the patient had Turner's syndrome, confirmed at the age of 58 by a 45 x 0 karyotype. They detail the originality of the clinical manifestations of partial abnormal pulmonary venous return and review the literature concerning cardiac malformations in Turner's syndrome.

Angiography↗
PubMed1990

Mortality prognostic factors in chest injury.

1,026 multiple trauma patients (P) were compared to P with chest injuries (PCT) (407). Severity indices were related to type of thoracic injury and mortality. The Injury Severity Score (ISS), Glasgow Coma Scale (GCS), Trauma Score (TS), CHOP, and the Respiratory Index (RI) were used. The mortality rate of P was 27.1% but increased to 32.9% for PCT (p less than 0.05). We noted that mortality rate was highly dependent on major chest trauma: 68.6% for flail chest (FC), 56% for lung contusion (LC), 42.3% for hemothorax (HA), and 38.1% for pneumothorax (PN). ISS and RI scores for PCT survivors were greater than ISS + RI scores for P survivors (p less than 0.05 and p less than 0.01). ISS values for LC, HA, and PN PCT survivors were greater than the ISS of P survivors (p less than 0.01). Nonsurviving PCTs, especially those with lung contusion, showed a highly significant increase in ISS and RI scores.

Adolescent↗
PubMed1990

[Elaboration of an ethogram for the diagnosis of Pattern "A"].

In order to develop a technique which allows the detection of Pattern A (P.A.) we present in this paper a series of steps for constructing an observation grill (ethogram) which allows for the quantification of behavior in situation of structured interview. The behavioral units making up the final ethogram are derived from inter-item correlations taken from a population of 48 subjects who had suffered heart attacks. The observations on this population permit an inclusion score in the P.A. These observations also confirm that the P.A. present a risk factor which is independent of classical risk factors. A significative positive correlation with work stress has been found showing, in accordance with the view of Friedman and Rosenman that the P.A. corresponds to a particular behavioral pattern which is dependent on the work environment.

Adult↗
PubMed1990

[An often ignored complication of left heart catheterization: embolism of cholesterol crystals. Report of 9 cases].

Cholesterol embolism (CE) is caused by the migration of cholesterol crystals from severe atheromatous lesions. Until recently, this was considered to be a classical but rare complication of atheroma. With the upsurge in techniques of left heart catheterization there has been a regain of interest in this subject. Nine cases of cholesterol embolism occurring after left heart catheterisation are reported, 3 after coronary angioplasty, and 3 cases after associated thrombolytic therapy. Three patients developed cutaneous syndromes (livedo reticularis, the "purple toe syndrome") with a favorable outcome in a few weeks. Two patients developed segmental necrosis of the small bowel requiring surgical resection of the affected area. Finally, in 4 cases, the patients died 12 hours to 3 months after catheterization: 2 patients had polyvisceral involvement; one patient developed cardiogenic shock; one patient had intestinal necrosis involving 2/3 of the ileum and the right colon. The cases illustrate the variability of the presentation of CE and its potential gravity. At present, the only effective measures are prophylactic; curative treatment remains particularly disappointing.

Aged↗
PubMed1990

Comparison of circadian blood pressure variations in hypertensive patients with renal artery stenosis and essential hypertension.

Ambulatory blood pressure measurements in 20 hypertensive patients with uni- or bilateral renal artery stenosis were compared with those in 20 essential hypertensive patients. Analysis of the 24 hour blood pressure curve of the renal artery stenosis group shows a tendency to equalization of blood pressure throughout the day. The nocturnal decrease of systolic or diastolic blood pressure was not significantly different between the two groups (9.2 vs. 15.3 mmHg). The blunted curve seems to be related more to the severity of hypertension than to its aetiology, but further studies are required to elucidate this point.

Adult↗
PubMed1990

[Elaboration of an ethogram for the diagnosis of the A Pattern in coronary pathology].

In order to develop a technique which allows the detection of Pattern A (PA) we present in this paper a series of steps for constructing an observation gril (ethogram) which allows for the quantification of behavior in situation of structured interview. The behavioral units making up the final ethogram are derived from inter-item correlations taken from a population of 48 subjects who had suffered heart attacks. The observations on this population permit an inclusion score in the PA. These observations also confirm that the PA present a risk factor which is independent of classical risk factors. A significative positive correlation with work stress has been found showing, in accordance with the view of Friedman and Rosenman that the PA corresponds to a particular behavioral pattern which is dependent on the work environment.

Coronary Disease↗
PubMed1990

[Incidence and severity of cardiac involvement in Streptococcus bovis septicemia. Report of 10 cases].

