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P Tcherdakoff

Publications and source records attributed to P Tcherdakoff.

At least 19 recordsLinked to original sources
PubMed1993

[Non-invasive ambulatory measurement of arterial pressure. Recommendations of the measurement group of the French Society of Arterial Hypertension].

Ambulatory blood pressure monitoring is being widely used now that relatively simple, reliable and well-tolerated, non-invasive blood pressure measuring devices have become available. The following recommendations are only to help physicians to use this technique in their daily practice: only use homologated devices; ambulatory monitoring should be performed during normal, everyday activities; at least one measurement of blood pressure should be taken every 1/4 hour during the day time (7 h-22 h) and every 1/2 hour during the night (22 h-7 h); the arm must be absolutely still and relaxed during the measurement; the function of the measuring device should be checked when the patient is fitted up and when the device is removed; data processing should provide at least: all values of blood pressure and heart rate, and their times of measurement, the mean values of systolic end diastolic blood pressure and heart rate during the day and during the night, the maximal and minimal systolic and diastolic blood pressure values, a chronogramme of the values. Reasonable indications of ambulatory blood pressure monitoring include: elimination of the "white coat" effect: to confirm the diagnosis of borderline hypertension; to demonstrate inversion of diurnal rhythm in severe hypertension; to demonstrate episodic hyper or hypotension; to confirm certain cases of toxaemia of pregnancy. It is also justified in the evaluation of antihypertension therapy, especially in cases of suspected drug resistance.

Ambulatory Care↗
PubMed1992

Percutaneous recanalization of a renal artery in aortic dissection.

Chronic renal failure acutely worsened in a patient with a type B aortic dissection. Aortography revealed an occlusion of the left renal artery without renal intimal tear. Percutaneous recanalization, performed with a self-expandable stent, resulted in improvement in the renal function. This technique offers a new therapeutic choice in patients with visceral complications of aortic dissection.

Aortic Dissection↗
PubMed1990

Comparative study on monotherapy with sustained-release diltiazem 300 mg and enalapril 20 mg in mild to moderate arterial hypertension.

The antihypertensive efficacy of sustained-release diltiazem 300 mg at a single daily dose was evaluated and compared to that of enalapril 20 mg at a single daily dose, and to a combination therapy of enalapril 20 mg with sustained-release diltiazem 300 mg in patients with mild to moderate arterial hypertension (supine diastolic blood pressure between 95 and 115 mm Hg). After a washout period and a placebo period, each lasting 2 weeks, 96 patients were randomized in this double-blind study to three parallel groups that were treated for 28 days. In the groups treated with diltiazem, enalapril, or the combination of both, the drop in arterial blood pressure was 20, 11, and 19 mm Hg for supine diastolic blood pressure (supine DBP): 18, 12, and 19 mm Hg for standing diastolic blood pressure (standing DBP); 22, 20, and 23 mm Hg for supine systolic blood pressure (supine SBP); and 21, 19, and 24 mm Hg for standing systolic blood pressure (standing SBP), respectively. The reduction in DBP was significantly more pronounced in the group treated with sustained-release diltiazem 300 mg than in the group treated with enalapril 20 mg. Cardiac tolerance was good for patients treated with sustained-release diltiazem 300 mg alone or the combination therapy: no orthostatic hypotension or lengthening of the PR interval in the electrocardiogram was observed. Although side effects of sustained-release diltiazem 300 mg occurred more frequently, they were not severe and disappeared immediately when treatment was suspended.

Blood Pressure↗
PubMed1988

[Hypertension in pregnant women and beta-blockers. Follow-up of 31 pregnancies].

The authors have conducted a study of 24 women (mean age: 28 years) whose 31 pregnancies were treated with a beta-blocker (propranolol, in most cases). The overall results were compared with data from the literature. The return to normal of the blood pressure (BP) was excellent (23 cases or 74.2%). The BP was poorly controlled in 8 out of 31 cases among which were found the 4 fetal deaths of the study. There was no toxemia, no maternal complications, no theoretical neonatal effect of the beta-blockers (nor bradycardia nor hypoglycaemia). As for fetal hypotrophy, it was more frequent when the ABP did not return to normal (57% hypotrophy vs 39%) and the beta-blocker, by causing a return to normal of the BP, decreases its incidence. In addition, the mean length of treatment exceeded 2.35 weeks in normotrophic newborns in comparison with the hypotrophic newborns. Concomitantly, the return to normal of the blood pressure is improved in normotrophic newborns. The risk of fetal hypotrophy attributed to the beta-blockers is therefore confirmed and these drugs even have a favorable effect on the birth weight.

Adult↗
PubMed1985

[Malignant pheochromocytoma. A case].

A case of malignant phaeochromocytoma is reported. The primary tumour was removed in 1970. Metastases were diagnosed in 1979 and management of the condition included antihypertensive treatment with alphamethylparatyrosine, antitumoral chemotherapy and surgical reduction of secreting tissue. In these rare tumours malignancy can only be confirmed by metastases, i.e. presence of chromaffin cells in loci where they are not usually found. Histology is of little value. High levels of catecholamine precursors or their metabolites in the urine may be a sign of malignancy, but some asymptomatic tumours are only revealed by metastases. Computerized tomography and radioisotope scanning with I131 metaiodobenzylguanidine are the best available methods to locate the lesions. In view of the small number of cases and of the unpredictable course (sometimes spread over many years) of malignant phaeochromocytomas, the effectiveness of treatments with alphamethylparatyrosine, chemotherapy and radiotherapy is difficult to evaluate.

Adrenal Gland Neoplasms↗
PubMed1983

[Coarctation of the abdominal aorta: diagnosis, pathogenesis, medical or surgical treatment. 7 cases].