Endocarditis due to the streptococcus Bovis is an affection which is more and more often recognized and whose link with the colic tumor pathology has been well established those last few years and confirmed in this study with a frequency of 60 p. cent. However, few studies have stated the gravity of the heart affection in streptococcus Bovis septicaemias. In this series of 10 streptococcus Bovis septicaemias, the valvular affection is frequent and serious. The vegetations are found in 9 cases out of 10. The aortic affection is slightly more frequent (8 times out of 10), against 7 times out of 10 for the mitral affection (double mitroaortic affection, 6 times). A valve replacement due to sub-acute or chronic cardiac failure was necessary in 6 cases out of 9, that is 66 p. cent. The mortality was nil.

Aged↗
PubMed1989

[Thrombosis in unstable angina. Is there a role for thrombolytic agents?].

Intracoronary thrombosis is more and more considered as a major etiological factor of unstable angina (UA). The physiopathological diagram from ulceration of the plaque to unstable then stable thrombosis is based on many arguments: pathological (Falk-Fuster), biological, angioscopic (Forrester) and finally angiographic; numerous studies have demonstrated the frequency of non-obstructive coronary thrombi in UA. Their frequency is directly related to the delay in control, in relation with the last painful episode, indicating the spontaneous lysis of the clot. This role suggests the beneficial effect of a thrombolytic treatment. Several non-randomized studies (Vetrovek, Mandelkorn, Gotoh, Vermeer) demonstrate reduction of the clots after thrombolysis. But considering spontaneous lysis, only randomized studies published to date (Gold, Topol and Nicklas) report encouraging results. More extended studies are necessary to specify the beneficial effect and the exact haemorrhagic risk of this treatment and the probable place of additional tests like transluminal coronary angioplasty (TCA) and aortocoronary by-pass.

Angina Pectoris↗
PubMed1989

[Angiography of right ventricular volume after surgical repair of tetralogy of Fallot].

Right ventricular volume and ejection fraction were measured in children who had undergone surgical repair for tetralogy of Fallot with excellent results. Fourteen children who had been operated upon at the age of 3 +/- 2.6 years had cardiac catheterization and cineangiography of the right ventricle at the age of 4.6 +/- 2.7 years. Right ventricular volumes were determined from single-plane cineangiography in right anterior oblique projection (Ferlinz method). Eleven children with a normal right ventricle served as controls. Dual projection cineangiography of the pulmonary artery enabled the pulmonary insufficiency to be divided into 4 grades. Echocardiography with colour-coded doppler velocimetry was also performed, showing the absence of residual shunt and of tricuspid, mitral and aortic valve abnormalities. The extension of pulmonary regurgitation flow to the right ventricle was analysed and divided into 4 grades. Pulmonary insufficiency was present in all patients; it was graded 1 or 2 by the two methods in 8 cases (group A) and 3 or 4 by one or the other of the two methods in 6 cases (group B). In 7 patients of group A the operation had included the insertion of a small patch to widen the pulmonary channels (infundibulum alone in 3 cases, transvalvular in 4 cases); in 5 patients of group B a large infundibulo-pulmonary transvalvular patch had been installed. The right ventricular systolic pressure was always below 50 mmHg (mean: 40.9 +/- 6.7 mmHg) and the systolic gradient between right ventricle and pulmonary artery never exceeded 30 mmHg (mean: 14.9 +/- 6.2 mmHg).(ABSTRACT TRUNCATED AT 250 WORDS)

Angiocardiography↗
PubMed1989

[Tissue plasminogen activator (alteplase) in acute massive pulmonary embolism. A pilot study].

Twenty six patients with acute (less than 5 days) pulmonary embolism (PE) confirmed by bilateral pulmonary angiography with a Miller index greater than 15 were given tissue plasminogen activator (Alteplase) (rt-PA) intravenously (n = 20) or directly into the pulmonary artery (n = 6). The dosage was 100 mg/7 hours (bolus 10 mg + 40 mg/2 hours + 50 mg/5 hours). Heparin (5000 IV as a bolus and 1000 IV/hour) was associated in all cases. The Miller index decreased from 24 +/- 1 (n = 26) before treatment to 12 +/- 1 (n = 25) (p less than 0.001) after 100 mg of Alteplase, and from 25 +/- 0.4 (n = 14) to 22 +/- 0.5 (n = 14) (p less than 0.001) after 50 mg. The mean pulmonary arterial pressures fell from 30 +/- 2 mmHg to 21 +/- 2 mmHg after 50 mg (n = 26) (p less than 0.001) and to 14 +/- 1 (n = 25) (p less than 0.001) after 100 mg of Alteplase. A decrease in mean pulmonary artery pressures (-22%, p less than 0.001) and total pulmonary resistances (-29%, p less than 0.001) was obtained after one hour of thrombolysis in 12 monitored patients. There were no fatalities. Severe haemorrhage occurred in 6 cases. Therefore, Alteplase induced a rapid dissolution of recent intrapulmonary thrombi without inacceptable haemorrhagic complications. Its action could be particularly beneficial in patients with right ventricular failure due to life threatening pulmonary embolism.

Acute Disease↗
PubMed1989

[Arterial and venous thromboembolic complications in patients with renal transplants. Apropos of 2 cases].

The study of two cases of young patients with renal transplants who, successively and a few months after the procedure, presented a thrombophlebitis of the lower extremities (with or without pulmonary embolism), then an acute coronary insufficiency, without any encouraging or triggering factor, raises the hypothesis that this is not a mere coincidence. In fact, in the literature, numerous cardiovascular risk factors) inherent in complicated chronic renal failure, dialysis, steroid therapy and immuno-suppressive treatment (Azathioprime, under these circumstances) were demonstrated. In addition, abnormalities of the platelets aggregation, hemostasis and fibrinolysis, were at the origin of thrombo-embolic accidents. Besides any specific cardiovascular risk factor or any obvious biological anomaly, there is still a predisposition of patients with renal transplants, to arterial as well as venous thrombo-embolic accidents.

Adult↗
PubMed1988

[Left ventricular hypertrophy in arterial hypertension].

Arterial hypertension is frequently and at an early stage complicated by left ventricular hypertrophy, i.e. an increase in muscular mass due to the proliferation of myofibrillae. This in fact is a physiological mechanism aimed at maintaining systolic function and systemic blood flow rate. Left ventricular hypertrophy may be associated with myocardial alterations, such as increase of collagen, abnormalities of diastolic function, reduced contractility, increased cell excitability and disorders of coronary perfusion. It is responsible for a higher risk of cardiovascular mortality. Antihypertensive treatments, therefore, must not only bring blood pressure down to normal values, but also reduce the myocardial mass. In order to avoid a detrimental effect on coronary reserve, it is highly desirable that arterial hypertension and left ventricular hypertrophy regress simultaneously. Regression of the myocardial hypertrophy associated with arterial hypertension is observed with most antihypertensive drugs, except vasodilators that act directly on the vascular smooth muscle, probably due to stimulation of the sympathetic system. Diuretics also have an inconstant beneficial effect on left ventricular hypertrophy. When a choice has to be made between two drugs that have the same antihypertensive activity, it is the one that also brings about an early and lasting regression of myocardial hypertrophy which must be prescribed.

Cardiomegaly↗
PubMed1988

[Large patent ductus arteriosus and interventricular communication associated with congenital absence of the pulmonary valve].

A case of pulmonary valve agenesis with ventricular septal defect and large patent ductus arteriosus is reported in a neonate. Heart failure occurred at 10 days of life; clinical examination showed continuous murmur. Echocardiography and angiocardiography visualized a major dilatation of the pulmonary artery. At cardiac catheterization there was an important left to right shunt through a large ductus, and pulmonary hypertension. There was also marked pulmonic regurgitation. Because of respiratory distress, ligation of ductus arteriosus was performed at 5 weeks of life. Five years later the patient is still in good condition. Patent ductus arterious is rarely associated with pulmonary valvular agenesis and ventricular septal defect. Our case is not explained by the fetal circulation theory described in this heart malformation.

Abnormalities, Multiple↗
PubMed1987

Continuous extradural anaesthesia in children. Clinical and haemodynamic implications.

This study reports the experience of a department of paediatric anaesthesia with 234 continuous extradural anaesthetics performed in 229 children over a 15-month period. Fifty-nine of the children were aged 0-2 yr, 71 were aged 2-8 yr and 104 were older than 8 yr. The surgical procedures lasted more than 60 min (mean 150 +/- 10.6 min); all were carried out under light general anaesthesia. Technical procedure and difficulties are reported. The only local anaesthetic agent used was bupivacaine with or without adrenaline. Mean initial dosage was 0.75 ml kg-1 for children weighing less than 20 kg and 1 ml/10 cm of height for children taller than 100 cm. Using 0.25% bupivacaine mean times until a further injection were 92.0 +/- 2.0 min for bupivacaine with adrenaline and 71.0 +/- 2.5 min for bupivacaine without adrenaline (P less than 0.001). A much longer duration of analgesia was found for younger children using the solution with adrenaline. A haemodynamic study was performed in 74 unpremedicated children (ASA I; aged 0-2 yr (n = 15), 2-8 yr (n = 26) and older than 8 yr (n = 35). Before induction of anaesthesia, heart rate (HR) was significantly increased in the youngest children, but no significant change was found for systolic arterial pressure (SAP). After extradural anaesthesia with 0.25% bupivacaine with adrenaline 1:200000, minimal changes in HR or SAP occurred in children younger than 8 yr; in those older than 8 yr a significant decrease in both HR and SAP was observed. Changes in SAP were at their maximum 25 min after the extradural block and changes in HR were not statistically significant before the 25th min following injection of local anaesthetic. The catheter remained in place in 155 children for postoperative analgesia, mainly for the first 48 h.

Adolescent↗