Seven cases of coarctation of the abdominal aorta are reported. The diagnosis, suggested by the presence of arterial hypertension associated with nonperception of the arterial pulse in the lower limbs and/or systolic murmur in the abdomen, is supported by non-invasive investigations, such as Döppler flowmetry of lower limb arteries and ultrasonography of the abdominal aorta. Arteriography, however, is mandatory because of frequently associated lesions of other arteries, notably renal and/or intestinal arteries. The type and location of these lesions are of prime importance to therapeutic decision. According to the results of the present study, surgery may not be required in all cases and may be replaced, in some very specific circumstances, by medical treatment. There is still disagreement concerning the congenital or acquired origin of this type of aortic coarctation and the mechanism of hypertension. The various theories put forward are discussed.

Adolescent↗
PubMed1983

[Are the theoretical drawbacks of beta-blocker treatment in pregnancy being confirmed? A review of the literature].

The use of beta-blocking drugs in the treatment of hypertension during pregnancy has been the subject of controversies on the basis of theoretical hazards due to the pharmacology and pharmacokinetic characteristics of these drugs. A review of the literature on the subject shows that: The danger of premature contractions, abortion or premature delivery does not seem to increase with the use of beta-blockers. The blood supply is not more impaired with beta-blockers than with other antihypertensive drugs according to fetal growth, birth-weight, frequency of perinatal deaths or APGAR score. Although beta-blocking drugs pass into fetal circulation, neonatal bradycardia, respiratory distress or hypoglycemia do not seem more frequent with beta-blockers. Beta-blockers pass from maternal plasma into milk but the 24 hour dose brought to the newborn by maternal feeding is so slight as to be negligible. Thus, the cumulative data and the favorable opinions of many authors, the greater efficiency of beta-blockers authorizes the use of these drugs in the treatment of hypertension in pregnancy, where it seems to improve the outcome of the pregnancy and the state of the fetus at birth.

Adrenergic beta-Antagonists↗
PubMed1983

[Current clinical problems of pheochromocytoma].

The diagnostic problem of pheochromocytomas raises two questions: should all hypertensives be routinely investigated for this condition, and what is the best diagnostic method? As this is a rare condition, systematic screening gives a low return; considering the large number of hypertensive patients, it is also costly. On the other hand, as systematic autopsy studies have shown, the missed diagnosis can be serious (especially during pregnancy or surgery). Screening for this condition is proposed when the clinical features are suggestive, in pregnancy, when surgery is undertaken in a hypertensive patient and in all cases of method is still a matter of controversy: urinary hormonal levels (especially metanephrine levels) are supported by some workers, whilst serum catecholamine levels are supported by others. In any case, pharmacodynamic tests should only be used when these two methods are inconclusive. The long term prognosis of operated pheochromocytoma is less favourable then used to be thought: a certain number have persistent benign hypertension which may require treatment and which may become malignant at a later date. Adrenal medullary hyperplasia is a clinical entity which should be recognised.

Adrenal Gland Neoplasms↗
PubMed1983

[Treatment of pheochromocytoma].

Apart from the problems of preparation for surgery, the difficulties lie mainly in general anaesthesia. Blood pressure variations and cardiac arrhythmias must be prevented. Anaesthesia must be given with a lot of care and must be deep, and some stages are particularly dangerous: induction, intubation (it is best to give a local anaesthetic with lignocaine), manipulation during dissection which should be very gentle, ablation of the tumour or clamping the draining veins. Treatment of the arrhythmias detected on ECG monitoring is based mainly on the use of lignocaine. Continuous monitoring of intra-arterial pressure is used to detect any variation. Only the severe bouts of hypertension need correction with phentolamine or nitroprussiate. In cases of shock, the essential point of management is to reestablish an adequate circulating volume: intravenous fluids are best given with control of pulmonary pressures which allows dangerous overload to be avoided. The specific problem of malignant pheochromocytoma is two-fold: treatment of the hypertension, at best with alpha-methyl-tyrosine or otherwise, with labetolol or prazosine, and treatment of the tumour, which has still not been resolved, and for which trials of chemotherapy are in progress.

Adrenal Gland Neoplasms↗
PubMed1983

Side-effects with long-term labetalol: an open study of 251 patients in a single centre.

An open study was carried out in 251 hypertensive patients, all but 10 of whom had been treated previously, mainly with beta-blockers or dihydralazine, to collect data primarily on the incidence of side-effects when long-term treatment with labetalol was substituted. Dosage ranged from 100 to 2400 mg per day (mean 654 mg per day) and treatment was continued for between 6 and 18 months (mean 7.8 months) in 229 patients. Labetalol proved to be at least as effective as previous therapy in the majority of patients and, although side-effects were reported in approximately half the study population, most were mild and transient requiring withdrawal in only 10%, within a few days or weeks in 20 patients. Scalp tingling was the most frequent of the side-effects particular to this drug. Postural hypotension and bradycardia was usually not very marked and troubles with micturition or sexual problems did not occur often. There was an improvement in Raynaud's and similar syndromes and arteritis in patients with these symptoms who had previously been receiving beta-blocking agents.

Adult↗
PubMed1981

[Treatment of certain refractory arterial hypertensions with a monoamine oxidase inhibitor].

Sixteen patients with refractory hypertension were treated with the monoamine oxidase inhibitor iproclozide at doses of 10 to 30 mg/day. Its addition to the previously prescribed antihypertensive therapy resulted in normalisation of blood pressure readings in two cases, significant improvement in seven cases and no change in four cases. Side effects due to iproclozide were relatively minor, the treatment having to be discontinued in three cases. Its association with alpha methyldopa or spironolactone did not lead to any untoward complications. Despite the success of other recently introduced drugs in refractory hypertension, this study shows that MAOI may be very useful in the management of this condition.

Female↗